APPROPRIATE TESTING CONDITIONS

HOW TO ADMINISTER NEPSY-II 35

across the table from the child, as this facilitates observation. Watching the child perform the task and recording, not only the formal Behavioral Observations provided on NEPSY-II, but also other observations and impressions, are integral parts of a thorough neuropsychological evaluation. These notations will be invaluable in understanding how the child approaches a specific task. Subsequent to the assessment, such knowledge will aid in the formulation of interventions.

For sensorimotor subtests, the clinician must sit across the table from the child in order to demonstrate the movements and positions and to observe the child from the correct orientation. However, on a few subtests (e.g., Body Part Naming, Arrows) the clinician may be able to administer the subtest more easily if he or she is seated beside or at a right angle to the child. This may facilitate the proper orientation of the materials and observation of the child’s response, pointing to the stimuli on the easel. (See Rapid Reference 2.1.)

Rapid Reference 2.1

Summary of Optimal Physical Environment for Testing

Room: quiet, well-ventilated, and well-lit.; temperature well-regulated to help concentration.

Furniture and Accessories: table with a smooth surface, ample room for materials; appropriate height.

•Use booster chair, if a low table unavailable for testing young children.

•Footstool or wooden box available for child if feet do not touch the fl oor.

•Comfortable chairs with arms to help to contain younger children; to provide elbow rests for the child and clinician.

Test Materials

Only the test materials being used should be visible on the table during the testing. Other materials may be distracting or cause anxiety for a child who worries about being able to accomplish a task. The clinician may want to place the materials he or she will use on a chair nearby but out of the child’s view. The NEPSY-II Stimulus Book easel should be placed so the front cover faces the examiner. The pages of the Stimulus Books are turned toward the child. The child should not be able to see the examiner’s side of the easel. The NEPSY-II kit contains all materials needed except the stopwatch, and any extra paper desired for taking notes.

36 ESSENTIALS OF NEPSY-II ASSESSMENT

Pencils (red, number two standard) are provided with the kit and need to be well sharpened for the tasks. Extra pencils can be kept available. A clipboard is a useful tool in many subtests as it facilitates observation and recording simultaneously. For young children (ages 3 to 6), use a thick, primary pencil.

Preparation of the Record Form

Prior to testing, mark the start-points for the child’s age on the Record Form. Also circle or highlight age-appropriate tests to be administered. The examiner can number the tests in the order she/he wishes to administer them or can prepare a guide sheet with the order, whichever is preferred. The clinician should note whether the child is to take a break or is to perform another subtest between immediate and delayed tasks. Note that if a subtest is to be placed between the immediate and delayed trials of a memory test, it should not be another memory test.

Establishing Rapport

It is important to establish rapport with the child before testing begins. Greet the accompanying adult in a friendly, relaxed manner so the child can be reassured about the way the examiner relates to people. Then greet the child, offering your hand for a handshake. Shaking hands with the child often makes him or her feel that this process is going to be a partnership and that he or she has an important role to play. However, if the child is shy about shaking hands, do not force it. When the child is young, get down on her or his level and chat for a few minutes about some matter to which the child can relate, for example, a toy the child has brought to the testing or an article of clothing. Explain that you will be doing all kinds activities with the child. When an adult refers to the clinician as “doctor,” or when the evaluation takes place in a hospital or medical center, the clinician should reassure the child that he or she will not be giving shots or doing anything to hurt the child. Older children need to be reassured that they will not be receiving grades on their performance.

When a young child or a child with a developmental delay has trouble separating from the parent (caregiver), the clinician may wish to invite the parent to walk back to the testing room with the clinician and the child. The clinician should reassure the child that the parent will know exactly where she or he is, and, perhaps, have the parent leave an article (a scarf, a book, etc.) with the child for security. Do not prolong the process. When the mother, father, or both have gone, the examiner may need to play with the child for a while to help him or her feel comfortable

HOW TO ADMINISTER NEPSY-II 37

before testing is initiated. Occasionally, with a small child or a child with developmental disorders, the parent needs to be present for the testing. When this is the case, talk to the parent prior to the testing about not prompting the child. Most children, however, will perform better if the parent is not present.

