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Introduction to Assessments

Psychological Assessments

Definition and Components Psychological assessment refers to the systematic evaluation of

an individual's behavior, thoughts, and emotions to better understand their functioning. It
involves multiple components, including variables for measurement, measurement methods,
data reduction and synthesis, and inferences drawn. Variables for measurement include aspects
such as beliefs, social behaviors, or emotional states. Measurement methods involve techniques
like interviews, observations, self-reports, or standardized tests to gather data. Data reduction
and synthesis refer to summarizing and interpreting raw data, such as calculating scores from
questionnaires, while inferences are conclusions made based on the data, such as treatment
effectiveness or risk assessment (Groth-Marnat & Wright, 2016).

The accuracy of psychological assessments directly influences our understanding of

relationships between behavioral, cognitive, and physiological factors. For instance,
psychological assessment helps us understand the impact of traumatic life stressors on immune
functioning, the relationship between depressed mood and self-efficacy, how social
contingencies affect self-injurious behavior, and the role of presleep worry in moderating the
impact of chronic pain on sleep quality (Haynes, Smith, & Hunsley, 2011).

Role in Clinical Judgments In clinical settings, psychological assessment plays a crucial role
in guiding decisions about treatment and intervention. Clinicians rely on assessments to
determine suicide risk, assess whether treatment or hospitalization is necessary, and identify
the variables contributing to a client’s behavioral problems. Psychological assessments also
help clinicians select appropriate treatment strategies, set intervention goals, and evaluate the
effectiveness of interventions over time. By providing reliable and valid data, assessments
support clinicians in making informed, evidence-based decisions that enhance client care
(Youngstrom, 2013).

Four Components of Psychological Assessment

The four important "pillars" of psychological assessment, as you mentioned, include:

1. Norm-Referenced Tests: These tests are designed to measure an individual's abilities

or traits in comparison to a larger population. The results are often presented in terms
of percentiles or standard scores, which allow for comparisons with a normative group.
Examples include intelligence tests, personality inventories, and achievement tests.
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These assessments provide objective data that helps in diagnosing conditions and
making informed decisions.

2. Interviews: Interviews are a fundamental component of psychological assessment,

providing an opportunity for direct interaction between the clinician and the client.
Through structured or unstructured interviews, the clinician gathers important
information about the client's history, symptoms, concerns, and overall functioning.
This process helps establish rapport and informs the clinician about the context and
severity of the presenting issues.

3. Observations: Behavioral observations involve systematically watching and recording

an individual's behavior in different settings. This can include structured situations or
natural environments, providing insights into how the person interacts with others, their
emotional responses, and their coping mechanisms. Observations are especially
valuable for assessing children, individuals with developmental disabilities, or those
unable to articulate their experiences.

4. Informal Assessment Procedures: These are non-standardized methods that do not

rely on formal tests or structured interviews but are still crucial for understanding a
person’s functioning. These procedures can include self-report questionnaires,
projective tests, or informal assessments like case histories, diaries, or feedback from
family members and teachers. Informal assessments help gather additional context or
information that might not be captured through formal testing or interviews.

Together, these pillars form a holistic and comprehensive approach to psychological

assessment, integrating different methods to understand the individual's mental health,
functioning, and needs.

Introduction to Neuropsychological Assessment

Comprehensive Batteries in Neuropsychological Assessment

Comprehensive neuropsychological batteries are critical tools for evaluating and diagnosing
cognitive and psychological functioning in individuals with neurological impairments. These
assessments are especially useful for identifying cognitive deficits that may arise from
conditions such as traumatic brain injury (TBI), stroke, dementia, neurodevelopmental
disorders, or psychiatric conditions. The purpose of a comprehensive neuropsychological
battery is to provide a thorough and multifaceted evaluation of an individual’s cognitive
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domains, which can then be used to guide treatment decisions, rehabilitation strategies, or other
interventions (Lezak et al., 2012).

1. Cognitive Domains Assessed

Comprehensive neuropsychological assessments typically evaluate a variety of cognitive

domains, each of which plays a critical role in daily functioning. These domains are assessed
through a combination of standardized tests designed to measure specific abilities. Below are
the most common cognitive domains and the tests used to assess them:

• Memory: Memory functions are crucial in understanding how individuals encode, store,
and retrieve information. Neuropsychologists evaluate different types of memory,
including:

o Short-term memory: The ability to hold a small amount of information for a brief
period.

o Long-term memory: The ability to store and retrieve information over extended
periods.

o Working memory: The ability to hold and manipulate information in mind over
short periods. Common tests include the Wechsler Memory Scale (WMS)
(Wechsler, 2009) and the Rey-Osterrieth Complex Figure Test (Rey, 1941). These
tests measure both verbal and non-verbal memory, which are essential for
evaluating the individual's cognitive health.

• Attention and Processing Speed: These functions are critical for an individual's ability to
focus, stay on task, and process information quickly. Neuropsychologists assess various
types of attention, such as sustained attention (focusing for extended periods), selective
attention (focusing on relevant stimuli while ignoring distractions), and cognitive
processing speed. Tests commonly used in this domain include the Continuous
Performance Test (CPT) and the Trail Making Test (TMT) (Reitan & Wolfson, 1993). These
assessments help determine how well an individual can maintain attention and process
information efficiently.

• Executive Function: Executive functions involve a set of higher-order cognitive skills that
are essential for planning, organizing, problem-solving, and regulating behavior. This
includes tasks such as problem-solving, planning, inhibition, and cognitive flexibility. A
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widely used test for assessing executive function is the Wisconsin Card Sorting Test
(WCST) (Heaton et al., 1993), which evaluates cognitive flexibility, the ability to shift
strategies, and problem-solving under changing rules.

• Language: Language skills are assessed to determine how well an individual can produce
and understand spoken and written language. This includes abilities such as fluency (rapid
verbal output), comprehension, and naming (retrieving words). One common test used in
language assessment is the Boston Naming Test (BNT) (Kaplan et al., 2001), which is
widely used to evaluate word-finding abilities and language deficits.

• Visuospatial Skills: These skills are necessary for interpreting and manipulating visual
information. Tests assessing visuospatial skills typically focus on abilities such as visual
perception, spatial reasoning, and the ability to replicate or design complex figures. An
example is the Block Design subtest from the Wechsler Adult Intelligence Scale (WAIS)
(Wechsler, 2008), which measures an individual’s ability to solve problems involving
spatial and visual tasks.

Two widely used comprehensive batteries include the Halstead-Reitan Neuropsychological

Battery (HRNB) and the Luria-Nebraska Neuropsychological Battery.

• Halstead-Reitan Neuropsychological Battery (HRNB): This battery includes a set of

tests designed to assess a range of cognitive abilities, including attention, memory, and
motor skills, among others. The HRNB has been a foundational tool in
neuropsychological assessment, providing both qualitative and quantitative data about
an individual’s cognitive functions (Reitan & Wolfson, 1993).

• Luria-Nebraska Neuropsychological Battery: This battery assesses a broad array of

cognitive functions, including motor abilities, language, memory, and reasoning. The
Luria-Nebraska battery is based on the work of Russian neuropsychologist A.R. Luria
and focuses on understanding brain-behavior relationships in both healthy and
neurologically impaired individuals (Luria, 1973).

Individualized Neuropsychological Assessment

Individualized neuropsychological assessment refers to the tailored evaluation of an

individual’s cognitive, emotional, and behavioral functioning based on their unique history,
presenting concerns, and specific needs. Unlike standardized battery assessments, which
follow a set protocol for all patients, individualized neuropsychological assessments take into
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account the person's background, including medical history, psychiatric conditions, lifestyle
factors, and cultural context. The purpose of this type of assessment is to generate a more
personalized and accurate picture of an individual’s cognitive profile, which can then be used
to guide diagnosis, treatment, and rehabilitation (Lezak et al., 2012).

Tailored Assessment Approach

Individualized assessments are flexible and may involve the selection of specific tests or tasks
based on the individual’s unique symptoms, developmental stage, or medical condition. The
first step in an individualized assessment is a thorough clinical interview, which helps the
clinician gather relevant background information, such as:

• Medical and Psychiatric History: Understanding any neurological or psychiatric

conditions that may influence cognitive function (e.g., Alzheimer’s disease, depression,
traumatic brain injury).

• Family History: Identifying hereditary factors or family members with cognitive

disorders can help predict potential risks.

• Lifestyle Factors: The individual’s education, occupation, and daily activities may
influence cognitive performance and be taken into consideration during the evaluation
(Schoenberg & Scott, 2014).

In an individualized assessment, the clinician may choose specific tests or modify existing tests
to capture the individual’s cognitive strengths and weaknesses accurately. For example, a
person with a history of head injury might be assessed with tests focusing on attention and
memory, while someone with dementia might undergo testing for executive function and
language abilities (Lezak et al., 2012).

Customizing Test Selection

The core principle of individualized neuropsychological assessment is the customization of test

selection to best assess the individual’s cognitive abilities, taking into account the clinical
presentation, functional impairments, and suspected condition. This allows for a more detailed
and accurate evaluation of specific domains of cognition.

• Cognitive Domains: While many comprehensive batteries assess multiple cognitive

domains, individualized assessments focus on the domains most relevant to the
individual's clinical concerns. For example, a person presenting with memory problems
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related to aging might undergo a more focused assessment of memory and learning
functions (Wechsler, 2009).

• Cultural and Linguistic Considerations: The cultural and linguistic background of

the individual must also be considered when selecting tests. Standardized tests may not
be culturally appropriate or fair for individuals from diverse backgrounds, which can
impact the validity of the assessment results. In these cases, culturally adapted tests or
non-verbal measures may be more appropriate (Sternberg, 2004).

Clinical Interpretation of Results

The individualized neuropsychological assessment not only provides test results but also
includes a detailed interpretation that integrates clinical observations, collateral information,
and the individual’s medical and psychiatric history. The neuropsychologist evaluates the
results in the context of the person’s personal and environmental factors, such as stressors,
coping mechanisms, and social support systems. This ensures that the results are interpreted
accurately and in a manner that accounts for any external factors that may affect cognitive
functioning.

The clinician may also rely on cross-domain comparisons, such as comparing performance
on verbal memory tests with performance on visuospatial tasks, to better understand how
different cognitive domains interact. For example, someone with a stroke affecting the right
hemisphere might exhibit deficits in visuospatial processing but intact verbal memory (Lezak
et al., 2012).

Furthermore, the clinician will typically consider the severity of the cognitive impairments in
relation to the individual’s functional ability. For instance, a person with mild cognitive
impairment (MCI) may not exhibit overt cognitive deficits in everyday life but may show subtle
declines on formal neuropsychological tests (Petersen, 2011). These nuanced observations help
clinicians determine the appropriate diagnosis, care plan, and potential interventions.

Applications in Diagnosis and Treatment Planning

Individualized neuropsychological assessment is especially useful in the diagnosis and

management of various neurological and psychiatric conditions, as it provides detailed
information on cognitive strengths and weaknesses. Some key areas where individualized
neuropsychological assessments are applied include:
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• Diagnosis of Cognitive Disorders: Individualized assessments are used to evaluate

conditions such as dementia, mild cognitive impairment (MCI), and traumatic brain
injury (TBI). This approach allows clinicians to pinpoint specific areas of cognitive
decline, which is critical for developing a targeted treatment plan (Lezak et al., 2012).

• Post-Intervention Monitoring: When assessing treatment effectiveness or recovery

following brain injury or surgery, individualized neuropsychological assessments help
to track cognitive changes over time. This allows for the monitoring of improvements
or deterioration in specific cognitive domains and aids in adjusting rehabilitation
strategies (Schoenberg & Scott, 2014).

• Rehabilitation and Intervention: Based on the assessment, clinicians can recommend

specific cognitive rehabilitation techniques tailored to the individual’s impairments. For
example, a person with language deficits due to a stroke might benefit from speech
therapy, while someone with executive function difficulties might work on strategies
for planning and problem-solving (Lezak et al., 2012).

Neuropsychological Tests Evaluate

Neuropsychological tests are standardized assessments used to evaluate cognitive, emotional,

and behavioral functions. These tests are designed to measure a variety of psychological
domains and provide objective data regarding how well an individual’s brain is functioning.
By examining different cognitive abilities, neuropsychological tests help to identify any
impairments or dysfunctions, and guide clinical decisions regarding diagnosis and treatment.
Neuropsychologists use these tests to assess a wide range of cognitive domains, including
memory, attention, executive functions, language, and motor skills (Lezak et al., 2012).

1. Memory

Memory is a core cognitive function, and neuropsychological tests assess several aspects of it,
including:

• Short-term memory: The ability to hold information briefly, such as remembering a

phone number for a few minutes.

• Long-term memory: The ability to store and recall information over extended periods.

• Working memory: The ability to hold and manipulate information in the mind for tasks
such as problem-solving.
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Tests like the Wechsler Memory Scale (Wechsler, 2009) and the Rey-Osterrieth Complex
Figure Test (Rey, 1941) are commonly used to evaluate different aspects of memory. These
tests help in identifying memory deficits related to conditions like dementia, traumatic brain
injury (TBI), and other neurological disorders.

2. Attention

Attention is a critical cognitive function necessary for daily activities. Neuropsychological tests
evaluate different types of attention, such as:

• Sustained attention: The ability to maintain focus over time, such as reading a book
or listening to a lecture.

• Selective attention: The ability to focus on relevant stimuli while ignoring distractions.

• Divided attention: The ability to process multiple stimuli at once, such as listening to
a conversation while reading a text.

Tests such as the Continuous Performance Test (CPT) (Rosvold et al., 1956) are designed to
assess sustained and selective attention. Attention deficits are commonly seen in individuals
with ADHD, TBI, and certain psychiatric conditions like depression or schizophrenia (Lezak
et al., 2012).

3. Executive Function

Executive functions are higher-order cognitive skills that involve planning, decision-making,
problem-solving, and self-regulation. Neuropsychological tests evaluate these functions to
understand an individual's capacity for managing complex cognitive tasks. Executive functions
include:

• Cognitive flexibility: The ability to shift thinking or adapt to new situations.

• Inhibition: The ability to suppress inappropriate responses or impulses.

• Planning and problem-solving: The ability to organize tasks and think critically.

Common tests include the Wisconsin Card Sorting Test (WCST) (Heaton et al., 1993), which
assesses cognitive flexibility and problem-solving abilities. Deficits in executive functioning
are often observed in individuals with frontal lobe damage, Alzheimer's disease, and
schizophrenia (Lezak et al., 2012).

4. Language
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Language functions are vital for communication, and neuropsychological tests evaluate both
verbal and written abilities. Tests assess different aspects of language, including:

• Word fluency: The ability to produce words quickly in a given category, such as
naming animals in a set period.

• Comprehension: The ability to understand spoken or written language.

• Naming and word-finding: The ability to retrieve and produce words when needed.

Tests like the Boston Naming Test (BNT) (Kaplan et al., 2001) assess an individual’s ability to
name objects and detect aphasia or other language deficits. Language impairments are common
in conditions like stroke, dementia, and aphasia (Lezak et al., 2012).

5. Visuospatial Skills

Visuospatial abilities involve the ability to perceive and manipulate objects in space. These
skills are crucial for tasks such as navigating environments, assembling objects, and
understanding maps. Neuropsychological tests assess:

• Visual perception: The ability to recognize objects and shapes.

• Spatial reasoning: The ability to understand the relationship between objects in space.

• Constructional ability: The ability to assemble or copy complex designs.

Tests such as the Block Design subtest of the Wechsler Adult Intelligence Scale (WAIS)
(Wechsler, 2008) are used to assess visuospatial skills. Deficits in visuospatial abilities are often
seen in individuals with right hemisphere brain damage, Alzheimer's disease, and other forms
of dementia (Lezak et al., 2012).

6. Motor and Sensory Functions

Motor skills and sensory processing are also assessed to understand an individual's ability to
perform coordinated movements and respond to sensory stimuli. Tests assess:

• Motor speed and coordination: The ability to perform physical tasks such as drawing,
writing, or copying shapes.

• Sensory processing: The ability to interpret sensory information like touch, sight, or
hearing.
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Motor and sensory function evaluations can identify impairments in conditions such as
Parkinson's disease, stroke, or multiple sclerosis (Lezak et al., 2012).

7. Emotional and Behavioral Functioning

While neuropsychological tests predominantly focus on cognitive functioning, emotional and

behavioral aspects are often assessed as well. Psychological tests may evaluate:

• Mood: The assessment of emotional states such as depression, anxiety, and irritability.

• Personality: The evaluation of personality traits and psychopathological tendencies,

which may influence cognitive performance.

Tests like the Beck Depression Inventory (Beck et al., 1996) and the Minnesota Multiphasic
Personality Inventory (MMPI) (Hathaway & McKinley, 1943) assess emotional functioning.
Emotional and behavioral issues can complicate the diagnosis of cognitive impairments and
may need to be considered when interpreting results.

8. Intelligence

Intelligence tests are often used to assess general cognitive ability, which includes reasoning,
memory, problem-solving, and comprehension. These tests help to measure an individual's
intellectual potential, providing insight into their cognitive strengths and weaknesses. The
Wechsler Adult Intelligence Scale (WAIS) (Wechsler, 2008) is one of the most widely used
intelligence tests in neuropsychological assessments.

Uses of Neuropsychological Assessments

Neuropsychological assessments are critical tools used in clinical psychology, psychiatry,

neurology, and rehabilitation. These assessments provide objective data that help clinicians
understand an individual's cognitive strengths and weaknesses, emotional state, and behavioral
patterns. The use of neuropsychological assessments is widespread in diagnosing neurological
disorders, tracking the progress of cognitive impairments, evaluating the effectiveness of
treatments, and informing rehabilitation strategies. Below are some of the primary uses of
neuropsychological assessments.

1. Diagnosis of Neurological and Psychiatric Disorders

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One of the primary uses of neuropsychological assessments is in diagnosing neurological and

psychiatric conditions. These assessments help identify cognitive deficits that may be linked to
specific disorders. Commonly assessed conditions include:

• Dementia and Alzheimer's Disease: Neuropsychological assessments help detect

early cognitive impairments, such as memory loss, executive dysfunction, and language
difficulties, which are hallmarks of dementia and Alzheimer's disease (Petersen, 2011).
Tests like the Mini-Mental State Examination (MMSE) (Folstein et al., 1975) and
Wechsler Memory Scale (WMS) (Wechsler, 2009) are commonly used in diagnosing
Alzheimer's and other dementias.

• Traumatic Brain Injury (TBI): Neuropsychological assessments are essential for

evaluating the cognitive impact of brain injuries. These tests assess areas like memory,
attention, processing speed, and executive functioning, which can be affected by TBI
(Iverson, 2006).

• Stroke and Other Neurological Conditions: Post-stroke neuropsychological

assessments evaluate cognitive impairments such as aphasia, visuospatial deficits, and
executive dysfunction. These evaluations guide rehabilitation planning (Lezak et al.,
2012).

• Psychiatric Disorders: Conditions such as schizophrenia, bipolar disorder, and

major depression can also be evaluated with neuropsychological testing to understand
the cognitive impacts of these conditions, including deficits in memory, attention, and
executive function (Burdick et al., 2010).

2. Evaluating Cognitive Functioning and Tracking Changes

Neuropsychological assessments are instrumental in tracking changes in cognitive functioning

over time. These assessments provide a baseline against which future cognitive changes can be
compared, helping to evaluate the progression of disorders and the effectiveness of treatments
or interventions. Key applications include:

• Monitoring Dementia Progression: In dementia, neuropsychological tests track the

decline in various cognitive domains such as memory, language, and executive
function. Regular assessments help clinicians understand the rate of progression and
adjust treatment plans accordingly (Petersen, 2011).
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• Assessing Recovery Post-Trauma or Surgery: After brain injury or neurological

surgery, neuropsychological assessments are used to evaluate cognitive recovery and
identify areas needing rehabilitation (Lezak et al., 2012). For instance, following a
stroke, cognitive testing helps monitor improvements or declines in cognitive domains.

• Evaluating Response to Treatment: In conditions like depression or anxiety, cognitive

deficits are often observed alongside mood disturbances. Neuropsychological
assessments can help evaluate how these deficits change as patients undergo treatment,
such as cognitive-behavioral therapy or pharmacotherapy (Burdick et al., 2010).

3. Cognitive Rehabilitation and Intervention Planning

Neuropsychological assessments play a crucial role in guiding rehabilitation strategies for

individuals with cognitive impairments. By identifying specific cognitive deficits, clinicians
can tailor rehabilitation programs to address individual needs. Key uses include:

• Cognitive Training: Neuropsychological assessments help to identify cognitive

strengths and weaknesses, allowing for the design of personalized cognitive training
programs. For example, individuals with memory deficits might receive memory-
enhancement techniques, while those with executive dysfunction may work on
planning and organizational skills (Lezak et al., 2012).

• Vocational Rehabilitation: For individuals who have experienced brain injury or

cognitive decline, neuropsychological assessments help guide vocational rehabilitation
efforts. These tests can identify the cognitive skills necessary for certain jobs and help
determine the types of work an individual may be able to return to after injury (Sohlberg
& Mateer, 2001).

• Educational Interventions: Neuropsychological assessments are also used in

educational settings to identify students with learning disabilities or cognitive
impairments. By pinpointing specific areas of difficulty, these assessments can help
design targeted interventions, such as tutoring, accommodations, or special education
services (García-Sánchez & García-Morales, 2019).

4. Assessing For Legal and Forensic Purposes

Neuropsychological assessments are often used in forensic settings to assess the cognitive and
emotional state of individuals involved in legal cases. These assessments are essential for:
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• Competency to Stand Trial: Neuropsychological testing is used to evaluate whether a

defendant has the mental capacity to stand trial, particularly if there is concern about
intellectual disability or severe mental illness (Heilbrun, 2012).

• Personal Injury and Disability Claims: In personal injury cases, neuropsychological

assessments are used to assess the impact of brain injuries or psychological trauma on
an individual’s cognitive functioning. This information can be used in litigation to
determine the extent of cognitive impairment and any long-term effects (Golden, 2003).

• Child Custody Evaluations: In cases of child custody, neuropsychological

assessments may be used to assess the mental health and cognitive functioning of
parents, ensuring that custody decisions are made in the best interests of the child
(Heilbrun, 2012).

5. Understanding Cognitive Aging and Preventive Health

As individuals age, cognitive decline can be a concern. Neuropsychological assessments help

identify early signs of cognitive aging, allowing for the early detection of potential issues such
as mild cognitive impairment (MCI) or early stages of Alzheimer’s disease. Early detection
through assessments allows for interventions that may help slow cognitive decline and improve
quality of life (Petersen, 2011).

• Early Detection of Alzheimer’s Disease: Neuropsychological tests can identify early

cognitive impairments in elderly individuals, particularly in domains like memory,
attention, and executive function. Early intervention can help slow the progression of
cognitive decline (Petersen, 2011).

• Promoting Brain Health: Some neuropsychological assessments are used in research

to study factors that contribute to healthy cognitive aging, such as the impact of diet,
exercise, and mental stimulation on brain function (Stern, 2009).

6. Research and Scientific Studies

Neuropsychological assessments are frequently used in research to investigate cognitive

function and the effects of various conditions on brain health. Research applications include:

• Clinical Trials: Neuropsychological tests are often used as outcome measures in

clinical trials testing new medications or therapies for neurological or psychiatric
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disorders. For example, cognitive testing might be used to evaluate the effectiveness of
a new drug for treating Alzheimer’s disease or TBI (Salthouse, 2011).

• Understanding Brain Function: Researchers use neuropsychological assessments to

understand the relationship between brain structure and cognitive function. This
includes investigating how different brain regions contribute to memory, attention, and
executive function (Lezak et al., 2012).

Limitations of Neuropsychological Assessments

While neuropsychological assessments are valuable tools in diagnosing and understanding

cognitive functioning, they also have several limitations that should be considered. These
limitations can affect the accuracy of results, the interpretation of cognitive abilities, and the
overall efficacy of the assessments in clinical practice. Below are key limitations of
neuropsychological assessments:

1. Cultural and Socioeconomic Bias

Neuropsychological tests are often standardized on specific populations, typically those from
Western, educated, industrialized, rich, and democratic (WEIRD) societies. This can lead to
cultural and socioeconomic bias, as individuals from different cultural backgrounds or lower
socioeconomic statuses may perform differently on standardized tests. For example, certain
tests may rely on language or cultural knowledge that is unfamiliar to individuals from different
backgrounds, potentially leading to underestimation of their cognitive abilities (Groth-Marnat,
2016). The lack of cultural sensitivity in assessment tools can skew the results and reduce the
validity of the interpretation.

• Example: The Wechsler Adult Intelligence Scale (WAIS) (Wechsler, 2008) includes
culturally specific references, which may not be equally understood by individuals from
non-Western cultures (Naglieri & Bornstein, 2003).

2. Limited Sensitivity and Specificity

Neuropsychological assessments can have limited sensitivity and specificity, particularly in

detecting mild cognitive impairments or differentiating between disorders with overlapping
symptoms. For instance, early-stage Alzheimer’s disease (AD) may not be easily distinguished
from other cognitive disorders, such as depression or anxiety, based on neuropsychological
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testing alone (Petersen, 2011). These assessments may fail to detect subtle cognitive changes,
which can delay early diagnosis and intervention.

• Example: Tests of memory and attention may not distinguish between cognitive
impairment due to depression and that due to neurodegenerative conditions (Cummings
et al., 2006).

3. Influence of Test Anxiety and Motivation

Test performance can be significantly influenced by factors unrelated to the individual's true
cognitive abilities, such as test anxiety, motivation, and emotional state. Individuals who are
anxious or unmotivated may underperform on assessments, which may lead to inaccurate
results that do not reflect their actual cognitive abilities. Additionally, the individual's mood or
psychological state may influence cognitive test results, leading to potential misinterpretations
(Groth-Marnat, 2016).

