The Use of Standardized Tests for Individualswith Cognitive-Communication Disorders

LynS.Turkstra, Ph.D.,1Carl Coelho, Ph.D.,2 andMarkYlvisaker, Ph.D.3

ABSTRACT

The assessment of individuals with cognitive-communication dis-orders after traumatic brain injury can present a major challenge to speech-language pathologists. For this reason, the Academy of Neurologic Com-munication Disorders and Sciences Practice Guidelines Group dedicated aspecific writing committee to this topic. This article summarizes the writingcommittee’s efforts related to the use of standardized, norm-referenced tests.The article begins with the key questions speech-language pathologistsmight ask in choosing a standardized test. We then provide a summary ofthe results of the writing committee’s data-gathering activities and a briefdescription of the tests that appeared to meet most established criteria forvalidity and reliability for use with this clinical population. The articleconcludes with the identification of areas in which instruments and addi-tional normative data are needed.

KEYWORDS: Assessment evaluation cognitive-communication brain

injury

Learning Outcomes: Upon completion of this article, the reader will be able to (1) define the terms

‘‘standardized’’ and ‘‘norm-referenced’’ in relation to tests, (2) discuss key criteria for evaluating a test’s reliability

and validity for the evaluation of individuals with cognitive-communication disorders after traumatic brain injury

and identify tests that meet those criteria, (3) describe some strengths and limitations of current instruments, and

(4) consider their own assessment practices in light of the findings.

Evidence-Based Practice for Cognitive-Communication Disorders after Traumatic Brain Injury; Editors in Chief, AudreyL. Holland, Ph.D., and Nan Bernstein Ratner, Ed.D.; Guest Editor, Lyn S. Turkstra, Ph.D. Seminars in Speech andLanguage, volume 26, number 4, 2005. Address for correspondence and reprint requests: Lyn S. Turkstra, Ph.D.,Department of Communicative Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706.E-mail: lsturkstra@wisc.edu. 1Department of Communicative Disorders, University of Wisconsin-Madison, Madison,Wisconsin; 2University of Connecticut-Storrs, Storrs, Connecticut; 3College of St. Rose, Albany, New York. Copyright#2005 by ThiemeMedical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662. 0734-0478,p;2005,26,04,215,222,ftx,en;ssl00249x.

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The assessment of individuals with cog-nitive-communication disorders after traumaticbrain injury (TBI) can present a major chal-lenge to speech-language pathologists. Theseindividuals are a heterogeneous group, withcomplex constellations of strengths and limita-tions, and their formal inclusion in our scope ofpractice is relatively recent.1 For this reason, theAcademy of Neurologic Communication Dis-orders and Sciences (ANCDS) Practice Guide-lines Group chose to dedicate a specific writingcommittee to the topic of assessment of indi-viduals with cognitive-communication disor-ders after TBI. The aim of this writing groupwas to evaluate the evidence base for stand-ardized and nonstandardized evaluation of cog-nitive-communication disorders and to provideguidelines for speech-language pathologistssearching for valid and reliable tools in clinicalpractice. We divided this effort into two parts:this article is a discussion of standardized as-sessment approaches and is a clinically orientedsummary of a comprehensive guidelines paperpublished elsewhere this year2; a companionarticle on nonstandardized assessment is alsoincluded in this issue of Seminars in Speech andLanguage. It should be noted that the writingcommittee focused on individuals with TBI butexpected that the results would inform clinicalevaluation of individuals with other acquiredcognitive impairments, particularly those withfrontolimbic lesions (e.g., related to anteriorcommunicating artery stroke or frontal lobetumors). A separate writing committee is ad-dressing issues specific to dementia (see www.ancds.org).

