Transcript WRAML - PAR - Psychological Assessment Resources

Wide Range Assessment of
Memory and Learning
Second Edition
David Sheslow, PhD
Wayne Adams, PhD
About the authors:
Dr. David Sheslow
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PhD in Clinical Psychology, University of North Carolina
at Greensboro
29 years at the DuPont Hospital for Children as chief
psychologist and co-director of the Division of
Behavioral Health, Department of Pediatrics
Teaches at the DuPont Hospital Pediatric and
Psychology Residency Programs
Private, Clinical Psychology practice
Published over 48 professional articles
About the authors:
Dr. Wayne Adams
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PhD in Developmental and Child Clinical Psychology from Syracuse
University
23 years at DuPont Hospital for Children, Director of the Division of
Psychology, Chief Psychologist within the Division of Behavioral
Medicine
Associate Professor at Jefferson Medical College
Published >30 articles, >60 presentations at conventions of
professional organizations
Diplomat status, Clinical Psychology, American Board of
Professional Psychology
Currently a tenured professor and chairperson of the APA
accredited Graduate Department of Clinical Psychology at George
Fox University, Newberg, OR
About the authors:
Drs. Adams and Sheslow have co-authored 5
instruments. They have extensive experience
working with children and teens with mild to
severe neurological disorders such as Learning
Disabilities, ADHD, and Traumatic Brain Injury.
It is this clinical involvement that lead to the
development of a memory battery when there
was none normed on children.
Evaluation of Memory:
Our Clinical and
Empirical Roots
Historical Roots
Hans Ebbinghaus (1850 – 1909)
 Immediate memory (digit span)
 Chunking
 Nonsense syllables
 Meaningfulness
 Rehearsal
 Interference
 Disadvantage of age
 Memory “illusions”
Historical Roots
Alfred Binet (1857 – 1911)
 Qualitative analysis
 Serial position effect
 “Importance” effect
 Acoustic vs. semantic recall effects
Frederic Barlett (1886-1969)
 Visual and motor memory
Historical Roots
Sigmund Freud
 Repressed memory effects
Theodule Ribot (1839-1916)
 Encoding, storage, retrieval
 Procedural and volitional memory
 Study of amnesias
Developmental aspects of memory
 Immediate memory improves during school years
 Declining long-term retention with age
Historical Roots
Associationism
 Function of habit strength
 Simple association between external stimulus
and observable response
Introduction of the Computer
 People are active information processors
 Memory is a “storage system” with stages
Historical Roots
Broadbent (1958)
 “serial processing”
Atkinson and Shiffrin (1968)
 Sensory register, short-term store, long-term
store
 Control processes
Craik and Lockhart (1972)
 “levels of processing”
Historical Roots
Developmental Aspects:
 Immediate recall improves during school years
 Improvement on immediate memory tasks is
particularly noticeable until 13 years of age
 Children’s performance across ages does differ
 Long-term retention declines with increasing age
 Gender differences are small or non-existent
 Memory performance is related to IQ but the
correlation is not very high
Historical Roots
Neuropsychological Influences
 H.M. (hippocampal lesion)
 Intact short-term, severely impaired long-term
 Support for multi-store model?
 Non-localized dimension?
 Executive processes
Contemporary Status
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Neuroimaging studies
Computational/connectionist models
Multi-system nature, active, dynamic
Interaction of:
 Memory
 Executive functions that control and regulate
 Knowledge and skills of learner
A sampling of historical memory concepts
found on WRAML2
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Primacy/Recency
List Learning
Learning Trials and
Learning Curve
Recognition Memory
Immediate vs.