• Example: Anxiety can impair attention and memory, potentially confounding the
results of neuropsychological tests, particularly those assessing these domains (Lezak
et al., 2012).

4. Limited Ecological Validity

Many neuropsychological tests are designed in controlled environments and may not accurately
reflect how cognitive abilities function in real-world settings. The tests are often conducted in
artificial settings that do not account for everyday challenges or the complexity of real-world
tasks. This issue is known as the limited ecological validity of neuropsychological assessments.
As a result, individuals may perform well in testing environments but struggle with cognitive
tasks in daily life (Sbordone, 2003).

• Example: A person with cognitive impairment may score well on standardized tests but
have difficulty managing daily tasks such as budgeting or driving due to the complex,
dynamic nature of these real-world activities (Lezak et al., 2012).

5. Time and Resource Intensive

Neuropsychological assessments are time-consuming and resource-intensive. Comprehensive

assessments typically require hours of testing and may need to be administered over multiple
sessions, especially for complex evaluations. These assessments can be costly, requiring trained
professionals, specialized tools, and sometimes long-term follow-up. This can limit access to
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these assessments, particularly in resource-limited settings or for individuals with limited

access to healthcare services (Groth-Marnat, 2016).

• Example: The Halstead-Reitan Neuropsychological Battery (Reitan & Wolfson,

1985) involves extensive testing that can take several hours to complete, which may
not be feasible for some patients or healthcare providers.

6. Individual Differences and Variability

Neuropsychological assessments are designed to measure cognitive functions on a broad scale,

but individual differences in cognitive abilities and the interpretation of test results can
complicate the process. Factors such as age, education level, gender, and premorbid functioning
can influence test performance, making it difficult to distinguish between typical cognitive
decline associated with aging and more severe cognitive disorders (Salthouse, 2010).
Additionally, individuals may demonstrate different cognitive profiles that do not fit neatly into
standardized categories, complicating diagnosis and treatment planning.

• Example: Age-related cognitive decline can lead to false positives for conditions such
as dementia, as normal aging may mimic the symptoms of neurodegenerative disorders
(Salthouse, 2010).

7. Lack of Standardization Across Settings

While neuropsychological assessments are standardized in terms of the procedures used, there
may be significant variability in their administration across different clinical settings. Factors
such as the clinician’s experience, the testing environment, and the availability of resources can
all influence the quality of the assessment. This lack of standardization can affect the reliability
and validity of the results, particularly when assessments are conducted in non-clinical or
community-based settings (Lezak et al., 2012).

• Example: Variations in the administration of the Trail Making Test (Reitan, 1955),
such as differences in time limits or test instructions, could affect performance
outcomes (Sbordone, 2003).

8. Over-Reliance on Test Scores

Clinicians may sometimes place undue emphasis on test scores, failing to consider the broader
context of an individual's health, life history, and environment. Neuropsychological
assessments provide valuable information, but they should not be used as the sole basis for
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diagnosis or treatment planning. It is important for clinicians to integrate test results with other
sources of information, such as clinical interviews and medical histories, to ensure a
comprehensive understanding of the individual’s condition (Groth-Marnat, 2016).

• Example: High performance on a neuropsychological test may not necessarily reflect

an individual's overall functioning if the individual has significant difficulty in everyday
activities (Lezak et al., 2012).

Research

Neuropsychological assessment plays a critical role in understanding brain-behavior

relationships, aiding in diagnosis, treatment planning, and monitoring recovery across various
neurological conditions. Over the years, these assessments have evolved significantly,
incorporating technological advancements, cultural considerations, and interdisciplinary
integration. This synthesis reviews the historical advancements, current applications, and future
directions of neuropsychological assessments, with a focus on traumatic brain injury (TBI),
epilepsy, and broader clinical practices.

Casaletto and Heaton (2017) provide a comprehensive review of the historical development of
neuropsychological assessments, highlighting key innovations such as the Lurian, Flexible and
Fixed Batteries, and the Boston Process Approach. These tools have formed the foundation for
standardized methods that are sensitive to brain-behavior relationships. Critical developments
include the establishment of normative standards, the incorporation of cultural considerations,
and the exploration of longitudinal changes in cognitive functions. The authors emphasize the
role of technology and cross-disciplinary collaboration, particularly the integration of
neuropsychology into primary care settings, as pivotal for enhancing diagnostic accuracy and
treatment outcomes. Despite significant advancements, challenges remain in addressing
unanswered questions and adapting to the rapid evolution of brain health research.

Sherer and Novack (n.d.) focus on the application of neuropsychological assessments in adults
with traumatic brain injury (TBI). These assessments are essential for monitoring recovery,
evaluating cognitive impairments, and formulating treatment recommendations. TBI often
results in deficits in memory, attention, and executive functions, requiring neuropsychological
evaluations to track recovery progress and assess the effectiveness of interventions. Cognitive
remediation, a specific focus of neuropsychological evaluation, is critical in addressing
cognitive side effects and guiding pharmaceutical interventions. Additionally, the economic
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impact of these assessments on healthcare outcomes underscores their value in both acute and
post-acute rehabilitation.

In the context of epilepsy, Jones-Gotman et al. (n.d.) highlight the importance of

neuropsychological assessments in diagnosing and managing epilepsy-related cognitive
impairments. These evaluations measure the effects of seizures on higher cortical functions
through tools such as functional neuroimaging, cortical mapping, and intracarotid anesthetic
procedures. Comprehensive assessments provide detailed insights into functions associated
with specific brain regions, while abbreviated evaluations offer practical alternatives in time-
constrained settings. The authors emphasize the significance of neuropsychological input in
refining treatment approaches and advancing epilepsy care.

Together, these perspectives illustrate the diverse applications of neuropsychological

assessments across conditions such as TBI and epilepsy while also emphasizing their broader
role in clinical and research settings. As technology advances and interdisciplinary integration
expands, the field must address ongoing challenges, including the development of novel
assessment tools, the refinement of diagnostic criteria, and the translation of findings into
effective interventions. Neuropsychological assessment will continue to be an indispensable
tool in understanding and enhancing brain health.
 19

References:

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory (2nd ed.). Pearson.

Burdick, K. E., Goldberg, T. E., & Keefe, R. S. (2010). Cognitive deficits in schizophrenia: A review
of the literature and implications for treatment. Schizophrenia Research, 121(1-3), 69-78.
[Link]

Cummings, J. L., Mega, M., Gray, K., & Rosenberg-Thompson, S. (2006). The neuropsychiatric
inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 56(11), 1-
9. [Link]

Casaletto, K. B., & Heaton, R. K. (2017). Neuropsychological assessment: Past and future. Cambridge
University Press. Retrieved from [Link]

Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-Mental State": A practical method for
grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3),
189-198. [Link]

Golden, C. J. (2003). Neuropsychological assessment: A clinical approach to brain function

evaluation. Academic Press.

Groth-Marnat, G., & Wright, A. J. (2016). Handbook of psychological assessment (6th ed.). Wiley.

Heilbrun, K. (2012). Forensic psychology: Research, clinical practice, and applications. Oxford
University Press.

Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtiss, G. (1993). Wisconsin Card Sorting
Test Manual: Revised and Expanded. Psychological Assessment Resources.

Iverson, G. L. (2006). Assessment of sports-related concussion. Journal of Head Trauma

Rehabilitation, 21(5), 313-325. [Link]

Jones-Gotman, M., Smith, M. L., Risse, G. L., Westerveld, M., Swanson, S. J., Giovagnoli, A. R., Lee,
T., Mader-Joaquim, M. J., & Piazzini, A. (n.d.). The contribution of neuropsychology to
diagnostic assessment in epilepsy. Epilepsy Research and Treatment.
 20

Kaplan, E., Goodglass, H., & Weintraub, S. (2001). Boston Naming Test (2nd ed.). Lippincott Williams
& Wilkins.

Lezak, M. D., Howieson, D. B., Bigler, E. D., & Tranel, D. (2012). Neuropsychological assessment
(5th ed.). Oxford University Press.

Luria, A. R. (1973). The working brain: An introduction to neuropsychology. Harper & Row.

Naglieri, J. A., & Bornstein, D. (2003). Culture-fair intelligence testing. In J. A. Naglieri & J. R.
Kaufman (Eds.), Intelligence and intelligence testing (pp. 127-156). Academic Press.

Petersen, R. C. (2011). Mild cognitive impairment: From concept to clinical implementation.

Current Alzheimer Research, 8(4), 351-357. [Link]

Reitan, R. M. (1955). The relation of the Trail Making Test to organic brain damage. Journal of
Consulting Psychology, 19(5), 393–394. [Link]

Rosvold, H. E., Mirsky, A. F., Sarason, I., Bransome, E. D., & Beck, L. H. (1956). A continuous
performance test of brain damage. Journal of Consulting Psychology, 20(5), 343–350.
[Link]

Salthouse, T. A. (2010). When does age-related cognitive decline begin? Neurobiology of Aging,
31(11), 1234-1239. [Link]

Salthouse, T. A. (2011). What cognitive abilities are involved in trail-making performance?

Intelligence, 39(4), 292-303. [Link]

Schoenberg, M. R., & Scott, J. G. (2014). Neuropsychological assessment: A practitioner's guide.

Springer Science & Business Media.

Sbordone, R. J. (2003). Neuropsychological assessment in clinical practice: A guide to test

interpretation and integration. Springer Science & Business Media.

Sherer, M., & Novack, T. A. (n.d.). Neuropsychological assessment after traumatic brain injury in
adults. In Comprehensive Textbook of Neuropsychological Assessment.
 21

Sternberg, R. J. (2004). Culture and intelligence. American Psychologist, 59(5), 325-338.

[Link]

Wechsler, D. (2008). Wechsler Adult Intelligence Scale (4th ed.). Pearson.

Wechsler, D. (2009). Wechsler Memory Scale (4th ed.). Pearson.

Youngstrom, E. A. (2013). Future directions in psychological assessment: Combining evidence-

based medicine innovations with psychology's historical strengths to enhance utility.
Journal of Clinical Child & Adolescent Psychology, 42(1), 139-159.
[Link]
 22

PGI Battery For Brain Dysfunction

Neuropsychological assessment is the normatively informed application of performance-based

assessments of various cognitive skills. Typically, neuropsychological assessment is performed
with a battery approach, which involves tests of a variety of cognitive ability areas, with more
than one test per ability area. These ability areas include skills such as memory, attention,
processing speed, reasoning, judgment, and problem-solving, spatial, and language functions.
(Harvey, P. D., 2012). Neuropsychological assessments (NPA) are not diagnostic, but
complement clinical understanding and management of neurocognitive disorders (NCD) A
tailored assessment based on initial screeners followed by comprehensive neuropsychological
batteries is ideal.

Fixed Battery

A fixed battery is a set of standardized neuropsychological tests that are administered to all
patients in the same way, regardless of their presenting problem. The tests are selected in
advance and are part of a defined structure or conceptual framework. Fixed batteries are used
to assess the nature, extent, location, and cause of brain function impairment in individuals
with brain injuries. The tests are validated individually and in relation to each other. The
Halstead–Reitan Neuropsychological Battery (HRB) is an example of a fixed battery. (Erin D.
Bigler, 2007). Fixed batteries have several advantages, including Standardized testing where
the e same tests are administered to all patients, which allows for direct comparison of test
scores across different patient groups and assessment settings, Research The standardized
nature of fixed batteries makes it easier to conduct research, develop data banks, and gain a
better understanding of their psychometric properties. (Casaletto, K. B., & Heaton, R. K., 2017)
However, fixed batteries also have some disadvantages, including: Time-consuming: Fixed
batteries can be time-consuming to administer, Cost: Fixed batteries can be expensive, Patient
tolerance: Patients may not tolerate excessive testing sessions. (Zimmerman, M. E., 2010)
Some argue that both fixed and flexible batteries are acceptable and equally adequate for
assessment. The main difference between the two is that flexible batteries are based on the
neuropsychologist's perception of the patient's complaints, while fixed batteries are
standardized. (Russell, E., Russell, S., & Hill, B., 2005)
 23

Evolution of PGI BBD

The Postgraduate Institute of Brain Dysfunction (PGI BBD) was developed at the Postgraduate
Institute of Medical Education and Research, Chandigarh (Pershad & Verma, 1990), and is
validated for use in the Hindi-speaking population. The battery includes five major tests:
memory scale, performance scale, verbal adult intelligence scale, Bender-Gestalt test, and the
Nahor-Benson test of perceptual acuity. Norms are based on a factorial sampling design for the
20-50 years age group. The battery assesses cognitive dysfunction using 19 test variables,
covering intelligence, memory, gestalt formation, and perceptual acuity, providing a profile of
the subject's cognitive functioning. A comprehensive interview is also conducted to gather
background information, important for differential diagnosis and clinical observations that
cannot be obtained through psychometric testing. This interview includes demographic data,
present complaints, symptom progression, daily living activities, environmental risk factors,
and past medical, developmental, educational, and professional history.

Application of PGI BBD

1. Clinical Assessment of Cognitive Impairments: The PGI-BBD battery is widely used

in diagnosing cognitive deficits in patients with various neurological conditions. For
instance, it helps in evaluating memory, attention, and problem-solving skills in
individuals recovering from traumatic brain injury (TBI). Similarly, it plays a vital role
in assessing stroke patients, identifying areas of cognitive dysfunction, and guiding
rehabilitation strategies. The battery is also instrumental in the early detection of
degenerative conditions like Alzheimer’s disease, providing insights into the
progression of dementia.
2. Psychiatric Evaluations: This battery is a valuable tool in psychiatric assessments,
helping clinicians understand the cognitive impact of mental health disorders. For
example, it is frequently used to evaluate memory and executive functioning
impairments in patients with depression. In schizophrenia, the tests can identify issues
with attention, working memory, and problem-solving, which are common in the
disorder. It is also applied to assess cognitive variations in bipolar disorder during manic
and depressive episodes.
3. Developmental Disorders: In developmental disorders, the PGI-BBD battery is used to
analyze cognitive strengths and weaknesses in children and adolescents. For children
 24

with learning disabilities, such as dyslexia, the battery can pinpoint specific areas of
difficulty, such as verbal memory or visuospatial skills. It is also effective in diagnosing
ADHD, by measuring sustained attention and impulse control. Furthermore, the battery
aids in assessing children with Autism Spectrum Disorder (ASD), helping clinicians
design individualized educational and therapeutic interventions.
4. Rehabilitation Planning: The PGI-BBD battery is crucial in formulating and
monitoring cognitive rehabilitation programs. By identifying specific cognitive deficits,
such as impaired memory or reduced attention span, therapists can tailor interventions
to the patient's needs. It also allows clinicians to track changes in cognitive functioning
over time, providing a clear picture of the patient’s progress. This is especially useful
in conditions like stroke or brain injuries, where recovery patterns can vary widely.
5. Research in Cognitive Neuroscience: Researchers frequently use the PGI-BBD
battery to study cognitive profiles in various neurological and psychiatric conditions.
For instance, it helps in understanding the cognitive changes caused by epilepsy or the
cognitive decline associated with aging. The battery is also valuable in evaluating the
effectiveness of new treatments, such as medications or cognitive therapies, by
comparing pre- and post-treatment cognitive performance.
6. Early Detection and Preventive Care: The battery plays a key role in the early
detection of cognitive impairments, allowing for timely interventions. It is particularly
useful for identifying mild cognitive impairment (MCI), which can precede dementia.
In high-risk populations, such as those with a family history of Alzheimer’s disease or
repeated head injuries, the PGI-BBD battery helps monitor cognitive health and
implement preventive strategies to delay or mitigate further decline.
 25

References

Casaletto, K. B., & Heaton, R. K. (2017). Neuropsychological Assessment: past and future.
Journal of the International Neuropsychological Society, 23(9–10), 778–790.
[Link]

Erin D. Bigler. (2007). A motion to exclude and the ‘fixed’ versus ‘flexible’ battery in ‘forensic’
neuropsychology: Challenges to the practice of clinical neuropsychology. Archives of
Clinical Neuropsychology. [Link]

Meyers, J. E. (2017). Fixed battery. In Springer eBooks (pp. 1–2). [Link]

3-319-56782-2_181-3

Harvey, P. D. (2012). Clinical applications of neuropsychological assessment. Dialogues in

Clinical Neuroscience, 14(1), 91–99. [Link]

R. Mona, C. Dinesh. (n.d). Neuropsychological Assessment: Review of the literature. The

International Journal of Indian Psychology. [Link]
content/uploads/ArticleSubmitted/article_c7a2f0092422fa6d82638dfb197c32c7.docx

Russell, E., Russell, S., & Hill, B. (2005). The fundamental psychometric status of
neuropsychological batteries. Archives of Clinical Neuropsychology, 20(6), 785–794.
[Link]

Zimmerman, M. E. (2010). Battery approach. In Springer eBooks (pp. 354–355).

[Link]
 26

Methodology

Aim: To assess if there is significant cognitive dysfunction in the participant.

Plan: To administer PGI Battery for Brain Dysfunction to assess if there is significant cognitive
dysfunction in the participant.

Materials:

1. Memory test proforma containing items for the 10 subtests

2. A set of 5 cards for Visual retention (Subtest IX)
3. A set of 2 cards – one having picture of 10 common objects and the second having
pictures of 20 common objects for Recognition (Subtest X)
4. Writing Material and A4 Sheets
5. Stopclock
6. Norms and Manual

Procedure, Instructions, and scoring:

Subtest I: PGI Memory Test

Subtest 1 – Remote Memory:

There are 6 questions, subject is asked the answers to these questions, verbatim is noted. Out
of items at Serial. No. 3a, 3b, 3c, only one item is to be enquired but these items are not alternate
of one another. If item at 3a is not applicable then ask 3b, if this is also not applicable then ask
item 3c. Reliability of the answer can be checked from the attendant and if there is no attendant,
items may be repeated after completing all the 10 sub tests. Any discrepancy the answer may
be settled, or answer may be marked wrong.

Scoring: Each correct answer is to be scored one. Thus, maximum score would be 6.

In case of normal, where items 5 and 6 could not be administered an arbitrary scoring system
was as follows

• If all the 4 items were correct then score 6

• If 3 out of 4 items were correct then score 5

• If 2 out of 4 items were correct then score 3

• If 1 out of 4 items were correct then score 1

 27

• If 0 out of 4 items were correct then score 0

Subtest 2 – Recent Memory:

It consists of 5 items, follow same procedure as in test one.

Scoring: Each correct answer is to be scored one. Thus, the maximum score on this test would
be 5.

Subtest 3 – Mental Balance:

i) Alphabet Forward: “I want to see how quickly you can say the alphabets A,B,C,…..”, subject
is given 30 seconds. If the subject finishes before 30 seconds note the time taken.

ii) “I want to see how well you can count backwards from 20-1”. Again 30 seconds is allotted.

iii) “Count backward by minusing 3s starting from 40”.

Scoring: Item 1 (Alphabet): All correct within 15 seconds (3), All correct beyond 15 seconds
(2), Irrespective of time required with one error/omission (1), More than one error/omission
(0).

Item II – Counting backward 20-1:

Same as item 1

Item III – Counting backward from 40 subtracting in 3’s:

All correct within 30 seconds (3), Correct beyond 30 seconds (2), with one error/omission
[irrespective of time] (1), More than one error (0).

Maximum score on this sub test would be 9.

Subtest 4 - Attention and Concentration:

(i) Digit Forward [DF]

“I want to see how well you can pay attention. Listen carefully to the numbers I read and repeat
them after I complete”. Test will be stopped after both sets of a series are failed.

(ii) Digit Backward [DB]

same procedure will be followed as mentioned above, only the change in this test is that the
numbers are repeated backwards.
 28

Scoring: Count the number of digits separately, both for DF and DB, reproduced correctly on
the longest item. Summation of DF and DB will form the score.

Maximum Score: 15.

Subtest 5 - Delayed Recall:

Consists of two lists with a set of five words in each. Follow the instructions given – “I am
going to read name of some objects, Listen carefully and when I ask you to repeat, you will do
so (read at the rate of one word per second and ask the subject to repeat it after an interval of
one minute). Same instruction has to be followed for both the lists and the responses are noted.

Note: Name may be recalled in any order. Simple put a tick on each name correctly recalled
and write down any name he has recalled but was not read to him. In the same manner
administer the 2nd list also, but before that ask him again “Listen to me carefully”. If he asks,
should he repeat the words in the same sequence, answer him “as you wish”.

Scoring: Each ticked word is to be counted in two lists. This total will form the score i.e one
point for each correctly recalled word.

Maximum score on this sub test would be 5+5=10.

Subtest 6 - Immediate Recall:

There are three sentences of increasing length. First sentence has 3 clauses, second has 4
clauses and the third sentence has 5 clauses. Read out the instruction as written on the memory
scale. “I am going to read a few small sentences one by one. Listen to them carefully because
when I am through I would like you to tell me the whole sentence as precisely as you
can.” Immediately after the presentation ask the subject to recall it. Note down the correctly
recalled clauses, omit incorrect clauses.

Scoring: One mark for each clause correctly reproduced. There are 3, 4 and 5 clauses in 1st
2nd and 3rd sentences respectively.

Maximum score therefore could be 3 + 4 + 5 =12

Subtest 7 - Verbal retention for similar pairs:

There are five noun – noun pairs. Read out the instruction from the memory scale. Each pair
has to be read distinctly and slowly at the rate of 2 seconds per pair. Give five seconds pause
(intervals) between 2 pairs. After last pair give 10 seconds interval and read the first word
 29

(noun) of the pair and ask what the second word were. (Noun) of the pair. Proceed exactly in
the same manner till all the five sentences are completed. Put tick on each pair if the responses
are correct.

Scoring: One mark for each correct reproduction of the associated word of the pair is to be
given.

Maximum score thus on this sub test is 5

Subtest 8 - Retention of Dissimilar Pairs:

There are five noun-objective pairs. Three trials are given. In each trial stimulus word (noun)
is presented in a random order as return against each pair. Give the instruction to the subject as
written for the sub-test 7. On last pair given an interval (pause) of 10 seconds and then read
the stimulus word ‘lamp’ (under first column one is written against lamp). If the response is
correct put a tick mark in the cell where 1 is written in first column. If answer is wrong or no
answer is given then tell the correct response and put a cross in the cell. Proceed to stimulus
word ‘Tree’ (2 under first column), if response is wrong correct it before moving to other
stimulus word. Like this complete the first trial in the order mentioned in first column.

Before starting second trial there is no need of presenting pairs again because where ever
response was wrong, it was corrected with a request to remember. For 2nd trial stimulus words
are to be presented in the sequence as mentioned in column two. Wrong responses are to be
marked putting a cross in the cell and if answer is correct put a tick, finishing the 2nd trial,
proceed with third trial in a sequence as given in column three.

Scoring: one mark for each correct reproduction of the associated word of the pair. In each
trial therefore, all the five responses might be true.

Maximum score on this sub test is 5+5+5=15.

Subtest 9 - Visual Retention:

There are five cards. Each card is to be presented for fifteen seconds and thirty seconds post
exposure period be observed silently. Thereafter subject is asked to draw the same design ‘from
his memory’. If his reproduction is incorrect in any way, then ask him to be attentive before
presenting the next card. If he seems to have forgotten an element (sub part) of the design, ask
him to put a point (dot) for that and complete the design. If he asks “can I use the eraser”, say
“as you please”.
 30

Scoring: Each type of geometrical figure correctly reproduced in sequence is given a score of
one. The scoring is as follows:

Card 1 to 3 Maximum score 2 each

Card 4 Maximum score 3 each

Card 5 Maximum score 4 each

Maximum score on this sub-test would be 2 + 2 + 2 + 3 + 4 = 13

Subtest 10 - Recognition:

There are two cards of similar size. First card contains 10 pictures of common objects and
second card contains 20 pictures (10 pictures of the first card are mixed with other 10
pictures). First card is to be presented to the subject for 30 seconds with a request to see and
remember the objects there in. On expiry of 30 seconds, card is removed and after an interval
of 120 seconds, second card is presented and subject is requested to identify the objects that
were present in earlier exposure.

S/He is not to be told at any stage about the number of objects present in card one and how
many objects yet s/he has to identify from card two.

Scoring: Each object correctly identified and named is to be given a score of one. An object
correctly identified but either not named or wrongly named or showing inability to name is to
be given a score of ½ (half).

Maximum score is 10.

Procedure:

1. Subject is made to sit comfortably.

2. PGI Memory scale booklet has to be used by the examiner.

3. Subject has to be instructed to follow the statement and the steps given in the PGI memory
scale.

4. For sub test 1 and 2 the subjects verbatim has to be recorded.

5. For sub test 3, the experimenter has to make a note of the subject’s time taken and error
committed.
 31

6. For 4th subtest the maximum number of digit series recalled correctly has to be noted.

7. For sub test 5, 6, 7 and 8 the responses of the subject has to be noted.

8. For sub test 9 and 10 are self-explanatory.

Subtest II: Battery Of Performance Tests Of Intelligence

Materials

1. Koh's Block Design test with 10 cards of design and 16 cubes

2. Pass-along test with 8 cards of design, 4 Boxes, and rectangular blocks

3. Stop watch

4. Writing material

A. Koh’s block Design test:

Procedure:

The test consists of 16 colored cubes and 17 cards with colored designs, which the subject is
supposed to duplicate by using the blocks. On every card, one design is printed , the subject
sees this design and makes a similar one out of the blocks placed before him. These designs
become correspondingly more and more complex having being simple in the start.