This article begins with a few definitions,followed by a discussion of the questionsspeech-language pathologists might ask inchoosing a standardized test of cognitive-com-munication skills. Next, we summarize theresults of the writing committee’s data gather-ing, including the results of surveys and liter-ature reviews. This includes a brief descriptionof the tests that appeared to meet most criteriafor validity and reliability for use with individ-uals with cognitive-communication disordersafter TBI. The article concludes by revisitingthe central issue that motivated the commit-tee—what, if any, standardized instruments arerecommended for speech-language pathologists

to use, and what is needed that does not cur-rently exist? Readers will note that this is not anexhaustive review of available tests of cognitionand communication, and the rationale for thechoice of instruments, as well as the role ofcollaboration in assessment, will be discussed.

DEFINITIONSFor the purposes of this project, a standardizedtest was defined as a test with clearly definedprocedures for administration. Many standar-dized tests are also norm referenced; that is, testscores are interpreted with reference to thescores from a normative sample.3,4 Standar-dized, norm-referenced tests were the focus ofthis review.

For brevity, the committee used the term‘‘test’’ to refer to both tests and measures ofperformance, recognizing that the more generalterm ‘‘measure’’ included instruments such asquestionnaires and checklists. From the per-spective of the International Classification ofFunctioning, Disability, and Health (ICF),published by the World Health Organization,5

a standardized test can measure any componentof health outcome, including impairments, lim-itations in activities and participation, and per-sonal or environmental factors. For example,executive function can be measured using astandardized test such as the Behavioral Assess-ment of the Dysexecutive Syndrome6 or using anonstandardized set of verbal problems devel-oped by a hospital for its own use. Similarly,performance in communication activities can bemeasured using a standardized test such as theCommunication Activities of Daily Living7 ora checklist from a published textbook, and com-munication participation can be measured usingthe recently published standardized Quality ofCommunication Life scale8 or a nonstandar-dized measure such as the number of conversa-tions that person engages in each week.

Standardized tests may be ‘‘functional,’’ inthe sense that they measure daily functioning,but because the administration is standardized,these tests are always limited in their ability tocapture the unique characteristics of an indi-vidual’s communication life. In the next section,we consider this and other limitations andstrengths of standardized tests, beginning

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with the key questions a clinician might ask inassessment.

KEY QUESTIONS FOR TESTEVALUATION

Question 1: Does the Person

Have a Problem?

Typically, the initial question asked by thespeech-language pathologist is whether a pa-tient or client has a cognitive-communicationdisorder. That is, is the individual’s communi-cation performance in a given context outsidethe range of values that would typically beexpected given that person’s age, race, sex,education, culture, ethnicity, and socioeco-nomic status? This first question raises twokey issues relevant to the selection of an assess-ment measure. First, a comparison with ‘‘typi-cal’’ values suggests a need for normative data,but those data must include scores from indi-viduals whose sociodemographic characteristicsresemble those of the client, at least for thecharacteristics that might affect communicationability. Thus, we have identified several criteriafor standardized, norm-referenced tests:

* The normative data must be from popula-tions that resemble those for whom the testwill be used (appropriateness of the standardi-zation sample).

* The test must be able to identify a cognitive-communication disorder as distinct from typ-ical communication behavior (discriminantvalidity), and the results should be consistentwith other, valid diagnostic information (con-current validity).

* The results should be the same regardless ofwho is giving the test (interrater reliability),and, to the extent that the individual and hisor her context does not change, the resultsshould be consistent over repeated adminis-trations (test-retest reliability).

Question 2: If There Is a Cognitive-

Communication Disorder, What Are

Its Characteristics?

A clinician evaluation does not conclude withthe diagnosis. Rather, the clinician aims to

characterize the factors contributing to per-formance. This is particularly true in cogni-tive-communication disorders, in which thecore feature is that impairments in underlyingcognitive processes such as working memory,self-regulation, and divided attention are man-ifest in difficulties in listening, speaking, read-ing, and writing. Thus, a critical requirement ofa standardized test for individuals with TBI isthat it considers the relation of cognition tocommunication in its construction and that itmeasures what the test authors claim to meas-ure.We can then add the following to our list oftest criteria:

* The test should be well described, includingreference to its theoretical and empiricalfoundations, and the authors should clearlydescribe the purposes and characteristics ofitems and subtests (content validity).

