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The Other Side of the Bell Curve: Multivariate Base Rates of High Scores on the Delis-Kaplan Executive Function System

  • Justin E. Karr (a1) (a2) (a3) (a4), Mauricio A. Garcia-Barrera (a5), James A. Holdnack (a6) and Grant L. Iverson (a2) (a3) (a4)

Abstract

Objective:

Previous researchers have examined the frequency at which healthy participants obtain one or more low scores on neuropsychological test batteries, proposing five psychometric principles of multivariate base rates: (a) low scores are common, with their frequency contingent on (b) the low score cutoff used, (c) the number of tests administered/interpreted, and (d) the demographic characteristics and (e) intelligence of participants. The current study explored whether these principles applied to high scores as well, using the Delis-Kaplan Executive Function System (D-KEFS).

Method:

Multivariate base rates of high scores (≥75th, ≥84th, ≥91st, ≥95th, and ≥98th percentiles) were derived for a three-test, four-test, and full D-KEFS battery, using the adult portion of the normative sample (aged 16–89 years; N = 1050) stratified by education and intelligence. The full D-KEFS battery provides 16 total achievement scores (primary indicators of executive function).

Results:

High scores occurred commonly for all batteries. For the three-test battery, 24.1% and 12.4% had 1 or more scores ≥95th percentile and ≥98th percentile, respectively. High scores occurred more often for longer batteries: 61.6%, 72.9%, and 87.8% obtained 1 or more scores ≥84th percentile for the three-test, four-test, and full batteries, respectively. The frequency of high scores increased with more education and higher intelligence.

Conclusions:

The principles of multivariate base rates also applied to high D-KEFS scores: high scores were common and contingent on the cutoff used, number of tests administered/interpreted, and education/intelligence of examinees. Base rates of high scores may help clinicians identify true cognitive strengths and detect cognitive deficits in high functioning people.

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Copyright

Corresponding author

*Correspondence and reprint requests to: Justin E. Karr, 79/96 Thirteenth Street, Charlestown Navy Yard, Charlestown, MA 02129, USA. E-mail: jkarr1@mgh.harvard.edu

