Achievement Tests
The assessment of academic achievement represents an integral component of the evaluation of children and adolescents, as school is the “work” of childhood. An important task of assessment is separating academic knowledge from rate of production (referred to as academic fluency) in children with response speed deficits due to motoric impairment or brain injury.
Many tests of achievement include a speeded component. Overall scores may be less helpful than specific scores that separate out fluency and basic skills. In addition, academic testing in youth with recentonset illness or injury may overestimate long-term academic capacity. Academic testing generally measures previously learned knowledge, which may be intact in children whose illness or disability has not yet affected schooling. Whether a child can continue to make progress is a critical question. This is particularly true in brain-injured youth whose deficits in attention, executive functions, and anterograde memory have a strong impact on mastery of new academic skills, and applies to other types of recent-onset3.5
Alternate Tests of Cognitive Ability
| INSTRUMENT (REF.) | DESCRIPTION | COMMENTS |
| Universal Nonverbal Intelligence Test (UNIT) (92) | Nonverbal test that measures both symbolic and nonsymbolic cognitive skills in the nonverbal domain. Age range: 5-17. | Requires some fine-motor functioning; designed to reduce cultural bias; easy to administer; useful with individuals with auditory or oromotor limitations, or who do not speak English. |
| Leiter International Performance Scale-Revised (Leiter-R) (93) | Nonverbal test developed for use with hearing- or language-impaired subjects; measures visual-spatial reasoning and nonverbal attention and memory. Age range: 2-20. | Motor responses are relatively simple, but some items are scored for speed, so motor impairments may affect results. Useful with individuals with auditory or oromotor limitations, or who do not speak English. |
| Comprehensive Test of Nonverbal Intelligence (C-TONI) (94) | Nonverbal test with pictorial and geometric subscales to measure concrete and abstract nonverbal skills. Only motor skill required is pointing, and this can be further adapted for severely motor-impaired individuals. No time limits. | Nonverbal test with option for oral administration in English-hearing individuals. Useful for individuals with combined limited motor functioning and auditory or oromotor limitations or who do not speak English. |
| Raven's Progressive Matrices Tests (95,96) | Measures nonverbal reasoning; three different forms for different age ranges; limited motor skills required; advanced version is useful for individuals considered to have above-average intelligence; no time limits | Limited in that it uses a single type of task; useful for individuals with auditory, oromotor, or physical disabilities, or who do not speak English. |
| Peabody Picture Vocabulary Test-III (PPVT-III) (98) | Multiple-choice test of receptive vocabulary; for individuals aged 2.6-90+; pointing is the only response required, and further adaptations can be made for severely motor-impaired; no time limits. | Useful as a screening device for measuring verbal functioning in children with significant expressive verbal or motor impairments; sometimes used to estimate general cognitive functioning in individuals who cannot participate in other types of assessment, but should be interpreted with great caution. |
| Kaufman Assessment Battery for Children-II (KABC-II) (79) | General intelligence battery that includes a nonverbal index that can be administered entirely without spoken language. Relatively complex and rapid motor responses are required. | Suitable for individuals with auditory or oromotor impairments, or non-English speakers; not for use with individuals with even mild motor impairment |
conditions that place higher coping demands on the child, leaving fewer resources available for basic academic learning.
Some of the more frequently used, individually administered, norm-referenced, and wide-range screening instruments for measuring academic achievement spanning kindergarten through twelfth grade include the Kaufman Test of Educational Achievement, 2nd Edition (K-TEA-II) (99), and the Wechsler Individual Achievement Test, 2nd Edition (WIAT-II) (100), and the Woodcock Johnson Psychoeducational Battery, Third Edition (WJ-III) (101). The Wide Range Achievement Test, 4th Edition (WRAT-IV) (102), is frequently used, but is a brief measure that yields limited information. The Peabody Individual Achievement Test-Revised (103) addresses generally similar content areas as the other major assessment tools, but minimizes the verbal response requirement by using a recognition format (eg, point to correct response based on four choices). Although this format may allow assessment of children presenting with certain impairments, language or motor, the results may not provide the best indication of expectations for student performance in the classroom, where recall and more integrated answers are required.
New assessment guidelines under the Individuals with Disabilities Education Act (IDEA, 2004) for diagnosing learning disabilities in public education settings include options for using response to intervention (RTI), which is a process of assessing progress in skill acquisition in response to scientifically supported interventions, using frequent brief assessments rather than a single cluster of standardized testing. While RTI is not specified for use in qualifying children under other special education diagnostic categories, such as health impairment, orthopedic impairment, sensory/ physical impairment, or brain injury, the RTI model provides a potential structure for assessing progress in the school setting.
The use of frequent brief assessments can be useful in the aforementioned situation of recentonset conditions, where it is important to identify children who are not making sufficient progress, despite showing intact pre-injury/illness skills.
This method of frequent assessment can also be useful in identification of children who, due to neurologic condition or medication side effects, show significant fluctuations in cognitive functioning. The AIMSweb assessment system (104) provides multiple alternate forms of brief assessments that can be administered weekly. Scores are compared against normative data, and patterns of progress are compared against typical rates of improvement among same-grade students. Various measures are offered in the areas of early numeracy and literacy, math calculation, reading fluency and comprehension, and written expression. There are Spanish versions of some measures. Psychometric data is strongest for the reading fluency measures. Not all school districts use the AIMSweb system.The Dynamic Indicators of Basic Early Literacy Skills (DIBELS) (105) include literacy measures for grades K-sixth. They can be downloaded at no charge. Guidelines are provided for score interpretation, and patterns ofprogress over time are measured. Physicians should be aware that RTI is provided as an option for identification of learning disabilities under federal law. Not all school systems will have a structure in place for using it, but for those that do, inclusion of the patient in the RTI process may yield valuable information. Table 3.6 provides a listing of achievement measures.