Karl H. Wiedl

Principles of dynamic assessment: The application of a specific model.

Abstract In this article theories of change and cognitive modifiability are contrasted with “static” models. The former provide the conceptual and empirical bases for dynamic or testing-the-limits approaches. Differentiating between person variables and assessment variables, we examine how and to what extent individual and group differences in mental functioning are affected by these two classes of variables. To do this, we describe our theoretical model and some of the empirical data that bear on the issues raised. Contrasting to the common test-train-retest paradigm general adhered to, our methods involve modifications of testing procedure within the testing situation. The methods found to be most effective involve elaborated feedback and overt, concurrent verbalization.

Learning potential on the WCST in schizophrenia is related to the neuronal integrity of the anterior cingulate cortex as measured by proton magnetic resonance spectroscopy

BACKGROUND In recent years, schizophrenia has increasingly been recognized as a neurocognitive disorder, which has led to a growing literature on cognitive rehabilitation, and suggested several potential enhancements to cognitive function. For instance, it has been shown that executive functioning deficits as measured by the Wisconsin Card Sorting Test (WCST) can be modified in a subgroup of schizophrenic patients. The neurobiological basis of cognitive remediation has not been elucidated so far, although structural, functional and metabolic abnormalities of the prefrontal cortex have been associated with cognitive impairment. METHODS In this study, learning potential was investigated in 43 schizophrenic patients and 37 age- and education-matched healthy controls, using a dynamic version of the WCST, which integrates instructions and feedback into the testing procedure. Performance was related to cerebral metabolism, assessed by single-voxel proton magnetic resonance spectroscopy of the dorsolateral prefrontal cortex (DLPFC) and the anterior cingulate cortex (ACC). RESULTS N-acetylaspartate (NAA), a marker of neuronal integrity, was significantly reduced in the DLPFC of schizophrenic patients as compared to the healthy control group. The level of NAA in the DLPFC positively correlated with performance in the dynamic WCST in healthy subjects, whereas in schizophrenic patients a significant correlation was observed between NAA and glutamate/glutamine in the ACC and learning potential. CONCLUSION These data imply a relationship between neuronal plasticity as assessed by learning potential and NAA levels of the prefrontal cortex in schizophrenic patients and healthy subjects, and suggest the involvement of differential neuronal networks in learning for schizophrenic patients compared to healthy controls.

Dynamic Assessment of Cognitive Rehabilitation Potential in Schizophrenic Persons and in Elderly Persons With and Without Dementia

Summary: Dynamic assessment is a diagnostic approach in which specific interventions are integrated into assessment procedures to estimate cognitive modifiability. The study investigates the utilit...

A Longitudinal Study of Learning Potential and Rehabilitation Outcome in Schizophrenia

OBJECTIVE The study examined whether a measure of learning potential is prospectively related to the success of a vocational rehabilitation program for patients with severe mental illness in Germany. METHODS At rehabilitation intake (November 2002 to January 2004), 41 persons with schizophrenia or schizoaffective disorders completed a test-train-test version of the Wisconsin Card Sorting Test as a measure of learning potential. Research participants were classified as high scorers, learners, or nonlearners. Rehabilitation outcome was assessed with measures of work capability during the rehabilitation program, level of functioning during rehabilitation and at three-month follow-up, and level of vocational integration at three-month follow-up. RESULTS Individual learning potential was associated with the improvement of work-related learning ability during rehabilitation and with the level of functioning and the level of vocational integration at three-month follow-up (about 15 months after the initial testing). Generally, high scorers had better rehabilitation outcome at all assessment points regarding all outcome measures. Even though learners and nonlearners started at comparable levels at the beginning of the rehabilitation, learners benefited more from the program, whereas nonlearners showed a rather unfavorable rehabilitation outcome. CONCLUSIONS Findings supported the assumption that learning potential is an informative predictor of rehabilitation outcome and may add information beyond static cognitive measures. Learning potential should be considered in the further development of vocational rehabilitation programs.

The Dynamic Assessment of Intelligence

Even though the study of mental abilities is one of the most widely researched areas in psychology, a number of often related definitional and methodological issues remain unresolved. There are several reasons for this, including the complicated nature of the construct intelligence, measurement issues, and problems concerning how individual and group differences in measured intelligence are to be explained and interpreted.

Anterior cingulate cortex activation is related to learning potential on the WCST in schizophrenia patients.

