Alternative Tests of Cognitive Function

Alternative tests of cognitive ability are of particu­lar utility with rehabilitation populations, where patients often have specific impairments (eg, motor impairments, sensory impairments) that preclude the valid use of more common measures.

Given that many of these alternative measures were designed for particular populations, scores generated are not interchangeable with scores of the major intel­ligence scales. Furthermore, the special formatting of these tests limits the applicability of results to “real- world” environments, where such intensive accommo­dations are not always made, and scores may not be as predictive of actual functioning in major settings such as school, home, or community. These instruments may be most useful as screening or supplemental tools in the assessment or interpretation processes.

The Universal Nonverbal Intelligence Test (UNIT) (92) is a test of intelligence that is designed to be completely nonverbal. It can be used with children ages 5-17 years. Administration is done through eight specified pantomime gestures. Responses are also entirely nonverbal, and consist of pointing, paper­pencil, and manipulating items. Multiple standardized teaching items are provided to help ensure that the examinee understands the purpose of gestures. The UNIT is most useful for children who have signifi­cant hearing or oromotor limitations, or who do not speak English. Relatively normal fine motor function­ing is required for valid use of the test.

The Leiter International Performance Scale-Revised (Leiter-R) (93) is a nonverbal test of intelligence for use with individuals ages 2-20 years. There are two bat­teries: visualization and reasoning, and attention and memory. The test is administered through nonverbal pantomime. Respondents manipulate items. Motor responses are relatively simple, and thus the test can be used with people with some degree of motor impairment. However, some of the items are scored for speed of response, in which case, even mild motor impairments could yield misleading results. This test is useful with individuals with hearing or oromotor limitations, or who do not speak English.

The Comprehensive Test of Nonverbal Intelligence (C-TONI) (94) is designed to assess intelligence in indi­viduals ages 6-89 years. It includes an overall com­posite and two subscales: pictorial and geometric. The test can be administered orally or in pantomime. The option of oral administration is for use with children who are not hearing impaired, as these children can be confused when a test is administered completely nonverbally. The C-TONI has the additional advantage of requiring no more complex motor response than pointing to the correct answer. Tests requiring only pointing are sometimes further modified by clinicians to accommodate severely impaired children for whom even pointing is too difficult (eg, the examiner points to each option and the examinee provides indication through predetermined head or trunk movements when the correct choice is reached).

Raven’s Progressive Matrices include three sepa­rate forms: Coloured Progressive Matrices (95) designed for children ages 5-11, Standard Progressive Matrices (96) for children ages 6-17, and Advanced Progressive Matrices (97) for older adolescents and adults, including individuals suspected of above-average intellectual ability.

The Peabody Picture Vocabulary Test-III (PPVT-III) (98) is a receptive vocabulary test, where the respon­dent is given a vocabulary word and points to the best match from a series of pictures. It is sometimes used as a screening device to estimate verbal cogni­tive abilities for students with expressive speech and/ or motor difficulties, though, of course, great caution is warranted, as the PPVT-III assesses only a single skill set. Visual-perception and native English skills are required. The PPVT-III can be used with children ages 2.6-90+ years.

As noted previously, the K-ABC-II (79) includes a distinct nonverbal index that can be administered entirely through nonverbal gestures and responses, which can be useful for children with certain disabili­ties. This test requires relatively complex and rapid motor responding, and would not be appropriate for use with individuals with even mild motoric impair­ment. Table 3.5 provides a complete listing.