For those who watch the Showtime series, The Tudors, this season brought a lot of changes in the life of King Henry VIII. Although not happy with his new queen’s inability to deliver an heir, Anne’s prospects got a lot worse after the king suffered a fall from a horse in a jousting accident.One very believable theory as to why Henry VIII had such a dramatic change in weight was that he lost his sense of smell, which can dramatically change a person’s eating habits. See a related blog at http://tbilaw.blogspot.com/2008/06/loss-of-smell-was-missed-sign-of-brain.html
Some historians conjecture that Henry was severely affected by a leg injury he suffered at the time, but others further hypothesize that Henry, who is reported to have been unconscious for several hours, may have suffered a brain injury which led to the drastic change of behavior he exhibited towards Anne Boleyn after his fall.
When one considers the sort of activities the king engaged in prior to his fall -jousting tournaments and break neck hunting expeditions – it might be expected that the king most likely had a history of “knocks to the head”. Regardless, his perception of his wife, Anne, certainly became very distorted and in keeping with many of the symptoms of a brain injury.
Very suddenly, he became convinced that the woman he had risked a kingdom for, had seduced him with witchcraft and he became very susceptible to the reports of wrongdoings from her enemies at court. Eventually this led to several trials for infidelity and treason. Five men were accused on unconvincing evidence and sentenced to death, including her own brother, George Boleyn.
The signs are in the change of behavior in the king. When he had divorced Catherine of Aragon, although she was banished from the court, she was treated with some sort of compassion and her daughter Mary was given safe refuge. Not so, with Anne Boleyn. She was granted no mercy and the king was impatient for her execution and announced his betrothal to Jane Seymour 24 hours later, believing that he had a sign during his period of unconsciousness that she was his salvation.
It was a somewhat chilling reminder to me of the type of fill in memory that exists after a major brain injury, in which facts are easily distorted or replaced because the survivor must make sense out of the gaps which occur. I can easily imagine Thomas Cromwell’s whisperings to the king of Anne’s shortcomings suddenly becoming accepted as truth in an attempt by Henry to replace his own confusion.
Many of Henry’s behavioral changes are in keeping with the theory that he suffered a brain injury. Although his leg injury may have complicated his activities, his sudden disinterest in exercise and former activities certainly would help explain many of the medical symptoms he suffered from that point on, foremost being the obesity he suffered until the end of his life.
The reason I found this historical incident so intriguing is because it related to my own experience with a severe brain injury survivor in which confabulation played a key role. The survivor would fill in gaps with whatever information the people he had contact with gave him, true or false, he had no ability to discern reality himself. Thus, in a situation with hostile family members, this led to some very distorted views of his situation, despite proof to the contrary.
Not only did he fill in holes in his memory with random information, whatever information he was given was exaggerated with every telling. Given the facts of his accident, each time he repeated what he believed to have happened, it became more and more fantastic. This point struck me on The Tudors when Henry breaks down and cries that Anne had slept with hundreds of men when proof of her infidelity was sketchy at best.
It is no doubt, chilling, to realize that the 72,000 executions King Henry VIII ordered in his lifetime may have been perpetuated by an undiagnosed brain injury.
Regardless of the actual historical facts surrounding Henry’s injuries, the depiction that the writers for The Tudors chose to encompass was very true to the nature of brain injury. Henry had other injuries that the doctors were more concerned with and his head injury would have gone untreated. He was unable to discern that those around him had their own personal political agendas and became vulnerable to a desperation to fill in missing gaps in his own memory of the facts. He exaggerated fantastic gossip to mammoth proportions. His former grief and compassion for his enemies turned to an unemotional detachment towards those around him. And a former inclination for personal gratification escalated to a point that would make him an infamous character in history.
One can dispute the argument, but the change of person exhibited by Henry following his accident leaves many questions as to what damage actually occurred in his jousting accident.
Rebecca Martin
Henry the VIII and Brain Injury Behavior Changes
From my co-author of https://waiting.com:
EDITORS NOTE: From the Brain Injury Association of America:
Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
https://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
Brain Injury Association of America
Policy Corner E-Newsletter – April 4, 2008
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________
Dear Advocates:
This week BIAA submitted written testimony to the House Appropriations Subcommittee in charge of funding TBI programs within the Department of Health and Human Services and the Department of Education, urging an increase in Fiscal Year 2009 funding for TBI programs.
On Wednesday, April 2, the House Veterans Affairs Subcommittee on Oversight and Investigations held a hearing on TBI Related Vision Issues, which highlighted the high rate of vision disturbances in cases of servicemembers returing from Iraq and Afghanistan with TBI.
