Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at the others and I keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing”.
This podcast is brought to you by PAR. The Brief-2 is the gold standard rating scale for measuring executive function. A new score report, an updated interpretive report, and a series of 10 intervention handouts are now available on PARiConnect. Learn more at parinc.com\brief2.
Hey folks, welcome back to the [00:01:00] podcast. Today is a clinical episode where I’m talking about two big changes that we have made to our testing battery recently.
I wonder if y’all have experienced this where it seems like a few of our measures are getting a little long in the tooth, so to speak. I’m not even sure what that means. Honestly, I’m going to go look that up after I’m done here, but they’re getting old. We’ve also noticed, maybe you’ve noticed this, that we have settled into administering the same thing for years probably.
During our testing team retreat back in February, we made two big changes to our battery that I thought I would share for anybody else who might be considering some different options in these areas. We were looking at our memory and learning assessment and our executive functioning assessment.
So this is a quick and pointed episode that also serves as, I would say, a mini review [00:02:00] of two different measures.
Before I get to the conversation, of course, I would love to invite any of you who would like to work together in building your practice or scaling your practice to reach out. You can go to thetestingpsychologist.com/consulting and schedule a pre-consulting call to figure out if it makes sense to work together. And if not, I’ll point you in the direction of whatever resources I might be aware of.
Okay, let’s chat about testing measures.
All right, everybody let’s bust right into it.
As I said, we have noticed for a while that we needed some updates to our standard battery. As practitioners that employ several neuropsychological measures, we are typically big fans of executive [00:03:00] functioning, memory, and learning. The only problem is that our current measures didn’t fit the bill. So we did a testing team retreat in February and we came to the conclusion that we would like to give a couple of new measures a try.
Here are the ones that we are trying to replace first of all.
We don’t love the D-KEFS. It is very old, right? It was published, I think, in 2000, maybe even a little bit before that. And it’s just old. It’s got outdated norms. It doesn’t seem to have the sensitivity that we would like for our population, which largely consists of kids and adults who aren’t severely impaired or even moderately impaired from head trauma or other complex medical issues. In other words, we’re finding that almost everyone comes back as average or maybe [00:04:00] below average. Now, I will say this, we typically only administer the Tower, Color-Word Interference and Trails from the D-KEFS. So we set out to replace those subtests.
We’re still working on Color-Word Interference and Trails, but we did move to the Tower of London-DX 2nd Edition. The reason we did this is because the sensitivity seems much better than the D-KEFS Tower and it goes down to age seven. So we gain an extra year compared to the D-KEFS. So right now we are piloting the Tower of London. It’s not new by any means. It is slightly newer. The norms are slightly more updated than the D-KEFS, but not a ton. I will say that, but the real reason, like I said, that we were drawn to the Tower of London is for the perceived better sensitivity and the age range.
[00:05:00] Now, we still haven’t settled on great replacements for Color-Word Interference and Trails. We are looking at the Stroop for kids and the CTMT2, Comprehensive Trail-Making Test 2.I will say that a big part of our decision was the cost of the D-KEFS. If you administer the D-KEFS, between the trails booklets and the response booklets and the scoring, it adds up pretty quickly.
Now, I know a lot of you out there probably saying, well, what about the D-KEFS 2.0? And that’s on the horizon. I would love for that to be the solution. And luckily, the Tower of London is pretty inexpensive. So if the D-KEFS 2.0 comes out and it’s amazing and we want to add it to the battery, I am totally fine doing that. I just want to see [00:06:00] what it looks like. We’re of course, still wary of the cost and just being honest, we’re going to save a lot of money in the next several months that justified purchasing the Tower of London and these couple of other things to potentially just tide us over to the D-KEFS 2.0, but we will see.
Let’s take a break to hear from a featured partner.
Y’all know that I love TherapyNotes, but I am not the only one. They have a 4. 9 out of 5-star rating on trustpilot.com and Google, which makes them the number one rated Electronic Health Record system available for mental health folks today. They make billing, scheduling, note-taking, and telehealth all incredibly easy. They also offer custom forms that you can send through the portal. For all the prescribers out there, TherapyNotes is proudly offering e prescribe as well. And maybe the most important thing for me is that they have live telephone support 7 days a week. So you can actually [00:07:00] talk to a real person in a timely manner.
