American Academy of Clinical Neuropsychology consensus conference statement on uniform labeling of performance test scores

Abstract

Objectives: Descriptive labels of performance test scores are a critical component of communicating outcomes of neuropsychological and psychological evaluations. Yet, no universally accepted system exists for assigning qualitative descriptors to scores in specific ranges. In addition, the definition and use of the term "impairment" lacks specificity and consensus. Consequently, test score labels and the denotation of impairment are inconsistently applied by clinicians, creating confusion among consumers of neuropsychological services, including referral sources, trainees, colleagues, and the judicial system. To reduce this confusion, experts in clinical and forensic neuropsychological and psychological assessment convened in a consensus conference at the 2018 Annual Meeting of the American Academy of Clinical Neuropsychology (AACN). The goals of the consensus conference were to recommend (1) a system of qualitative labels to describe results from performance-based tests with normal and non-normal distributions and (2) a definition of impairment and its application in individual case determinations. Results: The goals of the consensus conference were met resulting in specific recommendations for the application of uniform labels for performance tests and for the definition of impairment, which are described in this paper. In addition, included in this ARTICLE HISTORY

Serial Recall Order and Semantic Features of Category Fluency Words to Study Semantic Memory in Normal Ageing

“…The classification of test performance carried out in the group of older adults using the framework by Guilmette and co-authors ( Guilmette et al, 2020 ) revealed that the majority (∼85%) of test scores was “ within normal limits ,” with a further ∼10% of “ low average ,” ∼5% “ below low average ” and less than 1% “ exceptionally low ” scores. This was consistent with rates expected in healthy controls assessed with a multi-test battery ( Axelrod and Wall, 2007 ; Binder et al, 2009 ).…”

“…Of the two groups, particular care was taken to evaluate diagnostic statuses in the group of older adults, since in this age range prevalence of cognitive impairment is estimated to range between 5% and 40% ( Pais et al, 2020 ). To assess their cognitive profile the diagnostic labelling consensus proposed by the American Academy of Clinical Neuropsychology was followed, whereby performance above the expected 24th percentile is considered within normal limits ( Guilmette et al, 2020 ). We thus used the entire cohort of ≥70 year-old adults ( n = 75) from which the study group of older adults had been extracted, to define numerical cut-offs corresponding to the 24th, 8th, and 2nd percentile for each test score.…”

“…We thus used the entire cohort of ≥70 year-old adults ( n = 75) from which the study group of older adults had been extracted, to define numerical cut-offs corresponding to the 24th, 8th, and 2nd percentile for each test score. This was carried out to categorise performance into one of the following four labels: “ score within normal limits ”, “ low average score ”, “ below average score ”, and “ exceptionally low score ” ( Guilmette et al, 2020 ). For clinical interpretational purposes, we also relied on the principles outlined by Axelrod and Wall (2007) and by Binder et al (2009) , according to which a proportion of scores not within normal limits should be expected when a battery of tests is administered to healthy controls.…”

Functional and microstructural brain abnormalities, fatigue, and cognitive dysfunction after mild COVID-19

“…We controlled the effects of the age or schooling in a separate analysis using multiple linear regression residuals when normative data covered only one of these variables. For each test, the function was categorized as preserved (z-score > −0.66), including average, high average, above average, and exceptionally high scores), low average score (z-score between −0.7 and −1.26); below-average score (z-score between −1.32 and −1.82); and exceptionally low score (z-score < −1.96) (Beauchamp et al, 2015; Guilmette et al, 2020).…”

Mayo Normative Studies: Regression-Based Normative Data for the Auditory Verbal Learning Test for Ages 30–91 Years and the Importance of Adjusting for Sex

“…Analyses focused on rates of low test performance using a < −1 SD cutoff. Descriptors applied in clinical practice, including the recently published American Academy of Clinical Neuropsychology Consensus Statement (Guilmette et al, 2020), often include several descriptor categories to indicate degree of departure from average performance. Our focus on a < −1 SD cutoff captures all performances below that cutoff together, thus collapsing across several descriptor categories.…”