The time limit for the first 5 designs is 2 minutes and for the rest is 3 minutes. Performance is
not only based on how accurately the subject reproduces the design but also on the examiners
observations of behavior during the test like attention level etc. Subjects are encouraged to take
a short break from testing after completion of design no. 9. Testing is terminated after two
consecutive failures, a failure is counted even if the subject later corrects his error when asked
to do so by the examiner. Spontaneously corrected errors do not count as failures.

Instructions:

The subject is made to seat comfortably and after administering rapport, the following
instructions are given: “I am now going to place in front of you a card that has a design on it.
Please examine the design. Look at the design again until you feel that you are familiar with it.

Now the next thing we are going to do is arrange these four blocks so that when they are placed
side by side they will make up the same design as the one on the card. First, I will complete the
design with these four blocks, then I will give you a chance to duplicate the design. Here is the
 32

design I just made with the blocks. And here is the design on the card. Will you examine them
both and compare them to make sure they are the same design? Do you understand what you
have to do to make the design with the four blocks? Now I want you to make the same design
using these four blocks. You will be allowed a certain amount of time for each item Work
quickly, but as accurately as you can”.

B. Alexander Pass-a-Long test:

Procedure:

The usual rules for testing regarding the establishment of rapport between subject and so on,
are to be applied. The most convenient method is to have a small table, with the subject seated
on one side and the examiner on the other. The table should be such that when seated the table
surface is about level with his waist so that his arms can rest comfortably on it while working.
See that both his arms are allowed complete freedom of movement. During the administration
of the series of tests, care should be taken on two points in particular First, be careful that two
diagrams are not visible to the subject simultaneously, since a look at a previous diagram when
working at a test may vitiate the result. Second, be careful that the subject does not see any box
being prepared for use.

The table should be placed before the subject as the starting time of the sub-test is recorded.
After rapport has been established and such particulars noted regarding age, school, class may
be required, place box No.1 before the subject with the red end away from him and the diagram
No: I where it is easily seen during the work. The diagram should also have the red end away
from the subject. Explain that blocks can be moved within the box and illustrate by moving the
red block to the side to draw the attention of the subject to the fact that in the box the red block
is at the blue end and blue blocks are at the red and, while in the picture the red block is at the
red end and the blue block at the blue cud. Tell the subject that you will move the red block to
the red end of the box so as to be the same as the picture pointing to the picture when necessary.
Any words may be used to convey the subject. This initial test is in the nature of preparation
and may in an extreme case be demonstrated if the subject fails to realise what is required. It is
unlikely that any difficulty will be found in making this into a few words. Time the performance
by means of a stopwatch. The test is completed when the red block is at the red end and the
blue block as shown in the picture. The exact position of the red block at the red end is of no
importance. Though in later test, the position of the blue block at the blue end is important and
must be as shown in the diagram ( of tests 8 and 9).
 33

On completion of test No. I, proceed to test No. 2, placing the box and diagram as before. As
each test is completed note the time carefully, Go ahead till the subject fails to complete the
test in the time limit allowed. When failure occurs, replace the blocks in the starting position
and tell the subject to watch carefully. Demonstrate the test and always begin by moving the
red block towards the right hand of the subject. After the demonstration, proceed to the next
test. Go ahead till the subject fails on two successive tests. When this occurs, or alternatively
when test 9 is completed, the whole task is finished. In giving test 8 and 9, it is necessary to
draw the attention of the subject to the position of the small blue blocks in the box and in the
picture.

The subject should be warned at the start that the blocks must not be lifted out of the box. If at
any time, he attempts to lift them out, stop him and tell him that it must be moved inside the
box. This is a rare occurrence except with very young children. Where a subject

tries to turn a block by extreme pressure, say : “You don't need any strength, It moves quite
easily when you make room for it... (The comment is merely to indicate that pressure is
unnecessary). If the subject persists, leave him alone so long as no damage is being done ( and
that is scarcely possible ) since it indicates low intelligence, and he is merely wasting valuable
time.

Instruction:

● For tests 1-7: “You see the box. The blocks can be moved in it like this. (Demonstrate). Now,
you see that the red block is at the blue end. The blue blocks are at the red end. I want you to
move the red block to the red end so as to make it the same as the picture. (Pause). Go ahead
with it as quickly as you can.”

● For Test 8 and 9: " You see where the small blue ones are this time. See where they have to
be at the finish (pointing to the picture). Now go ahead and move red one to the red end the
same as in the picture".

Subtest III: Verbal Adult Intelligence Scale (Vais)

This battery of Verbal Tests of Intelligence includes four subtests:

1) Information

2) Digit Span

3) Arithmetic
 34

4) Comprehension

Materials

1. Items of four subtest and tables of norms for the evaluation of answers

2. Stop watch

3. Writing material

A. Information

Procedure:

This subtest consists of 33 items. Read each question exactly as stated if the responses to a
question is incomplete or not clear. You may say, Explain what you mean or tell me more about
it, “ but do not ask leading questions or spell the words. Do not alter the wordings of the
question. Record verbatim the subject’s response to each item in the appropriate space on the
Record Form. Discontinue after 7 consecutive failures.

Instructions:

“I will be asking you some questions and you have to tell me the response to each question that
I ask you”

Scoring:

1 point for each correct response. Essentials of acceptable answers are noted below, where
several acceptable answers are listed, the subject needs to give only one to receive the credit.
The maximum score is 33 points.

B. Digit Span

Procedure:

This subtest consists of digits that are to be read by the tester and immediately after the tester
reads out, the subject needs to repeat it either in the same order or in reverse order as instructed.
While reading the digits, the subject needs to be asked to be attentive. Digits need to be read
out at a steady rate of one digit per second while reading the digits, raise your right arm, keep
your elbow at the table and open your palm towards the subject when you are through with an
item-down your arm and palm indicating now he has to repeat the digits heard. Both sets of
each item need to be administered when the subject is able to repeat correctly on the first set.
 35

Put a tick mark on each correctly reproduced set on all the items administered. Start from the
lowest length. i.e. from item No:1 and continue till the subject fails on both sets of the same
length digits. While reading the digits always raise your arm and lower it when you go through.
If the subject’s reproduction is not in the desired sequence on any item repeat again by making
them aware if needed.

Digit Forward Instructions:

“I am going to say some numbers. Listen to them carefully, when I read them, you will repeat
them in the same order.”

Digit Backward Instructions:

“I am going to read some more numbers, but you will be required to read them backward, for
example, I say 2, 5 you will say 5,2”.

Scoring:

Each of the items is to be scored as 2,1 or 0 as follows:

2 points if the reproduction on both sets of an item is correct. 1 point if the reproduction is
correct in only one of the two sets.

0 points= if reproduction is not correct on any of the two sets.

There are 6 items on digit forward and 7 items on the digit backward, therefore the maximum
score would be 12 (6*2) + 14( 7*2) = 26.

C. Arithmetic

It consists of 15 items. Start with item 3 and give credit for items 1 and 2 if the subject passes
either item 3 or item 4. If both items 3 and 4 are failed, administer items 1 and 2 before
proceeding further. A problem may be repeated once if the subject requests it, or if it is apparent
that the subject did not understand. The subject may not be permitted to use pencil and paper
for any problem. However, the subject should not be discouraged from using a finger to ‘write’
on the table. For each item enter the subject’s answer in the appropriate space or Record Form.
Discontinue: After 5 consecutive failures.

Scoring
 36

1 point for each correct response. If the numerical quantity of response is correct, give credit
even if the units, such as rupees and paise, are not stated. Give credit if the subject
spontaneously corrects a wrong answer.

Maximum Score: 15 points

D. Comprehension

Procedure and Instruction

It consists of 18 items. Start with item 1. Read each question slowly to the subject. Some
subjects find it difficult to remember an entire question repeat the question, but do not alter the
wording or abbreviate it. It is good practice to repeat the question if no response is obtained
but no further urging should be given, except as it indicated below. If the subject is hesitant
give encouragement by saying :

Yes, tell more

Tell me something more about it.

If the subject does not give a two-point response to item 1, say: Engine is attached to draw the
train

This help may be only given to item 1, item 3,7,10,15 requires 2 correct responses to full credit.
If the subject gives one correct response but does not give another spontaneously, ask for a
second response. Say, “Tell any other way to keep the health it”. (For a similar statement of the
question), the examiner may request a second response only once during the administration of
each relevant item. That is to say the second response elicited from the subject is either
incorrect or an elaboration of the first response, the examiner may not ask for an additional
response. Record verbatim the subject’s response to each them in the appropriate space on the
Record Form.

Discontinuation Rule: After 6 consecutive failures (response scored 0).

Scoring:

Each item is scored 2,1 or 0, depending on the degree of understanding expressed and the
quality of the response. In scoring each item the examiner should match the response of the
subject against the general criteria and the sample answers given below each question.
Undoubtedly, some subjects were given unusual responses which are not typified by simple
 37

answers. In such instances, the score should be determined by the examiner’s own judgment.
Most of the 0-point examples given typify marginal resources, those which contain evidence
of some understanding may be queried in the natural manner prescribed above.

Particular care should be exercised in scoring items that require correct responses for full credit
(these items are indicated by an aster preceding the item number) In order to receive full credit,
the subject must express at least two of the general ideas which are indicated. Full credit cannot
be given if the subject gives two answers, both of which express the same idea ( It’s only one
point is earned if the subject responds to item 7 by saying that the number of foods needs to be
cooked because “cooking kills the germs” and “it is not healthy to eat uncooked food”).

There are 18 questions in total and the maximum score is 36.

2 points- Response showing knowledge that the engine provides power to train.

0 point- Responses do not include the idea of moving the train. To keep the engine warm… To
lead the passengers of freight; you could not go anywhere without a leader, like a captain in the
army to pay attention… To whistle when they come to a crossroad or a curve.

Subtest IV: Nahor-Benson Test

Materials

1. Eight cards with drawings and instructions

2. Writing material (A4 paper, Pencil, eraser)

Procedure and Instructions

Having established the workable rapport, place the blank sheet of paper on the table in front of
the subject. The paper is to be placed horizontally. Put a pencil and a rubber on the paper. Place
the first card at the top of the paper. Ask the subject to “copy it as precisely as possible”. After
getting an indication that he has copied it, remove the card, and place Card II. If his drawings
of previous cards deviated much from the original, then instructions may be repeated,
otherwise, there is no need of repeating the instructions. Continue like this till card VI is
presented. Present Card VI and ask the patient to “read the instruction as written on the Card
and do as required” (Instructions on the card may be in two or three languages depending upon
the regional preference, Card VII may be translated in Hindi because it is difficult to translate
cube in Hindi for low literates). Card VII and Card VIII may then be presented one by one. On
card VIII if a digital clock is made then ask the subject to make a complete clock with arms. If
 38

it is not clear from his drawing, ask him which one is the little arm, at what number it is set and
likewise, ask him to show the long arm and at what number it is set and likewise ask him to
show the long arm and at what number it is set. Finally, ask him what time is shown therein.

Scoring

Scoring is based on the principle of ‘all or none’,i.e. either a design is correct or it is incorrect.
Each incorrect drawing is given a score of one. These eight designs so the maximum error
score could be 8 and the minimum zero. While scoring for incorrect drawing, keep in mind the
educational and cultural background of the patient. A little departure in the copying design, if
the overall configuration is maintained, an individual belonging to deprived culture (rural) will
be able to read instructions with considerable difficulty and may be passed as correct. The
overall size of the copying design, tremulous lines, and space at joints are not considered
meaningful for scoring except for the overall configuration and proportions of parts.

Subtest V: Bender Gestalt Test

Materials

1. Nine cards of Bender Visual Motor Gestalt Test

2. Writing material (A4 paper, Pencil, eraser)

Procedure and Instructions:

Place a piece of paper, a rubber, and a pencil on the table. After making the patient comfortable
give the following instructions:

“Here are a few cards. I will show them one by one, you are required to copy them. Make your
copy as alike as the drawing on the card”.

If the subject asks any question, he/she should be replied in non-committal language, for
example, if he asks “Should I measure the length of the line”, or “Should I count the dots”;
Experiments should answer,” just make your drawing as much like this one as possible”. Do
not instruct the subject, whether he can use the eraser or not. If he asks, “Can I use the rubber”,
say “as you please”. Place the paper before the subject in a horizontal position, and the card
just on the top of the paper and ask the subject to copy it. If he picks up the card, Let him do,
If he turns the card put It again in a correct and When he places the card on the table, keep it
again at the top of the paper in the center. Do not allow the subject to rotate the paper, however,
If he changes his posture, let him do so. Remove the card when he gives an indication that he
 39

has copied it. If his copied design deviates markedly, ask him, “ what is this ?” If he names
some object note it down on a separate paper. In any case, if the copied design is not similar
either in size or shape, then before presenting the next card repeat the instruction by pointing
towards the presented card.

Scoring:

Here Hain’s method (1964) of scoring is given which was also followed by Bhargava and
Sandhu (1987). This is a simple and more quantitative procedure. In this method, the protocol
is searched for the following 15 signs. Each sign is coded only once. Each sign is given a
numerical weight. Each sign is scored on the basis of all or more i.e; either a sign is observed
in the protocol or is absent. There is no scope for a sign to be partially present. The numerical
weight or score for a sign remains the same whether that particular sign is observed in only one
design or in all nine designs.

1. Preservation - Score of 4

2. Rotation - Score of 4

3. Concretism - Score of 4

4. Added angles - Score of 3

5. Separation of lines - Score of 3

6. Overlap - Score of 3

7. Distortion - Score of 3

8. Embellishment - Score of 2

9. Partial rotation - Score of 2

10. Omission - Score of 1

11. Abbreviation - Score of 1

12. Separation - Score of 1

13. Absence of eraser - Score of 1

14. Closure - Score of 1

15. Point of contact - Score of 1

 40

Range of the scores:

Maximum = 34, Minimum=0

 41

Psychological Report

Socio-demographic details

Name: K.D

Age: 21 years

DOB: 08/06/2003

Sex: Female

Educational qualification: Pursuing MSc. Clinical Psychology degree in KJ

Name of examiner: Shreeya Kurghode

Referred by: Self

Date of reporting: 07/01/2025

Date of testing: 07/01/2025

Source of information: Self

Reliability of information: Adequate & Reliable

Referral question

To assess if there is significant cognitive dysfunction in the participant.

Evaluation procedure

Examiner administer PGI Battery for Brain Dysfunction to assess if there is significant
cognitive dysfunction in the participant examiner used different test like Memory Scale,
Performance Test for Intelligence, Verbal Adult Intelligence Scale. The room was well-lit and
free of distractions. The participant was made comfortable and a conversation was carried out
to dissipate any pre-test nervousness that the participant may have felt. Once it was ensured
that she was calm and attentive, she was told that she would perform an interesting task.
Thereafter, she was introduced to the assessment and any doubts she had were addressed. After
ensuring she was ready for the test, the same was administered.

Behavioral observation

The subject was relaxed and comfortable. During the test, she was feeling nervous and found
the test confusing. She was well oriented about surroundings and appropriately groomed.
 42

Rapport establishment: Rapport was built by asking her to relax and sit comfortably. Try to
know about her feelings. Rapport was easily established as the participant was very
cooperative. A friendly conversation was carried out in order to establish rapport. The
participant was clearly vocal about her feelings and clarified her doubts without hesitation. Her
comfort was ensured and the test was administered only after confirming she was ready

Alertness and consciousness: Fully aware, alert and conscious

Attention: Fully attentive

Eye contact: Maintained eye contact

Psychomotor activity: Regular

Speech: Proper

Cooperation: Cooperative

Motivation: Average

Comprehension: Appropriate Comprehension was seen

Problems related to vision/hearing/motor/other: None

Background history

Birth history: The participant was an unplanned baby. The mother was physically, mentally and
emotionally healthy throughout pregnancy. The participant was a full-trimester baby, with no
complications during or before birth. Post-birth she was breastfed.

Type of birth: Natural

Birth cry: Yes

Planned or unplanned: Unplanned

Presence of birth complications: No

Milestones: Normal and adequate

Motor: Walk- 11 months; the participant reported an early achievement of gross motor skills
especially related to walking and running; other fine motor skills were achieved at an
appropriate age.

Cognitive: age appropriate

 43

Speech: age appropriate

Social: fairly sociable

Emotional: the participant was not overly cranky or elated but reported a regular level of
emotional capacity and interaction with others.

Family history:

The participant lives in a nuclear family with her parents and her paternal grandmother.
Participant is a single child. Her father is a corporate worker, her mother is a homemaker. The
participant reported cordial, loving relationships with her family. She is emotionally closest to
her mother. She has lost both her maternal grandparents and paternal grandfather.

Type of family: Nuclear

Family tree:

Presence of mental disorder in the family (if any): None

Educational history:

She completed high school in Goa. She is currently pursuing her Master's in Bangalore. She
reported being an academic achiever throughout her educational years, had been in several
roles of leadership and was involved in extracurricular activities. She maintained positive
relationships with her classmates and friends.
 44

Table 1: Showing the raw score, dysfunction rating score and interpretation for all the
sub tests in PGIBBD
Sr No Sub tests Raw Score Converted Score Dysfunction Rating Score
PGI Memory Scale
I Remote Memory 6 5+ 0
II Recent Memory 5 5+ 0
III Mental Balance 9 5+ 0
IV Attention and Concentration 9 5+ 0
V Delayed Recall 10 5+ 0
VI Immediate Recall 11 5+ 0
VII Retention for Similar Pairs 5 5+ 0
VIII Retention for Dissimilar Pairs 15 5+ 0
IX Visual Retention 11 5+ 0
X Recognition 10 5+ 0
Battery of Performance Test of Intelligence
XI P/K X 100 122.85 Upto 199 0
XII Performance Quotient 156 81+ 0
Verbal Adult Intelligence Scale
XIII T.Q. on Information 23 112 0
XIV T.Q. on Digit Span 21 156 0
XV T.Q. on Arithmetic 14 120 0
XVI T.Q. on Comprehension 34 132 0
XVII Difference in PQ and VQ 1.2 Upto 14 0
XVIII Nahor and Benson Test 0 0-3 0
XIX Bender Gestalt Test 4 0-4 0
Total Dysfunction Rating 0
 45

Test Results
The PGI Battery for Brain Dysfunction was administered to KD, a 21-year-old female,
pursuing her master's at Kristu Jayanti College, Bangalore. The test aimed to assess if there
was any cognitive dysfunction in the participant.

PGI Memory Scale

Subtest I. Remote Memory

The Remote Memory of the participant was assessed using the Remote Memory Scale in the
PGI Memory Scale. The participant obtained a raw score of 6 and a converted score of 5+,
which gives a Dysfunction Rating Score of 0 and indicates No Dysfunction

Subtest II. Recent Memory

The Recent Memory of the participant was assessed using the Recent Memory Scale in the PGI
Memory Scale. The participant obtained a raw score of 5 and a converted score of 5+, which
gives a Dysfunction Rating Score of 0 and indicates No Dysfunction.

Subtest III. Mental Balance

The Mental Balance of the participant was assessed using the Mental Balance Scale in the PGI
Memory Scale. The participant obtained a raw score of 9 and a converted score of 5+, which
gives a Dysfunction Rating Score of 0 and indicates No Dysfunction.

Subtest IV. Attention and Concentration

The Attention and Concentration of the participant were assessed using the Attention and
Concentration Scale in the PGI Memory Scale. The participant obtained a raw score of 9 and a
converted score of 5+, which gives a Dysfunction Rating Score of 0 and indicates No
Dysfunction.

Subtest V. Delayed Recall

The Delayed Recall of the participant was assessed using the Delayed Recall Scale in the PGI
Memory Scale. The participant obtained a raw score of 10 and a converted score of 5+, which
gives a Dysfunction Rating Score of 0 and indicates No Dysfunction.

Subtest VI. Immediate Recall

 46

The Immediate Recall of the participant was assessed using the Immediate Recall Scale in the
PGI Memory Scale. The participant obtained a raw score of 11 and a converted score of 5+,
which gives a Dysfunction Rating Score of 0 and indicates No Dysfunction.

Subtest VII. Retention for Similar Pairs

The participant's Retention of Similar Pairs was assessed using the Retention of Similar Pairs
Scale in the PGI Memory Scale. The participant obtained a raw score of 5 and a converted
score of 5+, which gives a Dysfunction Rating Score of 0 and indicates No Dysfunction.

Subtest VIII. Retention of Dissimilar Pairs

The participant's Retention of Dissimilar Pairs was assessed using the Retention of Dissimilar
Pairs Scale in the PGI Memory Scale. The participant obtained a raw score of 15 and a
converted score of 5+, which gives a Dysfunction Rating Score of 0 and indicates No
Dysfunction.

Subtest IX. Visual Retention

The Visual Retention of the participant was assessed using the Visual Retention Scale in the
PGI Memory Scale. The participant obtained a raw score of 11 and a converted score of 5+,
which gives a Dysfunction Rating Score of 0 and indicates No Dysfunction.

Subtest X. Recognition

The Recognition of the participant was assessed using the Recognition Scale in the PGI
Memory Scale. The participant obtained a raw score of 10 and a converted score of 5+, which
gives a Dysfunction Rating Score of 0 and indicates No Dysfunction.

Battery of Performance Tests of Intelligence

Subtest I. Koh's Block Design

The intelligence of the participant was assessed using the Koh's Block Design Test. The
participant obtained a total score of 33 and the Test Quotient (TQ) was 172.

Subtest II. Pass-aLong Test

The intelligence of the participant was assessed using the Pass-aLong Test. The participant
obtained a total score of 34 and the Test Quotient (TQ) was 140.
 47

The total Performance Quotient (PQ) of the participant is 156, which gives a Dysfunction
Rating Score of 0 and indicates no dysfunction. The value on P/K*100 is 122.85 which gives
a Dysfunction Rating Score of 0 and indicates No Dysfunction.

Verbal Adult Intelligence Scale (VAIS)

Subtest I. Information

The factual ability of the participant was assessed using the Information Scale in the Verbal
Adult Intelligence Scale (VAIS). The participant has a raw score of 23 and the Test Quotient
(TQ) of 112. This gives a Dysfunction Rating Score of 0 and indicates No Dysfunction.

Subtest II. Digit Span

The digit span ability of the participant was assessed using the Digit Span Scale in the Verbal
Adult Intelligence Scale (VAIS). The participant has a raw score of 21 and a Test Quotient (TQ)
of 156. This gives a Dysfunction Rating Score of 0 and indicates No Dysfunction.

Subtest III. Arithmetic

The arithmetic ability of the participant was assessed using the Arithmetic Scale in the Verbal
Adult Intelligence Scale (VAIS). The participant has a raw score of 14 and a Test Quotient (TQ)
of 120. This gives a Dysfunction Rating Score of and indicates No Dysfunction.

Subtest IV. Comprehension

The comprehension ability of the participant was assessed using the Comprehension Scale in
the Verbal Adult Intelligence Scale (VAIS). The participant has a raw score of 34 and the Test
Quotient (TQ) of 132. This gives a Dysfunction Rating Score of 0 and indicates No
Dysfunction.

The participant has a total Verbal IQ of 130, and the difference between Performance Quotient
(PQ) and Verbal IQ (VQ) is 1.2 which gives a Dysfunction Rating Score of 0 and indicates No
Dysfunction.

Nahor and Benson Test

The brain dysfunction of the participant was assessed using the Nahor and Benson Test. The
participant obtained a score of 0, which gives a Dysfunction Rating Score of 0 and indicates
No Dysfunction.

Bender Gestalt Test

 48

The brain dysfunction of the participant was assessed using the Bender Gestalt Test. The
participant obtained a score of 4, which gives a Dysfunction Rating Score of 0 and indicates
No Dysfunction.

The total Dysfunction Rating Score of the participant is 0, which indicates that the participant
has no overall brain dysfunction.

Impression and Interpretation

The participant's score on PGI Battery for Brain Dysfunction reveals that she has no
dysfunctions in all the subtests of the PGI Battery for Brain Dysfunction.

Summary and Suggestion

The PGI Battery for Brain Dysfunction was administered on KD, a 21 yr. an old female student
in Kristu Jayanti College aiming to assess if there is any cognitive dysfunction in the
participant. The test results showed no dysfunction in all the subtests of the battery. The
participant can include journaling and meditation in her daily routine to maintain and help in
her positive well-being.
 49

NIMHANS Neuropsychological Assessment

Neuropsychological assessment is the normatively informed application of performance-based

assessments of various cognitive skills. Typically, neuropsychological assessment is performed
with a battery approach, which involves tests of a variety of cognitive ability areas, with more
than one test per ability area. These ability areas include skills such as memory, attention,
processing speed, reasoning, judgment, and problem-solving, spatial, and language functions.
(Harvey, P. D., 2012). Neuropsychological assessments (NPA) are not diagnostic, but
complement clinical understanding and management of neurocognitive disorders (NCD). A
tailored assessment based on initial screeners followed by comprehensive neuropsychological
batteries is ideal.

A flexible battery is a neuropsychological assessment approach where a neuropsychologist

selects tests based on a patient's presenting symptoms, history, and previous test results. This
approach is also known as "patient-centered testing". The flexible battery approach in
neuropsychological testing is characterized by its adaptability and lack of a fixed structure.
Unlike fixed batteries, which use a standardized set of tests, flexible batteries allow for
modifications based on the specific needs of the patient. This means that the set of tests
administered can be tailored to the patient’s referral question or presenting symptoms. For
instance, if a patient exhibits memory problems, the neuropsychologist may choose to
administer a range of memory tests to explore the issue further. This approach allows for a
more personalized evaluation, but it also comes with certain limitations, such as the absence of
a standard structure and the lack of scientific validation. Because flexible batteries rely on the
subjective judgment of the clinician, their consistency and reliability may vary from one
professional to another. This contrasts with fixed batteries, which follow a defined protocol,
but may not be as adaptable to individual patient needs. The Halstead-Reitan and Luria-
Nebraska Batteries are examples of neuropsychological test batteries that have incorporated
aspects of the flexible battery approach. They still maintain a degree of structure but allow for
customization depending on the case at hand (Goodglass, 1986).