* The test should look as if it is measuring whatit is supposed to and should appear as such tothe test-taker (face validity). For example, apediatric test of receptive vocabulary mightappear to an adult test-taker to be childish,and this might confound his or her responsetendencies.

* Individuals with cognitive-communicationdisorders—in this case related to TBI—should be mentioned in the test materials asa population for which the test is appropriate.Ideally, individuals with cognitive-communi-cation disorders should be included in thestandardization process so that clinicians cansee evidence of differences between typicaland injured groups and decide whether thetest has a sufficient sensitivity and specificityfor their use.

* A factor analysis, item analysis, or otherstatistical measure should indicate that thetest data are consistent with the intendedstructure of the test (construct validity).

Question 3: What Are the Implications

of the Test Results beyond the

Test Session?

Murray and Chapey9 identified several reasonsfor which one might perform a clinical assess-ment. These include medical or neurologicaldiagnosis, diagnostic classification (e.g., aphasia

STANDARDIZED ASSESSMENT/TURKSTRA ET AL 217

versus a cognitive-communication disorder),measuring progress, generating a prognosis, de-termining eligibility for services, and prepara-tion for legal testimony. No test will be valid forall of these purposes; rather, as Plante10 stated inrelation to child language tests, ‘‘the validity ofan assessment procedure is completely depend-ent on the purpose for which the clinicianemploys it and for the inferences the clinicianintends to draw’’ (p. 100). Thus, the test stimulimust engage cognitive and communicationprocesses that are invoked in the contexts towhich the results are to be generalized. Thetasks do not have to be the same as those in theindividual’s daily communication life as long asthey predict performance in those settings.Thus, another criterion is as follows:

* The tests should predict performance onother measures or in contexts to which theresults will be generalized (predictive validity).Beyond this, these contexts should be rele-vant to the client in his or her daily commu-nication life (ecological validity).

For example, if an individual needs specificskills for work, home, or school, the test shouldcapture critical elements of the demands thosecontexts place on communication. Also, if atest is used to make intervention and placementdecisions (e.g., decisions about independentversus assisted living or the use of assistivetechnology), there must be evidence that thetest scores do, in fact, predict performancein those contexts. Again, this does not meanthat test items must be identical to the context;rather, it means that the component skillsrequired are captured by the test.

Given the infinite variety of individualcontexts, the ANCDS writing committee’s ef-forts in regard to evidence for validity must beconsidered a ‘‘first-pass’’ attempt at identifyingwhich tests and approaches meet the most basiccriteria for a test. Ultimately, the decision ofwhich test or measure to use will depend on thecontext itself.

Question 4: Where Should I Begin

with Treatment?

Many clinicians surveyed by the ANCDS writ-ing committee reported that they used tests to

identify clients’ strengths and challenges as astarting point for intervention. In fact, manytest manuals include statements about using theresults to set treatment goals. Typically, thismeans that the subtest scores stand alone.For example, a test might have subtests forabstract reasoning, immediate memory, delayedmemory, calculation, and naming. A clinicianmight interpret low scores on one of thesesubtests as indicating an area in which inter-vention is needed. Most often, however, thefactor analysis of the test data does not supportthis use. That is, most tests used by speech-language pathologists are single-factor or, atmost, two-factor tests, for which the onlymathematically independent score is the totalscore. Most clinicians would be surprised toknow the extent to which the scores of ‘‘normal’’individuals in the standardization sample varyfrom subtest to subtest. Inspection of the stand-ard deviations of the standardization sample ona particular subtest can be informative in thisregard. Thus, to our list of criteria we shouldadd:

* A test that purports to identify ‘‘strengthsand weaknesses’’ for intervention should pro-vide statistical evidence that the measures ofthese individual components stand alone asdistinct scores (another aspect of constructvalidity).

