N

NEPSY-II child, rather than differences in normative groups

of various tests. Additionally, however, NEPSY-II
Sally L. Kemp tests can be administered individually, because
University of Missouri, Columbia, MO, USA tests were normed without order effects. Domain
scores were dropped from NEPSY-II. The change
in expressing the results emphasizes the clinical
Synonyms utility and quality of subtest performance, rather
than global performance levels. More definitive
Developmental neuropsychological assessment; scores are available to aid diagnosis and global
NEPSY scores do not wash out intra-domain differences.
Scores are expressed on the subtest level: pri-
mary scores represent the global aspects or key
Description clinical variables of the subtest. Combined scores
are total scores for a subtest derived by combining
NEPSY-II (Korkman et al. 2007) is the revised two measures within the subtest (e.g., completion
edition of the NEPSY, Developmental Neuropsy- time and errors on the inhibition naming score).
chological Assessment published originally in Process scores assess more specific abilities,
1998 (Korkman et al. 1998). NEPSY assessed skills, or error rates that provide additional insight
children aged 3.0–12.11 in five functional into a child’s abilities. Contrast scores are
domains: attention/executive function, language, designed to allow the clinician to compare statis-
sensorimotor, visuospatial, and learning/memory. tically higher to lower cognitive functions, and
The domains were theoretically, not statistically, behavioral observations are quantitative scores
derived. The NEPSY had the advantage of for behaviors observed during the assessment.
co-normed subtests, allowing scores to be com- Recommended batteries of 7–19 subtests for
pared to one another in a test profile. specific referral questions are provided on
The NEPSY-II includes 32 subtests, four that NEPSY-II. One battery provides a general survey
were not re-normed from the original NEPSY, and across domains (General Assessment Battery)
four delayed tasks. It assesses a wider age range of when the exact nature of the problem is vague.
children (aged 3–16 years) than did the NEPSY. Other referral batteries address specific diagnostic
A new domain, social perception, has also been questions without over-testing. (Referral batteries
added. NEPSY-II tests are co-normed on the same include learning differences – reading or mathe-
population, as were NEPSY subtests, so that dif- matics, attention/concentration, behavior man-
ferences seen should be real differences for the agement, language delays/disorders, perceptual
# Springer International Publishing AG 2018
J. Kreutzer et al. (eds.), Encyclopedia of Clinical Neuropsychology,
https://doi.org/10.1007/978-3-319-56782-2_1575-3
2 NEPSY-II

and/or motor delays/disorders, school readiness, Language Domain tests assess phonological
and social perception.) processing; the ability to repeat nonsense words,
A clinician should be familiar with basic neu- name or identify body parts, quickly access names
ropsychological principles and well versed in for printed stimuli, display verbal semantic and
pediatric psychopathology and neurology when phonemic fluency, and produce rhythmic oral
using the NEPSY-II. The aim is to diagnose sequences, as well as comprehension of oral
neurocognitive disorders stemming from neuro- instructions.
logical, developmental, or neuropsychiatric con- Memory and Learning Domain tests assess
ditions. NEPSY-II performance helps the clinician both verbal and nonverbal memory: immediate
understand a child’s cognitive processing, memory for sentences, narrative memory under
strengths and weaknesses, and performance rela- free recall, cued recall, and recognition condi-
tive to same-age peers, as well as how to make tions; repetition and recall of words presented
intervention recommendations for school, home, with interference; and immediate and delayed
and social contexts. memory for abstract designs, faces, names, and
For selected NEPSY-II subtests, Q-interactive lists.
assessment administration is now available. Sensorimotor Domain tests assess the ability to
Q-interactive assessment uses two iPads that talk imitate static hand positions, to produce repetitive
to each other via Blue Tooth connection. One and sequential finger movements, and to repro-
tablet is used to administer instructions, record duce rhythmic sequential hand movements, as
and score responses, take notes, and control visual well as the ability to use a pencil with speed and
stimuli. The client uses the other to view and precision.
respond to stimuli. Testing time can be reduced Social Perception Domain tests assess the fol-
up to 30% (Pearson 2013). Presently, you can lowing subcomponents of social perception:
administer the following subtests on the facial affect recognition and the ability to compre-
Q-interactive platform: hend others’ perspectives, intentions, and beliefs
(i.e., theory of mind). The Memory for Faces test
Attention & Executive Functioning Domain: from the Memory and Learning Domain also
Animal sorting, inhibition complements the Social Perception subtests.
Language Domain: Word generation Visuospatial Domain tests assess visuospatial
Memory and Learning Domain: Memory for processing through the ability to judge line orien-
Design tation, copy two-dimensional geometric figures,
Sensorimotor Domain: Fingertip tapping reconstruct three-dimensional designs from a
Visuospatial Processing Domain: Design copy- model or picture, and mentally rotate objects.
ing, picture puzzles Also assessed is the ability to deconstruct a picture
into its constituent parts, recognize part-whole
relationships, and use a small schematic map to
locate a target on a larger schematic map.
NEPSY-II Domains