Also this week, the House Energy and Commerce Committee held a hearing on H.R. 5613, legislation recently introduced which would place a moratorium until March 2009 on seven Medicaid regulations issued by the Department of Health and Human Services. BIAA has endorsed this legislation, and signed a letter of support spearheaded by the Consortium of Citizens with Disabilities (CCD) in favor of the legislation.
Unfortunately, no activity occurred this week on H.R. 1418, the House version of legislation to reauthorize the TBI Act, which was passed by the House Energy and Commerce Act on March 13, 2008. BIAA will continue to advocate strongly for floor consideration of the bill by the entire House of Representatives and full passage by Congress into law as quickly as possible.
*Distributed by Laura Schiebelhut, BIAA Public Affairs Manager, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637; lschiebelhut@biausa.org
The Policy Corner is made possible by the Adam Williams Initiative, Centre for Neuro Skills, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.
__________________________________________________________________
BIAA Submits Testimony to House Labor-HHS-Education Appropriations Subcommittee
This week BIAA submitted written testimony to the House Appropriations Subcommittee in charge of funding TBI programs within the Department of Health and Human Services and the Department of Education. BIAA’s testimony urges an increase in Fiscal Year 2009 funding for programs authorized through the TBI Act, as well as for TBI research programs conducted within the National Institute on Disability and Rehabilitation Research (NIDRR).
In the testimony, BIAA’s President and CEO Susan H. Connors states, “BIAA was gravely disappointed that last year, even as Congress had the good judgment to add hundreds of millions dollars to the budgets of the Department of Defense and the Department of Veterans Affairs to help address the problem of TBI among returning servicemembers, funding for the HRSA Federal TBI Program was reduced from $8.91 million to $8.754 million.”
Within the testimony, BIAA requests $30 million in funding for programs authorized through the TBI Act, as well as sufficient funding to sustain and increase medical rehabilitation research within NIDRR. The testimony also urges an allocation of at least $8.3 million to allow NIDRR to continue to fund 16 TBI Model Systems research centers.A copy of the testimony can be obtained by visiting BIAA’s website at the following address: http://www.biausa.org/policyissues.htm.
House VA Subcommittee Holds Hearing on TBI And Vision Problems
On Wednesday, April 2, the House Veterans Affairs Subcommittee on Oversight and Investigations held a hearing on TBI Related Vision Issues.
Testimony highlighted the high rate of vision disturbances in cases of servicemembers returing from Iraq and Afghanistan with TBI, and the need for a seamless system of care within the Department of Defense and Department of Veterans Affairs to address these eye injuries, including greater use of specialized vision screening.
In the hearing, the Blinded Veterans Association (BVA) noted research showing that 75 percent of servicemembers with documented TBI injuries also have complaints about vision problems, and that approximately 60 percent of those injured have associated neurological visual disorders. A study conducted by one of the panelists, Gregory L. Goodrich, who is a research psychologist at the VA Palo Alto Health Care System, found that both Polytrauma Level I and Level II patients had high rates of visual impairment and/or visual dysfunction, and that injuries caused by a blast event were associated with more vision related loss and/or deficits than other causes.
In his testimony, Tom Zampieri, Director of Government Relations at BVA, asserted, “At present the current system of screening, treatment, tracking, and follow-up care for TBI vision dysfunction is inadequate. Adding visual dysfunction to this complex mix, especially if undiagnosed, makes attempts at rehabilitation even more daunting and potentially disastrous unless there are significant improvements soon.”
Mr. Zampieri urged the Subcommittee to request that DoD/VA provide for the full implementation of the “Military Eye Trauma Center of Excellence and Eye Trauma Registry,” which was recently authorized as one of the Wounded Warrior provisions in last year’s defense authorization bill (H.R. 4986). BIAA has officially endorsed legislation (S. 1999) to create such a Center.
BIAA Supports Bill to Enact Moratorium on Harmful Medicaid Regulations
Also this week, the House Energy and Commerce Committee held a hearing on H.R. 5613, legislation recently introduced which would place a moratorium until March 2009 on seven Medicaid regulations issued by the Department of Health and Human Services. BIAA has endorsed this legislation, and signed a letter of support spearheaded by the Consortium of Citizens with Disabilities (CCD) in favor of the legislation.