If the reader is not familiar with the just-noted statistical aspects of test construction, itmight seem intimidating to make judgmentsabout the test’s validity. There are, however,several good sources of basic information thatcan be of assistance, including publicationsby Anastasi and Urbina4 and articles fromthe child language literature such as those byPlante10 and Sabers.11

REVIEW OF PUBLISHED TESTSThe questions just presented yielded a list oftest criteria, and these were the criteria used bythe ANCDS writing committee in their evalu-ation of standardized tests. The tests chosenfor evaluation were those recommended byspeech-language pathologists responding to asurvey on assessment (n¼ 84 tests) or by test

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publishers and distributors (n¼ 40 tests). Itshould be noted that neuropsychological testsof component processes were included only ifthey were recommended for or by speech-lan-guage pathologists. This is not to imply that theassessment of cognitive functions is beyond thescope of practice of speech-language pathology.Rather, detailed reviews of neuropsychologicaltests are available elsewhere12,13 and thus wereconsidered beyond the scope of the committee’sefforts.

The writing committee combined thetwo lists and completed a first-stage screeningto eliminate tests that did not mention TBIin the test manual. This yielded a final groupof 31 tests for children, adolescents, andadults, which are listed in Appendix A. Thesewere reviewed in detail to determine whetherthey met criteria for reliability and validityestablished by the Agency for Health CarePolicy Research (www.ahrq.gov/clinic/epc/,accessed August 1, 2005). Of these, seventests or measures met most of the publishedcriteria. These were considered by the commit-tee to be candidate tests for standardized assess-ment in appropriate contexts (i.e., where thetest’s goals, structure, and standardization sam-ple matched the needs of the clinician and thecharacteristics of the individual with the cog-nitive-communication disorder). They are asfollows:

* American Speech Language Hearing Asso-ciation Functional Assessment of Commu-nication Skills in Adults (ASHA-FACS14)

* Behavior Rating Inventory of ExecutiveFunction (BRIEF15)

* Communication Activities of Daily Living,Second Edition (CADL-27)

* Functional Independence Measure (FIM;Uniform Data System for Medical Rehabil-itation16)*

* Repeatable Battery for the Assessment ofNeuropsychological Status (RBANS17)

* Test of Language Competence–Extended(TLC-E18)

* Western Aphasia Battery (WAB19)

These tests and measures are discussed indetail in the full guidelines report.2 It is note-worthy that of the 31 tests reviewed, only 4,including the FIM, formally evaluated predic-tive validity, and only 2 (the BRIEF andASHA-FACS) formally evaluated perform-ance outside clinical settings. In general, testsused and recommended by speech-languagepathologists were strong in content and facevalidity (i.e., thoughtfully constructed) but rel-atively weak in construct validity (i.e., did notmeasure what the manual claimed, particularly‘‘strengths and weaknesses’’). Ecological validitywas not measured formally by any test and thusmust be considered a weakness. It is notewor-thy, however, that several of the tests (theCADL-2, ASHA-FACS, BRIEF, and TLC-E) were based on research about daily commu-nication needs in the target population, and theASHA-FACS and CADL-2 explicitly incor-porated consumer feedback about ecologicalvalidity into the design.

Several other issues are suggested by in-spection of the final list. First, from the ICFperspective, there are tests and measures at boththe impairment level and the activity/participa-tion level of health outcome. Although noneconsider personal or environmental factors in-fluencing performance (e.g., access to commu-nication opportunities, desire to engage in socialactivities, or partner competencies) and noneformally compare capacity with performance,three of the measures (the BRIEF, FIM, andASHA-FACS) incorporate the perspectives ofrelevant others in the individual’s daily life. Thisreinforces the point made earlier in this article,that ‘‘standardized’’ does not mean ‘‘impairment-oriented’’ or ‘‘nonfunctional’’ (in the sense ofaddressing activities in daily living). Second,the lists includes a comprehensive test battery(the WAB), a single construct battery (theTLC-E), and a screening test (the RBANS),as well as questionnaires, illustrating the range oftest types available in different settings.

