David S. Tulsky

The Functional Assessment of Cancer Therapy scale: development and validation of the general measure.

PURPOSE We developed and validated a brief, yet sensitive, 33-item general cancer quality-of-life (QL) measure for evaluating patients receiving cancer treatment, called the Functional Assessment of Cancer Therapy (FACT) scale. METHODS AND RESULTS The five-phase validation process involved 854 patients with cancer and 15 oncology specialists. The initial pool of 370 overlapping items for breast, lung, and colorectal cancer was generated by open-ended interview with patients experienced with the symptoms of cancer and oncology professionals. Using preselected criteria, items were reduced to a 38-item general version. Factor and scaling analyses of these 38 items on 545 patients with mixed cancer diagnoses resulted in the 28-item FACT-general (FACT-G, version 2). In addition to a total score, this version produces subscale scores for physical, functional, social, and emotional well-being, as well as satisfaction with the treatment relationship. Coefficients of reliability and validity were uniformly high. The scales ability to discriminate patients on the basis of stage of disease, performance status rating (PSR), and hospitalization status supports its sensitivity. It has also demonstrated sensitivity to change over time. Finally, the validity of measuring separate areas, or dimensions, of QL was supported by the differential responsiveness of subscales when applied to groups known to differ along the dimensions of physical, functional, social, and emotional well-being. CONCLUSION The FACT-G meets or exceeds all requirements for use in oncology clinical trials, including ease of administration, brevity, reliability, validity, and responsiveness to clinical change. Selecting it for a clinical trial adds the capability to assess the relative weight of various aspects of QL from the patients perspective.

Is speed of processing or working memory the primary information processing deficit in multiple sclerosis

Objective: To examine whether processing speed or working memory is the primary information processing deficit in persons with MS. Design: Case-control study. Setting: Hospital-based specialty clinic. Participants: 215 adults with clinically definite MS. Main Outcome Measure: Mean demographically corrected T-scores, prevalence rates of impairment and relative risk of impaired Processing Speed and Working Memory Index Scores from the WAIS–WMS III. Results: Deficits in Processing Speed were much more common than Working Memory in all comparisons. This was observed for both relapsing remitting (RRMS) and secondary progressive MS (SPMS) subjects, but accentuated in the latter group. Conclusions: Results strongly suggest that the primary information processing deficit in persons with MS is in speed of processing.

Cognition assessment using the NIH Toolbox

Vision is a sensation that is created from complex processes and provides us with a representation of the world around us. There are many important aspects of vision, but visual acuity was judged to be the most appropriate vision assessment for the NIH Toolbox for Assessment of Neurological and Behavioral Function, both because of its central role in visual health and because acuity testing is common and relatively inexpensive to implement broadly. The impact of visual impairments on health-related quality of life also was viewed as important to assess, in order to gain a broad view of ones visual function. To test visual acuity, an easy-to-use software program was developed, based on the protocol used by the E-ETDRS. Children younger than 7 years were administered a version with only the letters H, O, T, and V. Reliability and validity of the Toolbox visual acuity test were very good. A 53-item vision-targeted, health-related quality of life survey was also developed.

Memory Span on the Wechsler Scales

This study had two goals. One was to assess whether the WMS-III Spatial Span subtest operates as a visual analogue of Digit Span while the second was to determine whether backward span is a more sensitive measure of working memory than the forward span condition. Analyses based on the WAIS-III–WMS-III standardization and clinical group data revealed some important distinctions between Digit and Spatial Span. The two tasks exhibited differences in patterns of performance on the forward versus backward conditions, in their relationships with age, and in their methodology. Moreover, the backward conditions of both Digit and Spatial Span did not appear more affected by risk factors such as aging or pathology than the forward scores. This runs contrary to the widespread notion that backward span provides differential sensitivity regarding working memory processing.

Redefining the factor structure of the Wechsler Memory scale-III: Confirmatory factor analysis with cross-validation

The purpose of this study was to revisit the underlying factor structure of the Wechsler Memory Scale-III. The WMS-III Technical Manual (Wechsler, 1997) presented findings from confirmatory factor analyses that support a three- and five-factor solution with separate immediate and delayed memory factors. A rigorous structural equation modeling approach was used to examine the factor structure of the test. The results verify that a three-factor model composed of verbal (immediate and delayed), visual (immediate and delayed), and working memory factors accurately represents the factor structure of the WMS-III. Results were crossvalidated on an independent sample.

