1. NEPSY-II
Overview
BY
BROOKE SCHAUDER, PHD

2. 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

3. Background
 Original NEPSY developed in 1998 (Finnish version in 1988)
 NEPSY-II increases content and psychometric properties
 Strong basis for development was Luria’s 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

4. 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

5. 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

6. Reliability & Validity
 MOST have adequate to
high internal consistency  Lower Reliability
or stability  Response Set Total Correct
(.55 for 11 & 12 year olds)
 Highest relaibility subtests:
 Inhibition Total Errors (.35
 Comprehension of
Instructions for 10 year olds)
 Design Copying  Memory for Designs Spatial
and Total Scores
 Fingertip Tapping
 Memory for Designs Delayed
 Imitating Hand Positions
Total Score (.44 for 10 year
 List Memory
olds)
 Memory for Names
 Phonological Processing
 Picture Puzzles
 Sentence Repetition

7. 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

8. 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

9. Attention and Executive Functioning
(self-regulatory skills)
 Strategic planning SUBCOMPONENTS
 Regulation based on Initiation
environmental feedback Inhibition
Selective Attention
Flexibility
Sustained Attention
Fluency
Working Memory

10. Language
 Expressive  Receptive
 Oromotor Control and  Phonological Processing
Articulation  Repetition
 Naming
 Repetition
 Word Generation

11. Memory and Learning
 Immediate and Delayed  Supraspan Learning:
Memory memorization of material
 Encoding exceeding max. capacity
 Retrieval for immediate memory
(through repetition)
 Working Memory
 Memory Span
 Repetition
 Rote Memory

12. 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

13. Visual and Visuoperceptual Processing
 Visual Perception
 Spatial Processing
 Visuoconstructional Skills
 Local and Global Processing

14. Referral Questions
 Learning Disorder –  Perceptual/Motor Delays
Language  School Readiness
 Learning Disorder –  Social/Interpersonal
Mathematics Differences
 ADHD  General
 Behavioral Problems
 Language Delays

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. Behavioral Problems
(continued)
 Affect Recognition
 Theory of Mind
 Arrows
 Design Copying

22. 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

23. 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

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

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

26. 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

27. 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

28. 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

29. School Readiness
 Major Domain Assessed: Language
Perceptual/Motor Delays/Disorders
 Attention and Executive, Sensorimotor, Visuospatial
Processing

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. Interpretation
 Low Picture Puzzles:
 Poor visual perception, poor scanning
 Low Route Finding
 Poor visual-spatial relations, poor orientation

40. 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

41. 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

42. 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

43. 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

44. 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

45. Scoring
 Behavioral Observations, such as “distracted, off-task
behaviors, physical movement” receive cumulative
percentages or percents.

46. THE END