Evolution of NIMHANS Neuropsychological battery

In the 1980s and early 1990s, Indian neuropsychological testing largely relied on adapting
Western tools such as the WAIS, WCST, and the Rey-Osterrieth Complex Figure Test.
However, these tests faced significant challenges due to cultural and linguistic differences
between Western and Indian populations. Recognizing the need for culturally appropriate
 50

assessments, NIMHANS developed a battery of tests specifically designed for the Indian
context. This new battery incorporated local norms and addressed cultural, educational, and
linguistic diversity within the population. The NIMHANS Neuropsychological Battery
emphasizes cultural relevance, aiming to minimize language and cultural biases. It provides
comprehensive assessments across various cognitive domains, including attention, memory,
executive functions, and motor abilities. A key feature is its multilingual nature, offering tests
in several Indian languages to ensure broader accessibility and applicability. In the mid-1990s,
the first standardized version of the battery was released, marking a significant milestone. The
following years saw continuous refinements, particularly in enhancing the battery’s sensitivity
to conditions such as dementia, schizophrenia, and traumatic brain injury. The inclusion of
neuroimaging integration and tools for assessing cognitive development in children further
expanded its utility.

In recent years, efforts have focused on digitizing the battery, improving its accessibility and
efficiency. Today, the NIMHANS battery plays a pivotal role in cognitive aging research,
particularly in dementia studies, and remains widely used in research on psychiatric and
neurological conditions.

Areas assess using NIMHANS Neuropsychological battery

The NIMHANS Neuropsychological Battery test assesses various cognitive domains to

evaluate mental functioning. These include:

1. Speed: This measures motor and mental speed through tasks like the Motor Speed test,
Finger Tapping test, and the Digit Symbol Substitution test, which assess reaction time
and processing speed.
2. Attention: This domain includes tests for different types of attention such as Focused
Attention (Colour Limit test), Sustained Attention (Digit Vigilance test), and Divided
Attention (Triads test).
3. Executive Functions: This encompasses a range of higher-order cognitive abilities,
including Verbal Fluency (Control Oral Word Association test), Category Fluency
(Animal Naming test), Design Fluency, and tasks assessing Working Memory (e.g., N-
Back test, Self-Ordered Pointing test), Planning (Tower of London test), Set Shifting
(Wisconsin Card Sorting test), and Response Inhibition (Stroop Effect).
4. Comprehensive Cognitive Function: This domain assesses verbal comprehension
through the Token test.
 51

5. Learning and Memory: This includes both verbal and visual learning and memory
assessments, such as the Auditory Verbal Learning test, Logical Memory test, and the
Visual Design Learning test.
6. Visuo-Spatial Function: The Visual Complex Figure test is used to assess visuo-spatial
construction abilities.
Application of NIMHANS Neuropsychological Battery

1. Diagnosis of Cognitive Impairments and assess Developmental disorder: It helps in

diagnosing cognitive deficits like dementia, traumatic brain injury, epilepsy, stroke, and
neurodegenerative diseases such as Parkinson's or Alzheimer's disease. Also use to
assess learning disabilities or ADHD, helping to design interventions.
2. Monitoring Disease Progression: The battery can track cognitive decline or
improvement over time, making it useful for monitoring the progression of
neurodegenerative conditions or the effectiveness of treatment interventions.
3. Pre-and Post-surgical Evaluation: It is often used in pre-surgical and post-surgical
evaluations, particularly for patients undergoing procedures like epilepsy surgery, to
assess changes in cognitive functions post-Intervention.
4. Psychiatric Evaluations: The battery holds in differentiating between cognitive deficits
due to psychiatric disorders (such as schizophrenia, depression) versus those caused by
organic brain damage
5. Rehabilitation and Cognitive Remediation: The test results guide personalized
rehabilitation and cognitive remediation programs, providing a foundation for targeted
therapeutic interventions based on an individual's specific cognitive strengths and
weaknesses.
 52

References

Goodglass, H. (1986). The flexible battery in neuropsychological assessment. In Springer

eBooks (pp. 121–134). [Link]

Harvey, P. D. (2012). Clinical applications of neuropsychological assessment. Dialogues in

Clinical Neuroscience, 14(1), 91–99. [Link]

National Institute of Mental Health and Neuro Sciences. (n.d.). Clinical psychology-
neuropsychology. Retrieved December 18, 2024, from [Link]
psychology/clinical-psychology-neuropsychology/]

Rao, S. L., Subbakrishna, D. K., & Gopukumar, K. (2004). NIMHANS Neuropsychology

Battery Manual.

Tripathi, R., & Tiwari, S. C. (2011). Psychology and Developing Societies, 23(1), 133-166.
 53

Methodology

Aim: To assess the neuropsychological profile of the individual.

Plan: To use the NIMHANS neuropsychological battery to assess the

neuropsychological profile.

I. Digit Symbol Substitution test

Aim: To assess the Mental speed of the participant

Materials Required:

1. Digit symbol substitution test sheet

2. Writing materials

3. Stopwatch/ clock

Mental Speed: Digit Symbol Substitution Test

Procedure:

The subject is seated comfortably and the test sheet is placed in front of him or her. The
principle of substituting symbols is explained. Practice is given for the first ten squares after
which the test commences.

Instructions:

“Please sit comfortably. There are 4 rows of digits in this sheet. Beneath each row of digits,
there is a blank row. Each digit has a symbol .You have to substitute a symbol for each digit.
You have to go row by row.( Demonstration for substitution for the first three digits is given
by the examiner.) You can start now. Yes this is correct. Have you understood? Please start
Now. Do as fast as you can.”

Scoring:

The time taken to complete the test forms the score. Errors made are noted down.

Duration: The test takes about 7 minutes.

II. Digit Vigilance Test

Aim: To assess the sustained attention capacity of the participant

 54

Materials Required:

1. Digit vigilance test sheet

2. Writing materials (pencil)

3. Stopwatch/ clock

Procedure:

The subject is seated comfortably and ·the digit vigilance sheet is placed in front of the subject.
The subject is asked to scan the sheet and cancel the target numbers 6 and 9 (by drawing ' mark
on them). He/ she is asked to cancel the digits as fast as possible without missing the targets or
canceling wrong numbers. The test could not be given to illiterate subjects, as they could not
recognize numbers.

Instructions:

"Please look at this sheet. There are different digits arranged in rows. The digits are randomly
arranged. Please cancel the digits 6 and 9 as fast as you can. Do not cross other digits and be
sure not to miss any of the target digits. Do as fast as you can." ·

Score:

There are two scores. [Link] time taken to complete the test. 2. Error score-Sum total of the
number of omissions i.e. the number of 6 and 9 which have not been cancelled and the number
of commissions i.e. the number of digits other than the target digits which have been cancelled.

Duration: The test takes about 15 minutes.

III. Triads Test

Aim:

To assess the divided attention

Materials Required:

1. Traids test sheet with 15 sets of 3 words and corresponding 1 or 2 digit numbers.

2. Writing materials (pencil) to trace trace number on the arm of the subject.

3. Blind fold/ goggles.

Procedure:
 55

The subject is blindfolded. In order to familiarize the subject with the two tasks, each task is
explained following which an example is given for each task. First, the verbal triads task is
explained. A triad sample is given and the subject is asked to call out the word, which does not
belong to the category to which the other two words belong. Next, the tactual identification
task. ' is explained: A sample digit is written on the palm of the· non-dominant hand and the
subject is asked to call out the digit. The subject is told that the two tasks will be given
simultaneously and attention should be divided between both. The subject is asked to call out
the odd word first and then the number. The test consists of 16 such trials. In each trial the
words are spoken at the rate of one word per second. Simultaneously the number is also written
slowly. The commencement of each trial is signaled by asking the subject to pay attention.

Instructions:

"You will have to do two tasks together in this test. In the first task you will hear three words
one after another, in which two words belong to the same group while the third word does not.
You have to call out the word, which does not belong to the other two. For example, mother,
child, sky are three words in which the words mother and child belong together but the word
sky does not belong to the other two. I will call out 3 words now. Please hear carefully. Shop,
Market, Moon. Which word does not belong here? (Wait for the subject to respond, if the
response is correct then say) Yes you are right, it is the word moon. (If the subject does not
respond correctly then explain the example till she/he gets the concept of the odd word correctly
and verify the understanding with another example). Now I will explain the second task. I will
write a number on your left hand (non-dominant hand), you have to. say which number it is.
(Write any number and wait for the response. If it is correct then say) Yes it is the number.
(Here also you will have to gives enough trials till the subject recognizes the numbers properly.
Trials for recognition of double-digit numbers should also be given). Now we will commence
the main test. You will have to do both tasks together. I will be saying a group of three words
and simultaneously writing a number on your left hand. You will have to say the word, which
does not belong to the other two and tell the number, which has been written on your hand. Pay
attention to both tasks.

Score:

The number of errors committed on each task is counted. Omission in saying the word or the
number is also counted as an error. Two types of errors, and number errors are counted. The
maximum errors in either category are 16 as there are 16 trials in the test.
 56

Duration: The test takes about 7 minutes.

IV. Controlled Oral Word Association Test (COWA)

Aim: To assess the phonemic fluency

Procedure:

The subject is seated and told that he /she has to generate words beginning with a consonant,
which will be provided by the tester. A practice trial is given with the consonant other than the
ones used in the test. The subject is asked to generate words for one minute in the case of each
consonant, starting with the consonant F, A and ending with S' or with 'Ka' and ending with
"Ma' as the case may be. The precautions to be taken while generating the words are also
mentioned. After the subject has understood the task, he/she is given the test. After each one-
minute trial, the subject is given a short rest pause before commencing the next trial.

Instructions:

I will be saying a consonant. You will have to say the words, which begin with that consonant.
You must say as many words as you can in one minute. You must not repeat the same words or
give names of persons and places. Also you must not give different derivations of the same
word such as ask, asking, asked. Please say as many words as you can in one minute. Are you
ready? Say the words beginning with the letter E (After one minute ask the subject to stop)
now take a brief rest. (Give about 30 seconds rest) Now say the words beginning with the letter
A'. You will be given one minute. (Give another rest for one minute) Now say the words
beginning with the letter S for one minute." The subjects who were not fluent in the English
language are asked to generate words beginning with the consonants Ka', Pa, Ma'. They are
told that the words beginning with a consonant can also begin with the inflections of the
consonant. For example, words beginning with Ka' can also commence with 'Kaa', 'Ki, Kee',
'Ku', 'Ke etc.

Score: The total number of acceptable new words produced in one minute is noted down for
each trial. The average new words generated over 3 trials forms the score.

Duration: Approximately 5 minutes.

V. Design Fluency

Aim: To assess the visual fluency of the subject

 57

Materials Required:

1. Black sheet of paper

2. Writing materials

3. Stopwatch/ clock

4. Manual

Procedure:

The subject is asked to draw as many new forms as possible in a given period of time. There
are two conditions to this test. These are the Free and Fixed conditions. In the Free condition,
the subject is given 5 minutes to draw new designs. In the Fixed condition, the subject draws
novel designs with the restriction that only four straight or curved lines may be used per design.
The subject has to draw the design using not more or less than four lines. He/she is given four
minutes to draw the designs. In both the Free and. Fixed conditions, the subject is told that
drawings should not be geometric forms, similar to the previous designs or elaborations of a
previous design, and should not be meaningful or capable of being named. He/she is also told
that scribbles are not permitted. Only one warning is given it the subject commits any of the
above mistakes. The score in each conditions the number of novel designs produced. The test
is not administered to illiterate subjects, as it is difficult for them to hold a pencil.

Instructions:

“In this test you have to draw new designs. “The designs should not be drawings of objects that
you see such as that to a house, flower or man or of geometric figures such as a circle or triangle.
You also should neither draw rangoli or embroidery designs nor should you scribble. Also
please do not draw the same design in different ways. Further you should not spend time in
drawing too big a design. You must think well and draw new designs. Each design should be
different from the previous ones.

Free Condition: Here is a sheet of paper and pencil. I will give you five minutes.* Please draw
as many new designs as possible in this time. The designs should not have name or meaning
and they have to be different from each other. I will draw some samples here. (The examiner
draws 2-3 designs so that the subject understands the concept). Now you can start.

Fixed Condition: Here is another sheet of paper. I will give you four minutes. Please draw
designs using any combination of the four lines given on top of the sheet. The 4 lines are shown
 58

in the figure is given in the appendix. The designs should not be capable of being named or
given a meaning. They have to be different from each other. You must use only four lines, not
more or less. The lines may be straight lines or curved lines. A straight line will count as one
line. A semi-circle or a curve facing any direction will count as one line. A circle will count as
one line. I will draw some samples here. (The examiner draws 2-3 designs so that the subject
understands the concept).Now you can start."

Score:

The number of novel designs drawn in each condition forms the score for that condition. The
novel design score is the total output minus the sum of perseverative responses + nameable
drawings + drawings with the wrong number of lines (only for the fixed condition) +
perseverative responses including rotations or mirror-1mageversIons of previous drawings +
variations on a theme + complicated drawings that differ from previous ones by small details
and scribbles. There are two scores in this test, one is the novel design score for the freec
conditioned the other is the novel design score for the fixed condition.

Duration: Approximately 12 minutes

VI. Stroop Test

Aim: To assess the visuo perceptual ability of the subject

Materials Required:

1. Stroop test consisting of list A & list B

2. Writing sheet to note responses

3. Stop clock

4. Writing materials

5. Manual

Procedure:

The stimulus sheet is placed in front of the subject. The subject is asked to read the stimuli
column-wise as fast as possible. The time taken to read all the 11 columns is noted down. Next,
the subject is asked to name the color in which the word is printed. This time also the subject
proceeds column wise. The time taken to name all the colors is noted down. The words are
presented in the mother tongue of the subject.
 59

Instructions:

"You see this sheet with words printed in different colors. Read the words column wise as test
as you can. You can correct yourself if you make mistakes. (After the subject completes the
reading task the next instruction is given). Now you have to name the color in which the word
is printed. Please do so as fast as you can."

Score:

The reading time and the naming time were converted into seconds. The reading time was
subtracted from the naming time to get the Stroop effect score. Uncorrected errors were noted
down separately for both the phases.

Stroop effect score = Time taken to name- Time taken to read the words

Duration: The test takes about 20 minutes.

VII. Token Test

Aim: The aim of the test is to measure verbal comprehension

Materials Required :

1. Squares and circles of 2 sizes (large & small) in 5 colours tokens.

2. Sheet with instructions and space to record scores.

3. Writing materials and manual.

Procedure:

Squares and Circles of two sizes in five colors, called as tokens, are placed in front of the
subject. The task of the subject is to follow the spoken instruction of the examiner. There are 6
levels of instructions, which increase gradually in difficulty as the test progresses. The spoken
instructions which the subject has to follow are given in the table 15.1 in the appendix.

The order of placing tokens is fixed. If the level involves only large tokens, the circles are
placed in a first row nearest to the tester, while the squares are placed in a second row beneath
it. If the level involves both the large and the small tokens, the large circles are placed in the
first row, the large squares in the second row, and the small circles in the third row and the
small squares in the last row. The positions of the tokens are the same across all the levels,
which are given in the appendix.
 60

In each level instruction is given once for each item. It the subject does not understand it or
does not follow the command correctly, the instruction is repeated. After two such repetitions
the trial is considered a failure and the next trial is commenced.

Instructions:

"You see some coloured bits of cardboard in different colours and shapes. These are called
tokens. I will be telling you what to do with them. You have to do what I ask you to. Please
listen carefully and follow my instructions."

Scoring:

A score of one is given each time the subject follows the instructions correctly. A half mark is
deducted for every repetition. If the subject fails to follow the instruction correctly even after
two repetitions, the trial is considered a failure and a score of zero is given. The maximum
score is 36.

VIII. Auditory Verbal Learning Test (AVLT)

Aim: The aim of the test is to assess the verbal and auditory learning

Materials Required:

1. AVLT Sheet

2. Writing Materials

Procedure:

Words in List A are presented at the rate of one word per second during 5 successive trials. The
words are presented in the same order in every trial. Each trial consists of the presentation of
all 15 words, immediately followed by recall of the same. In each trial, after the presentation
the subject is asked to recall the words but no cues are given. The examiner notes down the
responses verbatim in the order in which the subject gives them. On an average, recall in each
trial takes about 2 minutes. After the completion of all the five trials of List A, words in List B
are presented once and an immediate recall is taken for the same. The presentation of List B
serves as an interference and prevents the subject from recalling the words from List A
subsequently from immediate memory. This is followed by the immediate recall of words from
List A. After a delay of 20 minutes, words from List A are again recalled to form the delayed
recall score. List A is not read out again for immediate and delayed recall. Following delayed
 61

recall, recognition of the words in List A is tested. The words in List A are randomly mixed
with 15 new words. The new words are either phonemically or semantically similar to words
in List A. The words are called out one at a time and the subject indicates whether each word
belonged to List A or not. Hits and errors are recorded. The words are presented in the mother
tongue of the subject or in English whichever the subject prefers.

Instructions:

You will be hearing some words now. I will be saying these words slowly. Please listen to them
carefully. After I finish saying all the words, you have to say aloud as many words as you
remember. You can say the words in any order. It need not have to be in the same order in which
I had said. Now please listen.(The 15 words are called out aloud one at a time at the rate ot one
word per second). I have completed the words; now, tell me as many words as you remember.
Can you try to remember some more words? Is that all? All right now we will start the next
trial. I will be saying the same words again. You have to remember them and later repeat as
many as you can out of them. You have to recall all the words, even the words that you have
recalled in the previous trial. (The trials progress in this manner till all the 5 trials with List A
are completed Even if the subject learns all the 15 words before 5 trials, all the 5 trials have to
be administered). I will be saying another set of words now. Listen carefully and try to
remember them. (The 15 words from List B are called out). I have completed the words, try
and remember as many as possible from the list. Have you completed? All right, now can you
try to recall the words from the prev1ous list, which you have heard repeatedly? Try to
remember some more words. Is that all ? We will now take some rest. You can relax." (The
subject is given a brief rest of a few minutes and then another test which does not involve long-
term memory is given. After a lapse or 20 minutes from the completion of the last recall of List
A, i.e. the recall which took place after list B was presented, a delayed recall of words form
List A is taken). Now please try to remember the words, which you heard repeatedly in the
beginning. You must try and recall as many as you can from the words belonging to the first
list. Yes start now. Is that all? Please try some more. Have you completed, try and remember
some more words. All right now we can go on to the next part ot the test. I will be saying some
words. Some of the words are from the first list which you heard repeatedly. You have to tell
which words are from that list. If the word was in that list please say "Yes “otherwise say "No".
Are you ready? I will start. (The tester calls out the words in the recognition list one by one at
the rate of one word per sound).”
 62

Score:

The number of words correctly recalled in each of the 5 trials of List A as well As the total
number of words recalled over all the five trials forms the learning score. The number of words
recalled correctly in the immediate recall trial, delayed recall trial and the recognition trial form
the memory score. In the recognition trial the Hits are scored separately. Omissions and
commissions form the errors. The other scores are the Long Term Percent Retention which is
calculated by the formula: Delayed recall score / Trial 5 X 100.

Duration: The test takes about 30 minutes.

IX. Complex Figure Test

Aim: To assess the visuo-constructive ability and visual memory

Materials Required:

1. An 8.5 by 11 inch card containing a complex figure.

2. A plain paper of same size to draw on

3. Writing materials

4. Stop clock

Procedure:

An 8.5 inch by 11- inch card containing the complex figure is placed in front of the subject. A
paper of same size of the complex figure card is placed in front of the subject. The patient has
to copy the figure on the paper. The patient is not allowed to use rulers to draw lines, but rather
has to draw it freehand. An eraser may be used.

Instructions:

“You see this figure on the card. Please copy it carefully as it is on this paper."

Scoring:

The time taken to copy and the number of facts correctly copied forms the score. The
correctness of the reproduction is assessed according to the scoring system given in the test
manual.
 63

Duration: The test takes 10minutes.

Tests of Visual learning and memory

Procedure:

The complex figure is recalled by drawing it from memory. The subject is asked tob recall the
figure twice: the first time is an immediate recall three minutes after the copying is completed,
and the second time is a delayed recall 30 minutes later. For the intervening three minutes, after
the patient finishes copying the design and before the immediate recall, another task such as
one measuring verbal fluency may be given to the subject or the examiner may engage the
subject in a brief clinical interview. After the lapse of three minutes another sheet of paper, the
size of the complex figure card, is placed in front of the subject and the subject is asked to draw
the design again. Following this, during the thirty minutes before the second, delayed recall is
given, the subject is given another task he/she is not told that the design has to be drawn after
this delay period. After thirty minutes have elapsed, another sheet of paper, once again the size
of the complex figure card, is placed in front of the subject and the subject is asked to draw the
same design from memory. The subject is not allowed to use rulers to draw lines, but has to
draw it freehand. Erasers may be used. The complex figure is exposed to the subject only during
the initial copying. It is not exposed before immediate recall or delayed recall.

Instructions:

“Please draw the same design which you copied earlier on this paper. Draw as much as you
remember. (If the subject says that he/she does not remember anything, then the subject is
persuaded to draw as much as he/she remembers. After the subject finishes the immediate
recall, a delay period of 30 minutes is given. At the end of the delay period another sheet of
paper is placed in front of the subject). Now please draw the design that you had copied earlier
Please try and remember as much as you can. "

Score:

On each of the copy, immediate recall and delayed recall trials, a score of 0, 0.5, 1 or 2 was
assigned to each unit of the figure based on the accuracy and placement criteria. An accurately
drawn and correctly placed unit was given a score of 2. An accurately drawn but incorrectly
placed unit was assigned a score of 1. An inaccurately drawn but correctly placed unit also was
assigned a score of 1. An inaccurately drawn but recognizable and incorrectly placed unit was
 64

assigned a score of 0.5. An inaccurately drawn/unrecognizable/incorrectly drawn/omitted unit

was given a score of 0. In the copy trial, the time taken to copy was also noted down.

Duration: The test takes about 15 minutes, as another non-visual test can be given in the delay
period.
 65

Psychological Report

Socio-demographic details

Name: K.D

Age: 21 years

DOB: 08/06/2003

Sex: Female

Educational qualification: Pursuing MSc. Clinical Psychology degree in KJ

Name of examiner: Shreeya Kurghode

Referred by: Self

Date of reporting: 22.02.2025

Date of testing: 22.01.2025

Source of information: Self

Reliability of information: Adequate & Reliable

Referral question

To use the NIMHANS neuropsychological battery to assess the neuropsychological profile of

participant.

Evaluation procedure

The NIMHANS Neuropsychological Battery was administered to K.D, a 21-year-old female.

It was explained that the participant would be required to complete a series of cognitive tasks
as part of the NIMHANS Neuropsychological Battery. The instructions for each task were
provided as per the standardized protocol, ensuring that the participant understood the
requirements. It was clarified that no additional guidance could be given beyond the initial
instructions, but any doubts regarding the procedure were addressed before beginning. After
confirming the participant’s readiness, the assessment was administered in a structured manner,
ensuring that responses were recorded systematically for further analysis.

Behavioral observation
 66

The subject was relaxed and comfortable. During the test, she was feeling nervous and found
the test confusing. She was well oriented about surroundings and appropriately groomed.

Rapport establishment: Rapport was built by asking her to relax and sit comfortably. Try to
know about her feelings. Rapport was easily established as the participant was very
cooperative. A friendly conversation was carried out in order to establish rapport. The
participant was clearly vocal about her feelings and clarified her doubts without hesitation. Her
comfort was ensured and the test was administered only after confirming she was ready

Alertness and consciousness: Fully aware, alert and conscious

Attention: Fully attentive

Eye contact: Maintained eye contact

Psychomotor activity: Regular

Speech: Proper

Cooperation: Cooperative

Motivation: Average

Comprehension: Appropriate Comprehension was seen

Problems related to vision/hearing/motor/other: None

Background history

Birth history: The participant was an unplanned baby. The mother was physically, mentally and
emotionally healthy throughout pregnancy. The participant was a full-trimester baby, with no
complications during or before birth. Post-birth she was breastfed.

Type of birth: Natural

Birth cry: Yes

Planned or unplanned: Unplanned

Presence of birth complications: No

Milestones: Normal and adequate

 67

Motor: Walk- 11 months; the participant reported an early achievement of gross motor skills
especially related to walking and running; other fine motor skills were achieved at an
appropriate age.

Cognitive: age appropriate

Speech: age appropriate

Social: fairly sociable

Emotional: the participant was not overly cranky or elated but reported a regular level of
emotional capacity and interaction with others.

Family history:

The participant lives in a nuclear family with her parents and her paternal grandmother.
Participant is a single child. Her father is a corporate worker, her mother is a homemaker. The
participant reported cordial, loving relationships with her family. She is emotionally closest to
her mother. She has lost both her maternal grandparents and paternal grandfather.

Type of family: Nuclear

Family tree:

Presence of mental disorder in the family (if any): None

Educational history:
 68

She completed high school in Goa. She is currently pursuing her Master's in Bangalore. She
reported being an academic achiever throughout her educational years, had been in several
roles of leadership and was involved in extracurricular activities. She maintained positive
relationships with her classmates and friends.
 69

Table No. 1: Showing the scores, percentile, interpretation of the participant, data obtained in the
NIMHANS Neuropsychology Battery.