A third, and perhaps the most important,theme that emerges from the lists here and inthe Appendix is the striking absence of a testdeveloped for the evaluation of communicationin individuals with cognitive-communicationdisorders, versus tests of basic neuropsycholog-ical functions that may be administered by

*The FIM was included because of its psychometric strengths,with the caveat that the items for evaluation of communicationare very limited and the rating scale may lack the sensitivity tocapture meaningful improvements.

STANDARDIZED ASSESSMENT/TURKSTRA ET AL 219

speech-language pathologists or tests borrowedfrom other populations, such as aphasia. Todate, much of the research on communicationdisorders after TBI has focused on charac-terizing behavior, including communicationbehaviors in contexts such as discourse. Nowthat more data are emerging, it is hoped that thiswill lead to the development of new tests specif-ically for this population. A promising develop-ment in this regard is the recent publication ofthe Functional Assessment of Verbal Reasoningand Executive Strategies,20 which was designedspecifically for the assessment of cognitive-communication skills in activities that requirereading, writing, and reasoning. Many of therespondents to the ANCDS survey commentedon the shortcomings of existing tests and theneed for tests across service delivery settings.This is a critical research need for the future.

ADVICE FROM THE EXPERTSTo put the test review in context, the ANCDSwriting committee reviewed the work of expertsin the field, as published in texts and chapters.The expert authors were Kennedy andDeRuyter,21 Hartley,22 Gillis, Pierce, andMcHenry,23 Ylvisaker and Gioia,24 Sohlbergand Mateer,25 and Blosser and DePompei.26

The general consensus of these experts was thatstandardized tests should be viewed as only onecomponent of an evaluative process that in-cludes multiple sources of information. Theyconsidered tests to be useful for the identifica-tion of cognitive and linguistic functions thatmight influence communication performancebut noted the discordance between standar-dized tests—most of which are at the impair-ment level—and the needs of clients in lifeoutside clinical settings.

Most of the experts recommend a combi-nation of cognitive tests and language or aphasiatests, acknowledging the many psychometricproblems in this approach, including the ques-tionable validity of using tests designed forlanguage development or aphasia for an individ-ual with an acquired cognitive-communicationdisorder. Overall, the authors noted that thelimitations of existing measures could lead to amisleading picture of the individual’s communi-cation performance outside clinical settings.

RECOMMENDATIONS OF THEWRITING COMMITTEETypically, evidence-based practice papers con-clude with a statement about practice standards,guidelines, or options, depending on the qualityof the available evidence. Given the limitedevidence in regard to standardized assessmentfor individuals with cognitive-communicationdisorders, the committee limited its recommen-dations to practice options. In brief, these wereas follows: (1) to use caution when evaluatingindividuals with cognitive-communication dis-orders using existing standardized tests, giventhe limitations discussed in this article; (2) toconsider standardized testing ‘‘within a broaderframework that considers evaluation of theperson’s pre-injury characteristics, stage ofdevelopment and recovery, communication-related demands of personally meaningfuleveryday activities and life and communicationcontexts’’2(p. xxxii); and (3) to collaborate withother professionals who evaluate cognitivefunction, particularly when considering theuse of impairment-level cognitive tests. Withthe caveats noted previously, the committeealso recognized that the seven tests on the finaltest list met most of the established criteria forreliability and validity and thus might be usedin appropriate contexts.

The writing committee identified severalareas in which there is a critical need for futureresearch. These included research to developimproved standardized measures of communi-cation (including social communication andconnected discourse) at the impairment andactivity/participation levels of health outcome,measures that consider context factors such aspartner communication competence, studies ofthe predictive value of tests beyond clinicalassessment settings, and normative data forpopulations that were underrepresented in orexcluded from the standardization samples ofmost tests, including individuals from minoritypopulations and those with preexisting lan-guage disorders.