Attention and Executive Functioning Domain

Historical Background
tests assess the following subcomponents of atten-
tion and executive functioning: inhibition of auto-
Development of NEPSY, Developmental
matic and learned responses, monitoring, and self-
Neuropsychological Assessment
regulation; vigilance; selective and sustained
The Finnish NEPSY was originally developed as
attention; the capacity to establish, maintain, and
a brief clinical instrument by Marit Korkman
change a response set; nonverbal problem solv-
(1980) using Luria’s principles to assess young
ing; planning and organizing a complex response;
children of age 5–6 years in five functional
and figural fluency.
domains.
NEPSY-II 3

Development of the American NEPSY began geographical region. A further 260 children with
in 1987 with the collaboration of Marit Korkman, clinical diagnoses participated and 1060 concur-
Ursula Kirk, and Sally Kemp. Following national rent validity cases were collected. After all stan-
tryouts (1990–1994), and standardization and val- dardization and validation data were reviewed, the
idation phases (1994–1996), NEPSY, a Develop- final selection of subtests for each of the six func-
mental Neuropsychological Assessment was tional domains was made. Subtests were selected
published in January 1998 (Korkman et al. for each referral battery and scores were derived.
1998). A corresponding version of NEPSY for This final evaluative stage produced a comprehen-
children aged 3–12.11 was published in Finland sive and reliable instrument.
(Korkman et al. 1997) and in 2000 a Swedish
version was published.
Psychometric Data
Revision and Development of NEPSY-II
The initial process of revising the 1998 US
The reliability procedures used in NEPSY-II vary
NEPSY began in the fall of 2003. Four revision
among the subtests based on the properties of the
goals for the NEPSY-II were formulated: (1) to
subtest. Reliability coefficients were obtained uti-
improve domain coverage, (2) to enhance clinical
lizing the split-half and alpha methods. Stability
and diagnostic utility, (3) to improve psychomet-
coefficients and decision-consistency procedures
ric properties, and (4) to enhance usability and
were used when the above methods were not
ease of administration. The NEPSY-II was devel-
appropriate. Along with statistical significance
oped in three phases: a pilot (2004), a tryout
and p values, effect sizes are reported as evidence
(2005), and a national standardization and valida-
of reliability and validity. Most NEPSY-II subtests
tion phase (2005–2006) with publication in the
have adequate to high internal consistency or sta-
spring of 2007 (Korkman et al. 2007). In October
bility. Values that range from 0.20 to 49 are
2008, after standardization and validation phases
reported as small effect sizes, from 0.50 to 0.79
were completed in Finland, a corresponding ver-
as moderate effect sizes, and values of 80 and
sion of NEPSY-II was published there (Korkman
greater are reported as large effect sizes. Reliabil-
et al. 2008).
ity coefficients are provided in the NEPSY-II
During the NEPSY-II revision, new subtests
Clinical and Interpretative Manual (Korkman
were designed and piloted. Subtests with poor
et al. 2007, pp. 54–59) for all subtest primary
reliabilities were deleted or revised. Floor and
and process scores. The highest reliability coeffi-
ceiling problems were addressed by the addition
cients are seen in Table 1 across four age bands.
of easier and more difficult items. Data analyses
The reliability for special groups supports the
were conducted to evaluate psychometric proper-
generalizability of the instrument. A sample of
ties of the subtests and to identify administration
260 children diagnosed with one of the following
and scoring problems. Review also raised the
disorders was collected: ADHD, Asperger’s dis-
question of expanding the age range to 16 years.
order, autistic disorder, emotional disturbance,
Final revisions and modifications of the subtests
deaf and hard of hearing, language disorder, math-
were completed. For those few 1998 NEPSY sub-
ematics disorder, reading disorder, intellectually
tests in which normative changes were not
disabled (i.e., mental retardation), and traumatic
expected based on the Flynn effect (Flynn 1984,
brain injury. Most reliabilities were high as can be
1987) or changes in the population (e.g., most
seen in Table 2 showing reliability coefficients of
Sensorimotor subtests), the decision was made
selected NEPSY-II primary and process scaled
not to renorm.
scores for special groups.
The standardization version of NEPSY-II was
administered to 1200 typical children aged 3–16.
The normative sample was stratified by age, sex,
race/ethnicity, parent education level, and
4 NEPSY-II