Sr. No Domain Test Score Type Raw Score Percentile Interpretation

Test Of Speed
1. Digit symbol substitution test Time Taken 100 73 Above Average
Test Of Attention
2. Digit Vigilance test Time Taken 550 100 Above Average
Number Of Errors - -
3. Triads Test Number Of Errors 2 80 Above Average
Test of Executive Function
4. COWA Average New Words 14 60 Average
5. Design Fluency Total Design Free 11 25 Below Average
Total Design Fixed 3 5 Below Average
6. Stroop Test Stroop Effect 52 100 Above Average
Test Of Comprehension
7. Token Test Correct Responses 35.5 75 Above Average
Test Of Learning and Memory
8. AVLT Trial 1 8 50 Average
Trial 2 10 30 Below Average
Trial 3 13 50 Average
Trial 4 15 95 Above Average
Trial 5 15 95 Above Average
Total 61 40 Below Average
List B 10 80 Above Average
IR 12 20 Below Average
DR 15 95 Above Average
LTPR 100 95 Above Average
Hits 15 95 Above Average
9. Complex Figure Test Copy 36 95 Above Average
IR 34 90 Above Average
DR 36 95 Above Average
 70

Test Results
The NIMHANS neuropsychology battery, was administered to K.D, a 21-year-old female, currently
pursuing her master’s degree in Bangalore, with the aim of assessing her neuropsychological
functioning. In the Digit Symbol substitution test, K.D achieved a raw score of 100, corresponding to
73rd percentile. This percentile indicates that K.D’s performance falls within the top 27 % compared to
others in her age group who took the same test.

In the digit vigilance test, K.D attained raw score of 554 placing her at 100th percentile. This percentile
suggests that K.D’s performance is better than 100 percentages of individuals in her age group.
Additionally, no errors were made by K.D.

In the Triads Test, K.D committed 2 errors and achieved a raw score of 13, placing her in the 80 th
percentile. This percentile suggests that K.D’s performance falls within top 20% compared to others in
her age group who took the same test.

In the COWA – Controlled Oral Word Association Test, K.D scored 14, corresponding to the 60th
percentile, this indicates that K.D’s performance falls within top 40% compared to others in her age
group that took the test.

In the Design Fluency, K.D achieved a raw score of 11 in Free Design Fluency, placing her at the 25 th
percentile, indicating lower performance. In Fixed Design Fluency, K.D’s score of 3 places her at 5 th
percentile.

In Stroop test, K.D achieved a raw score of 52, corresponding to 100th percentile indicating her
performance is better than 100% of other participants in her age group.

In the token test, K.D obtained a total score of 35.5, corresponding to 75th percentile, indicating her
performance is better than 75% of other participants in her age group who took the same test.

In auditory verbal learning test, K.D obtained varying scores across trials with percentiles ranging from
20-95th percentile. For example, in trial 1, K.D’s score of 8 corresponding to 50th percentile indicating
average level of performance. However, in the trial 5, her score is of 15 corresponding to 95 th percentile
indicating superior performance.

In the complex figure test, K.D achieved a raw score of 36 in the copy phase, placing her at 95 th
percentile, indicating superior performance. Additionally, in both the immediate recall and delayed
recall phase, her score is 34 and 36 respectively, corresponding to 90th and 95th percentile respectively
indicating superior performance in memory tasks.

Impression and Interpretation

 71

The NIMHANS neuropsychology battery, was administered to K.D, a 21-year-old female, currently
pursuing her master’s degree in Bangalore, provides a comprehensive assessment of her
neuropsychological functioning across various cognitive domains.

Digit Symbol substitution test:

K.D’s performance falling within 73rd percentile suggesting above average speed and accuracy in
processing information in completing tasks requiring visual-motor coordination.

Digit Vigilance Test:

K.D’s performance placing her at 100th percentile suggesting excellent sustained attention and vigilance
with low error rate compared to her peers.

Triad Test:

K.D’s performance is at 24th percentile suggest challenge in perceptual organization and problem-
solving skills compared to her peers.

COWA Controlled Oral Word Association Test:

K.D’s performance falling within the 60th percentile suggesting above average verbal fluency abilities
compared to others in her age group.

Design Fluency:

J’S’s performance in free design fluency at 25th percentile indicating poor ability in generating novel
designs. However, her performance in fixed design fluency is 5th percentile suggesting extreme
difficulties in adapting to structured tasks.

Stroop Test:

K.D’s performance falling within 100th percentile indicating an extremely strong cognitive flexibility
and inhibition abilities, as she performed 100% better than her peers.

Token Test:

K.D’s performance, at the 75th percentile, suggesting an above average comprehension and auditory
processing skills compared to others in her age group.

Auditory-Verbal Learning Test:

K.D’s performance varies across trials, whit scores ranging from the 20-95th percentile. Overall, she
demonstrates strengths in immediate verbal memory (trial 5), but may show average performance in
some aspects of verbal learning and recall (trial 1).
 72

Complex Figure Test:

K.D’s performance in the copy paste, immediate recall, and delayed recall phases, all falling withing
the 90th-95th percentile, indicated superior visual spatial abilities and above average memory
performance.

Participant K.D demonstrates strengths in several cognitive domains including attention, visual motor
co-ordination, cognitive flexibility and visual spatial abilities. However, there are areas of potential
challenges such as perceptual organization, verbal fluency and certain aspects of memory and problem
solving. These findings provide valuable insights into K.D’s cognitive profile which can inform
interventions and support strategies tailored to her specific strengths and weaknesses.

The participants score on NIMHANS Neuropsychology Battery reveals that the client has normal
functioning of neuropsychology.

Summary and Suggestions:

The participant was administered on NIMHANS Neuropsychology Battery which reveals that the client
has normal functioning of neuropsychology and further assessment is not needed.
 73

Benton Visual Retention Test

The Benton Visual Retention Test (BVRT or simply Benton test), now in 7th edition, is widely
used test for visual memory, visual perception and/or visual construction. It is an individually
administered test for people aged eight years to adulthood. Additionally, it can be used to detect
potential learning difficulties and other conditions that could impair a person's memory. The
participant is shown 10 designs, one at a time and asked to replicate each one of them from
their memory as similar as possible on a plain sheet of paper. The test is untimed and the results
are professionally scored by form, shape, pattern and arrangement on the paper.

History

Dr. Arthur L. Benton developed the Visual Retention Test (BVRT) in 1946 to measure
immediate nonverbal memory and visual-motor integration, complementing the auditory digit
span test in neuropsychological evaluations. Unlike the digit span test, which focuses on
auditory processing, the BVRT uses visual and motor skills, reducing emotional influence and
minimizing tester-participant interaction. The original version included seven cards with two
forms to prevent memorization. A 1955 revision added norms for children ages 8 to 16 and
expanded the test with more designs. In 1992, a further revision by Abigail Benton Sivan was
published by Pearson Assessment.

Neuropsychology of visual processing

often synonymous with visual neuroscience, visual cognition, perceptual corelates etc. The
study of visual neuropsychology aims to clarify the connections between the physiological
operation and anatomical features of visual cerebro-cortical structures and visual perceptions
and visually-mediated behaviours that they produce through testing on both healthy and brain-
damaged people.

To study them the researchers, use the psychophysical techniques and neuroimaging to explore
what are the functions of and how the cortical regions are involved in the visual processing.
The key findings are highlighted as following:

• Visual perceptions feel coherent and unified but the studies also show that different
brain streams can function independently to some extent.
• Behavioural dissociations manifest as processing difficulties in one domain in the
relative absence of difficulties in another, so suggesting independence of the two
domains.
 74

• Double dissociation is observed when two patients show complementary deficits

providing evidence that different domains are processed by separate brain systems.
• The patients with the brain damage often have varied neutral functioning. However, the
case studies revealed unexpected relationships and specializations in visual processing.
• Lastly, visual perceptions and visually guided behaviors arise from simultaneous and
largely parallel processing in both streams.

Some cerebral visual impairment includes the following:

• Akinetopsia (Motion Blindness): A condition where individuals cannot perceive

moving objects' direction and speed but can see static shapes and colors. It is caused
by brain damage, such as from trauma, stroke, or tumors, affecting the ventral occipito-
temporal cortex, specifically areas like MT+/V5 or the lateral occipital complex
(LOC), essential for motion detection and object recognition.
• Balint’s Syndrome: A rare neurological disorder resulting from bilateral damage to the
occipito-parietal cortex, causing three main symptoms: optic ataxia (difficulty reaching
objects), optic apraxia (trouble shifting gaze), and simultanagnosia (inability to
recognize multiple objects at once). It is often linked to strokes, trauma, or diseases
like Alzheimer's.
• Optic Ataxia: A condition where individuals struggle to reach visible objects despite
normal vision and motor skills. It stems from damage to the dorsal visual stream,
particularly the posterior parietal cortex, which aids in visually guided movement.
Brain injury on the right-side effects reaching with either hand for objects on the left,
while left-side damage leads to difficulty reaching objects in both visual fields,
especially with the right hand.

Evolution of BVRT

The Benton Visual Retention Test (BVRT), developed by Arthur Benton in 1946, is a
neuropsychological assessment tool designed to measure visual memory and visual-motor
integration. Its development stemmed from the need to assess cognitive functions such as
memory and perception without relying on verbal skills, making it particularly useful for
individuals with brain damage, developmental disorders, or learning disabilities. Initially, the
BVRT required individuals to view geometric shapes and reproduce them from memory,
evaluating their ability to retain and recall visual information.
 75

In the 1970s and 1980s, the BVRT evolved with the development of the Benton Visual
Retention Test-Short Form (BVRT-SF), which was designed to provide a quicker and more
practical version of the original test. The shorter form allowed for more efficient use in various
clinical settings, especially where time constraints were a concern, such as in emergency
medical settings or large-scale research studies. Additionally, this version of the BVRT allowed
for age-specific adaptations, making it more suitable for children and older adults. As
neuropsychological research advanced, the BVRT gained prominence in the study of brain
injuries, particularly those affecting the right hemisphere, which is involved in visual-spatial
processing. Researchers began to recognize that poor performance on the BVRT could be
linked to specific brain lesions, which solidified its use in diagnosing conditions like stroke,
Alzheimer's disease, and traumatic brain injuries. By the late 20th century, the BVRT became
an essential tool for tracking cognitive decline, especially in neurodegenerative diseases, where
early signs of cognitive impairments were not immediately apparent through other clinical
symptoms.

The 1980s and 1990s saw further advancements in the psychometric properties of the BVRT.
The test underwent studies that confirmed its strong internal consistency and test-retest
reliability across different populations. These studies demonstrated the BVRT's ability to
distinguish between individuals with neurological disorders and those without, establishing its
reliability in both clinical and research contexts. This period also saw the BVRT being
integrated with other neuropsychological assessments, such as the Wechsler Adult Intelligence
Scale (WAIS), to provide a more comprehensive view of cognitive functioning. In the 2000s,
the BVRT was increasingly used alongside neuroimaging techniques, which revealed that the
test activates brain regions involved in visual-spatial processing, including the occipital and
parietal lobes. This advancement helped to understand the underlying neural mechanisms of
the BVRT and its role in diagnosing and evaluating neurological conditions. Today, the BVRT
remains a widely used tool in clinical neuropsychology for diagnosing conditions such as
Alzheimer's disease, Parkinson’s disease, stroke, and brain injuries. It also continues to be
useful in monitoring cognitive decline and evaluating the effects of therapeutic interventions.

Need for BVRT

The Benton Visual Retention Test (BVRT), developed in 1946, is a vital neuropsychological
tool designed to assess visual memory and visual-motor integration, engaging both visual and
motor skills. Unlike traditional auditory memory tests, the BVRT reduces emotional influence
 76

and language dependency, making it valuable for diagnosing brain damage, cognitive
impairments, and neurological disorders such as Alzheimer's disease, strokes, and traumatic
brain injuries. The test helps clinicians evaluate a person’s ability to remember and reproduce
visual designs, which can reveal subtle cognitive dysfunctions not detected by other tests. One
of the key benefits of the BVRT is its ability to identify early cognitive decline, particularly in
neurodegenerative conditions. Poor performance on the BVRT can signal the onset of
Alzheimer's disease before other clinical symptoms arise, enabling early intervention. It also
monitors the progression of cognitive disorders, offering a reliable way to track changes over
time. In addition, the BVRT is useful in identifying learning disabilities and differentiating
between various types, especially in children with reading difficulties or ADHD. This makes it
an important tool for clinicians and educators.

Moreover, the BVRT is effective in detecting malingering, as individuals attempting to simulate

cognitive impairment tend to make more errors, particularly distortions, compared to those with
genuine brain damage. This makes the BVRT a crucial tool in ensuring accurate diagnoses. It
also offers cross-cultural applicability, with normative data from multiple countries supporting
its use in diverse populations, overcoming language barriers and enhancing its reliability across
different groups.

The application:

The Benton Visual Retention Test (BVRT), originally developed by Dr. Arthur L. Benton in
1946, is a neuropsychological assessment tool designed to measure immediate nonverbal
memory, with a particular focus on visual and motor skills.

Clinical and Diagnostic Uses

One of the key strengths of the BVRT is its sensitivity to different types of brain damage and
cognitive dysfunction. The test is particularly effective in detecting visuospatial disturbances
commonly associated with right hemisphere brain damage. Individuals with right hemisphere
damage tend to perform poorly on the BVRT, especially during the delayed recall section, as
the right hemisphere plays a significant role in visual processing and memory. In contrast,
individuals with left hemisphere damage may exhibit poorer performance in other sections, but
the presence of a delay often provides clearer distinctions between left and right brain damage.
Studies show that individuals with left hemisphere damage often benefit from the delayed recall
portion of the test, while individuals with right hemisphere damage show a decline in
performance over time. Despite its sensitivity to brain damage, the BVRT's ability to
 77

differentiate between various diagnoses is limited. While it can detect cognitive impairment, it
does not always distinguish between unilateral right and left-brain damage. Both types of brain
damage may result in similar patterns of performance on the test, making it difficult to pinpoint
the exact location of the impairment.

The BVRT is also useful for assessing early cognitive decline, particularly in the detection of
dementia. Research has shown that individuals with cognitive impairments, such as those at
risk for Alzheimer’s disease, tend to perform poorly on the test. One study found that
participants who made six or more errors on the BVRT were nearly twice as likely to develop
Alzheimer's disease 10 to 15 years later compared to those with fewer errors. This predictive
ability highlights the BVRT’s value in identifying individuals at risk for neurodegenerative
diseases.

Applications in Children and Learning Disabilities

The BVRT is also valuable in identifying children with learning disabilities, especially those
related to visual-spatial processing. Children with reading disabilities tend to perform worse
on the BVRT, as they struggle with recalling visual patterns. Additionally, children diagnosed
with Attention-Deficit/Hyperactivity Disorder (ADHD), particularly those on stimulant
medications, have been found to perform poorly on the test compared to healthy children. The
BVRT helps differentiate between various cognitive difficulties in children, offering insights
into their visual memory and processing abilities.

Detection of Malingering

The BVRT can also serve as a tool for detecting malingering, a condition where individuals
intentionally feign cognitive impairment. Studies have shown that individuals who are
malingering often make more errors on the BVRT, particularly distortions of the visual designs,
compared to patients with genuine cognitive impairments. The test helps clinicians distinguish
between individuals with legitimate cognitive issues and those attempting to exaggerate or
fabricate their symptoms.
 78

References

Visual Neuropsychology. (2008b). In Visual Neuropsychology [Article].

[Link]
content/uploads/2018/08/2008_Brooks_Einpress_visual-[Link]

Manna, C. G., Alterescu, K., Borod, J. C., & Bender, H. A. (2010). Benton Visual Retention
Test. In Springer eBooks (pp. 392–394). [Link]
3_1110
 79

Methodology

Aim: To assess the visual working memory of the participant

Plan: To administer the Benton Visual Retention Test

Materials:

1. Benton Visual Retention Test Form-C with 10 designs

2. Manual

3. Blank Sheets, pencil and eraser

4. Stop clock

Procedure:

Provides an interval between the encoding process & execution of the drawing. It requires the
examinee to retain the percept for a brief period of time.

With the administration the examinee views each design for 10seconds.

After a delay of 15 seconds, he or she reproduces the design from memory.

Instructions:
"I will show you a page on which there are one or more figures. I want you to study the design
for 10 seconds; then I will cover the page. After 15 seconds, I want you to draw the figure or
figures on the paper I give you. Make your drawing as much like the one on the page as you
can."

If the examinee asks specific questions (e.g. Whether or not size is important, whether or not
lines must be perfectly straight), you may repeat the same instructions about making the
drawing as much like the stimulus design as possible, but do not give more specific
instructions). You may also repeat the instructions if it appears that the examinee is not exerting
optimal effort. if the examinee is not spending an excessive amount of time on the
drawing, encourage him or her to work a little faster.

Stand the stimulus booklet to its base so that the cover faces you. open the stimulus booklet to
the divider page (not design one) of the form you are administering. Turn to design one and
allow the examinee to view it for 10 seconds. then cover the design page which is the next
screening page and wait 15 seconds.
 80

Unlike with the other methods of Administration, the examinee is not given the responses
booklet and pencil before viewing the stimulus design. Instead, give the pencil and the response
booklet to the examinee at the end of 15 seconds post-exposure intervals. Have the booklet
opened to the page for design one and place it in front of the examinee so that the design number
in the lower right corner is upright to the examinee.

Eraser and corrections are permitted. after the examinee has finished drawing the design, take
away both the response booklet and the pencil. then present the next design. Present each
subsequent design without comment, with one exception. before introducing design 3, say “Do
not forget to draw everything you see”. If the examinee omits the peripheral vision figure in
his or her Reproduction of design 3, make the statement before introducing design 4.

The examinee may make corrections and erase. No spontaneous praise is offered, but you may
offer reassurance if the examinee asks about the quality of his/her performance.

Sometimes an examinee may attempt to fill the 15 sec waiting intervals by starting a
conversation. If so, tactfully stop the conversation by encouraging the examinee to concentrate
and to keep the design in mind. Some examinee attempts to retain the memory of a design by
tracing it with their fingers on the table surface. This finger is permissible as long as no visual
record is made.

Scoring:

The scoring of BVRT is objective and based on explicit principles. Two scores for describing
an examinee’s performance as possible. 1 score is based on the number of correct reproductions
and is called the Number Correct Score. It is a measure of the examinee’s overall level of
performance. The other score is the number error and provides information about the frequency
of specific types of errors made by the examinee. This information is of interest because error
types differentially correlate with specific diseases. Inter scorer agreement has been found to
be very high for both the overall score and the majority of the error categories.

Number correct Score:

For the number correct score, the examinee’s reproduction of each design is judged on an all
or none basis. If the reproduction contains no errors, it is scored as correct and awarded 1 point.
If the reproduction contains any errors, it receives 0 point. The error or errors are neither
categorized nor specified. The range of possible scores for any single form of the test (10
designs) in 0-10 points.
 81

Number error score:

In any less-than-perfect reproduction of design, the examinee necessarily makes one or more
specific errors. For the number error score, the no of errors is recorded, and each error is
classified and recorded by type. This method of recording errors facilitates analysis of the
qualitative characteristic of an examinee’s performance. The specific types of errors are
grouped into 6 major categories: Omissions, Distortions, Perseverations, Rotations,
misplacements, and size errors. Within these categories are 56 specific error types.

Categorizing errors according to central, left or right (e.g. Omission of major figure[M],
omission of left major figure [ML], omission of right major figure [MR] increases the no of
errors to more than double the no. if errors were not specified. The definition of each error type
and its accompanying notation symbol are from below and on the full pages.

(8 types of errors from the previous edition [MRI, MLI, IMC, STM, STMR, STML, VERM,
WOV] were deleted because they were non-discriminating, rarely used and cumbersome to
assess). An incorrect reproduction may contain as many as 4 specific errors. Theoretically, the
number error score has a very wide range, but in practice the upper limit for one protocol is
about 24 errors.

Initially, the ‘Number Error Score’ method may appear inordinately detailed and time-
consuming, but this has not proved to be the case.

Examiners with relatively little experience in scoring responses to the BVRT can accurately
score a protocol that has a fair number of errors in about 5 minutes.
 82

Psychological Report

Socio-demographic details

Name: K.D

Age: 21 years

DOB: 08/06/2003

Sex: Female

Educational qualification: Pursuing MSc. Clinical Psychology degree in KJ

Name of examiner: Shreeya Kurghode

Referred by: Self

Date of reporting: 05.02.2025

Date of testing: 05.02.2025

Source of information: Self

Reliability of information: Adequate & Reliable

Referral question

To assess the visual working memory of the participant by administering Benton Visual
Retention Test.

Evaluation procedure

Examiner provides an interval between the encoding process & execution of the drawing. It
requires the examinee to retain the percept for a brief period of time. With the administration
the examinee views each design for 10 seconds. After a delay of 15 seconds, he or she
reproduces the design from memory. The room was well-lit and free of distractions. The
participant was made comfortable and a conversation was carried out to dissipate any pre-test
nervousness that the participant may have felt. Once it was ensured that she was calm and
attentive, she was told that she would perform an interesting task. Thereafter, she was
introduced to the assessment and any doubts she had were addressed. After ensuring she was
ready for the test, the same was administered.

Behavioral observation
 83

The subject was relaxed and comfortable. During the test, she was feeling nervous and found
the test confusing. She was well oriented about surroundings and appropriately groomed.

Rapport establishment: Rapport was built by asking her to relax and sit comfortably. Try to
know about her feelings. Rapport was easily established as the participant was very
cooperative. A friendly conversation was carried out in order to establish rapport. The
participant was clearly vocal about her feelings and clarified her doubts without hesitation. Her
comfort was ensured and the test was administered only after confirming she was ready

Alertness and consciousness: Fully aware, alert and conscious

Attention: Fully attentive

Eye contact: Maintained eye contact

Psychomotor activity: Regular

Speech: Proper

Cooperation: Cooperative

Motivation: Average

Comprehension: Appropriate Comprehension was seen

Problems related to vision/hearing/motor/other: None

Background history

Birth history: The participant was an unplanned baby. The mother was physically, mentally and
emotionally healthy throughout pregnancy. The participant was a full-trimester baby, with no
complications during or before birth. Post-birth she was breastfed.

Type of birth: Natural

Birth cry: Yes

Planned or unplanned: Unplanned

Presence of birth complications: No

Milestones: Normal and adequate

 84

Motor: Walk- 11 months; the participant reported an early achievement of gross motor skills
especially related to walking and running; other fine motor skills were achieved at an
appropriate age.

Cognitive: age appropriate

Speech: age appropriate

Social: fairly sociable

Emotional: the participant was not overly cranky or elated but reported a regular level of
emotional capacity and interaction with others.

Family history:

The participant lives in a nuclear family with her parents and her paternal grandmother.
Participant is a single child. Her father is a corporate worker, her mother is a homemaker. The
participant reported cordial, loving relationships with her family. She is emotionally closest to
her mother. She has lost both her maternal grandparents and paternal grandfather.

Type of family: Nuclear

Family tree:

Presence of mental disorder in the family (if any): None

Educational history:
 85

She completed high school in Goa. She is currently pursuing her Master's in Bangalore. She
reported being an academic achiever throughout her educational years, had been in several
roles of leadership and was involved in extracurricular activities. She maintained positive
relationships with her classmates and friends.
 86

Test Results

The Benton Visual Retention Test (BVRT) was administered to KD, a 2l year old Female
pursuing her Masters in Kristu Jayanti college. The test aimed to assess visual working memory
of the participant. The form C and administration D in which each design was exposed for 10
seconds, followed by reproduction from the memory by the subject after a delay of 15 seconds,
was administered on the participant. The total number. of correct responses was 9. The total
number. of errors was 1. The category of error was Right distortion (SMR). There were no left
errors.

Impression & Interpretation

The error of right distortion was seen in card 10. This indicates that there might be an
impairment in visual memory in the left visual field. This shows that she has an average level
of visual memory.

Summary & suggestion

Benton visual Retention Test was administered on KD to assess the visual working memory.
The right distortion indicates that she might have impairment in the left visual field.
 87

Wisconsin’s Card Sorting Test

The Wisconsin Card Sorting Test-64 Card Version (WCST-64) is an abbreviated form of the
standard 128-card version of the Wisconsin Card Sorting Test (WCST; R. K. Heaton. 1981).
The WCST-64 normative. reliability, and validity data are derived from the same samples
described in the Wisconsin Card Sorting Test Manual-Revised and Expanded (R. K. Heaton,
Chelune, Talley, Kay, & Curtiss, 1993). The WCST-64 maintains the task requirements of the
WCST, therefore, much of what is known about the WCST will generalize to the WCST-64 i.e,
administration and scoring reliability. Although some of the WCST literature may not be
directly applicable to the WCST-64, it will provide helpful information until additional WCST-
64 studies become available

WCST Test Development

Loosely modeled after tests utilized by animal researchers as well as an existing instrument,
the Weigl Color-Form Sorting Test, used with humans, the WCST was developed in 1948 as a
measure of abstract reasoning ability and the ability to shift cognitive set. As such, the WCST
can be considered a measure of "executive function" requiring the ability to develop and
maintain an appropriate problem-solving strategy across changing stimulus conditions in order
to achieve a future goal. Similar to other measures of executive function, the WCST requires
cal concentration. (b) planning, (c) cognitive flexibility in shifting set, (e) working memory,
and (f) inhibition of impulsive responding (Chelune & Haer, 1986; Goys & Willis, 1991, Welsh
& Pennington, 19881)

The WCST is popular among clinicians due to its sensitivity to brain dysfunction affecting the
frontal lobes (Drewe, 1974). This sensitivity often leads to its association with “frontal” or
“pre-frontal” functioning. However, this classification is an oversimplification, as the frontal
lobes serve a wide range of cognitive functions beyond those assessed by the WCST. Moreover,
impaired performance on the WCST can also occur in individuals with brain diseases not
directly involving the frontal lobes. Therefore, interpreting WCST results should be done
within the context of a comprehensive neuropsychological evaluation that integrates medical,
psychosocial, and historical data.
 88

The WCST consists of four stimulus cards and 128 response cards featuring different forms
(crosses, circles, triangles, stars), colors (red, blue, yellow, green), and numbers (one to four).
In the standard administration, the four stimulus cards are placed in a left-to-right order: one
red triangle, two green stars, three yellow crosses, and four blue circles. The respondent is
given 64 response cards and asked to match each one with the stimulus cards, with feedback
on whether the match is correct or incorrect. Initially, the sorting principle is based on color,
and once the respondent correctly matches a certain number of cards, the principle shifts to
form, and later, to number, with no warning. The process continues through several shifts in
sorting principles. Various versions of the WCST have been developed, differing in the number
and order of response cards, sorting categories, and shifting criteria. R.K. Heaton (1981)
standardized the test materials, administration (six category shifts after 10 correct responses
per rule), and scoring procedures, with expanded normative data based on age (6-89 years) and
education (≤8 to 18+ years) available in the Wisconsin Card Sorting Test Manual-Revised and
Expanded.

