The Booklet Category Test (BCT) is a modified, highly portable version of the Halstead Category Test that has been shown to be very sensitive to brain damage. The BCT is commonly used in neuropsychological assessment in Western countries, however, no information on psychometric properties of the BCT had been report in the Chinese population thus far. This is a single-center, hospital-based, prospective, case-controlled cognitive instrument validation study. The study objective is to examine the criterion, convergent and divergent validity, test-retest reliability, internal consistency and ease of administration of the BCT in Chinese. Ten healthy controls, 12 patients with focal frontal contusions and ten patients with non-frontal contusions were recruited. The Chinese BCT did not differentiate between patients with cerebral contusions from controls, or between patients with focal frontal contusions from those with non-frontal contusions using receiver operating curve analyses. However, it showed good convergent validity with tests of spatial reasoning and had acceptable divergent validity, excellent internal consistency (Cronbach’s ss= .928) and test-retest reliability (ICC = .982, p < .982) and was generally well accepted by local participants. These results showed that the BCT is a valid and reliable clinical measure of spatial reasoning applicable to the Chinese population. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Eighty-eight (N = 88) non-brain-injured adults were tested with one of two versions of the Booklet Category Test (BCT). Forty-four (N = 44) individuals were tested with the standard version of the BCT, and forty-four (N = 44) were tested with a revised BCT in which between-subtest cueing was removed, called the Noncued Category Test (NCT). The results of this study indicate that removal of cueing instructions changes the Category test significantly. Subjects administered the NCT scored significantly more errors than those who were administered the standard Category test. While BCT scores correlated significantly with nonverbal intelligence scores, NCT scores did not. However, the difference in these correlations was not significant, indicating that the intelligence aspect measured in the two versions is not different. Neither the BCT nor the NCT correlated significantly with the Wisconsin Card Sort, Word Fluency, Stroop, or Trail Making Test. It is recommended that the NCT be administered to circumscribed clinical populations in order to best utilize present findings.

To date, no research exists examining criterion-related validity of alternate, computerized forms of the Category Test. The intent of this study was to address criterion-related validity of three full forms of the Category Test. In that, the goal was to examine equivalency of each version in their ability to differentiate brain-injured from non-brain-injured individuals. Forty-nine (N = 49) healthy adults and 45 (N = 45) brain-injured adults were tested using three versions of the Category Test, the BDI, and the WAIS-R NI. ANOVA indicated no significant differences between versions of the Category Test or an interaction between Category Test version and group membership on the total error score. MANOVA performed between versions of the Category Test and Subtest error scores indicated significant differences between versions on Subtest 3 and Subtest 6. Group membership (brain-injured v. non-brain-injured) produced a significant main effect on all subtests of the Category Test except Subtest 2. Several exploratory analyses were performed examining the relationship between neuropsychological impairment, group membership based on Category Test error scores, and the WAIS-R NI. Clinical applications, such as the use of serial testing to index neurorehabilitation gains, were discussed.