SUMMARY AND CONCLUSIONSGiven the limitations of most of the stand-ardized tests in our field, it is tempting toabandon the notion of standardized assessment

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for individuals with cognitive-communicationdisorders after TBI. The heterogeneity of thisgroup and the discrepancy between perform-ance in structured versus unstructured settingsmight suggest that a standardized approach willnever yield useful information for an individualclient. Nonstandardized approaches have manylimitations, however, as discussed in the nextarticle. Thus, rather than abandoning stand-ardized tests, we should take an active role indeveloping instruments that meet our needs.

As the field of speech-language pathologybegins to incorporate formally the ICF frame-work in assessment, we will need new assess-ment tools that capture multiple elements ofhealth outcome. The recent publication ofmeasures such as the ASHA Quality of Com-munication Life Scale8 is an encouraging movein this direction, and we look forward to futureresearch evidence that our instruments make adifference to the health outcomes of our clients.

ACKNOWLEDGMENTS

This work was supported by funding from theAmerican Speech-Language-Hearing Associa-tion (ASHA), ASHA Division 2: Neurophysi-ology and Neurogenic Speech and LanguageDisorders, and the Department of VeteransAffairs. Support was also provided by the Uni-versity of Minnesota and CaseWestern ReserveUniversity. The authors wish to thank the manystudents and clinicians who contributed to theproject, including Barbara Ambuske, KristenBaker, Jamie Mayer, Nichole Orsini, and KateRuth.

REFERENCES

1. Adamovich B, Chapey R, Larkins P, et al. Therole of speech-language pathologists in the habil-itation and rehabilitation of cognitively impairedindividuals. American Speech-Language-HearingAssociation Subcommittee on Language andCognition. ASHA 1987;29:53–55

2. Turkstra L, Coelho C, Ylvisaker M, et al. Practiceguidelines for standardized assessment for personswith traumatic brain injury. J Med Speech LangPathol 2005;13:ix–xxviii

3. American Educational Research Association.Standards for Educational and Psychological

Testing. Washington, DC: American Psycholog-ical Association; 1985

4. Anastasi A, Urbina S. Psychological Testing.Upper Saddle River, NJ: Prentice-Hall; 1997

5. World Health Organization. International Classi-fication of Functioning, Disability and Health-Report. Geneva: Switzerland: World HealthOrganization; 2001

6. Wilson BA, Alderman N, Burgess PW, Elmslie H,Evans JJ. Behavioural Assessment of the Dysex-ecutive Syndrome. Bury St. Edmunds, England:Thames Valley Test; 1996

7. Holland A, Frattali C, Fromm D. CommunicationActivities of Daily Living. 2nd ed. Austin, TX:Pro-Ed; 1999

8. Paul D, Frattali CM, Holland AL, Thompson CK,Caperton CJ, Slater S. Quality of CommunicationLife Scale. Rockville, MD: American Speech-Language-Hearing Association; 2005

9. Murray LL, Chapey R. Assessment of language dis-orders in adults. In: Chapey R, ed. Language Inter-vention Strategies in Aphasia and Related NeurogenicCommunication Disorders. 4th ed. Philadelphia, PA:Lippincott Williams & Wilkins; 2001:55–118

10. Plante E. Observing and interpreting behaviors: anintroduction to the clinical forum. Lang SpeechHear Serv Sch 1996;27:99–101

11. Sabers DL. By their tests we will know them. LangSpeech Hear Serv Sch 1996;27:102–108

12. Lezak MD. Neuropsychological Assessment. 3rded. New York: Oxford University Press; 1995

13. Spreen O, Strauss E. A Compendium of Neuro-psychological Tests. 2nd ed. New York: OxfordUniversity Press; 1998

14. Frattali C, Thompson C, Holland A, Wohl C,Ferketic M. American Speech Language HearingAssociation Functional Assessment of Communi-cation Skills for Adults. Rockville, MD: AmericanSpeech Language Hearing Association; 1995