Shortened Versions of the WCST

The WCST is widely used across various patient groups, but concerns about patient comfort,
managed care, and research budgets have led to the development of shorter versions. Three
shortened versions are reported: the Modified WCST (mWCST), WCST-3, and WCST-64. The
mWCST was created for patients with Alzheimer's disease and others for whom the standard
WCST is too difficult. In the mWCST, task demands are reduced, using only 48 response cards
that match the stimulus cards in a single dimension. After six correct responses, the examiner
informs the respondent of a category change. The test ends either after six category shifts or
when all 48 cards have been used.

The WCST-3 uses the standard administration procedure, but the test is discontinued when the
respondent has completed three correct categories. This version has been shown to correlate
well with the WCST. However, for individuals who do not complete three categories (these are
often those respondents who are most impaired and who work more slowly) this version does
not decrease administration time because all 128 cards are administered. The WCST-64 uses
only the first 54 cards of the standard version of the WCST and all respondents complete b
trials (or cards). The advantages of the WCST-64 over the shortened versions previously
discussed are a significant decrease in administration time while, at the same time retaining the
task requirements of the standard version Additionally, the variability in the number of cards
 89

administered is removed (i.e. all examinees are administered all 64 cards) so comparisons of
test-retest stability are more straightforward, as ate comparisons with normative and validity
data.

Application of WCST

1. Executive Function Assessment: The WCST evaluates key executive functions,

including cognitive flexibility, planning, working memory, and inhibition, essential for
problem-solving and adapting to changing situations.
2. Frontal Lobe Dysfunction: It is particularly useful for identifying impairments linked
to frontal lobe dysfunction, often seen in conditions like traumatic brain injury, stroke,
and neurodegenerative diseases (e.g., Alzheimer's, Parkinson’s).
3. Neuropsychological Evaluations: The test is a valuable tool in comprehensive
neuropsychological assessments, helping clinicians distinguish between various
cognitive disorders and providing insights into a patient’s cognitive abilities.
4. Clinical Diagnosis: It aids in the diagnosis of conditions such as schizophrenia, ADHD,
PTSD, and OCD, where difficulties in shifting cognitive sets or inhibiting impulsive
responses are common.
5. Treatment and Rehabilitation Monitoring: The WCST helps track changes in executive
function over time, monitoring progress in patients undergoing treatment or
rehabilitation for cognitive impairments.
6. Research Tool: Widely used in research, the WCST provides insights into cognitive
flexibility and executive functions in both healthy individuals and clinical populations,
contributing to studies on aging and neurocognitive disorders.
7. Shortened Versions: Versions like the WCST-3 and WCST-64 offer more efficient
testing, reducing administration time while preserving core cognitive task demands,
useful for patients with cognitive impairments.
 90

References

Chelune, G. J., & Haer, D. S. (1986). Neuropsychological implications of the Wisconsin Card
Sorting Test. Journal of Clinical and Experimental Neuropsychology, 8(3), 317-333.

Drewe, E. A. (1974). The effects of frontal lobe damage on environmental control of behavior
in man. Neuropsychologia, 12(4), 417-443.

Goy, L., & Willis, L. (1991). Cognitive assessment of brain damage using the Wisconsin Card
Sorting Test. Journal of Clinical Neuropsychology, 13(5), 549-558.

Heaton, R. K. (1981). A manual for the Wisconsin Card Sorting Test. Psychological Assessment
Resources.

Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtiss, G. C. (1993). Wisconsin
Card Sorting Test Manual: Revised and Expanded. Psychological Assessment
Resources.

Welsh, M. C., & Pennington, B. F. (1988). Assessing frontal lobe functions in children: The
Wisconsin Card Sorting Test. Neuropsychology, 2(2), 131-144.
 91

Methodology

Aim: To study is to assess the executive functioning of the participants

Plan: To administer the Wisconsin Card Sorting Test - 64 (WCST-64) to assess the executive
functioning of the participants

Materials Required:

• Four stimulus cards.

• One deck of 64 response cards

• WCST-64 Record Booklet

• WCST-64 Professional Manual

Procedure:

The administration should take place in a quiet room with illumination adequate for viewing
the WCST-64 stimuli. A table or desk and two chairs, one for the examiner and one for the
respondent, are required. The table or desk should provide ample space for arranging the cards
and should be free of extraneous materials. In addition to the WCST-64 materials, the examiner
will need a pen or pencil for recording the individual's responses. A clipboard to hold the record
booklet is also desirable to shield the record booklet from the respondent's view. Prior to
administration, the examiner should inspect the WCST-64 response card deck to ensure that
the cards are arranged in the proper orientation and numerical sequence. This cannot be
overemphasized; deviations from proper orientation and numerical sequence will result in a
nonstandard test administration that will complicate the use of available norms and the
interpretation of test results. Hand the respondent the deck of response card the figures facing
up and the numbers on the reverse the cards oriented toward the respondent. Directions Before
the administration, the examiner should enter the respondent's demographic information in the
spaces provided in the WCST-64 Record Booklet along with any medical and/or emotional
factors that may affect test performance. The respondent should sit at the table across from and
facing the examiner.

Remove the response card deck from the box and set the box aside. Turn to the second page of
the record booklet but do not allow the respondent to see this page. Place the stimulus cards on
the table in a row in front of the respondent, being sure to allow sufficient room to place the
response cards between the stimulus cards and the edge of the table nearest the respondent. The
 92

stimulus cards are always presented from the respondent's perspective in a standard left-to-
right order, beginning with the red triangle (on the respondent's left), followed by the two green
stars, the three yellow crosses, and the four blue circles. Be sure the stimulus cards are properly
oriented. The peak of the triangle points toward the examiner, the tops of the two stars point
toward the examiner, and the horizontally arranged crosses are closest to the examiner. While
you are placing the stimulus cards on the table, say the instruction to the respondent. Hand the
respondent the deck of response cards with figures facing up and the numbers on the reverse
side of the cards oriented toward the respondent.

Because of the ambiguous nature of the WCST-64, individuals may ask the examiner various
questions. Although it is permissible to clarify the meaning of the stimulus (key) cards and the
manner in which the individual is to respond the examiner must never violate the integrity of
the WCST 64 by giving any indication of the sorting principles (categories) or the nature of the
shifts from one category to the next. Generally, repeating the instructions provides sufficient
clarification for most individuals. In our experience, even young children have little difficulty
with the standard instructions. However, for some younger children, it may be less threatening
to introduce the WCST-64 in the context of a "game" rather than as a test.

The first correct sorting category is Color. As the respondent begins to sort the response cards,
the examiner responds with "correct" or "right" each time the individual matches according to
Color, and with "incorrect" or "wrong" each time the individual matches to a stimulus
dimension other than color. This process continues until the individual has produced 10
consecutive Color responses. Without comment or any other indication, the examiner then
changes the correct sorting category to Form. It is important that the examiner make a smooth
and undetectable transition, both verbally and nonverbally, between sorting categories. Form
remains as the correct sorting category (principle) until the individual has again attained 10
consecutive correct responses. Without warning or cue as to what is happening, the examiner
then changes the correct sorting category to Number. After 10 consecutive correct responses to
Number, the examiner will switch back to colour as the correct sorting category, and then to
Form, and then to Number in the manner just described. This sequence (Colour, Form, and
Number) is repeated until all 64 cards have been used. At no time during or after the
administration of the WCST-64 should the examiner provide the respondent with any
information that is not contained in the initial instructions.
 93

The WCST-64 is not timed, and the respondent is informed of this in the instructions. While
individuals vary in the amount of time needed to complete the test, most do so within 10
minutes. Occasionally, a respondent may begin to sort the cards very quickly, and the examiner
may decide to ask the individual to slow down, so the examiner can keep up in the record
booklet. However, slowing down the rate of feedback to the respondent (withholding feedback
until the response has been recorded) is often sufficient to maintain a comfortable response rate
for both the respondent and the examiner. Nonetheless the examiner should practice the
administration and recording procedures until he or she can at least keep up with respondent
who sorts one card per second. Practice segments in the Wisconsin Card Sorting Test Videotape
can be used to increase recording speed. In extreme cases, or when administering the WCST-
64 to young children, the examiner may retain control of the response card deck and the
individual the response card for each trial. However, slowing down too much can interfere with
performance because the respondent may become distracted and lose track of the task.

Respondents will sometimes become confused about how to form the response card piles below
the stimulus cards. If the respondent begins to form columns (instead of piles) below the
stimulus cards or begins to stack the response cards on top of the stimulus cards, the examiner
should help by moving the response cards to the appropriate position and by repeating some or
all of the test instructions. If the examiner believes that a respondent may be matching new
response cards to the top card on the response card piles rather than to the stimulus cards, he
or she should remind the individual of the correct procedure. This may well be the case if the
individual begins to make other responses (i.e., responses that do not match any of the three
stimulus dimensions of colour, Form, and Number). As a general rule, it is helpful to redirect a
respondent's attention to the correct procedure for sorting to the stimulus (key) cards
when other responses occur. If a respondent should become frustrated and begin randomly
"dealing" the response cards rather than making an effort to match them to the stimulus cards,
the examiner should stop the individual and insist that he or she look at the stimulus cards and
try to match to them.

Instructions:

This test is a little unusual because I am not allowed to tell you very much about how to do it.
You will be asked to match each of the cards in this deck (point to the response card deck) to
one of these four key cards (point to each of the stimulus cards in succession, beginning with
the red tri- angle). You must always take the top card from the deck and place it below the key
 94

card you think it matches. I cannot tell you how to mate the cards, but I will tell you each time
whether you are right or wrong. If you are wrong, simply leave the card where you have placed
it and t to get the next card correct. There is no tin limit on this test. Are you ready? Let's begin.

Orientation of WCST-64 stimulus (key) cards:

Respondent

Examiner

Recording Responses

Accurate recording of the individual's responses is critical to the subsequent scoring of the
WCST-64 administration. The record booklet should be out of the respondent's view at all
times. As the individual responds to each item, the examiner should draw slashes (/) through
each dimension that is the same on both the response and stimulus cards. If the response card
and stimulus card match on only one dimension, a slash should be drawn through the symbol
on the record booklet that corresponds to that dimension. For example, if the response card
matches only the Colour of the stimulus card, the item in the record booklet for that response
would be marked ¢ FNO. If the response card matches two dimensions, the slash would be
drawn through both of the corresponding symbols in the record booklet. For example, if the
response card has both the same Colour and the same Number of figures as the stimulus card,
the response would be recorded as C F N 0. If the response and stimulus cards are exactly the
same, the response would be recorded as C F N 0. Finally, if the response card does not match
any dimension on the stimulus card, the response would be recorded as Other (i.e. CFNO). The
response dimensions should be recorded in the same manner for each item, regardless of
whether the response is correct or incorrect with respect to the current correct sorting category.
The examiner should be proficient enough to record responses at a rate of one card per second.
Again, there are practice segments in Wisconsin Card Sorting Test: Administration and Scoring
Videotape that can be used to increase recording speed.
 95

The category sequence, C F N C F N, presented at the top of the second page of the record
booklet, corresponds to the sequence of correct sorting categories. To begin, write the letter
"C" to the left of the Item 1 to represent the first correct sorting category. During administration,
mark through each category at the top of the page as it is success- fully completed
(e.g... C F N C F N). To determine when a respondent successfully completes a category and
to assist in later scoring, consecutively number continuous correct responses, up to 10,. on the
line provided to the left of each item. Only correct responses are numbered. Any time a
respondent interrupts a sequence of correct responses by making an error, begin renumbering
the next correct item with the number 1. When the criterion of 10 consecutive correct responses
has been reached, draw a horizontal line beneath the last item, make a slash through the symbol
of the completed category at the top of the page, and then write the symbol for the next correct
sorting category below the horizontal line and to the left of the item number. These recording
procedures are illustrated.

Scoring

An advantage of the WCST-64 and WCST over many other tests of "executive functioning'" is
the generation of multiple scores that reflect different aspects of test performance. However,
calculating these test measures requires carefully following complex scoring procedures.
Obtaining an operational understanding of the test (i.e. becoming familiar with the manner in
which the scores are derived) will greatly facilitate clinical interpretation.

Before delineating the specific steps for scoring the WCST-64 administration, it is helpful to
reexamine the nature of the test and the terms used to describe the various features of a
respondent's response. Successful performance on the WCST-64 requires a respondent to first
determine the correct sorting principle on the basis of examiner feedback and then to maintain
this sorting principle or set (e.g. Colour) across changing stimulus conditions while ignoring
other stimulus dimensions (e.g., Form and Number). A failure to Maintain Set occurs when a
respondent makes five or more consecutive correct responses and then makes an error before
successfully achieving a category by getting 10 consecutive correct matches. However, as soon
as the individual makes 10 consecutive correct responses within a category (e.g., Color), the
examiner changes the correct sorting principle to a new category (e.g., Form) without
informing the respondent. Now, in light of the feedback that the previous sorting principle is
no longer correct, the individual must inhibit the tendency to persist or perseverate with the old
principle and must use the examiner's feedback to determine the new, correct sorting principle.
 96

WCST-64 scores and Scoring Dimensions

Each response an individual makes can be thought of as occurring on three separate

dimensions, each of which should be evaluated: correct-incorrect, ambiguous- unambiguous,
and perseverative-nonperseverative.

Correct-Incorrect. The examiner gives the respondent feedback for each response indicating
whether it is correct or incorrect, depending on whether or not the response matches the current
correct sorting principle. Responses that match the current sorting principle are scored as
correct whereas incorrect responses are scored as errors. Correct responses are those items the
examiner numbered in the record booklet during the administration of the WCST-64. After the
administration is completed, the examiner should circle all items that were not numbered
during the administration. Circled (unnumbered) items represent incorrect responses (i.e.
errors).

Ambiguous- Unambiguous. When a response card matches a stimulus card on one and only
one stimulus characteristic (e.g., Color), the principle the respondent used for the match is
obvious and unambiguous (see Glossary in Appendix A) to the examiner. For example, a
response card with three red circles is matched to the stimulus card with a Single red triangle.
However, response cards can match the stimulus card on more than one stimulus dimension.
For example, a response card with three red triangles is matched to the stimulus card with a
single red triangle. In this situation, it is unclear, or ambiguous (see Glossary in Appendix A),
to the examiner whether the respondent is matching on the basis of Color or Form. Simply
stated, a response that matches a stimulus card on one and only one characteristic is said to be
an unambiguous response (e.g., ¢ FN O), and any response that matches a stimulus card on two
or more characteristics is said to be an ambiguous response (e.g. CFNO). Other responses are
also ambiguous because the basis for the response is unclear. The ambiguous-unambiguous
response dimension is independent of whether the response is a correct response or an error
(e.g., it is possible to unambiguously match to a sorting principle that is not currently correct).
Carefully recording all characteristics on which the response card matches the stimulus card
throughout the WCST-64 administration allows the examiner to score this dimension
accurately after the test is completed.

Perseverative-Nonperseverative. When a respondent persists in responding to a stimulus

characteristic that is incorrect, the response is said to match the "perseverated-to" principle and
is scored as perseverative (see Glossary in Appendix A). Respondents may perseverate on
 97

Colour, Form, or Number. However, it is not possible to perseverate to the other category
because the examiner can never be sure of the basis for the match. Once a perseverated-to
principle has been established and is operative, or "in effect," responses that match the
perseverated-to principle are scored as perseverative regardless of whether they are correct or
incorrect. Responses that d not match the perseverated-to principle are non-perseverative.
Perseverative Responses are indicated after completion of the test by entering the letter "p" in
the space to the right of the item in the rec booklet.

Three distinct situations define the perseverated-to principle for scoring Perseverative
Responses:

1. The perseverated-to principle is established at the beginning of the test the first time the
respondent makes an unambiguous error. The first unambiguous error only establishes the
perseverated-to principle and is not scored as perseverative. Any Subsequent unambiguous
error that matches the established perseverated-to principle is scored as perseverative, even if
other responses that do not match this perseverated-to principle intervene in the sequence.
Thus, it is possible to make Perseverative Responses before successfully completing a category.
The respondent sorted the second card, which contains four red crosses, to the stimulus card
with three yellow crosses. This response is an unambiguous error that matches the sorting
principle of Form (i.e., CFNO) and establishes Form as the perseverated-to-principle. Every
time the respondent now makes an unambiguous error to Form (Cards 3 and 4), the response
is scored as perseverative until the perseverated-to principle changes. Figure 4b illustrates this
scoring rule when other responses do not match this perseverated-to-principle intervention
sequence. This respondent made an unambiguous error to the principle of Form on Card 2, but
correctly matched the next four cards to the principle of Color before making the first
Perseverative Response to Form on Card 7.

2. The most common situation in which a respondent makes Perseverative Responses occurs
after the individual completes a category by making 10 consecutive correct matches. Because
the respondent is not aware that the examiner has now changed the sorting principle, he or she
is likely to continue to respond according to the previously correct principle. However, after a
category has been successfully completed and the examiner has changed the sorting principle
the previously correct category now becomes the perseverated-to principle currently in effect.
Although some researchers consider this rule to be "counterintuitive" (Flashman, Horner, and
Freides, 1991, p. 193), the first unambiguous response to match the new perseverated-to
 98

principle (i.e., the previous correct sorting category) is an unambiguous Perseverative Error.
Figure 4c presents an example of scoring according to this rule.

An ambiguous response (C F N O in this example) may also be scored as perseverative when

it meets the first two conditions that ensure that it is part of a consistent pattern of perseverative
responding. A string of two or more consecutive ambiguous responses can be perseverative as
long as they satisfy all three of the following conditions. These conditions apply regardless of
whether the ambiguous response is Correct or incorrect.

a. The ambiguous response must match the perseverated-to principle that is currently in effect
(in our example, Color as defined by the previous sorting category).

b. The nearest unambiguous responses both preceding (Card 11) and following (Card 13) the
ambiguous response (Card 12) must each be perseverative and must match the perseverated-
to principle. This is known as the sandwich rule, in that the ambiguous response must be
"sandwiched" between two unambiguous Perseverative Responses (Flashman et al., 1991, p.
191).

C. For consecutive ambiguous responses to be scored as perseverative, all responses between

the two unambiguous Perseverative Responses must match the perseverated-to principle in
effect. That is, the match to the perseverated- to principle must run continuously throughout all
responses between the two unambiguous Perseverative Responses and must not be broken by
any response that does not match this new perseverated-to principle. An ambiguous response
is scored as perseverative. Ambiguous responses may also be scored as perseverative before
the respondent successfully completes the first category if they meet these same three
conditions. First, the response or responses must match the perseverated-to principle currently
in effect. Next, the response or responses must be preceded and followed (sandwiched) by
unambiguous Perseverative Responses. Finally, the match to the perseverated-to principle must
run continuously throughout all responses between the two unambiguous Perseverative
Responses and must not be broken.

3. The final situation defining a perseverated-to principle occurs when a respondent changes
the principle to which he or she is perseverating That is, it is possible for the perseverated-to-
principle to change within any category of the test when (a) the respondent makes three
unambiguous errors to a sorting principle that is neither correct nor currently perseverative,
and (b) all responses between the first and the third unambiguous error match this sorting
principle. When this situation occurs, the sorting principle running through these three
 99

unambiguous errors becomes the new perseverated-to principle. This new perseverated-to
principle, however, is not operative for scoring purposes until the second unambiguous error
occurs. The responses from a respondent who sorted to Form on Card 2, which establishes
Form as the perseverated-to principle at the beginning of the test. The unambiguous matches
to Form on Cards 4, 7, and 8 are, therefore, scored as Perseverative Errors. However, starting
with Card 9, the respondent makes the next three matches to Number. Because Cards 9, 10,
and 1l are uninterrupted, unambiguous errors to a principle other than Form, Number becomes
the new perseverated-to principle on Card 10. Thus, the responses made on Cards 10 and 11
are scored as Perseverative Errors. Scoring principles for a longer series of Perseverative Errors
where the perseverated-to principle has changed from Form (Card 2) to Number (Card 11). A
more complex scoring situation arises when a string of responses that match the new
perseverated-to principle contains ambiguous responses. Provided that the string contains three
unambiguous errors that match the new perseverated-to principle and is not broken by any
response that does not match the new perseverated-to principle, the second unambiguous
incorrect response in the sequence is scored1 as perseverative. Additionally, all of the
ambiguous responses sandwiched between the second and third unambiguous Perseverative
Errors are also scored as perseverative, regardless of whether they are correct or incorrect. Even
though the ambiguous responses sandwiched between the first and second unambiguous errors
must match the new perseverated-to principle, the new principle is not operative until the
second unambiguous error; therefore, these ambiguous responses are not scored as
perseverative. The respondent makes the first unambiguous error by matching to Form on Card
2 and, thus, makes the first perseverative error on Card 3. However, the respondent then begins
to sort by Number, making the first unambiguous error to Number on Card 5. Card 6 is also an
unambiguous error to Number, as is Card 8, which represents the third unambiguous error that
matches the principle of Number. Because the ambiguous response on Card 7 (C F N O)
matches the principle of Number, the responses from Card 5 to Card 8 all match to Number
without interruption, defining Number as the new perseverated-to principle. Therefore,
beginning with the second unambiguous error in the sequence (i.e., Card 6), responses 6
through 15 are all scored as perseverative. The ambiguous response on Card 7 is also scored as
perseverative, even though it is correct because it is both preceded and followed by
unambiguous Perseverative Errors. The example, is a similar situation, with the first
unambiguous error of the series beginning with the Number response on Card 36. In this case,
the ambiguous response on Card 38 (i.e., ¢FN 0) that separates the second and third
unambiguous incorrect responses is a Perseverative Response. It is also an error and is,
 100

therefore, circled. This Perseverative Response may also be called a Perseverative Error. Card
40 is not scored as perseverative because it does not conform to the sandwich rule. Number of
Categories Completed. The Number of Categories completed is simply the number of
categories (i.e., each sequence of 10 consecutive correct matches to the current sorting
category) that the respondent successfully completed during the test. Typically, the examiner
marks off each category (C F NCF N) as it is successfully completed at the top of the second
page of the record booklet.

Trials to Complete First Category. The total number of trials to successfully complete the first
category gives an indication of the initial conceptualization of the sorting strategy before a shift
of set is also required. The scoring examples presented in Figure 4 show that Respondent "a"
took 16 trials to complete the first category, whereas Respondent "d" took only 10 trials. On
rare occasions, a respondent will be administered all 64 cards without ever successfully
completing the first category. In this case, the respondent receives a Trials to Complete First
Category raw score of 65.

Failure to Maintain Set. A Failure to Maintain Set (see Glossary in Appendix A) occurs when
a respondent makes five or more consecutive correct matches but then makes an error before
successfully completing the category. A Failure to Maintain Set is not scored if, toward the end
of the test, the respondent has matched correctly five or more cards and simply runs out of
cards(i.e., Card 64 is completed).

An example of a respondent who had considerable difficulty maintaining the correct sorting
principle of Color. On Card 2 (not shown), the respondent made an unambiguous error to Form
which established Form as the perseverated-to principle. Despite receiving positive feedback
from the examiner for numerous unambiguous correct matches to Color, this individual was
unable to continue responding consistently according to this principle. Within a series of fewer
than 15 trials, this respondent failed to maintain set two times on Cards 23 and 30.

Conceptual Level Responses. Conceptual Level Responses (see Glossary in Appendix A)

presumably reflect insight into the correct sorting principles. Conceptual Level Responses are
defined as consecutive correct responses occurring in runs of three or more. These responses
are called Conceptual Level Responses because it is presumed that some insight into the correct
sorting strategy is required in order to make three or more consecutive correct matches and that
a correct series of this length would be unlikely to occur by chance alone.
 101

Conceptual Level Responses of an individual who made 33 Conceptual Level Responses across
the 64 cards of the test. Figure 8 presents the data for a respondent who made 35 Conceptual
Level Responses across the 64 cards of the test. Note that Card 59 is scored as a Conceptual
Level Response, although a change in category occurs as Card 59 Learning to Learn. Learning
to Learn (after Tarter, 1973) reflects the respondent's average change in conceptual efficiency
across the consecutive categories of the WCST-64. This measures whether or not a respondent
becomes increasingly proficient in moving from one principle to the next as the test progresses.
Calculating this score requires four steps.