Maintaining Rapport

Good rapport is essential to productive assessment. The clinician should introduce the test to the child by talking about the many different activities the child will be doing with the clinician. Explain that each task will be easy at first, and then the items may get harder. The examiner should explain that some tasks are easy and others are hard, but reassure the child that when the items get hard, he or she just needs to do his or her best. This can help reassure the child that he or she is not the only one who finds some items difficult. When items become difficult, the examiner can validate the child’s feelings by acknowledging, “Sometimes these get hard,” or “That one was tough; let’s try a different one.” Occasionally, children may need to be reassured by explaining to them that some tasks are really difficult and that they need not know or be able to solve them all, but just try their best.

In general, it is best to praise effort rather than achievement. “You are really working hard!” or “You really kept at that problem until it was solved!” It is fine to use stickers or little treats as reinforcers for small children and for older children with cognitive impairments. These should not be offered as rewards for correct performances but rather for staying on task and working. At best, rewards are offered at the end of the sessions, but may be needed during testing. Older children without developmental delay may find reinforcers “babyish.” As subtest materials are being changed for new ones, small talk will help keep the child at ease.

DON’T FORGET

Validate the Child’s Feelings

When items get diffi cult, validate the child’s feelings.

•“Sometimes these are hard.”

•“That one was tough; let’s try a different one.” Praise effort, not achievement.

•“You are really working hard!”

•“You really kept at that problem until it was solved!”

38 ESSENTIALS OF NEPSY-II ASSESSMENT

Taking Breaks

A child who becomes fatigued is unproductive and does not perform according to his or her capacity. Watch for signs of fatigue such as squirminess, asking how long it will be, stretching, and so forth. Take a break as soon as possible when any of these signs is observed. It is advisable to have juice and crackers or a similar snack available for the child during the break, but ask permission from the accompanying person to give the child a snack before the assessment begins. Looking out the window with the child for a while may provide a little “mental recess.” If necessary, relocate to a playroom or office where some toys are kept or take a short walk with the child. Providing a change of scene and position before returning to work may help.

When the delayed memory section of a subtest is the next one to be administered, the examiner can give the child a break of 15 to 25 minutes or administer another subtest from a different domain until the appropriate time has elapsed before the delayed trial. For example, if Memory for Names has been administered to a young child, the examiner could administer Block Construction or a subtest other than a memory test to fill in the time gap before Delayed Memory for Names is due to be administered. Conversely, breaking for lunch or for the day after an immediate memory subtest has been administered will spoil the delayed trial because the time gap will be too great for the delayed trial to be administered. In such cases only the results of the immediate memory test can be reported.

C A U T I O N

Do Not Take a Break Between an Immediate and

Delayed Memory Test

•Breaking for lunch or for the day after an immediate memory subtest will spoil the delayed trial.

•Time gap will be too great for the delayed trial to be administered.

•Only the results of the immediate memory test can be reported.

To allow for the appropriate delay between memory sections, the examiner can:

•Give the child a break of 15–25 min.

•Administer another subtest from a different domain (not another memory test).

HOW TO ADMINISTER NEPSY-II 39

Testing Considerations

It is essential for the assessment to address:

•The referral question

•The needs of the child with respect to particular complaints or problems, and to intervention needs

•Time constraints

•The setting in which the assessment takes place

•The child’s age

These questions or circumstances are considered in planning the assessment by selecting the appropriate NEPSY-II subtests or employing a Referral Battery.

Subtest Order

A NEPSY-II normative sample was collected using multiple subtest administration orders. This means that the NEPSY-II subtests are not subject to order effects; they do not have to be administered in the order that they appear in the Administration Manual. Subtests can be used individually in any order or the examiner can develop his or her own battery. Because of this flexibility, however, it is essential to plan in advance the order in which the subtests are to be administered. That said, a certain degree of freedom to do online changes in subtest order is advised so as to accommodate for signs of fatigue or frustration that the child may exhibit during the assessment. The subtest order can be varied as the clinician feels is suitable for the child’s age, attention, interests, and difficulties. In order to accommodate varying subtest administration orders, subtest administration instructions are presented in alphabetical order in both the Stimulus Books and the Administration Manual of NEPSY-II.

C A U T I O N

Plan Order of Assessment in Advance

•NEPSY-II subtests are not subject to order effects, so do not have to be administered in the order seen in the Administration Manual, Record Form, or Stimulus Books.

•Subtests can be used individually in any order or the examiner can develop his or her own battery.