15. Gioia GA, Isquith PK, Guy SC, Kenworthy L.Behavior Rating Inventory of Executive Function.Odessa, FL: Psychological Assessment Resources;2000

16. Functional Independence Measure, Uniform DataSet for Medical Rehabilitation. Buffalo, NY:University at Buffalo; 1996

17. Randolph C. Repeatable Battery for the Assess-ment of Neuropsychological Status. San Antonio,TX: Psychological Corporation; 2001

18. Wiig E, Secord W. Test of Language Compe-tence-Expanded Edition. San Antonio, TX: Psy-chological Corporation; 1989

19. Kertesz A. Western Aphasia Battery. San Antonio,TX: Psychological Corporation; 1982

20. MacDonald S. Functional Assessment of VerbalReasoning and Executive Strategies. Guelph,Ontario: CCD Publishing; 2005

STANDARDIZED ASSESSMENT/TURKSTRA ET AL 221

21. Kennedy M, DeRuyter F. Language and cognitivebasis for communication disorders following trau-matic brain injury. In: Beukelman D, Yorkston K,eds. Communication Disorders following Trau-matic Brain Injury: Management of Cognitive,Language, and Motor Impairments. Austin, TX:Pro-Ed; 1991:123–190

22. Hartley LL. Cognitive-Communicative Abilitiesfollowing Brain Injury: A Functional Approach.San Diego, CA: Singular Publishing; 1995

23. Gillis RJ, Pierce JN,McHenry M. Traumatic BrainInjury Rehabilitation for Speech-Language Path-

ologists. Boston, MA: Butterworth-Heinemann;1996

24. Ylvisaker M, Gioia G. Cognitive assessment. In:Ylvisaker M, ed. Traumatic Brain Injury Rehabil-itation. 2nd ed. Boston, MA: Butterworth-Heine-mann; 1998:159–179

25. Sohlberg MM, Mateer CA. Cognitive Rehabil-itation: An Integrative NeuropsychologicalApproach. New York: Guilford Press; 2001

26. Blosser JL, DePompei R. Pediatric TraumaticBrain Injury: Proactive Intervention. Clifton Park,NY: Thompson Learning; 2003

Appendix A. Standardized Tests Reviewed

American Speech Language Hearing Association—Functional Assessment of Communication Skills

Aphasia Diagnostic Profiles

Behavior Rating Inventory of Executive Function (Parent Report Form)

Behavioral Assessment of the Dysexecutive Syndrome

Brief Test of Head Injury

California Verbal Learning Test–Second Edition

California Verbal Learning Test for Children

Children’s Orientation and Amnesia Test

Clinical Evaluation of Language Fundamentals (Third Edition)

Cognitive Linguistic Quick Test

Communication Activities of Daily Living (Second Edition)

Comprehensive Assessment of Spoken Language

Controlled Oral Word Association Subtest

Discourse Comprehension Test

Functional Independence Measure

Galveston Orientation and Amnesia Test

LaTrobe Communication Questionnaire

Measure of Cognitive-Linguistic Abilities

Mount Wilga High Level Language Test

Multilingual Aphasia Examination

Paced Auditory Serial Addition Test

Rancho Los Amigos Levels of Cognitive Functioning

Repeatable Battery for the Assessment of Neuropsychological Status

Rivermead Behavioral Memory Test

Ross Information Processing Assessment (Second Edition)

Scales of Cognitive Ability for Traumatic Brain Injury (Normed Edition)

The Speed and Capacity of Language Processing Test

The Token Test (Shortened Form)

The Awareness of Social Inference Test

Test of Everyday Attention for Children

Test of Language Competence–Extended

Western Aphasia Battery

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