The legislation, which was introduced by Representatives John D. Dingell (D-MI) and Tim Murphy (R-PA) on March 13, 2008, would delay the implementation of seven harmful Medicaid regulations through March 2009, including several rules which would be especially deleterious to individuals with traumatic brain injury.
One of these rules would limit rehabilitation services for Medicaid beneficiaries, severely curtailing the ability of people with disabilities – including TBI – to receive rehabilitation services now covered under Medicaid. Access to these rehabilitative services is essential, as in many cases, these services play a vital role in allowing people with TBI to live independently in the community.
Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
https://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
Brain Injury Association of America
Policy Corner E-Newsletter – April 4, 2008
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________
Dear Advocates:
This week BIAA submitted written testimony to the House Appropriations Subcommittee in charge of funding TBI programs within the Department of Health and Human Services and the Department of Education, urging an increase in Fiscal Year 2009 funding for TBI programs.
On Wednesday, April 2, the House Veterans Affairs Subcommittee on Oversight and Investigations held a hearing on TBI Related Vision Issues, which highlighted the high rate of vision disturbances in cases of servicemembers returing from Iraq and Afghanistan with TBI.
Also this week, the House Energy and Commerce Committee held a hearing on H.R. 5613, legislation recently introduced which would place a moratorium until March 2009 on seven Medicaid regulations issued by the Department of Health and Human Services. BIAA has endorsed this legislation, and signed a letter of support spearheaded by the Consortium of Citizens with Disabilities (CCD) in favor of the legislation.
Unfortunately, no activity occurred this week on H.R. 1418, the House version of legislation to reauthorize the TBI Act, which was passed by the House Energy and Commerce Act on March 13, 2008. BIAA will continue to advocate strongly for floor consideration of the bill by the entire House of Representatives and full passage by Congress into law as quickly as possible.
*Distributed by Laura Schiebelhut, BIAA Public Affairs Manager, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637; lschiebelhut@biausa.org
The Policy Corner is made possible by the Adam Williams Initiative, Centre for Neuro Skills, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.
__________________________________________________________________
BIAA Submits Testimony to House Labor-HHS-Education Appropriations Subcommittee
This week BIAA submitted written testimony to the House Appropriations Subcommittee in charge of funding TBI programs within the Department of Health and Human Services and the Department of Education. BIAA’s testimony urges an increase in Fiscal Year 2009 funding for programs authorized through the TBI Act, as well as for TBI research programs conducted within the National Institute on Disability and Rehabilitation Research (NIDRR).
In the testimony, BIAA’s President and CEO Susan H. Connors states, “BIAA was gravely disappointed that last year, even as Congress had the good judgment to add hundreds of millions dollars to the budgets of the Department of Defense and the Department of Veterans Affairs to help address the problem of TBI among returning servicemembers, funding for the HRSA Federal TBI Program was reduced from $8.91 million to $8.754 million.”
Within the testimony, BIAA requests $30 million in funding for programs authorized through the TBI Act, as well as sufficient funding to sustain and increase medical rehabilitation research within NIDRR. The testimony also urges an allocation of at least $8.3 million to allow NIDRR to continue to fund 16 TBI Model Systems research centers.A copy of the testimony can be obtained by visiting BIAA’s website at the following address: http://www.biausa.org/policyissues.htm.
House VA Subcommittee Holds Hearing on TBI And Vision Problems
On Wednesday, April 2, the House Veterans Affairs Subcommittee on Oversight and Investigations held a hearing on TBI Related Vision Issues.
Testimony highlighted the high rate of vision disturbances in cases of servicemembers returing from Iraq and Afghanistan with TBI, and the need for a seamless system of care within the Department of Defense and Department of Veterans Affairs to address these eye injuries, including greater use of specialized vision screening.
In the hearing, the Blinded Veterans Association (BVA) noted research showing that 75 percent of servicemembers with documented TBI injuries also have complaints about vision problems, and that approximately 60 percent of those injured have associated neurological visual disorders. A study conducted by one of the panelists, Gregory L. Goodrich, who is a research psychologist at the VA Palo Alto Health Care System, found that both Polytrauma Level I and Level II patients had high rates of visual impairment and/or visual dysfunction, and that injuries caused by a blast event were associated with more vision related loss and/or deficits than other causes.
In his testimony, Tom Zampieri, Director of Government Relations at BVA, asserted, “At present the current system of screening, treatment, tracking, and follow-up care for TBI vision dysfunction is inadequate. Adding visual dysfunction to this complex mix, especially if undiagnosed, makes attempts at rehabilitation even more daunting and potentially disastrous unless there are significant improvements soon.”