The first step is to determine whether or not a learning-to-learn score can be calculated. This is
accomplished by counting the number of categories that were completed or attempted. A
category is said to have been "attempted" when there are at least 10 trials in the category, even
if the category is not successfully completed. A Learning to Learn score can be calculated only
for individuals who have completed three or more categories or who have completed two
categories and attempted a third (see Figures 7 and 8). Next, a Percent errors score is calculated
for each completed or attempted category (i.e., total errors made within that category the total
number of trials comprising that category X 100). Third, Percent errors difference scores for
each consecutive pair of adjacent categories are then computed. Percent errors difference scores
are calculated by subtracting the Percent errors score for Category 2 (Form) from the Percent
errors score for Category 1 (Color), the Percent errors score for Category 3 (Number) from the
Percent errors score for Category 2 (Form), and so forth. Finally, the Percent errors difference
scores are summed and averaged to yield an average difference, which is the Learning to Learn
raw score.

A positive Learning to Learn score indicates improved efficiency across consecutive

categories, presumably because of learning. Most respondents, however, will obtain a negative
Learning to Learn score because the Percent errors difference score between Category 1 and
Category 2 is included in the calculation. Including this first difference score makes it more
difficult to obtain a positive Learning to Learn score because of the novel difficulty of making
the first shift of set. As such, Learning to Learn scores for the WCST-64 tend to be more
negatively skewed in comparison to the WCST (i.e., there are fewer successive Percent error
difference scores to compensate for a negative Percent errors difference score occurring
between Categories I and 2). However, the normative data take this fact into account (i.e., the
norms reflect how a given respondent's Learning to Learn score compares with those of the
appropriate reference group). Therefore it is possible to identify a relatively good performance
 102

even when the total raw score is negative. Additionally, because this score can be calculated
only for respondents who have completed three or more categories or who have completed two
categories and attempted a third, it is less likely that a Learning to Learn score can be calculated
for the WCST-64 than for the WCST. Figure 7 illustrates the calculations involved in obtaining
the Learning to Learn score. As seen in this figure, the respondent successfully completed three
categories and attempted a fourth, which included only 12 cards. Thus, a Learning to Learn
score can be calculated for this individual. The number of cards comprising each category was
determined and recorded in the appropriate space on the Learning to Learn Score Worksheet
(see Figure 7), along with the number of errors made within each category. Dividing the number
of errors made in each category by the number of cards comprising each category and
multiplying by 100 yields the following four Percent errors scores: 16.67% (2/12), 36.84%
(7/19), 38.10%o (8/21), and 75.00% (9/12). The Percent errors difference scores between
consecutive pairs of adjacent categories are: -20.17 (i.e., 16.67 36.84), -1.26 (i.e., 36.84 38.10),
-36.90 (i.e., 38.10- 75.00). The sum of these Percent errors difference scores equals-58.33,
which results in an average difference, or Learning to Learn raw score, of -19.44 (i.e., -58.33
3). This score clearly indicates that this individual became less, rather than more, efficient on
the consecutive categories of the WCST-64, although the percentile score reveals that this
performance is not unusual for a neurologically normal person.

Calculating WCST-64 Scores:

After reviewing each item and marking errors and Perseverative Responses in the record
booklet as suggested earlier, the WCST-64 scores may be calculated. The third page of the
record booklet provides areas for recording and calculating WCST-64 scores. Total Number
Correct and Total Number of Errors. Count the number of items that the examiner numbered
during the administration. Enter this number in the space provided for the Total Number
Correct Raw score. Count the number of items that were circled, and enter this in the space
provided for the Total Number of Errors raw score. The addition of these two scores will always
equal 64.

Perseverative Responses, Perseverative Errors, and Nonperseverative Errors. Count the

number of items that were marked with the letter "p and enter this raw score in the space
provided for the Perseverative Responses raw score. Count the number of items that were
circled and marked with the letter"p," and enter this number in the space provided for the
Perseverative Errors raw score. Count the number of items that were circled but were not
 103

marked with a "p." Enter this number in the space provided for the- Nonperseverative Errors
raw score. To check scoring accuracy, the sum of the Perseverative errors raw score and the
Nonperseverative Errors raw score should equal the raw score for total Number of Errors.

Conceptual Level Responses. Examine the second page of the record booklet and identify all
consecutive correct responses that Occurred in runs of three or more. Be sure to include
ambiguous correct responses that continue a run across categories. Sum the number of correct
responses occurring within these runs. Enter this sum in the raw score column beside
Conceptual Level Responses. Number of Categories Completed. Count the number of
sequences of 10 consecutive correct matches and enter this raw score in the space provided for
the Number of Categories Completed.

Trials to Complete First Category. Look at the second page of the record booklet. Beginning
with Trial (Card)

1. Count the number of trials (cards) required to complete the first category. In the scoring area,
enter this number in the raw score column for Trials to Complete First Category. In the rare
case where a respondent never successfully completes the first category, Trials to Complete
First Category is assigned a raw score of 65. Failure to Maintain Set. Count the number of
sequences of five or more correct matches followed by at least one error that occurred prior to
successfully completing a category. Enter this number in the space provided for the Failure to
Maintain Set raw score.

Learning to Learn. Determine whether a Learning to Learn score can be calculated by counting
the number of categories that were completed or attempted. If the total Number of Categories
Completed and attempted is fewer than three, a Learning to Learn score cannot be calculated.
In this case, enter "N/A" as the Learning to Learn raw score.

If a Learning to Learn score can be calculated, count the number of trials (cards) comprising
the first category. On the Learning to Learn Score Worksheet, enter this number in the space
for Category 1 in the Number of trials column. Use an analogous procedure to determine the
number of trials comprising the remaining categories and enter these numbers in the
appropriate spaces on the worksheet. Divide errors score for Category 1 by the Number of trials
for Category 1 and multiply the result by 100. Enter this number rounded to the second decimal,
in the space labelled percent errors for category 1. Use an analogous procedure to calculate and
record the Percent errors scores for the remaining categories. Subtract the percent errors score
for category 2 from the percent error scores of categories 1 and enter the result in the space
 104

provided for category number 2 percent errors difference score. Subtract the percent errors
score for category 3 from the percent errors score for category 2 and enter the result in the
space provided for the Category number 3 Percent errors difference score. Sum the Percent
errors difference scores, divide this sum by the number of Percent errors difference scores that
were summed, and round this result to the second decimal. Enter this number in the space
labelled Average difference. Transcribe this Average difference score to the space provided for
the Learning to Learn raw score.
 105

Psychological Report

Socio-demographic details

Name: K.D

Age: 21 years

DOB: 08/06/2003

Sex: Female

Educational qualification: Pursuing MSc. Clinical Psychology degree in KJ

Name of examiner: Shreeya Kurghode

Referred by: Self

Date of reporting: 18.02.2025

Date of testing: 18.02.2025

Source of information: Self

Reliability of information: Adequate & Reliable

Referral question

To administer the Wisconsin Card Sorting Test - 64 (WCST-64) to assess the executive functioning of
the participants.

Evaluation procedure

The Wisconsin consists of two games of 64 cards (in its manual version) each; The cards are
composed by the combination of three kinds of attributes: the shape (triangle, star, cross and
circle), the color (red, blue, green and yellow) and the number (one, two, three or four
elements). The task is to deal the cards according to a criterion, for example, color. When the
subject makes ten consecutive correct answers, he or she gets a category, and from the last one
the classification criteria are changed without prior warning. If the examinee continues
classifying the cards with the criteria of the previous category, the examiner will score in
perseverative errors. The room was well-lit and free of distractions. The participant was made
comfortable and a conversation was carried out to dissipate any pre-test nervousness that the
participant may have felt. Once it was ensured that she was calm and attentive, she was told
that she would perform an interesting task. Thereafter, she was introduced to the assessment
 106

and any doubts she had were addressed. After ensuring she was ready for the test, the same was
administered.

Behavioral observation

The subject was relaxed and comfortable. During the test, she was feeling nervous and found
the test confusing. She was well oriented about surroundings and appropriately groomed.

Rapport establishment: Rapport was built by asking her to relax and sit comfortably. Try to
know about her feelings. Rapport was easily established as the participant was very
cooperative. A friendly conversation was carried out in order to establish rapport. The
participant was clearly vocal about her feelings and clarified her doubts without hesitation. Her
comfort was ensured and the test was administered only after confirming she was ready

Alertness and consciousness: Fully aware, alert and conscious

Attention: Fully attentive

Eye contact: Maintained eye contact

Psychomotor activity: Regular

Speech: Proper

Cooperation: Cooperative

Motivation: Average

Comprehension: Appropriate Comprehension was seen

Problems related to vision/hearing/motor/other: None

Background history

Birth history: The participant was an unplanned baby. The mother was physically, mentally and
emotionally healthy throughout pregnancy. The participant was a full-trimester baby, with no
complications during or before birth. Post-birth she was breastfed.

Type of birth: Natural

Birth cry: Yes

Planned or unplanned: Unplanned

Presence of birth complications: No

 107

Milestones: Normal and adequate

Motor: Walk- 11 months; the participant reported an early achievement of gross motor skills
especially related to walking and running; other fine motor skills were achieved at an
appropriate age.

Cognitive: age appropriate

Speech: age appropriate

Social: fairly sociable

Emotional: the participant was not overly cranky or elated but reported a regular level of
emotional capacity and interaction with others.

Family history:

The participant lives in a nuclear family with her parents and her paternal grandmother.
Participant is a single child. Her father is a corporate worker, her mother is a homemaker. The
participant reported cordial, loving relationships with her family. She is emotionally closest to
her mother. She has lost both her maternal grandparents and paternal grandfather.

Type of family: Nuclear

Family tree:

Presence of mental disorder in the family (if any): None

Educational history:
 108

She completed high school in Goa. She is currently pursuing her Master's in Bangalore. She
reported being an academic achiever throughout her educational years, had been in several
roles of leadership and was involved in extracurricular activities. She maintained positive
relationships with her classmates and friends.
 109

Test Results

The Wisconsin's Card Sorting Test (WCST- 64) was administered to KD, a 21-year-old female
pursuing her Masters in Kristu Jayanti College. The aim of the test was to assess the executive
functioning of the subject.

The participant obtained a raw score of 55 for Total Number of Correct responses. She obtained
a raw score of 9 for Total Number of Errors, with a corresponding standard score of 112, T
score of 58 and a Percentile score of 79. This means that the participant scored better than 79%
of the population who took the same test. In other words, only 21% of people scored equal to
or higher than this participant in terms of total errors made.

The participant obtained a raw score of 4 for Perseverative Responses, with a corresponding
standard score greater than 116, T score and Percentile is 61 and 86 respectively. This means
that the participant scored higher than 61% of the population in terms of perseverative
responses. This suggests that 39% of people scored equal to or higher than this participant in
this aspect.

The participant obtained a raw score of 4 for Perseverative Errors, with a corresponding
standard score of 116, T score of 61 and a Percentile score of 86. This means that the participant
scored higher than 61% of the population in terms of perseverative responses. This suggests
that 39% of people scored equal to or higher than this participant in this aspect.

The participant obtained a raw score of 5 for Non-perseverative Errors, with a corresponding
standard score of 102, T score of 51 and a Percentile score of 55. This means that the participant
scored higher than 51% of the population in terms of non-perseverative responses. This
suggests that 49% of people scored equal to or higher than this participant in this aspect.

The participant obtained a raw score of 51 for Conceptual Level Responses, with a
corresponding standard score of 101, T score of 51 and a Percentile score of 53. The participant
scored better than 51%of the population in conceptual level responses. This suggests that 49%
of people scored equal to or higher than this participant in this aspect.

In Number of Categories Completed, the subject obtained a raw score of 5 and a percentile
greater than 16. The participant's percentile in this category is greater than 16, meaning they
scored higher than at least 16% of the population.
 110

In Trials to Complete First Category, the subject obtained a raw score of 10 and a percentile
greater than 16. The participant's percentile in this category is greater than 16, meaning they
scored higher than at least 16% of the population.

The subject obtained a raw score of 0 in Failure to Maintain Set.

In Learning to Learn, the subject obtained a raw score of (-9.19) and a percentile 11-16. The
participant's score falls within the 11-16 percentile range, indicating they performed better than
11-16% of the population in this category.

Impression and Interpretation

The Wisconsin Card Sorting Test (WCST) results for KD, a 21-year-old female pursuing her
Masters at Kristu Jayanti College, provide valuable insights into her executive functioning
abilities.

Total Number of Correct Responses:

KD obtained a raw score of 55, indicating a reasonably good performance in accurately sorting
cards according to the given criteria.

Total Number of Errors:

KD made 9 errors, resulting in a standard score of 112, T score of 58, and a Percentile score of
79. This means that the participant scored better than 79% of the population who took the same
test. Indicating above average cognitive flexibility.

Perseverative Responses:

KD made 4 perseverative responses, scoring higher than 86% of the population in this aspect.
Above average level of ability in shifting attention away from previous responses.

Perseverative Errors:

KD made 4 perseverative errors, with a percentile score of 86, i.e. she scored higher than 86%
of the population in this aspect This suggests an above average tendency to repeat the same
errors despite feedback or changing task demands.

Non-perseverative Errors:

KD made 5 non-perseverative errors, scoring higher than 55% of the population in this aspect.
This suggests average level in making errors not related to perseveration.
 111

Conceptual Level Responses:

KD scored better than 53% of the population in conceptual level responses, indicating average
level of ability to form new conceptual categories and demonstrating flexibility in abstract
thinking.

Number of Categories Completed:

KD completed 5 categories, scoring higher than at least 16% of the population, suggesting
moderate performance compared to the general population.

Trials to Complete First Category:

KD completed 5 categories, scoring higher than at least 16% of the population, suggesting
moderate performance compared to the general population.

Failure to Maintain Set:

KD scored 0 in Failure to Maintain Set, indicating no difficulties in maintaining cognitive sets

during the test.

Learning to Learn:

KD scored higher than at least 11-16% of the population in this category, indicating moderate
proficiency in learning new strategies or adapting to changing task demands.

Overall, KD's performance on the WCST suggests strengths in areas of executive functioning.
Such as maintaining cognitive sets and learning to learn, cognitive flexibility, perseveration,
and abstract thinking. These findings provide valuable information for understanding KD's
cognitive profile.

The participant's scores were interpreted and was found to have above average score in Total
Number of Errors, Perseverated Responses and Perseverated Errors; average level of
functioning in Non-Perseverated Errors and Conceptual Level Responses. The participant
obtained below average scores in Number of Categories Completed, Trials to Complete First
Category and Learning to Learn.

Summary & Suggestions

KD, a 21-year-old female was administered the Wisconsin's Card Sorting Test (WCST - 64)
and was found to have below average to below average executive functioning and is
neurologically intact.
 112

Lexical Decision-Making Experiment

A lexical decision-making experiment is a widely used method in psycholinguistics and

cognitive psychology to investigate how individuals process and recognize words. In this
experiment, participants are presented with a series of letter strings and are required to decide
as quickly and accurately as possible whether each string is a word (e.g., "apple") or a non-
word (e.g., "bline"). The experiment measures reaction times and accuracy to explore the
underlying mechanisms of word recognition, lexical access, and semantic processing.

Theories on Lexical Decision-Making experiment

Lexical decision-making (LDM) refers to the cognitive process of determining whether a string
of letters is a word or a non-word. Theories explaining lexical decision-making often focus on
how information is processed in the brain, the time taken to recognize words, and the factors
influencing response accuracy and speed. In understanding these mechanisms, various
theoretical models have been proposed.

• Dual-Route Models

Dual-route models suggest that there are two pathways through which words are processed
during a lexical decision task: a direct route and an indirect route. The direct route involves
accessing the mental lexicon directly to verify whether a string of letters corresponds to a
known word, while the indirect route involves using phonological or orthographic rules to
process unfamiliar words (Coltheart, Rastle, Perry, Langdon, & Ziegler, 2001). This model
emphasizes the role of both lexical memory and rule-based processing, depending on the type
of word being processed.

Coltheart et al. (2001) in their "Dual-Route Cascaded Model" (DRC) propose that the direct
route relies on the orthographic representation of words in the lexicon, while the indirect route
relies on a phonological processing system for non-word stimuli.

• Interactive Activation Models

The Interactive Activation Model (IAM) posits that word recognition is based on parallel
processing and involves feedback mechanisms between different levels of representation
(McClelland & Rumelhart, 1981). In this model, word recognition occurs through the
activation of various units that represent letters, bigrams, and words, with top-down influences
 113

from higher-level word representations to lower-level letter representations. This bidirectional

interaction helps to efficiently discriminate between words and non-words.

McClelland and Rumelhart (1981) argue that words are recognized as a result of the
simultaneous activation of units at multiple levels, which then facilitate a fast decision on
whether the letter string is a word.

• Logogen Models

The Logogen Model (Morton, 1969) emphasizes the concept of a "logogen," which is a unit
that stores a representation of a word. According to this model, when a word is encountered, it
activates its corresponding logogen, and once the activation reaches a threshold, the word is
identified. The recognition of words thus depends on the rate of accumulation of activation
within each logogen.

Morton (1969) describes the logogen as a device that accumulates evidence in favor of a word,
which is later compared to the threshold required for recognition. Non-words do not activate
any logogen, leading to a quicker rejection.

• Connectionist Models

Connectionist models like the Semantic Network Model (Collins & Quillian, 1969) suggest
that lexical decision-making is influenced by the structure of the mental lexicon itself. This
model highlights the idea that words are stored in a semantic network, with connections
between concepts based on their meanings. The recognition of words is thought to be faster
when there is greater semantic relatedness between the word and other concepts in the network.

Collins and Quillian (1969) argue that words are stored in nodes, and lexical decisions are
influenced by the semantic distance between the word in question and other related concepts
in the network. The closer the relationship, the quicker the decision.

• Distributional Models

Distributional models propose that word recognition is influenced by statistical properties of

language, specifically the frequency and co-occurrence of words (Luce, 1986). These models
suggest that words that occur more frequently in language are recognized more quickly during
lexical decision tasks. This idea aligns with findings showing that reaction times for high-
frequency words are faster than those for low-frequency words.
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Luce (1986) discusses the Neighbourhood Activation Model (NAM), which posits that
lexical decision-making is influenced by the frequency and similarity of a word's neighbours.
Words with many similar words in their "neighbourhood" are processed faster due to the greater
activation within the lexical neighbourhood.

Applications of Lexical Decision-Making Experiments

Lexical decision-making experiments have wide-ranging applications in psycholinguistics,

cognitive psychology, and clinical research. By measuring response times and accuracy in
distinguishing between words and non-words, researchers can investigate the underlying
mechanisms of language processing and related cognitive functions. Below are key application
areas supported by research findings.

• Understanding Word Recognition and Lexical Access

Lexical decision tasks (LDTs) provide insights into how individuals access the mental lexicon
to recognize words. For example: Word frequency effects observed in LDTs demonstrate that
high-frequency words are processed faster, reflecting the organization and accessibility of the
mental lexicon (Forster & Chambers, 1973). Reaction times and error rates help refine models
of word recognition, such as the dual-route cascaded model (Coltheart et al., 2001).

• Exploring Semantic Processing

LDTs are commonly used to investigate the role of semantics in word recognition: Semantic
priming effects—faster responses to words preceded by semantically related primes (e.g.,
“doctor” and “nurse”)—highlight how words are linked within semantic networks (Meyer &
Schvaneveldt, 1971). Semantic LDTs aid in understanding the structure of these networks and
how word meanings are retrieved during comprehension.

• Studying Bilingualism

LDTs help examine language processing in bilingual individuals: They reveal how lexical
representations from both languages interact. For instance, bilingual participants show cross-
linguistic influences when performing LDTs, providing evidence of shared and distinct lexical
systems (Dijkstra et al., 1998). The experiment is used to test bilingual word recognition
models, such as the Bilingual Interactive Activation Model (Grainger & Dijkstra, 1992).

• Assessing Language Impairments

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Lexical decision-making experiments are useful for diagnosing and understanding language-
related disorders: Dyslexia: Individuals with dyslexia often show delayed reaction times and
increased error rates in LDTs, revealing difficulties in phonological processing and word
recognition (Seymour et al., 2003). Aphasia: LDTs are employed to evaluate lexical retrieval
deficits in aphasic patients, helping clinicians identify specific areas of impairment (Tyler et
al., 2000).

• Cognitive Neuroscience

LDTs have been combined with neuroimaging techniques to explore the neural basis of lexical
processing: Functional MRI (fMRI) and Event-Related Potentials (ERP) studies using LDTs
help identify brain regions involved in word recognition, such as the left inferior frontal gyrus
and temporal regions (Binder et al., 2005). These experiments aid in understanding how neural
activation patterns differ across tasks or in populations with specific conditions.

• Researching Reading Processes

LDTs are integral to studying reading comprehension and development: By comparing the
processing of regular and irregular words, LDTs help test theories of reading, such as dual-
route models of reading aloud (Coltheart et al., 2001). They are also used to study how
orthographic, phonological, and semantic factors influence reading in both children and adults
(Ziegler et al., 2001).

• Examining Individual Differences

Lexical decision-making experiments are used to investigate how individual differences affect
language processing: Reaction times in LDTs are linked to cognitive abilities such as verbal
intelligence and working memory (Yap et al., 2009). Differences in age, education, or cultural
background can also be explored, providing insights into the variability of lexical access and
processing.

Recent Research in the area of Lexical Decision Making

Recent research has significantly advanced our understanding of lexical decision-making,

shedding light on the factors influencing word recognition and the cognitive processes
involved. For instance, Cox et al. (2023) examined the effects of word type (e.g., nouns, verbs)
and frequency on lexical decision performance across age groups. Their findings revealed that
aging influences how word types and frequencies are processed, with older adults showing
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distinct patterns compared to younger individuals. Similarly, Garcia and Willis (2021) explored
how individuals process words and pseudowords in naming and lexical decision tasks, finding
that older adults exhibit longer response times and reduced accuracy, indicating age-related
declines in lexical processing efficiency.

The role of reading fluency was also highlighted in a study by Jones and Robinson (2022), who
observed that middle-school students with higher fluency demonstrated faster and more
accurate lexical decisions, emphasizing fluency's importance in word recognition. Meanwhile,
Smith and Taylor (2024) investigated how joint learning of orthography and semantics
improves lexical categorization during reading. They found that integrating orthographic and
semantic cues enhances reading speed and accuracy, underscoring the value of multi-cue
linguistic training. Finally, Chen et al. (2023) examined the impact of unisensory (visual only)
and multisensory (visual and auditory) information on lexical decision-making. Their findings
revealed that multisensory information significantly improves word recognition speed and
accuracy, highlighting the benefits of sensory integration in lexical processing. Collectively,
these studies provide a comprehensive view of lexical decision-making, considering factors
like age, fluency, linguistic training, and sensory modalities.
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References:

Chen, X., Li, Z., & Wang, J. (2023). The effect of unisensory and multisensory information on
lexical decision-making. Scientific Reports, 13, Article 41791.
[Link]

Coltheart, M., Rastle, K., Perry, C., Langdon, R., & Ziegler, J. C. (2001). DRC: A dual-route
cascaded model of visual word recognition and reading aloud. Psychological Review,
108(1), 204–256. [Link]

Collins, A. M., & Quillian, M. R. (1969). Retrieval of information from semantic memory.
Journal of Verbal Learning and Verbal Behavior, 8(2), 240–247.
[Link]

Cox, D. J., Planchon, J., & Wierenga, C. (2023). Word type and frequency effects on lexical
decisions are processed differently across the adult lifespan. Journal of Cognitive
Neuroscience, 36(10), 2227–2245. [Link]

Dijkstra, T., van Heuven, W. J., & Grainger, J. (1998). Simulating semantic priming in a
bilingual lexicon. Bilingualism: Language and Cognition, 1(1), 51–66.
[Link]

Forster, K. I., & Chambers, S. M. (1973). Lexical access and naming time. Journal of Verbal
Learning and Verbal Behavior, 12(6), 627–635. [Link]
5371(73)80042-8

Garcia, L. E., & Willis, S. (2021). Word or pseudoword? The lexicality effect in naming and
lexical decision tasks across the adult lifespan. PLOS ONE, 16(9), Article e0299266.
[Link]

Jones, M., & Robinson, P. (2022). Examining the impact of reading fluency on lexical decision
performance in middle-school students. Journal of Experimental Child Psychology,
214, Article 105382. [Link]

Luce, P. A. (1986). Neighborhoods of words in the mental lexicon. Psychological Review,

93(1), 56–82. [Link]
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McClelland, J. L., & Rumelhart, D. E. (1981). An interactive activation model of context

effects in letter perception: Part 1. An account of basic findings. Psychological Review,
88(5), 375–407. [Link]

Meyer, D. E., & Schvaneveldt, R. W. (1971). Facilitation in recognizing pairs of words:

Evidence of a dependence between retrieval operations. Journal of Experimental
Psychology, 90(2), 227–234. [Link]

Smith, A. J., & Taylor, E. R. (2024). Investigating lexical categorization in reading based on
joint learning of orthography and semantics. npj Science of Learning, 9(3), Article 237.
[Link]

Tyler, L. K., Marslen-Wilson, W. D., & Stamatakis, E. A. (2000). Differentiating lexical form,
meaning, and structure in the neural language system. Proceedings of the National
Academy of Sciences, 97(12), 6725–6730. [Link]

Yap, M. J., Balota, D. A., Sibley, D. E., & Ratcliff, R. (2009). Individual differences in visual
word recognition: Insights from the English Lexicon Project. Journal of Experimental
Psychology: Human Perception and Performance, 35(3), 745–766.
[Link]

Ziegler, J. C., Perry, C., & Coltheart, M. (2001). The DRC model of visual word recognition
and reading aloud: An extension to German. Psychological Review, 108(3), 662–689.
[Link]
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Methodology

The lexical decision task (LDT) is a procedure used in many cognitive psychology and
psycholinguistics disciplines. The basic procedure involves measuring how quickly people
classify stimuli as words or non-words for making decisions.