If you’re trying to switch from another EHR, the transition is incredibly easy. They’ll import your demographic data free of charge so you can get going right away. So, if you’re curious, or you want to switch, or you need a new EHR, try TherapyNotes for two months, absolutely free. You can go to thetestingpsychologist.com/therapynotes and enter the code testing. Again, totally free, no strings attached. Check it out and see why everyone is switching to TherapyNotes.
The Brief2 is the gold standard rating scale for measuring executive function. A new score report and updated interpretive report are available on PARiConnect help you get the answers you need about executive functioning and ADHD quickly. Also available is a series of 10 downloadable, easy-to-understand Brief2 intervention handouts designed to provide parents, students, and teachers with strategies to support and improve behaviors at [00:08:00] home and in school. Learn more at parinc.com\brief2.
All right. Let’s get back to the podcast.
The other measures that we set out to replace were the CVLTC and The Rey Complex Figure Test. Now, some of you out there may be wondering why in the world we would want to replace these tests. I love both of those measures, but the combo was getting, I would say, a little tedious, and in an effort to shorten the battery as much as we could while covering the most important, I would say, 90% to 95% of things that those tests measured and process scores and whatnot, we decided to move to the ChAMP or [00:09:00] Child and Adolescent Memory Profile.
One of the big reasons that we also decided to move to something else is because a lot of us were finding, maybe you found this as well, that the Rey or the RCFT, in particular, is, I think, pretty confounded by demands on motor skills and executive functioning skills.
So again, for our population, we’re not seeing folks with significant impairment in the vast majority of cases. So we can still pull out these measures in those cases, but for the vast majority of folks, we would get a lot of good information from the copy condition of the Rey. But then we found that the immediate and delayed and even recognition conditions were pretty heavily influenced by the executive functioning skill that they employed in the copy condition.
And so, if they [00:10:00] didn’t have a good copy, it would impact the memory, of course, or the recall and the encoding. So we’ve decided to move to something different that does not have motor demands or as many executive functioning demands.
Now, we are going to still keep the REY Copy so that we can keep it as a measure of executive functioning, but we are ditching the recall and recognition components of the Rey.
So, like I said, we settled on the Child and Adolescent Memory Profile or ChAMP for the following reasons: It’s brief, it’s 35 minutes from start to finish. It has a great age range that covers the vast majority of our kids and young adults. The age range is 5 to 21. It covers a wide variety of memory. It’s got verbal, visual, immediate, and delayed. It’s not confounded by motor or EF demands aside [00:11:00] from the typical executive functioning demands on working memory, but not planning or organization like the Rey.
The norms are relatively updated. They’re from 2012. This is about as good as you can get for a test that was published in the last five years or so. They have clinical and non-clinical samples. An awesome bonus is that there’s a built-in validity indicator to the ChAMP or the PVT, and they had relatively large effect sizes for different clinical populations that are actually helpful.
Now, what do we lose? We lose some of the process scores from the CVLT like Learning slope, for example, and serial versus semantic. But in the end, we felt like this was a pretty positive step and we can always supplement with the CVLT to zone in on verbal [00:12:00] memory concerns. Regarding visual memory, like I said, we’re still going to administer the Copy condition of the Rey, but mainly as an executive functioning and visual-motor test.
So this quick summary, like I said, of some changes that we are making. We are, of course, looking forward to the WAIS-5 and what that might look like in the fall and the D-KEFS 2.0 like I mentioned earlier.
If you are making changes to your battery or have found great supplements or measures to cover some of these areas, I would love to know about them. We certainly considered the WRAML and the TUMBLE and Trails-X, of course. We considered all these things, but ultimately, like I said, we settled on the ChAMP and the Tower of London for the time being. But it’s always good to revisit your [00:13:00] battery and make sure that you are administering the most up-to-date and effective measures.
And look, if you want to come at me gently or not so gently about these choices, please do so. Send me an email: jeremy@thetestingpsychologist.com. Say, Jeremy, these are poor choices. There are so much better measures out there to do what you want to do. Just give me the reasoning, give me the rationale and I would love to consider it and talk about it on a future podcast.
All right, y’all. That’s it for our battery changes. Happy testing.
All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes. So make sure to check those out.
If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your [00:14:00] podcast.
And if you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist Mastermind Groups. I have mastermind groups at every stage of practice development, beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.
The information contained in this podcast and on The Testing Psychologis[00:15:00]website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.
Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and the listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.