References

Hide All
Baron, I.S. (2004). Delis-Kaplan Executive Function System. Child Neuropsychology, 10(2), 147152. doi: 10.1080/09297040490911140
Binder, L.M., Iverson, G.L., & Brooks, B.L. (2009). To err is human: “Abnormal” neuropsychological scores and variability are common in healthy adults. Archives of Clinical Neuropsychology, 24(1), 3146. doi: 10.1093/arclin/acn001
Brooks, B.L., Holdnack, J.A., & Iverson, G.L. (2011). Advanced clinical interpretation of the WAIS-IV and WMS-IV: Prevalence of low scores varies by level of intelligence and years of education. Assessment, 18(2), 156167. doi: 10.1177/1073191110385316
Brooks, B.L., Iverson, G.L., Feldman, H.H., & Holdnack, J.A. (2009a). Minimizing misdiagnosis: Psychometric criteria for possible or probable memory impairment. Dementia and Geriatric Cognitive Disorders, 27(5), 439450. doi: 10.1159/000215390
Brooks, B.L., Iverson, G.L., & Holdnack, J.A. (2013). Understanding and using multivariate base rates with the WAIS-IV/WMS-IV. In Holdnack, J.A., Drozdick, L.W., Weiss, L.G., & Iverson, G.L. (Eds.), WAIS-IV, WMS-IV, and ACS: Advanced Clinical Interpretation (pp. 75102). San Diego, CA: Elsevier Science. doi: 10.1016/B978-0-12-386934-0.00002-X
Brooks, B.L., Iverson, G.L., Holdnack, J.A., & Feldman, H.H. (2008). Potential for misclassification of mild cognitive impairment: A study of memory scores on the Wechsler Memory Scale-III in healthy older adults. Journal of the International Neuropsychological Society, 14(3), 463478. doi: 10.1017/S1355617708080521
Brooks, B.L., Iverson, G.L., Lanting, S.C., Horton, A.M., & Reynolds, C.R. (2012). Improving test interpretation for detecting executive dysfunction in adults and older adults: Prevalence of low scores on the Test of Verbal Conceptualization and Fluency. Applied Neuropsychology: Adult, 19(1), 6170. doi: 10.1080/09084282.2012.651951
Brooks, B.L., Iverson, G.L., & White, T. (2007). Substantial risk of “Accidental MCI” in healthy older adults: Base rates of low memory scores in neuropsychological assessment. Journal of the International Neuropsychological Society, 13(3), 490500. doi: 10.1017/S1355617707070531
Brooks, B.L., Iverson, G.L., & White, T. (2009b). Advanced interpretation of the neuropsychological assessment battery with older adults: Base rate analyses, discrepancy scores, and interpreting change. Archives of Clinical Neuropsychology, 24(7), 647657. doi: 10.1093/arclin/acp061
Brooks, B.L., Sherman, E.M.S., & Iverson, G.L. (2010). Healthy children get low scores too: Prevalence of low scores on the NEPSY-II in preschoolers, children, and adolescents. Archives of Clinical Neuropsychology, 25(3), 182190. doi: 10.1093/arclin/acq005
Chodosh, J., Reuben, D.B., Albert, M.S., & Seeman, T.E. (2002). Predicting cognitive impairment in high-functioning community-dwelling older persons: MacArthur studies of successful aging. Journal of the American Geriatrics Society, 50(6), 10511060. doi: 10.1046/j.1532-5415.2002.50260.x
Cook, N.E., Karr, J.E., Brooks, B.L., Garcia-Barrera, M.A., Holdnack, J.A., & Iverson, G.L. (2018). Multivariate base rates for the assessment of executive functioning among children and adolescents. Child Neuropsychology, 25(6), 836858. doi: 10.1080/09297049.2018.1543389
Crawford, J.R., Garthwaite, P.H., & Gault, C.B. (2007). Estimating the percentage of the population with abnormally low scores (or abnormally large score differences) on standardized neuropsychological test batteries: A generic method with applications. Neuropsychology, 21(4), 419430. doi: 10.1037/0894-4105.21.4.419
Crawford, J.R., Garthwaite, P.H., Sutherland, D., & Borland, N. (2011). Some supplementary methods for the analysis of the Delis-Kaplan Executive Function System. Psychological Assessment, 23(4), 888898. doi: 10.1037/a0023712
Davis, F.B. (1959). Interpretation of differences among averages and individual test scores. Journal of Educational Psychology, 50(4), 162170. doi: 10.1037/h0044024
Deary, I.J., Starr, J.M., & MacLennan, W.J. (1998). Is age kinder to the initially more able?: Differential ageing of a verbal ability in the healthy old people in Edinburgh study. Intelligence, 26(4), 357375. doi: 10.1016/S0160-2896(99)00005-7
Delis, D.C., Kaplan, E., & Kramer, J.H. (2001). The Delis-Kaplan Executive Function System: Technical manual. San Antonio, TX: The Psychological Corporation.
Heled, E., Hoofien, D., Margalit, D., Natovich, R., & Agranov, E. (2012). The Delis-Kaplan Executive Function System sorting test as an evaluative tool for executive functions after severe traumatic brain injury: A comparative study. Journal of Clinical and Experimental Neuropsychology, 34(2), 151159. doi: 10.1080/13803395.2011.625351