Delayed Recall
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Sustained Attention
Working Memory
Gist vs. Verbatim
Verbal vs. Visual
Rote vs. Meaningful
Early Memory Measures
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Rey (list learning of 15 words) 1958
Rey-Osterrieth Complex Figure Task (1944)
Wechsler Memory Scale (1945)
Wechsler Memory Scale – Revised (1987)
Wechsler Memory Scale – III (1997)
Wide Range Assessment of Memory and
Learning (1990)
Test Revision
WRAML
(1990)
WRAML2
(2004)
Major Modifications
WRAML to WRAML2
Upper age range extended from 17 to 90
years
 Indexes better reflect factor structure:
Verbal Memory, Visual Memory,
Attention/Concentration
 Number of Core Subtests (6 vs. 9)
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Major Modifications
WRAML to WRAML2
 Delay
Memory Tasks (7 vs. 4)
 2 Working Memory
 Recognition Memory (4 vs. 1)
 Qualitative Analyses (25+ vs. 0)
 Updated stimulus materials
WRAML2 Structure
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Core Subtests
Optional Subtests
Qualitative Analyses
Core Indexes and Subtests
General Memory
Index
Verbal Memory
Index
Story Memory
Verbal Learning
Visual Memory
Index
Design Memory
Picture Memory
Attn/Concentration
Index
Finger Windows
Number Letter
Psychometric Properties
of the WRAML2
Test Development
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Focus group meetings, research
Inclusion of working memory and recognition
Item tryout (n = 140)
Item Response Theory, Rasch analysis
Development of Standardization Edition
Standardization
Stratified Sampling Using
 Age
 Gender
 Geographic Region
 Education Level
 Ethnicity
N=1,200, 80 for each of 15 age groups
Reliability: Core Subtests
r values
Person Separation
Item Separation
Internal Consistency
Test-Retest
(median interval = 49 days)
.85 - .94
.99 – 1.0
.81 – 92
GMI = .93
.59 - .77
GMI = .82 (=6.7 pts)
Subtest Interscorer Reliability = .98
Internal Validity
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Item separation = .98 to 1.00
Factor Analysis
Three-factor Core Model: Verbal Memory, Visual
Memory, Attention/Concentration
Applies to all demographic groups
Working Memory – Attention/Concentration r = .99
Three-factor Optional Model: Working Memory, Verbal
Recognition, Visual Recognition
Differential Item Functioning: most in high .90s, .88 on
Story Memory between Hispanic and White
External Validity
Wechsler Memory Scale-III
Children’s Memory Scale
Test of Memory and Learning
California Verbal Learning Test-II
WAIS-II
WISC-III
WRAT3
WJ-III
.60
.49
.69
.68
(GMI w/ GMI)
(GMI w/ GMI)
(CMI w/GMI)
(Trial 1-5 Index
w/ Verbal Learning)
.67 (FSIQ w/ GMI)
.44 (FSIQ w/ GMI)
.11 to .60 (w/ GMI)
Pediatric Clinical Groups
Clinical Group
WRAML2
Verbal MI Visual MI GMI
Reading Disordered 91.2
91.3
89.2
(n=24)
ADHD
102.5
97.8
97.4
(n=23)
LD/ADHD
89.2
91.0
84.3
(n=23)
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10
ADHD
8
6
RD
4
RD/ADHD
2
Controls
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Adult Clinical Groups in Manual
Clinical Group
WRAML2 GMI
Alcohol Abuse
91.4
Parkinson Disease
98.6
Traumatic Brain Injury
82.0
Alzheimer’s Disease
79.1
Administration
General Points:
 Clipboard
 Pronunciation
 Practice
 Organize Forms
Administration Time:
 Core Subtests:
30 - 40 minutes
Age-Based Normative Scores
 Scaled Scores - Subtests
Mean = 10, SD =3
 Standard Scores - Indexes
Mean=100, SD =15
 Percentiles - Indexes
 Age Equivalents
5 – 16 years
Other Data Available
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Confidence Intervals
Index Discrepancy Data
Statistical significance
Prevalence data
Scaled and/or Cut Scores for qualitative analyses
Qualitative Analyses (with quantitative support)
Age-based descriptive statistics and clinical base
rates (prevalence) are provided
Computer scoring program available
Core Indexes and Subtests
General Memory
Index
Verbal Memory
Index
Story Memory
Verbal Learning
Visual Memory
Index
Design Memory
Picture Memory
Attn/Concentration
Index
Finger Windows
Number Letter
Story Memory Subtest
Core Subtest (1), Verbal Memory Index
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Two Stories read to Participant
A & B = 5-8 years
B & C = 9 years and older
Immediate Recall Trial
Upper case scoring criteria = requires an exact
response
Lower case scoring criteria = acceptable gist
responses listed in manual
Story Memory Subtest
Core Subtest (1), Verbal Memory Index
Tips:
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Practice reading stories out loud
Use a pencil to point to each word as it is read
Note unusual gist responses so can score later
Transfer to Verbatim and Gist columns later
Story Memory Subtest
Associated Optional Subtests and
Qualitative Measures
Story Memory Delay Recall
 Story Memory Retention
 Individual Story Comparison
 Verbatim and Gist Measures
 Story Memory Delay Recognition
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Verbal Learning Subtest
Core Subtest (3), Verbal Memory Index
List-learning task
13 words, 8 years and younger
16 words, > 9 years
 Common words
 Four learning trials
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Verbal Learning Subtest
Core Subtest (3), Verbal Memory Index
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Tips:
One second pause between words
Number repetition order IF have time
Write first letter of word in free space
Verbal Learning Subtest
Associated Optional Subtests and
Qualitative Measures
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Verbal Learning Delay Recall
Trials 1 – 4
Verbal Learning Slope
Verbal Learning Retention
Verbal Learning Intrusion Errors
Verbal Learning Recognition
Semantic vs. Phonological Error analysis for
Recognition
Design Memory Subtest
Core Subtest (2), Visual Memory Index
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5 Design Memory Cards
Design Memory Response Form
Copying – aid for judging accuracy
Young examinees
Any age with poor visual-motor skills
Drawing task
5 second exposure
10 second pause before drawing
Design Memory Subtest
Core Subtest (2), Visual Memory Index
Tips:
 Take back the pencil each time after drawing is
complete
 Hold the pencil to deter grabbing
 Let clock run and note time vs. resetting
 Scoring guidelines in manual
Associated Optional Subtest:
 Design Memory Recognition
Picture Memory Subtest
Core Subtest (4), Visual Memory Index
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4 Memory Stimulus Cards
Picture Memory Response Form
Red China Marker
10 second exposure
“Put an X on each part of the picture that
has been changed, moved or added.”