NEPSY-II, Table 1 NEPSY-II subtests with highest reliability coefficientsa across four age bands in the normative
sample
Average r by age bandb
Subtest scores 3–4 years 5–6 years 7–12 years 13–16 years
Comprehension of instructions Total Score 0.86 0.82 0.75 0.64
Sentence Repetition Total Score 0.89 0.87 – –
Phonological Processing Total Score 0.88 0.92 0.86 0.66
FT Sequences Combined Scaled Score – 0.84 0.98 0.92
Imitating Hand Positions (IH) Total Score 0.89 0.82d 0.82d –
List Memory and LM Delayed (LM and LMD) Total – – 0.91 –
Memory forames Total Score 0.80d 0.80d 0.81
Design Copying Total Score 0.88 0.85 0.78 0.82
Picture Puzzles Total Score – – 0.85 0.81
a
Internal consistency (alpha or split-half reliability) coefficients are reported unless otherwise indicated
b
Average reliability coefficients calculated with Fisher’s z transformations
c
All composite (combined and contrast) scores scaled score reliabilities are based on decision consistency of classification
d
Average reliability coefficients were calculated for 5–12 years

NEPSY-II, Table 2 Reliability coefficients of selected NEPSY-II primary and process scaled scores for special groups
Average r by age bands
Subtest scores 5–6 years 7–12 years
Attention and Executive Functioning
Clocks (CL) Total Score – 0.88
Inhibition (IN) Naming Total Completion Time 0.94 0.84
IN Inhibition Total Completion Time 0.80 0.80
IN Switching Total Completion Time – 0.86
Language
Comprehension of Instructions (CI) Total 0.83 0.80
Phonological Processing (PH) Total Score 0.92 0.90
Memory and learning
Memory for Designs (MD) Content Score 0.77 0.86
Memory for Designs (MD) Spatial Score 0.96 0.88
MD Total Score 0.95 0.93
Sentence Repetition Total Score 0.96 –
Word Interference (WI) Repetition Score – 0.80
WI Recall Total Score – 0.67
Social Perception
Affect Recognition Total Score 0.90 0.88
Theory of Mind Total Score 0.85 –
Visuospatial Processing
Arrows (AW) Total Score 0.92 0.92
Block Construction (BC) Total Score 0.94 0.85
Design Copying (DCP) Motor Score 0.89 0.74
DCP Gobal Score 0.78 0.73
DCP Local 0.77 0.74
DCP Total 0.91 0.88
Geometric Puzzle (GP) Total Score – 0.82
Picture Puzzle (PP) Total Score – 0.89
NEPSY-II 5

Clinical Uses ▶ Language Disorders

▶ Learning Disorders
NEPSY-II demonstrates differential sensitivity to ▶ Neuropsychological Assessment Battery
specific and general cognitive deficits exhibited ▶ Q-Interactive
by children commonly evaluated in clinical set- ▶ Sensorimotor Assessment
tings. Independent examiners and researchers col- ▶ Theory of Mind
lected data for special group studies. The clinical ▶ Traumatic Brain Injury
groups met specific inclusion criteria. While only ▶ Visuospatial Processing
group performance is reported, the purpose of the
validity studies was to provide initial evidence for
the clinical utility and discriminant validity of the
References and Readings
NEPSY-II subtests. The NEPSY-II can provide
valid information on the neuropsychological abil- Daniel, M. H. (2013). Equivalence of q-interactive™ and
ities of children in these special groups. Results paper administrations of cognitive tasks: Selected
for these groups can be found in the NEPSY-II nepsy ® –ii and cms subtests. New York: Pearson.
Clinical and Interpretive Manual (Korkman Farmer, J., Kanne, S., Grissom, M., & Kemp, S. (2010).
Pediatric neuropsychology in medical rehabilitation
et al. 2007). settings. In R. G. Frank, M. Rosenthal, & B. Caplan
(Eds.), Handbook of rehabilitation psychology
(2nd ed.). Washington, DC: American Psychological
Cross-References Association.
Kemp, S., & Korkman, M. (in press). Essentials of NEPSY-
II assessment. New York: Wiley.
▶ Affect Asperger’s Disorder Kemp, S., Kirk, U., & Korkman, M. (2001). Essentials of
▶ Attention NEPSY assessment. New York: Wiley.
▶ Attention Deficit, Hyperactivity Disorder Korkman, M., Kirk, U., & Kemp, S. (1998). NEPSY devel-
opmental neuropsychological assessment. San
▶ Auditory Processing Antonio: Psychological Corporation.
▶ Autistic Disorder Korkman, M., Kemp, S., & Kirk, U. (2001a). Develop-
▶ Automaticity mental assessment of neuropsychological function with
▶ Deaf/Hearing Impairment the aid of the NEPSY. In A. Kaufman & N. Kaufman
(Eds.), Specific learning disabilities, psychological
▶ Developmental Gerstmann Syndrome assessment, and evaluation (pp. 347–386). New York:
▶ Emotional Disturbance Cambridge University Press.
▶ Executive Functions Korkman, M., Kemp, S., & Kirk, U. (2001b). Effects of age
▶ Global Versus Local Processing on neurocognitive measures ages 5–12: A cross-
sectional study on 800 children from the USA. Devel-
▶ Inhibition opmental Neuropsychology, 20, 331–354.
▶ Intellectual Disability Korkman, M., Kirk, U., & Kemp, S. (2007). NEPSY-II
▶ Interference (2nd ed.). San Antonio: Harcourt Assessment.