Holdnack, J.A., Tulsky, D.S., Brooks, B.L., Slotkin, J., Gershon, R., Heinemann, A.W., & Iverson, G.L. (2017). Interpreting patterns of low scores on the NIH toolbox cognition battery. Archives of Clinical Neuropsychology, 32(5), 574584. doi: 10.1093/arclin/acx032
Homack, S., Lee, D., & Riccio, C.A. (2005). Test review: Delis-Kaplan executive function system. Journal of Clinical and Experimental Neuropsychology, 27(5), 599609. doi: 10.1080/13803390490918444
Huey, E.D., Goveia, E.N., Paviol, S., Pardini, M., Krueger, F., Zamboni, G., Tierney, M C., Wassermann, E.M., & Grafman, J. (2009). Executive dysfunction in frontotemporal dementia and corticobasal syndrome. Neurology, 72(5), 453459. doi: 10.1212/01.wnl.0000341781.39164.26
Ivins, B.J., Lange, R.T., Cole, W.R., Kane, R., Schwab, K.A., & Iverson, G.L. (2015). Using base rates of low scores to interpret the ANAM4 TBI-MIL battery following mild traumatic brain injury. Archives of Clinical Neuropsychology, 30(1), 2638. doi: 10.1093/arclin/acu072
Karr, J.E., Garcia-Barrera, M.A., Holdnack, J.A., & Iverson, G.L. (2017). Using multivariate base rates to interpret low scores on an abbreviated battery of the Delis-Kaplan Executive Function System. Archives of Clinical Neuropsychology, 32(3), 297305. doi: 10.1093/arclin/acw105
Karr, J.E., Garcia-Barrera, M.A., Holdnack, J.A., & Iverson, G.L. (2018). Advanced clinical interpretation of the Delis-Kaplan Executive Function System: Multivariate base rates of low scores. The Clinical Neuropsychologist. doi: 10.1080/13854046.2017.1334828
McKinlay, A., Grace, R.C., Dalrymple-Alford, J.C., & Roger, D. (2010). Characteristics of executive function impairment in Parkinsons disease patients without dementia. Journal of the International Neuropsychological Society, 16(2), 268277. doi: 10.1017/S1355617709991299
Mistridis, P., Egli, S.C., Iverson, G.L., Berres, M., Willmes, K., Welsh-Bohmer, K.A., & Monsch, A.U. (2015). Considering the base rates of low performance in cognitively healthy older adults improves the accuracy to identify neurocognitive impairment with the Consortium to Establish a Registry for Alzheimer’s Disease-Neuropsychological Assessment Battery. European Archives of Psychiatry and Clinical Neuroscience, 265(5), 407417. doi: 10.1007/s00406-014-0571-z
Oakes, H., Lovejoy, D., Tartar, S., & Holdnack, J.A. (2013). Understanding index and subtest scatter in healthy adults. In Holdnack, J.A., Drozdick, L.W., Weiss, L.G., & Iverson, G.L. (Eds.), WAIS-IV, WMS-IV, and ACS: Advanced clinical interpretation (pp. 103169). San Diego, CA: Elsevier Science. doi: 10.1016/B978-0-12-386934-0.00003-1
Palmer, B.W., Boone, K.B., Lesser, I.M., & Wohl, M.A. (1998). Base rates of “impaired” neuropsychological test performance among healthy older adults. Archives of Clinical Neuropsychology, 13(6), 503511. doi: 10.1016/S0887-6177(97)00037-1
Rabin, L.A., Paolillo, E., & Barr, W.B. (2016). Stability in test-usage practices of clinical neuropsychologists in the United States and Canada over a 10-Year Period: A follow-up survey of INS and NAN members. Archives of Clinical Neuropsychology, 31(3), 206230. doi: 10.1093/arclin/acw007
Scarmeas, N., & Stern, Y. (2004). Cognitive reserve: Implications for diagnosis and prevention of Alzheimer’s disease. Current Neurology and Neuroscience Reports, 4(5), 374380. doi: 10.1007/s11910-004-0084-7
Schretlen, D.J., Testas, S.M., Winicki, J.M., Pearlson, G.D., & Gordon, B. (2008). Frequency and bases of abnormal performance by healthy adults on neuropsychological testing. Journal of the International Neuropsychological Society, 14(3), 436445. doi: 10.1017/S1355617708080387
Shunk, A.W., Davis, A.S., & Dean, R.S. (2006). Review of Delis-Kaplan Executive Function System (D-KEFS). Applied Neuropsychology, 13(4), 275–27. doi: 10.1207/s15324826an1304_9
Strong, C.A.H., Tiesma, D., & Donders, J. (2011). Criterion validity of the Delis-Kaplan Executive Function System (D-KEFS) fluency subtests after traumatic brain injury. Journal of the International Neuropsychological Society, 17(2), 230237. doi: 10.1017/S1355617710001451
Swanson, J. (2005). The Delis-Kaplan Executive Function xSystem: A Review. Canadian Journal of School Psychology. doi: 10.1177/0829573506295469
The Psychological Corporation. (1999). Wechsler Abbreviated Scale of Intelligence. San Antonio, TX: Psychological Corporation.

Keywords

The Other Side of the Bell Curve: Multivariate Base Rates of High Scores on the Delis-Kaplan Executive Function System

  • Justin E. Karr (a1) (a2) (a3) (a4), Mauricio A. Garcia-Barrera (a5), James A. Holdnack (a6) and Grant L. Iverson (a2) (a3) (a4)

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