Revising a Standard: An Evaluation of the Origin and Development of the WAIS-III

Publisher Summary The development of the Wechsler Adult Intelligence Scale III (WAIS-III) began officially in November, 1992 and marked the first revision of the adult test to be undertaken following David Wechslers death in 1981. The WAIS-Revised (WAIS-R) was among the most frequently used tests for assessing the cognitive abilities of adults. Though still an extremely popular and widely used test when development of the WAIS-III began, a five year development plan would allow the WAIS-III to be released just when the normative information was becoming outdated. Cognitive tests appear to require new normative data every 15-20 years and based on these estimates, the norms of the WAIS-R would be in danger of becoming obsolete by the late 1990s. The revision not only afforded an opportunity to update the normative information but presented an opportunity to make other larger or smaller changes, based upon research findings and clinical usage. Since the WAIS-R standardization sample had been collected during 1979-1980, new normative information would certainly have been needed by the targeted 1997 publication date set for the WAIS-III. However, the recognition that many improvements to the test could be made that would assure its continuing value in both research and clinical practice was of importance to the development of the WAIS-III.Publisher Summary The development of the Wechsler Adult Intelligence Scale III (WAIS-III) began officially in November, 1992 and marked the first revision of the adult test to be undertaken following David Wechslers death in 1981. The WAIS-Revised (WAIS-R) was among the most frequently used tests for assessing the cognitive abilities of adults. Though still an extremely popular and widely used test when development of the WAIS-III began, a five year development plan would allow the WAIS-III to be released just when the normative information was becoming outdated. Cognitive tests appear to require new normative data every 15-20 years and based on these estimates, the norms of the WAIS-R would be in danger of becoming obsolete by the late 1990s. The revision not only afforded an opportunity to update the normative information but presented an opportunity to make other larger or smaller changes, based upon research findings and clinical usage. Since the WAIS-R standardization sample had been collected during 1979-1980, new normative information would certainly have been needed by the targeted 1997 publication date set for the WAIS-III. However, the recognition that many improvements to the test could be made that would assure its continuing value in both research and clinical practice was of importance to the development of the WAIS-III.

Assessment of the Non-Native English Speaker: Assimilating History and Research Findings to Guide Clinical Practice

Publisher Summary This chapter describes how to interpret scores when an individual who speaks English as a second language is assessed with English language standardized tests like the Wechsler Adult Intelligence Scale-III (WAIS-III) and Wechsler Memory Scale-III (WMS-III). The need to develop sound methods for the assessment of individuals from non-native English-speaking backgrounds may seem like a recent challenge, stemming from the rapid growth of ethnic/linguistic and immigrant populations. Actually, the concern dates back to the earliest days of cognitive assessment. In some ways, modern-day psychology as a profession has been inattentive to a challenge that initially presented a century ago. To facilitate chances of success with this challenge now and in the future, it is necessary to understand the assumptions, motivations, and the mistakes of the past, and then identify new concepts and methodologies for describing cognition and for considering the roles of language and culture in assessment. The chapter reviews the lengthy history in America of testing individuals from diverse cultural and linguistic backgrounds that reveals how early professionals who lacked empirical guidance approached cognitive testing. The chapter concludes with discussing recent research that examines the role of language and acculturation-related factors to determine their utility in interpreting cognitive test performance.

Objective and subjective handicap following spinal cord injury: interrelationships and predictors.

Abstract Objective: To investigate the relationship between objective and subjective indicators of handicap or community participation among people with spinal cord injury (SCI) 1year postinjury. Design: Longitudinal correlational study of quality of life indicators linked to Northern New Jersey SCI System database. Setting and participants: A total of 126 (80% male) participants was assessed at 1 year post-SCI. Age ranged from 14-83 years (median age = 34 years); 47% had tetraplegia, and 53% had paraplegia. Primary measures: Objective (or normative) handicap was measured using the Craig Handicap Assessment and Reporting Technique and the Community Integration Questionnaire. Subjective feelings about each area of handicap or community participation were assessed using the Andrews Delighted-Terrible scale. Results: Significant correlations were found between objective and subjective indicators of handicap in work life, social life, mobility, and economic status. Subjective handicap also correlated modestly with seventy of impairment and length of hospitalization. These correlations were, however, weak or inconsistent across individuals. Subjective quality of life was not related to preinjury economic or social handicap. Some participants spontaneously reported dissatisfaction with items outside of the standard outcomes scales used (eg, sexuality and personal relationships). Conclusions: The weakness and inconsistency of relationships between objective and subjective appraisals of areas of community participation is a challenge to outcomes measurement and has implications for the targeting of interventions. More research is needed to understand relationships between objective indicators of community participation and subjective appraisals of these areas.

The Wechsler Memory Scale, Third Edition: A New Perspective

Publisher Summary Although the Wechsler Memory Scale-III (WMS-III) includes several new components—some that are unfamiliar and others that have weaknesses in their design—the revision of the WMS is significant in its attempt to represent the more recent research in the field of memory assessment. The WMS-III has one of the largest and most representative standardization databases to assess memory and make optimal clinical recommendations. Furthermore, the value of the powerful database that has been obtained through the co-norming procedure of the WMS-III with the Wechsler Adult Intelligence Scale III (WAIS-III) cannot be overstated. Although the emphasis has moved away from intelligence quotient scores to factor scores and away from MQ scores to specific memory processes, the most significant and meaningful advancement in the production of the third editions of the WAIS-III and WMS-III is the use of a co-norming methodology. As with every assessment tool, work remains to be accomplished to improve the ability to apply most effectively within the WMS-III and to interpret the data to its maximal capacity. The WMS-III should therefore be viewed as a work in progress, with ongoing research in the field facilitating improved methodology and means of comparison.

Historical Overview of Intelligence and Memory: Factors Influencing the Wechsler Scales

Publisher Summary This chapter describes some of the earliest work in testing that influences the development of psychological science. Though the foundation of Wilhelm Wundts laboratory is the recognized milestone in the birth of psychological science, several prior events laid the foundations for the description and the measurement of intelligence in the Western world. Educators were struggling with notions akin to intelligence prior to the middle of the 1800s. Several efforts mark some of the initial approaches to the education of children and adults with mental retardation and are further suggestive of the increasing awareness of educators about individual differences in intelligence. The 19th century witnessed some remarkable and creative attempts to capture the essence of human mentality through the use of various tests. In the 1870s, the earliest psychological laboratories were founded by Sir Francis Galton in London, England, and Wilhelm Wundt in Leipzig, Germany.