Correct Zoo card only
Picture Memory Subtest
Core Subtest (4), Visual Memory Index
Tips:
 Put Memory Stimulus Cards in order
 Can use a crayon – liquid markers typically
bleed
 Familiarize yourself with the Zoo responses, in
particular, so can quickly correct if needed
Associated Optional Subtest/Qualitative Measure:
 Commission Errors
 Picture Memory Recognition
Finger Windows Subtest
Core Subtest (7), Attention/Concentration Index
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Finger Windows Card
Start places determined by age
5-8 years = A
9 years & older = 4
1 second in window, 1 second between
windows
Correct A, B, and C only
If 4 is incorrect, go to A
Finger Windows Subtest
Core Subtest (7), Attention/Concentration Index
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Tips:
May be easier to write numbers in order
while looking at card
Can place pencil on table between
windows to aid timing
Number Letter Subtest
Core Subtest (9), Attention/Concentration Index
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1 per second
Examinee repeats the sequence in
the same order
Optional Subtests
Working
Memory
Index
Verbal
Working
Memory
Additional
Subtests
Symbolic
Working
Memory
Sentence
Memory
Subtest
Qualitative
Analyses
Sound Symbol
Subtest
Verbal Working Memory
Optional Subtest (14), Working Memory Subtests
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Only administer to 9 and older
9 to 13 years = Level A and B
14 to adult = Level B and C
A: Repeat animals first, then non-animals
B: Repeat animals small to large first, then
non-animals
C: Repeat animals small to large first, then
non-animals small to large
Verbal Working Memory
Optional Subtest (14), Working Memory Subtests
Example: Level B, Item B-6
Examiner: nail, elephant, lake, crab, kangaroo
Participant: crab, kangaroo, elephant, nail, lake
Scoring: 1 for animal grouping, 1 for non-animal
grouping, bonus of 1 if both groupings are
correct – intrusions are not accepted
 Can teach on items A-1, A-2, A-3, B-1 but score
first response
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Verbal Working Memory
Optional Subtest (14), Working Memory Subtests
Tips:
 Directions are lengthy and wordy so must
practice frequently before administering to
ensure correct pronunciation. Use inflection to
aid understanding.
 If size dimensions are questioned (i.e. nose to
scissors) say, “Think of the most usual size.”
Symbolic Working Memory
Optional Subtest (16), Working Memory Subtests
Administered to 9 years and older only
 Auditory input, non-verbal response
 2 Levels
A: Numbers in order
Number Stimulus Card
B: Numbers order, then letters in order
Number-Alphabet Stimulus Card
 Training items for each level
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Symbolic Working Memory
Optional Subtest (16), Working Memory Subtests
Tips:
 Stress “numerical” and “alphabetical” order
when reading directions
 Remove or flip card after every item response
 Subjects often point very quickly so may want
to remember visually or write series on paper
while watching
Sound Symbol
Optional Subtest (13), Additional Subtests
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5 – 8 years only
Phonemes paired with visual symbols
Sound Symbol Booklet
Learning Trial
4 Test Trials (I to IV)
Provide positive feedback or correct
responses on the first 3 Test Trials
If no response in 5 seconds, provide
response and flip or just flip if Trial IV
Sound Symbol
Associated Optional Subtest and
Qualitative Measures
Sound
Symbol Delay Recall
Trial 1 – 4
Sound Symbol Retention
Sound Symbol Slope
Sentence Memory
Optional Subtest (15), Additional Subtests
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8 and younger = Begin with Item 1
9 to adult = Begin with Item 8 (go back if
necessary)
Say each sentence once only
2 points = 0 error
1 point = 1 error
0 point = 2 errors or more
Can teach #1 until they understand but score first
attempt
Sentence Memory
Optional Subtest (15), Additional Subtests
Scoring:
 Response must be verbatim
 Additions, omissions, changing word form, and
contracting are one error
Tips:
 Place pencil on each word to decrease error
 Record incorrect response for scoring and
analysis
Optional Subtests
Delay Recall Subtests
Story Memory Recall
Verbal Learning Recall
Sound Symbol Recall
Recognition Subtests
Story Memory Recognition
Design Recognition
Picture Memory Recog.