This study examined the utility of the Trail Making Test Quotient (Trails B/ Trails A) in assessing executive functioning relative to that of common tests of executive function such as the Wisconsin Card Sorting Test, Category Test, and the Stroop Test. The purpose of the current study was to investigate the relationship of the Trail Making Test Quotient (Trails B/ Trails A) with other common tests of executive functioning (i.e., Wisconsin Card Sorting Test, Stroop, Category Test) to determine whether these tests are measuring similar domains of functioning or whether Trail Making Test Quotient (Trails B/ Trails A) offers a more pure measure of executive functioning over and beyond that of Trail Making Test B alone or the difference score, Trail Making Test (Trails B- Trails A). A series of partial correlations were conducted involving the Trail Making Test scores (Quotient, Difference, and B [Raw]), and the scores of the executive functioning measures (Wisconsin Card Sorting Test, Category Test, and Stroop), controlling for age, education, and gender. Trails Quotient, Trails B Raw, and Trails Difference were found to significantly negatively correlate with WCST Total # of Categories. Only Trails B Raw and Trails Difference were found to significantly positively correlate with WCST Perseverative Responses and Category Error. None of the Trail Making Test measures used in this study were found to significantly correlate Stroop Interference. Correlation coefficients were compared to determine the strength of Trails Quotient's relationship with the aforementioned executive functioning measures relative to that of Trails Difference and Trails B Raw. Contrary to the hypotheses of the current study, the Trails Quotient demonstrated a significantly weaker correlation with WCST Total # of Categories, WCST Perseverative Responses, and Category Error than that of Trails Difference and Trails B Raw. Additionally, there were no significant differences in the correlation coefficients of Trails Quotient, Trails Difference, and Trails B Raw with Stroop Interference. However, upon further investigation using exploratory factor analyses, it was discovered that Trails Quotient may have represented a particular component of executive functioning more so than the Trails Difference and Trails B Raw. The results suggest that Trails Quotient offers a unique estimate of executive skill specific to cognitive organization, whereas Trails B Raw and Trails Difference represent multiple executive domains including regulatory and organizational abilities. Clinical practice will benefit from the current study's findings in that assessment of complex executive functioning will be more precise. Future research is needed to determine the utility of the Trails Quotient in identifying specific types and locations of brain injury. Assessment of specific impaired frontal skills common to degenerative dementias and traumatic brain injury may be possible with the use of Trails Quotient contingent upon further research. Future research into the domains of executive functioning and the Trail Making Test should focus on specific skills within regulatory and organizational components, and the development of normative data for Trails Quotient.

The capacity of Raven's Standard Progressive Matrices (SPM) and the Booklet Category Test (BCT) to discriminate between groups of brain-injured, simulated malingering, and normal participants was investigated in this study. Exploratory analyses were also conducted to examine the differences between groups categorized as sophisticated and naive fakers. Clinical decision rules and discriminant function analyses were utilized to identify malingerers. Clinical decision rules ranged in hit rates from 41% to 78%, in sensitivity from 2% to 100%, and in specificity from 86% to 100%. Discriminant functions ranged in hit rates from 81% to 86%, in sensitivity from 68% to 73% and in specificity from 82% to 87%. Overall, the least helpful detection method examined was below chance responding on either measure, while the most efficient was gross errors for SPM.

Modified administration techniques that relied on patient verbalization of reasoning on each item were devised. For the WCST, verbalized scores correlated highly with conventional scores. However, patterns of age, education, and IQ covariates for each scoring condition were very different, raising questions concerning what such verbalized scores measured. Further research based upon a prospective research design was suggested to address this question. Factor analysis of WCST scores for each scoring condition resulted in almost identical three-factor solutions in each case: (a) ineffective, perseverative responding; (b) nonperseverative number errors; and (c) Maintaining Set. A three-part hierarchy of response determinants for the CT was utilized, consisting of (a) concrete perceptual attributes; (b) cognitive organization of perceptual attributes into abstract patterns; and (c) relating abstract patterns to the corresponding number responses. Decision trees were devised to prescribe a set of rules for coding each score. Utilization of this approach yielded adequate test-retest reliability for recoding responses. Sets of variables for each subtest were factor analyzed, with second order factor analysis of all factors from each subtest in order to determine if common cognitive process scores on each subtest described cognitive process scores on other subtests. Results revealed similar factor solutions for each subtest, but subtest-specific factors were not predictive of similar factor scores on other subtests, except for Subtests V and VI, which are based upon the same principle. Factors related to Maintaining Set predicted most of the variance in subtest error scores. Factor scores related to Determinant Shifting were predictive of error scores to a much lesser degree than Maintaining Set factor scores. Determinant Shifting factor scores appeared to be independent of Maintaining Set factor scores, and also showed much more independence from age, education, and IQ covariates. The relationship between CT and WCST factor scores was slightly lower than the relationship between CT error scores and WCST summary scores. Suggestions for further research were discussed.

The clinical utility of the Intermediate Category Test, a measure of executive functioning in children 9 to 14 years of age, is currently limited by the availability of only a Total Error score for normative interpretation. The Process Scoring System (PSS) was developed to provide a standardized method of assessing specific processing patterns and problem-solving errors. The purpose of this study was to determine the ability of the PSS scores to discriminate between children with and without suspected executive deficits, thereby providing evidence of criterion-related validity.