Mr. Zampieri urged the Subcommittee to request that DoD/VA provide for the full implementation of the “Military Eye Trauma Center of Excellence and Eye Trauma Registry,” which was recently authorized as one of the Wounded Warrior provisions in last year’s defense authorization bill (H.R. 4986). BIAA has officially endorsed legislation (S. 1999) to create such a Center.
BIAA Supports Bill to Enact Moratorium on Harmful Medicaid Regulations
Also this week, the House Energy and Commerce Committee held a hearing on H.R. 5613, legislation recently introduced which would place a moratorium until March 2009 on seven Medicaid regulations issued by the Department of Health and Human Services. BIAA has endorsed this legislation, and signed a letter of support spearheaded by the Consortium of Citizens with Disabilities (CCD) in favor of the legislation.
The legislation, which was introduced by Representatives John D. Dingell (D-MI) and Tim Murphy (R-PA) on March 13, 2008, would delay the implementation of seven harmful Medicaid regulations through March 2009, including several rules which would be especially deleterious to individuals with traumatic brain injury.
One of these rules would limit rehabilitation services for Medicaid beneficiaries, severely curtailing the ability of people with disabilities – including TBI – to receive rehabilitation services now covered under Medicaid. Access to these rehabilitative services is essential, as in many cases, these services play a vital role in allowing people with TBI to live independently in the community.
Best Performance Method in Neuropsychological Assessment
There are two fundamental premises upon which the statistical application of the science of neuropsychology is based: The first is that a determination can be made of what a given individual’s premorbid abilities were. The second is that an individual is giving consistent best effort throughout the test battery. Neither assumption works perfectly, but the extent to which these two assumptions work well enough, will determine whether legitimate statistical based diagnostic conclusions can be incorporated into the assessment. In today’s blog, we will discuss the Premorbid Ability assumption. In tomorrow’s, the consistent best effort issue.
Premorbid ability. By premorbid ability, we mean a given individuals abilities prior to the onset of the accident or disease process. If no assumptions can be made about premorbid ability, no diagnosis about “cause” can be made by a neuropsychologist. All they are capable of saying is that a given individual has certain weaknesses and disabilities, but no definitive diagnosis can be made. Thus, some method of assessing premorbid ability is essential.
Most neuropsychologists don’t look at enough information in determining pre-morbid IQ. They base far too much of their assessment with respect to pre-morbid ability on the test battery itself. In our earlier example of the person with the IQ of 135 post the accident, that is less of a problem. Clearly a person who has a post-morbid IQ of 135, was very superior before the onset. But most cases are not so clear cut. A previously brilliant person may not continue to have a very superior IQ after the accident. If certain deficits bring the person down into an IQ range of 110 or so, we would likely need to look for other evidence to determine IQ.
One way is by looking at the areas where they still have strengths. If their average scores are in the 130 or above area, and there are a few scores in areas we might suspect would be effected by the injury, then it might be easy to say this person was very superior before. But again, that is the easy pattern to spot. Most profiles are not that obvious.
Another method is to look at certain subtest scores, where it is believed that a given ability is unlikely to be substantially effected by the given injury. Reading scores are often thought to be an ability that is rarely changed significantly by a mild or moderate injury. Thus, a neuropsychologist might say that a person with a “very superior” reading score and a much lower current IQ, had pathological deficits, based on the retained ability to read at a high level.
All of these methods work far better with someone with a very high IQ. When you are dealing with people in the average range, IQ’s of 90-110, it becomes much more difficult to make such assumptions about premorbid IQ from subtest scores.
Another method is to assume IQ based on a assessment of that person’s educational level. So a person with a college degree would be assumed to have a higher IQ than someone without. The obvious flaw in such logic, that some brilliant people don’t go to college, isn’t even the most significant problem. The significant problem is that it groups all college graduates together. Ask anyone who went to college. Not all of their classmates were of equal intelligence and ability.
Another method, one I believe to be considerably better than the first two, is called the ‘best performance method.” The best performance method is based upon the assumption that a person’s highest areas of achievement are the best indicators of premorbid ability. If these areas of highest achievement are in contrast to significantly lower subtests scores that may point to pathology.
Of course, there is considerable disagreement as to how to apply the “best performance method.” Many neuropsychologists dismiss it as they interpret this method as applying only to the best performance on individual tests, within the full battery of tests. That would mean if the person got 99% in arithmetic or vocabulary, that would mean that such person is in the 99%. It is easy to poke holes in a restricted use of the “best performance method” because we all have normal variances in what we are good at.