Verbal Learning Recog.
Story Memory Delay Recall
Optional Subtest (5), Delay Recall Subtests
Return to Story Memory (1) scoring pages
 Administer same story set as Story Memory
 Do not read story to examinee
 Indicate performance in the Delay Recall
column
 No Verbatim or Gist columns for delay but
must comply with same scoring guidelines
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Verbal Learning Delay Recall
Optional Subtest (8), Delay Recall Subtests
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Return to Verbal Learning (3) scoring
pages
Do not read the list to the examinee
Sound Symbol Delay Recall
Optional Subtest (17), Delay Recall Subtests
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Return to Sound Symbol (13) scoring pages
Sound Symbol Booklet
Do not name any symbols
Delay Recall Trial is the same set as the
Learning Trial
Story Memory Recognition
Optional Subtest (6), Recognition Subtests
Administer same story set as Story
Memory
 Give automatic credit for any correct detail
given during Story Memory Recall
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Design Memory Recognition
Optional Subtest (10), Recognition Subtests
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Design Memory Recognition Booklet
Pencil or Marker
Review directions until examinee independently
understands
Make sure page is correctly oriented
Do not let examinee go back once a page is
finished
Picture Memory Recognition
Optional Subtest (11), Recognition Subtests
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Picture Memory Recognition Booklet
Pencil or Marker
Review directions until examinee independently
understands
Do not let examinee go back once a page is
finished
Can clarify that picture can appear on either the
Picture Stimulus Card (cards with scenes) or Picture
Memory Response Form (marked changes)
Verbal Learning Recognition
Optional Subtest (12), Recognition Subtests
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Administer if Verbal Learning and Verbal
Learning Delay Recall have been administered
Ask for recognition of each word on list
Optional Qualitative Analysis
 Semantic Error Total
 Phonological Error Total
WRAML2 Screening Form
1st Four Core Subtests
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Story Memory
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Design Memory
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Verbal Learning
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Picture Memory
Administration Time: 20 - 30 minutes
Memory Screening Index and General
Memory Index correlation = .91
Scores
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Raw – Scaled – Sum of Scaled – Index
Graphic Representation
Index Score Discrepancy Analyses
Core Subtest vs. Recognition Discrepancy
Retention: Subtest minus Recall raw score
Qualitative Analyses - Scores
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Story Memory
Individual Story/Verbatim and Gist Scale Score
Picture Memory
Commission Errors - Descriptive
Verbal Learning
Trials/Slope/Intrusion Errors – Graph and Descriptive
Verbal Learning Recognition
Semantic and Phonological Errors - Descriptive
Sound Symbol
Trials/Slope/Retention – Graph and Descriptive
Qualitative Analyses - Possible Implications
Story Memory
 Forgetting “chunks” - Limited sustained attention
 Delay better than recall - Need for memory
consolidation
 Reliance on Gist related to Reading Disability
 Poor Delay Recall common in dementia or left temporal
lobe head injury or stroke
 Retention is particularly poor with moderate to severe
brain injury, although immediate recall can be intact
Qualitative Analyses - Possible Implications
Verbal Learning
 Flat curve could suggest adequate auditory memory
but difficulty recalling rote information
 Slight curve suggests subject may benefit from
repetitive review
 Variable curve could suggest attention/organization
issues
 Poor slope suggests limited or decreased learning;
adequate slope suggests learning efficiency
Qualitative Analyses - Possible Implications
Verbal Learning, continued
 Retention score < the 5th percentile could suggest
recent brain injury or progressive dementia
 Frequent intrusion errors may suggest limited selfmonitoring, difficulty using feedback to change
performance, disorganized processing, or confusion
 Poor recognition may be associated with congenital
developmental delay or neurologically based illness or
injury
Qualitative Analyses - Possible Implications
Picture Memory
 Low Recognition and adequate Memory (rare) could
suggest developmental delay, neurologically-based
illness or injury, fatigue, poor motivation/attention, or
malingering
 Poor Memory and adequate Recognition may suggest
early-to-mid-stage Alzheimer’s
 High Commission Errors may be associated with poorly
modulated work style, disinhibition, and poor impulse
control as often seen in AD/HD, TBI, and mania
Qualitative Analyses - Possible Implications
Sound Symbol
 Retention score < the 5th percentile may
suggest memory loss typical of phonologicallybased reading disability, recent brain injury, or
recent seizure disorder
 Phonological/visual associates (tabe, wah, haa)
are similar to the decoding aspects of reading