Language Functioning Tests
To examine this function is to assess what is felt to be a central aspect of brain functioning and the foundation of human thought. Language development is well delineated, and proceeds from spoken to written competency in normal childhood.
Receptive and expressive abilities require separate assessment, as do the modalities of written language. Speech as the mechanical aspect of oral communication is assessed as distinct from language per se. One element can be intact, while the other has significant impairment, and evaluation distinguishes between the two.An acute injury most notably, but even an illness, may produce a frank aphasia, but this often resolves from its most dramatic state. Deficits remain that are more subtle, but important to address. Common deficits after injury differ between an adult and a child. In childhood and adolescence, deficits in word finding, dyscalculia, and problems with formulating written language are common (29). Functional problems, like difficulty with instructions or following commands, require analysis to determine the degree of linguistic difficulty versus other factors, such as attention or memory. As is always the case, the determination of concurrent difficulty in other tasks provides the diagnostic information to hone in on the core problem(s).
Components like phonologic processing, naming, language comprehension (oral and written), and understanding the syntactic structure of language, as well as the productive aspects of language, should be covered. The profound impact of language deficits on academics makes it a particularly important aspect for assessment. Problems with reading comprehension are often seen, and because reading is one of the primary tools for learning once a child enters elementary school, the impact can be widespread on competent school functioning.
There are many well-accepted tests to measure all these aspects.
For receptive language, the Peabody Picture Vocabulary Test-III (54), Token Test (55), or the Bracken Basic Concept Scale-Revised (56) are widely used. These vary from single-word comprehension to grammatical/syntactical structure to linguistic concepts. Similar tests exist to investigate expressive oral language. Batteries like the Clinical Evaluation of Language Functions (57) or the Test of Written Language-2 (58) offer the advantages of batteries, while covering various aspects of language so that differential levels can be discerned.3.3
Tests of Nonverbal/Visual-Perceptual Function
| INSTRUMENT (REF.) | DESCRIPTION | COMMENTS |
| Rey-Osterreith Complex Figure Test (ROCF) (50) | Copying of complex figure and a delayed recall condition; alternate forms exist for repeat administration; ages 6 and up | bgcolor=white>Taps planning, visual organization, and memory for complex visual information|
| Beery Developmental Test of Visual-Motor Integration. 4th ed. (VMI) (51) | Design-copying test of 24 forms of progressive difficulty; supplemental tests of visual perception and motor coordination; Ages 3+; procedures for younger children | Long-standing test with new additions; visuoperceptual, visuomotor integration is assessed |
| Facial Recognition Tests (52) | Requires direct matching and side profiles of photos of human faces; norms for ages 6+ | Present in standalone tests, but also in batteries, including memory aspect; implications of right hemisphere function |
| Wide Range Assessment Battery of Visual Motor Ability (WRAVMA) (53) | Battery of 3 tests: drawing, matching, and pegboard. Can be administered individually or as a battery yielding a composite; ages 3-16. | Sound psychometrics yield standard scores and percentile for each subtest |
A long tradition in neuropsychological evaluation is the evaluation of aphasia, the disturbance in the basic language capacity of the brain. This capacity begins at the level of auditory discrimination and phonologic awareness, proceeding to words, then meaningful word combinations. The Boston Diagnostic Aphasia Examination (59), though its full utility with children has been questioned has long been in use. Issues such as fluency skills, where the ability to generate words within a parameter, such as beginning sound, or rapid naming are basic language skills that can be lacking due to developmental or acquired problems. Though they are not everyday language skills, they represent an automaticity of language that can affect more complex skills, such as reading.