However, another interpretation of the best performance method is that it makes a full assessment – not just of the scores on the given battery of tests – but also the person’s real world performances or achievements. For example, if a person has graduated from medical school, one assumes that they are very near the top of the pre-morbid ability level. Likewise, if they have risen to the top of any profession, they would be assumed to be near the top.
In my opinion, the overall preferred method, which of course is harder to reduce to statistical probabilities, is to use of the real world “best performance method”. Such method considersall factors, school records, work performance records, areas of retained strength on the test. If someone got a math score of 700 and a verbal score of 700 on the SAT when applying to college, they clearly were way above average at that time. If they went on to graduate from a competitive law school or medical school, we must almost assume that they were at the superior or likely very superior level.
If the scores were good, but not great, if they graduated from college with more than a B average and went on to have a successful career, we can’t assume they were only average. Whether they are high average or superior is open to interpretation but that is what professionals are supposed to do: make subjective interpretations of complex multi-faceted variables, to reach conclusions.
Who a person was before injury is far more complex than how well they do now on a reading score. Only if neuropsychologists look at not the basic outline of a person’s premorbid life, but level of achievement within that life, will neuropsychology be able to identify the true areas of acquired deficits and disability.
Tomorrow the concept of “consistent best effort.”
Premorbid ability. By premorbid ability, we mean a given individuals abilities prior to the onset of the accident or disease process. If no assumptions can be made about premorbid ability, no diagnosis about “cause” can be made by a neuropsychologist. All they are capable of saying is that a given individual has certain weaknesses and disabilities, but no definitive diagnosis can be made. Thus, some method of assessing premorbid ability is essential.
Most neuropsychologists don’t look at enough information in determining pre-morbid IQ. They base far too much of their assessment with respect to pre-morbid ability on the test battery itself. In our earlier example of the person with the IQ of 135 post the accident, that is less of a problem. Clearly a person who has a post-morbid IQ of 135, was very superior before the onset. But most cases are not so clear cut. A previously brilliant person may not continue to have a very superior IQ after the accident. If certain deficits bring the person down into an IQ range of 110 or so, we would likely need to look for other evidence to determine IQ.
One way is by looking at the areas where they still have strengths. If their average scores are in the 130 or above area, and there are a few scores in areas we might suspect would be effected by the injury, then it might be easy to say this person was very superior before. But again, that is the easy pattern to spot. Most profiles are not that obvious.
Another method is to look at certain subtest scores, where it is believed that a given ability is unlikely to be substantially effected by the given injury. Reading scores are often thought to be an ability that is rarely changed significantly by a mild or moderate injury. Thus, a neuropsychologist might say that a person with a “very superior” reading score and a much lower current IQ, had pathological deficits, based on the retained ability to read at a high level.
All of these methods work far better with someone with a very high IQ. When you are dealing with people in the average range, IQ’s of 90-110, it becomes much more difficult to make such assumptions about premorbid IQ from subtest scores.
Another method is to assume IQ based on a assessment of that person’s educational level. So a person with a college degree would be assumed to have a higher IQ than someone without. The obvious flaw in such logic, that some brilliant people don’t go to college, isn’t even the most significant problem. The significant problem is that it groups all college graduates together. Ask anyone who went to college. Not all of their classmates were of equal intelligence and ability.
Another method, one I believe to be considerably better than the first two, is called the ‘best performance method.” The best performance method is based upon the assumption that a person’s highest areas of achievement are the best indicators of premorbid ability. If these areas of highest achievement are in contrast to significantly lower subtests scores that may point to pathology.
Of course, there is considerable disagreement as to how to apply the “best performance method.” Many neuropsychologists dismiss it as they interpret this method as applying only to the best performance on individual tests, within the full battery of tests. That would mean if the person got 99% in arithmetic or vocabulary, that would mean that such person is in the 99%. It is easy to poke holes in a restricted use of the “best performance method” because we all have normal variances in what we are good at.
However, another interpretation of the best performance method is that it makes a full assessment – not just of the scores on the given battery of tests – but also the person’s real world performances or achievements. For example, if a person has graduated from medical school, one assumes that they are very near the top of the pre-morbid ability level. Likewise, if they have risen to the top of any profession, they would be assumed to be near the top.
In my opinion, the overall preferred method, which of course is harder to reduce to statistical probabilities, is to use of the real world “best performance method”. Such method considersall factors, school records, work performance records, areas of retained strength on the test. If someone got a math score of 700 and a verbal score of 700 on the SAT when applying to college, they clearly were way above average at that time. If they went on to graduate from a competitive law school or medical school, we must almost assume that they were at the superior or likely very superior level.