Aim: Assess the lexical decision-making capacity of the participant.

Plan: Using lexical decision-making experiment using CogLab 2.0.

Procedure:

Participant was welcomed into the computer lab and was made to sit in front of the screen and
rapport was established and the instructions were given. A window will appear that fills nearly
the entire screen, and a smaller window will appear with abbreviated instructions. Close the
instructions window. Participant can open it again later from the Lab Info. menu.

Press the space bar to start a trial. A small fixation square will appear in the middle of the
screen. Fix on this square. One to four seconds later, a word or nonword will appear above the
fixation square. Decide if the item is a word or a nonword as quickly as possible. Press the /
key if the item is a word. Press the z key if the item is not a word. The item will disappear when
participant press either of these keys, so they will know their response has been recorded.

Two to three seconds later, the next word or nonword will appear. Again, decide if the item is
a word or nonword by pressing the / key or z key as quickly as possible. They will receive
feedback when they respond too quickly (before the item appears), too slowly, or incorrectly.

There are at least 70 total trials. They must classify the items correctly for the trial to count, so
if they find that they are making many classification mistakes, slow down. At the end of the
experiment, the experiment window will close and a new window will appear that displays
your data as a table and a plot (if appropriate) and provides an explanation of the experiment
and results.

Instructions:

“Press the space bar to start the experiment. The screen will go dark, and a small fixation square
will appear in the middle of the screen. Stare at this square. One to four seconds later, a word
or nonword will appear above the fixation square. Decide if the item is a word or a nonword as
quickly as possible. Press the / key (slash) if the item is a word. Press the z key if the item is
not a word. The word will disappear after you make your response and then one to four seconds
 120

later, another word or nonword will appear. For each item, decide if it is a word or nonword
and press the / key or the z key as quickly as possible.

If you find that you are making many classification mistakes, slow down. You will be told if
you make a mistake, and trials with mistakes will be repeated later in the experiment. A trial
will also be counted as a mistake if you respond so quickly that you must have pressed a key
before the word appeared, or you respond so slowly that you must not have been ready”.

1. Make sure that the participant has understood the instructions correctly.

2. Environmental noise should be kept minimal

Discuss the reaction time of the participant in five conditions

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Psychological Report

Socio-demographic details

Name: S.K

Age: 21 years

DOB: 08/06/2003

Sex: Female

Educational qualification: Pursuing MSc. Clinical Psychology degree in KJ

Name of examiner: Shreeya Kurghode

Referred by: Self

Date of reporting: 8.03.2025

Date of testing: 8.03.2025

Source of information: Self

Reliability of information: Adequate & Reliable

Referral question

To assess the lexical decision making of the participant.

Evaluation procedure

Using lexical decision making experiment using CogLab 2.0.

Behavioral observation

The subject was relaxed and comfortable. During the test, she was feeling nervous and found
the test confusing. She was well oriented about surroundings and appropriately groomed.

Rapport establishment: Rapport was built by asking her to relax and sit comfortably. Try to
know about her feelings. Rapport was easily established as the participant was very
cooperative. A friendly conversation was carried out in order to establish rapport. The
participant was clearly vocal about her feelings and clarified her doubts without hesitation. Her
comfort was ensured and the test was administered only after confirming she was ready

Alertness and consciousness: Fully aware, alert and conscious

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Attention: Fully attentive

Eye contact: Maintained eye contact

Psychomotor activity: Regular

Speech: Proper

Cooperation: Cooperative

Motivation: Average

Comprehension: Appropriate Comprehension was seen

Problems related to vision/hearing/motor/other: None

Background history

Birth history: The participant was an unplanned baby. The mother was physically, mentally and
emotionally healthy throughout pregnancy. The participant was a full-trimester baby, with no
complications during or before birth. Post-birth she was breastfed.

Type of birth: Natural

Birth cry: Yes

Planned or unplanned: Unplanned

Presence of birth complications: No

Milestones: Normal and adequate

Motor: Walk- 11 months; the participant reported an early achievement of gross motor skills
especially related to walking and running; other fine motor skills were achieved at an
appropriate age.

Cognitive: age appropriate

Speech: age appropriate

Social: fairly sociable

Emotional: the participant was not overly cranky or elated but reported a regular level of
emotional capacity and interaction with others.

Family history:
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The participant lives in a nuclear family with her parents and her paternal grandmother.
Participant is a single child. Her father is a corporate worker, her mother is a homemaker. The
participant reported cordial, loving relationships with her family. She is emotionally closest to
her mother. She has lost both her maternal grandparents and paternal grandfather.

Type of family: Nuclear

Family tree:

Presence of mental disorder in the family (if any): None

Educational history:

She completed high school in Goa. She is currently pursuing her Master's in Bangalore. She
reported being an academic achiever throughout her educational years, had been in several
roles of leadership and was involved in extracurricular activities. She maintained positive
relationships with her classmates and friends.
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Test Results:

Table No: 1 showing trial by trial data of Lexical Decision Task

Trial Condition RT (ms)

1 Unassociated 907.0
2 Associated 799.0
3 Associated 657.0
4 Nonword-word 987.0
5 Nonword-word 781.0
6 Word-nonword 2159.0
7 Nonwords 1907.0
8 Word-nonword 2457.0
9 Unassociated 830.0
10 Associated 642.0
11 Nonword-word 954.0
12 Unassociated 767.0
13 Unassociated 392.0
14 Associated 531.0
15 Unassociated 486.0
16 Associated 641.0
17 Unassociated 625.0
18 Unassociated 581.0
19 Associated 423.0
20 Associated 485.0
21 Associated 439.0
22 Associated 579.0
23 Unassociated 485.0
24 Unassociated 534.0
25 Nonword-word 719.0
26 Nonwords 1002.0
27 Word-nonword 844.0
28 Word-nonword 876.0
29 Unassociated 595.0
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30 Unassociated 516.0
31 Unassociated 563.0
32 Nonword-word 594.0
33 Nonword-word 641.0
34 Nonwords 970.0
35 Unassociated 1080.0
36 Nonwords 909.0
37 Associated 658.0
38 Word-nonword 814.0
39 Nonwords 922.0
40 Associated 501.0
41 Nonword-word 674.0
42 Associated 689.0
43 Unassociated 548.0
44 Associated 609.0
45 Associated 500.0
46 Nonwords 627.0
47 Word-nonword 955.0
48 Nonwords 799.0
49 Associated 407.0
50 Unassociated 532.0
51 Word-nonword 845.0

Table No 2: Showing summary for lexical decision making

Data Summary

Condition Reaction Time (ms)

Associated words 570.67
Unassociated words 629.40
Word followed by nonword 1278.57
Nonword followed by word 764.29
Two nonwords 1019.43
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The Participant SK, a 21-year-old female postgraduate student studying in Kristu Jayanti
College was brought in to assess the lexical decision-making capacity of the participant through
lexical decision-making experiment using CogLab 2.0. The conditions that are being studied
here are Associated words, Unassociated Words, Word then nonword, Nonword then word and
two nonwords. The reaction time taken in Associated Words Condition by the subject is 570.66
milliseconds, 629.4 milliseconds in Unassociated Words Condition, 1278.57milliseconds in
Word then nonword Condition. The reaction time taken by the subject in Nonword then word
is 764.28 milliseconds and in Two nonwords Condition the reaction time is 1019.42
milliseconds. The words were actually arranged in sequential pairs. Sometimes the pair words
were associated with each other by meaning (e-g., doctor, nurse). Other times the words were
not associated (e.g., doctor, mountain). For other pairs, one or both of the items were not words.
The key result is found by looking at the average reaction times (ms) to the second word,
dependent on the relationship between the word pair. Semantic priming is present then the RT
for associated words is smaller than RT for unassociated words. The fastest of all conditions
were associated words which proves that response times to the second word should be faster
when the second item is a word that is semantically associated to the first item than when it is
unrelated.

Impression & Interpretation:

The lexical decision-making experiment using CogLab 2.0 aimed to assess SK’s ability to make
lexical decisions under various conditions. SK, a 21-year-old female postgraduate student,
participated in the experiment, which included conditions such as Associated Words.
Unassociated Words, Word then Nonword. Nonword then Word, and Two Nonwords.

The results indicate that SK exhibited varying reaction times across different conditions. In the
Associated Words condition, SK demonstrated the fastest reaction time of 570.66 milliseconds,
followed by 629.4 milliseconds in the Unassociated Words condition. This suggests that SK
was quicker to make lexical decisions when the word pairs were semantically associated
compared to when they were unrelated.

Furthermore, in the Word then Nonword condition, SK's reaction time was 1278.57
milliseconds, while in the Nonword then Word condition. it was 764.28 milliseconds. Lastly,
in the Two Nonwords condition, SK's reaction time was 1019.42 milliseconds.

The presence of semantic priming is evident from the results, as indicated by the faster reaction
times for associated words compared to unassociated words. This suggests that SK's lexical
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decision-making process was influenced by the semantic relationship between the word pairs.
The faster reaction times for associated words support the hypothesis that response times to the
second word should be quicker when it is semantically related to the first word.

Overall, SK's performance in the lexical decision-making experiment highlights her ability to
efficiently process and recognize words, particularly when they are semantically associated.
These findings contribute to our understanding of SK's cognitive processes involved in lexical
decision-making and the influence of semantic priming on her reaction times.

Summary & Suggestions:

In this Lexical Decision-Making task, the participant SK, scored fastest in the associated word
with 570.66 milliseconds as reaction time and slowest in word then nonword with 1278.57
milliseconds as reaction time.
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Risky Decision Making

Risk-based decision making allows the uncertainties to be characterized, and integrated into
such activities as planning, crisis prevention and management. The risk-based decision-making
methods form a process by which decisions can be made regarding safety, durability,
serviceability, and compatibility.

Introduction to Risky Decision Making

Decision-making is an integral part of life, ranging from everyday choices like what to eat to
significant decisions like undergoing surgery. The process involves evaluating immediate and
long-term consequences, balancing potential gains and losses, and considering factors that
influence risk-averse or risk-seeking behaviours. Neural mechanisms, particularly in the frontal
lobe and reward pathways, play a crucial role during decision-making.

Psychological disorders such as anxiety, depression, and schizophrenia can significantly impact
decision-making and risk-taking behaviours. Individuals with these conditions face challenges
in evaluating treatment options (e.g., medication, psychotherapy, or surgery) while also
managing everyday decisions. Understanding how decision-making relates to risk-taking
behaviour is essential, especially in the context of mental health. Traditional theories suggest
we make decisions rationally, opting for the choice with the highest expected value. For
instance, when deciding whether to pay to roll a die, one might calculate probabilities and
choose the option with the most favourable outcome.

However, our decisions are not always driven by logic alone. In 1738, Bernoulli introduced the
idea of utility, emphasizing that subjective perceptions of value play a significant role. This
means personal factors—like how much we value a potential gain or fear a loss—can influence
our choices as much as objective calculations. This idea evolved into prospect theory, which
explains how individual circumstances shape decisions.

According to prospect theory, the way we perceive gains and losses depends on our current
situation. For example, someone with only $5 might avoid a $4 gamble, while someone with
$5000 might see the same gamble as worth the risk. Moreover, the way a decision is framed—
whether it highlights potential gains or losses—can profoundly impact whether we lean toward
risk-taking or [Link], decision-making is far more complex than simple calculations. It
is shaped by personal values, current circumstances, and how choices are presented, which
explains why we often make decisions that might not seem entirely rational.
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Introduction to Heuristics and Judgement

Heuristic comes from Greek word meaning "to discover." A heuristic is a problem-solving
approach based on personal experience, helping to simplify decision-making by reducing the
amount of information needed. It streamlines the process by focusing on a limited number of
signals or options. While heuristics can speed up decisions, they can also lead to errors and
biased judgments. A heuristic is a “cognitive shortcut” that enables quick decision-making and
judgments without extensive research or analysis. It plays a crucial role in both problem-
solving and decision-making processes. When we are trying to solve any problem, we turn to
these short cuts so we get to the solution quickly.

Heuristics can help in making decisions and solve problems more quickly, but they’re not
without disadvantages—they can sometimes lead us to overlook better solutions or make
biased judgments. For example, just because something worked before doesn’t mean it will
work every time. Researchers have identified many types of heuristics that guide our thinking.
Some are quite specific, like the "price heuristic," where we assume expensive items are better
quality, or the "outrage heuristic," where our judgment of a crime’s punishment depends on
how shocking it feels. Shah and Oppenheimer point to three big ones—representativeness,
availability, and anchoring and adjustment.

Types of Heuristics

System 1 and System 2: Daniel Kahneman's "dual process" theory divides thinking into two
systems: System 1 and System 2. System 1 is fast, automatic, and effortless, relying on
intuition and associations. It acts like an autopilot, filtering irrelevant information and
handling repetitive tasks. This system simplifies thinking to prevent information overload.
System 2, on the other hand, is slower, deliberate, and effortful, correcting errors and biases
from System 1. It focuses on precision, analytical thinking, and flexibility. Together, these
systems balance efficient, intuitive thinking with reflective, rule-based reasoning.

Availability Heuristic: The availability heuristic refers to judging the likelihood of an event
based on how easily examples come to mind. It assumes that if something is easily recalled, it
is perceived as more important or more likely. This leads decision-makers to rely on recent or
vivid information, skewing judgments. For example, rare but dramatic events like terrorist
attacks or shark attacks are feared more, despite being statistically unlikely. Media coverage
 130

amplifies these events, making them seem more common. As a result, people often
overestimate the likelihood of such events, ignoring more common risks like heart disease or
traffic accidents.

Anchoring and Adjustment Heuristic: The anchoring and adjustment heuristic involves
starting with an initial value or anchor and adjusting it to make estimates. These heuristic
influences decision-making, especially in numerical estimates. For example, a used car
salesman sets a high price to anchor the buyer, making a lower price seem like a better deal. In
the property market, sellers often set high asking prices, affecting buyers' offers. Even when
the price is too high or too low, buyers adjust their offers based on the initial price. This results
in the final price being biased towards the starting value, showing how anchors influence
judgments.

Representativeness heuristics: The representativeness heuristic is a mental shortcut where we

judge the likelihood of an event by comparing it to our mental prototypes or stereotypes. This
leads us to make decisions based on how much something resembles the typical case, often
ignoring other important factors like rules of chance or independence. For example, if someone
is described as shy and orderly, people might assume they're more likely to be a librarian rather
than a farmer, based on the stereotype of librarians. Another example is the gambler’s fallacy,
where people think a coin toss will "even out" after several heads, even though each toss is
independent. This heuristic saves time but can lead to biased thinking and reliance on
stereotypes.

Other heuristics:

• The consistency heuristic involves responding in ways that maintain consistency in

one’s behaviour or decisions.

• The educated guess heuristic allows a person to draw conclusions based on past
experiences without doing thorough research, applying what they’ve observed before
to a new situation.

• The absurdity heuristic is used when encountering an atypical or seemingly

ridiculous situation, where something just doesn’t make sense or seems too far-
fetched to be true.

• The common-sense heuristic is based on practical judgment, relying on simple,

clear-cut reasoning to make decisions when the right answer seems obvious.
 131

• The contagion heuristic leads people to avoid things perceived as bad or

contaminated, like avoiding eggs during a salmonella outbreak due to the belief that
they are contaminated.

Research in the area of Decision Making

An analysis of student decision making for educational recommender systems (Robert &
Tomohito, 2023)

This study conducted by Robert and Tomohito(2023) dives into the challenges students face
when making decisions in self-directed learning projects, offering insights into how technology
can help. Researchers worked with seven students from an engineering school in Japan,
observing how they planned and completed a five-week project. The goal was to uncover what
influenced their choices, how they navigated the process, and where they struggled.

The findings show that students often made decisions based on emotions, personal experience,
and perceived ease, rather than exploring all their options. Many struggled to think creatively
about alternatives (divergent thinking) and had trouble evaluating the best paths forward
(convergent thinking). These challenges sometimes led to decisions that didn’t align with their
goals or potential.

The study highlights how educational recommender systems could step in to bridge these gaps.
By suggesting a broader range of options and simplifying complex decisions, these tools could
help students think more critically and make choices that truly benefit their learning journey.
Instead of just predicting what students might choose, these systems could guide them to better
decisions, tailored to their unique needs and circumstances.
 132

References

Buelow, M. T. (2020). An introduction to risky decision making. In Elsevier eBooks (pp. 3–

13). [Link]

Dale, S. (2015). Heuristics and biases. Business Information Review, 32(2), 93–99.
[Link]

Robert, W. S., & Tomohito, Y. (2023). An analysis of student decision making for educational
recommender systems. Educational Research and Reviews, 18(4), 54–62.
[Link]
 133

Methodology

Aim: To assess the risky decision-making ability of the participant.

Plan: Using COGLAB 2.0 assess the risky-decision making ability of the participant in loss
and gain conditions.

Hypothesis:

The proportion for the gain problems should be smaller than the proportion for the loss
problems.

Materials Required

1. Risky Decision-making test using COGLAB 2.0

2. Writing materials

Variable

Independent variable – gain/loss

Dependent variable-Participant’s response

Procedure

A window will appear where the experimental questions and choices will be presented, and a
smaller window will appear with abbreviated instructions. Close the instructions window.
Participant can open it again later from the Lab Info. menu.

On each trial Participant will be asked to imagine that he/she have just received a bonus of a
certain amount of money. This amount will vary across questions. Participant will see two
options and will be asked which one Participant would prefer. For example, Participant might
see:

Imagine that from your job you get a bonus of $350. You are now faced with a situation where
you must choose one of the following options. Which would you choose?

A: A sure loss of $60

OR

B: 0.4 probability of losing $0 and 0.6 probability of losing $100

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If you pick Option A, you will have a final total of $290 because you are guaranteed to lose
$60. If you pick Option B, you might lose nothing (and keep all $350) but you might lose $100
and end up with only $250. For this example, if you picked Option B you would lose $100 six
times out of ten.

To indicate Participant’s preference, click on the button that corresponds to the option that you
think is best. If Participant prefer Option A, click on the A button. If Participant prefer Option
B, click on the B button. In making decision, try to imagine what the money would actually be
worth to Participant. For example, if Participant owe a threatening loan shark $290, perhaps it
is better to pick the riskless situation (Option A) so that you are certain to be able to completely
pay off the debt. On the other hand, if Participant really need $350, and having $290 will not
suffice, perhaps it is better to take the risky option (Option B) and hope you keep all the money.
Participant should make the decision relative to your real-world situation (which is hopefully
not so stressful). Some people will like Option A best and some will like Option B best; there
are no absolutely correct answers.

Other trials include options with gains instead of losses of money. The starting amount of
money, the loss or gain amounts, and the probabilities vary across trials. After you make your
choice, click on the Next trial button to start the next trial. There are a total of 12 trials.

At the end of the experiment, the experiment window will close and a new window will appear
that displays your data as a table and a plot (if appropriate) and provides an explanation of the
experiment and results.

Instructions

“Start a trial by clicking on the Next trial button. You will be given a scenario and asked to
choose between two options.

Click on the A button if you prefer Option A.

Click on the B button if you prefer Option B.”

Experimental Control

1. Make sure that the participant has understood the instructions properly

2. External noise or disturbances has to be avoided.

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Psychological Report

Socio-demographic details

Name: S.K

Age: 21 years

DOB: 08/06/2003

Sex: Female

Educational qualification: Pursuing MSc. Clinical Psychology degree in KJ

Name of examiner: Samruddhi Surve

Referred by: Self

Date of reporting: 8.03.2025

Date of testing: 8.03.2025

Source of information: Self

Reliability of information: Adequate & Reliable

Referral question

To assess the visual working memory of the participant by administering Benton Visual
Retention Test.

Evaluation procedure

Examiner provides an interval between the encoding process & execution of the drawing. It
requires the examinee to retain the percept for a brief period of time. With the administration
the examinee views each design for 10 seconds. After a delay of 15 seconds, he or she
reproduces the design from memory. The room was well-lit and free of distractions. The
participant was made comfortable and a conversation was carried out to dissipate any pre-test
nervousness that the participant may have felt. Once it was ensured that she was calm and
attentive, she was told that she would perform an interesting task. Thereafter, she was
introduced to the assessment and any doubts she had were addressed. After ensuring she was
ready for the test, the same was administered.

Behavioral observation
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The subject was relaxed and comfortable. During the test, she was feeling nervous and found
the test confusing. She was well oriented about surroundings and appropriately groomed.

Rapport establishment: Rapport was built by asking her to relax and sit comfortably. Try to
know about her feelings. Rapport was easily established as the participant was very
cooperative. A friendly conversation was carried out in order to establish rapport. The
participant was clearly vocal about her feelings and clarified her doubts without hesitation. Her
comfort was ensured and the test was administered only after confirming she was ready

Alertness and consciousness: Fully aware, alert and conscious

Attention: Fully attentive

Eye contact: Maintained eye contact

Psychomotor activity: Regular

Speech: Proper

Cooperation: Cooperative

Motivation: Average

Comprehension: Appropriate Comprehension was seen

Problems related to vision/hearing/motor/other: None

Background history

Birth history: The participant was an unplanned baby. The mother was physically, mentally and
emotionally healthy throughout pregnancy. The participant was a full-trimester baby, with no
complications during or before birth. Post-birth she was breastfed.

Type of birth: Natural

Birth cry: Yes

Planned or unplanned: Unplanned

Presence of birth complications: No

Milestones: Normal and adequate

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Motor: Walk- 11 months; the participant reported an early achievement of gross motor skills
especially related to walking and running; other fine motor skills were achieved at an
appropriate age.

Cognitive: age appropriate

Speech: age appropriate

Social: fairly sociable

Emotional: the participant was not overly cranky or elated but reported a regular level of
emotional capacity and interaction with others.

Family history:

The participant lives in a nuclear family with her parents and her paternal grandmother.
Participant is a single child. Her father is a corporate worker, her mother is a homemaker. The
participant reported cordial, loving relationships with her family. She is emotionally closest to
her mother. She has lost both her maternal grandparents and paternal grandfather.

Type of family: Nuclear

Family tree:

Presence of mental disorder in the family (if any): None

Educational history:
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She completed high school in Goa. She is currently pursuing her Master's in Bangalore. She
reported being an academic achiever throughout her educational years, had been in several
roles of leadership and was involved in extracurricular activities. She maintained positive
relationships with her classmates and friends.
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Test Results

The Participant SK, a 21-year-old female postgraduate student studying in Kristu Jayanti
College was brought in to assess the risky decision-making capacity of the participant in loss
and gain conditions using risky decision-making Cog Lab 2.0. The number of times risky
decision were taken in gain problems was 0 times and the number of times risky decision taken
in loss problems was 1. The proportion of risky choices in gain problems were found out to be
0.0 and loss problems were found out to be 1.0. Past research has shown that people treat risk
differently for choices involving gains than for choices involving losses. In particular, when
the choices are gains, people tend to be risk-avoiding. That is, they prefer a sure gain to a risky
(probabilistic) gain. On the other hand, people tend to be risk-seeking when the choices involve
losses. That is, they prefer a risky loss (that might lead to no loss at all) than a sure loss of a
certain amount. The hypothesis which says that the proportion for the gain problems should be
smaller than the proportion for the loss problems is hence proved.

Table No. 1: Showing scores of the subject for risky decision making

Trial Problem Type Expected amount Set up Prob. Responses

after choice amount Gain/Loss $0
1 Loss 721.0 1057.0 0.2 Risky
2 Loss 959.0 1219.0 0.2 Risky
3 Gain 1815.0 986.0 0.1 Riskless
4 Gain 721.0 385.0 0.2 Riskless
5 Loss 1025.0 1361.0 0.1 Risky
6 Gain 590.0 315.0 0.3 Riskless
7 Gain 324.0 187.0 0.3 Riskless
8 Gain 1025.0 689.0 0.1 Riskless
9 Loss 590.0 865.0 0.3 Risky
10 Loss 1815.0 2644.0 0.1 Risky
11 Gain 959.0 699.0 0.2 Riskless
12 Loss 324.0 461.0 o.3 Risky
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TableNo. 2: Data summary

Question frame type Proportion of risky choice selected

Gain 0.0
Loss 1.0

Impression & Interpretation:

The assessment aimed to evaluate S. K’s risky decision-making capacity in both gain and loss
conditions using the Cog Lab 2.0 risky decision-making task. In gain problems, SK made risky
decisions three times, while in loss problems. she made zero risky decisions. The proportion of
risky choices in gain problems was calculated to be 0.0, while in loss problems, it was 1.0.

The results suggest that SK's decision-making behavior aligns with previous research findings,
which indicate that people tend to treat risk differently depending on whether the choices
involve gains or losses. Specifically, individuals typically exhibit risk-averse behavior in gain
situations, preferring a sure gain over a risky one. Conversely, in loss situations, individuals
tend to be risk-seeking, opting for a risky choice that may result in no loss rather than accepting
a certain loss.

In SK's case, the proportion of risky choices in gain problems was indeed smaller than in loss
problems, contradicting the hypothesis that the proportion for gain problems should be larger.
This indicates that SK's decision-making behavior follows the expected pattern, demonstrating
risk-averse tendencies in gain situations and risk-seeking tendencies in loss situations
understanding of risk and a tendency to make decisions in line with expected behavioral.

Overall, SK's performance on the risky decision-making task suggests a nuanced patterns based
on the nature of the outcomes (gains vs. losses). These findings provide valuable insights into
SK's decision-making processes and may have implications for understanding her behavior in
various real-life contexts.

Summary & Suggestions:

In this Risky Decision-making task, the participant S.K., has 0.0 proportion of risky choices in
Gain problems and 1.0 proportion of risky choices in gain problems which accepts the
hypothesis.