The purpose of this investigation was two-fold. First, to examine the level of diagnostic accuracy of psychologists when their decisions were subjected to statistical procedures that analyzed group differences and group membership predictions. Second, to examine the sensitivity of the Wisconsin Card Sorting Test (WCST; Heaton, Chelune, Talley, Kay, & Curtiss, 1993) in differentially identifying children who experience ADHD and RD-LD symptoms. The diagnostic battery used to identify ADHD, RD-LD, and Normal subjects included intellectual, academic achievement, attention, and hyperactivity measures recognized as sensitive to these disorders. Performance on the WCST was then examined to determine its usefulness in discriminating between the aforementioned groups.Scores for the diagnostic variables for 115 subjects (mean age = 9.8 years; males = 80; females = 35) were analyzed using oneway ANOVAs to determine differences between groups. A subsequent cluster analysis was conducted using Ward's method to determine group membership of the subjects and resulted in a sample of 87. This cluster analysis resulted in a four cluster solution with the groups being identified as ADHD, RD-LD, Normal, and "Close Calls."Two linear discriminant analyses were performed with the first using the diagnostic groups diagnosed by the previous psychologists as groups and diagnostic variables as predictors. The second used the diagnostic groups diagnosed by evaluating psychologists and the WCST variables used as predictors to examine their ability to discriminate between groups and predict membership.The first linear discriminant analysis yielded two significant functions of three indicating confidence in the diagnoses provided by the evaluating psychologists. The second linear discriminant analysis yielded no significant findings when using the WCST variables as predictors. As a result, it appears the WCST provides little useful information in the differentiation between ADHD, RD-LD, and normals. / Department of Educational Psychology

Objective: Lack of insight into illness is common in patients with schizophrenia diagnoses. It is supposed to reflect deficits of executive functioning that are frequently assessed with the Wisconsin Card Sorting Test. Studies on the remediability of WCST deficits in schizophrenia, however, raise doubts about its construct validity and suggest the use of a dynamic pretest-training-posttest paradigm (WCSTdyn) and single-case analysis (Reliable Change Index, RCI) in studies on insight. Moreover, a multifactorial etiology with neurocognitive and motivational factors, as suggested by Startup's (1996) model, has to be taken into consideration. The model hypothesizes a quadratic function of the relationship between insight and cognition, which means that both cognitively impaired and cognitively intact patients with low insight are to be expected. Method: Three interrelated studies on WCSTdyn and insight were conducted. In study 1, the split-half reliability of the WCST-128 was investigated in a non-psychiatric sample (N = 110). Study 2 compared different RCI single-case tests of significance of intraindividual change on data from N = 400 patients with schizophrenia diagnoses. Furthermore, a typology with three homogenous subgroups was developed and first steps toward an external validation were taken. In study 3, the three types of test-takers were compared on two measures of insight (Item G12 of the Positive and Negative Syndrome Scale [PANSS]; Osnabrueck Scale of Therapeutic Attitudes and Identification of Psychological Problems in Schizophrenia [OSSTI]). The model by STARTUP (1996) was tested by means of regression and cluster analyses including scales on coping (Freiburg Questionnaire of Coping with Illness, FKV: MUTHNY, 1989) and defensiveness (Eppendorf Schizophrenia Inventory, ESI-FR: MAß, 2001; N = 85). Results: The WCST-64 was sufficiently stable (r_tt = .70 [Total Number Correct]). Concordances of different RCI methods were high (kappa = .72 - .90). 45 % of the sample consisted of high scorers, in 43 % a low initial score could be normalized by a short training intervention (learners), and in only 12 % of the sample the WCST deficits were not amenable to training (nonlearners). Insight of nonlearners was significantly reduced (G12: g = 0,45). Finally, three clusters were identified with configurations of insight and WCSTdyn scores consistent with the prediction by STARTUP (1996). Patients with intact neurocognition but low insight responded in a significantly more defensive manner (g = 0,38). They did not differ in self-rated coping, however. A quadratic relationship could not be confirmed. Conclusion: The RCI-based performance typology developed in studies 1 and 2 is a universally applicable analytic tool for future studies on insight-limiting neurocognitive deficits with the WCSTdyn. Results from study 3 point in the direction of a multifactorial etiology of lack of insight in schizophrenia with differential contributions of neurocognitive deficits (e.g., interference control) and defensiveness.

Current studies done using a learning test for children have problems as they only make evaluations of Physically and Neurologically Impaired (PNI) children who can succeed in the test and can be considered as a PASS/FAIL test. This pilot study takes a holistic view of cognitive testing of PNI children using a user-test-device triad model and provides a framework using non-PNI children and adults as controls. Comparisons using adapted off-the-shelf novel interfaces to the computer, in particular, an Electroencephalograph (EEG) head-set, an eye-tracker and a head-tracker and a common mouse were carried out. In addition, two novel multi-modal technologies were developed based on the use of brain-waves and eye-tracking as well as head-tracking technologies to support the study. The devices were used on three tests with increasing cognitive complexity. A self-developed measure based on success streaks (consecutive outcomes) was introduced to improve evaluations of PNI children. A theoretical model regarding a fit of ability to devices was initially setup and finally modified to fit the view of the empirical model that emerged from the outcomes of the study. Results suggest that while multi-modal technologies can address weaknesses of the individual component modes, a compromise is made between the user’s ability for multi-tasking between the modes and the benefits of a multi-modal device but the sample size is very small. Results also show children failing a test with a mouse but passing it subsequently when direct communication is used suggesting that a device can affect a test for children who are of a developing age. This study provides a framework for a more meaningful conversation between educational psychologists as well as other professionals and PNI parents because it provides more discrimination of outcomes in cognitive tests for PNI children. The framework provides a vehicle that addresses scientifically the concerns of parents and schools.

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