If the scores were good, but not great, if they graduated from college with more than a B average and went on to have a successful career, we can’t assume they were only average. Whether they are high average or superior is open to interpretation but that is what professionals are supposed to do: make subjective interpretations of complex multi-faceted variables, to reach conclusions.
Who a person was before injury is far more complex than how well they do now on a reading score. Only if neuropsychologists look at not the basic outline of a person’s premorbid life, but level of achievement within that life, will neuropsychology be able to identify the true areas of acquired deficits and disability.
Tomorrow the concept of “consistent best effort.”
Understanding Neuropsychological Statistics in Diagnosing Brain Injury
Yesterday’s blog threw out a few numbers to illustrate some basic starting principles about neuropsychology. As an aid to our further discussion of this neuropsychology, today I will give some basic numerical principles to help in further understanding the numeric part of neuropsychological assessment.
First, neuropsych scores are typical given in one of three scoring methods: Standard score, percentile score and T scores. T scores are a little bit too complicated to try to explain to a laymen, so I will limit this discussion to standard scores and convert them to percentile scores.
Most people are somewhat familiar to standard scores, because IQ’s are given in them. Yesterday I used the example of our successful professional who had a post accident IQ of 135. An IQ of 100 is perfectly in the middle. Something below 70 is evidence of significant impairment. Each time you move down the standard score grid by 10 points, it represents a significant drop.
Here are the basic categories of Standard scores, with their percentile equivalents.
Very superior — 130 and above — 98% and above
Superior __ 120 to 129 — 92% to 97%
High Average — 110 to 119 — 76% to 91%
Average — 90 to 109 — 25% to 75%
Low Average — 80 to 89 — 8% to 24%
Borderline — 70 to 79 — 3% to 7%
Impaired — below 70 — 2% and below
T scores use the same basic concept, and again using 10 points as the break point, but with a T score, the mid point is 50. Some neuropsychologists may disagree as to the exact point that separates these categories, but this is certainly representative of the concept.
The second term to understand in terms of understanding the statistical analysis done by a neuropsychologist is the concept of “deviations”. While I am incapable of synthesizing the dozens of different explanations of this concept into one cohesive definition, in essence, when you move from one category like very superior, to superior, you have moved one deviation. When you move from very superior to high average, that would be two deviations. Movements of two deviations are deemed to be significant.
Yesterday’s example of an IQ score of 135, which was very superior, to an average processing speed score of 100, is a movement of three standard deviations. That could be quite significant, but of course is only one factor to be looked at in doing a full blown “assessment.”
Tomorrow: assessing premorbid IQ and other ability levels.
First, neuropsych scores are typical given in one of three scoring methods: Standard score, percentile score and T scores. T scores are a little bit too complicated to try to explain to a laymen, so I will limit this discussion to standard scores and convert them to percentile scores.
Most people are somewhat familiar to standard scores, because IQ’s are given in them. Yesterday I used the example of our successful professional who had a post accident IQ of 135. An IQ of 100 is perfectly in the middle. Something below 70 is evidence of significant impairment. Each time you move down the standard score grid by 10 points, it represents a significant drop.
Here are the basic categories of Standard scores, with their percentile equivalents.
Very superior — 130 and above — 98% and above
Superior __ 120 to 129 — 92% to 97%
High Average — 110 to 119 — 76% to 91%
Average — 90 to 109 — 25% to 75%
Low Average — 80 to 89 — 8% to 24%
Borderline — 70 to 79 — 3% to 7%
Impaired — below 70 — 2% and below
T scores use the same basic concept, and again using 10 points as the break point, but with a T score, the mid point is 50. Some neuropsychologists may disagree as to the exact point that separates these categories, but this is certainly representative of the concept.
The second term to understand in terms of understanding the statistical analysis done by a neuropsychologist is the concept of “deviations”. While I am incapable of synthesizing the dozens of different explanations of this concept into one cohesive definition, in essence, when you move from one category like very superior, to superior, you have moved one deviation. When you move from very superior to high average, that would be two deviations. Movements of two deviations are deemed to be significant.
Yesterday’s example of an IQ score of 135, which was very superior, to an average processing speed score of 100, is a movement of three standard deviations. That could be quite significant, but of course is only one factor to be looked at in doing a full blown “assessment.”
Tomorrow: assessing premorbid IQ and other ability levels.