The remediation of executive function in patients with schizophrenia is important in rehabilitation because these skills affect the patients capacity to function in the community. There is evidence that instructional techniques can improve deficits in the Wisconsin Card Sorting Test (WCST) in some schizophrenia patients. We used a standard test/training phase/standard test format of the WCST to classify 36 schizophrenia patients as high-achievers, learners or non-retainers. All healthy controls performed as high-achievers. An event-related fMRI design assessed neural activation patterns during post-training WCST performance. Patients showed a linear trend between set-shifting related activation in the anterior cingulate cortex and learning potential, i.e. increased activation in high-achievers, a trend for increased activation in learners, and no activation in non-retainers compared to controls. In addition, activation in the temporoparietal cortex was highest in patients classified as learners, whereas in non-retainers activation was increased in the inferior frontal gyrus compared to controls and high-achieving patients. These results emphasize the relevance of the ACCs neural integrity in learning set-shifting strategies for patients with schizophrenia. Also, our results support the hypothesis that compensatory neural activation in patients with schizophrenia helps them to catch up with healthy controls on cognitive tasks.

Entwicklung und psychometrische Kennwerte des Fragebogens zur Evaluation von Psychotherapieverläufen (FEP)

Zusammenfassung. Die kontinuierliche Messung des therapeutischen Fortschritts ist im Rahmen der Qualitatssicherung in Psychotherapie und Psychiatrie ein zentrales Element. In dieser Arbeit wird ein...

Dynamic Assessment of Executive Functioning: (How) Can We Measure Change?

Dynamic Assessment (DA) is a diagnostic approach that integrates specific behavioral interventions into cognitive testing procedures and thus turns these procedures into tests of learning potential. An important issue in DA is the question of how change in performance following these interventions can be expressed statistically. In this study we describe both categorical and dimensional approaches to assessment of learning potential. A sample of patients suffering from schizophrenia, schizoaffective, or bipolar affective disorders (n = 115) completed a test-training-test version of the Wisconsin Card Sorting Test (WCST) at two times with an interval of 12 months. The goal of this analysis was to investigate psychometric properties of common measures assessing performance change in executive functioning and to evaluate pragmatically their usefulness for DA. We analyzed the stability of different learning potential measures, their intercorrelation, convergent construct validity, discriminant construct validity using a measure of psychopathology, and their concurrent and prospective criterion validity using measures of social functioning. Learner groups, posttest scores, and regression residuals proved to be the most stable and valid measures of learning potential. Pros and cons of the different approaches are discussed.

Dynamic Testing: A Comprehensive Model and Current Fields of Application

In the introductory section of the paper, some general issues of Dynamic Testing (DT) are addressed: conceptualizations of performance change within a formal theory of psychological testing, a proposition on how to define DT, basic paradigms of applying the approach, and some recent historical trends. In the next section, the question of what happens during DT in terms of psychological processes is discussed. With regard to this question, a transactional model is presented where performance and performance change is conceptualized as being related to variations in aspects of a task, the person, and the mode of intervention. Several studies are presented to illustrate differentiations of the model. Its applicability is further demonstrated by recent studies in schizophrenia research, revealing strong differences between the patients in responsivity to intervention and underlining the salience of these characteristics for clinical and rehabilitational issues. Concluding remarks focus on specific requirements of basic and applied research in DT and the need to increase the implementation of DT in the professional community.

Stigma as a predictor of insight in schizophrenia.

Insight in schizophrenia can be seen as a multifactorial phenomenon. Although multifactorial pathways have also been suggested for insight formation, motivational explanations have rarely been tested. The present study explores stigma as one possible determinant of a motivated lack of insight in integrated models of insight formation. It examines the contribution of socio-demographic and clinical variables, neurocognitive functions, symptoms, and stigma to the prediction of insight into illness. Patients diagnosed with schizophrenia spectrum disorders (N=111) participated in a comprehensive battery of instruments to measure insight dimensions, stigma, neurocognitive functions, symptoms, socio-demographic and clinical variables. Blockwise multiple regression analysis indicates significant association of variability in insight dimensions with gender (7%) and stigma (i. e., stereotype agreement: 5%). Our findings demonstrate an incremental validity of stigma, which indicates a motivational pathway of insight formation. This study enables better understanding of the multifactorial nature of insight, which should be considered in therapeutic interventions to improve insight. The roles of gender and neurocognitive functions in insight formation are also discussed.