An Investigation of videotape rescoring of certain subtests of the Porch Index of Communicative Ability

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1 University of Montana ScholarWorks at University of Montana Graduate Student Theses, Dissertations, & Professional Papers Graduate School 1974 An Investigation of videotape rescoring of certain subtests of the Porch Index of Communicative Ability Caroline Lee Massarotto The University of Montana Let us know how access to this document benefits you. Follow this and additional works at: Recommended Citation Massarotto, Caroline Lee, "An Investigation of videotape rescoring of certain subtests of the Porch Index of Communicative Ability" (1974). Graduate Student Theses, Dissertations, & Professional Papers This Thesis is brought to you for free and open access by the Graduate School at ScholarWorks at University of Montana. It has been accepted for inclusion in Graduate Student Theses, Dissertations, & Professional Papers by an authorized administrator of ScholarWorks at University of Montana. For more information, please contact

2 AN INVESTIGATION OF VIDEOTAPE RESCORINO OF CERTAIN SUBTESTS OF THE PORCH INDEX OF COMMWICATIVE ABILITY By C aro lin e Lee M assarotto Diploma in Speech Therapy, U h iv ersity o f Queensland, A u s tra lia, 1968 Presented in p a r t i a l fu lfillm e n t o f th e requirem ents fo r the degree of M aster of A rts DIVERSITY OF MONTANA 197U Approved: triairman, Orad^M^ Date Ç ù - ^ a 7.

3 UMI Number: EP39507 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. UMT OMMrtation Publithing UMI EP39507 Published by ProQuest LLC (2013). Copyright in the Dissertation held by the Author. Microform Edition ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code uest ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml

4 ACKNOWLEDGEMFÎITS The w rite r would lik e to thank her th e s is committee members. D r, Robert Chaney and D r. Wesley Shellen f o r th e ir suggestions and advice. G ratitude i s also expressed to the c lin ic ia n s and p a tie n ts from the Speech Pathology Departments a t the d e n ro s e H ospital in Edmonton and the V eteran s A dm inistration H o sp ital in Denver, who went out o f th e i r way to help in th is study. F in a lly, th e w rite r wishes to express sin c ere a p p reciatio n both to Paul and to Dr. Kellogg Lyndes fo r th e i r help and encouragem ent. I t was a combination o f the fo rm er's p a tien c e and the l e t t e r 's continued advice th a t made th e completion o f t h is th e s is p o s s ib le. i i

5 TABLE OF CONTEKTS C hapter PsLge I. INTRODUCTION... 1 S ta tm e n t of th e P ro b le m... 3 Review o f the L i t e r a t u r e... ^ I I. PROCEDURE...11 S u b je c ts...11 E q u ip m e n t...12 Standard T est C o n d itio n s...12 E:q)erim ental P r o c e d u r e s...12 n i. RESULTS Average Scores Score C h a n g e s Types o f Changes Subjects and C lin ic ia n s IV. DISCUSSION A nalysis o f Average S c o r e s...2? Score C h a n g e s Type o f Response C lin ic ia n s C o n c lu s io n s...33 V. SÜMMARÏ BIBLIOGRAPHY...38 APPENDIX...la i l l

6 LIST OF TABLES Table Page 1. The PICA C ategories f o r Scoring R e s p o n s e s D ifferences Between Average Scores f o r VGS Under the A dm inistration and Review C o n d itio n s D ifferences Between Average Scores fo r E ight G estural S ubtests Under the A dm inistration and Review C onditions fo r Each T est Given U. D ifferences Between Average Scores fo r Four V erbal S ubtests Under the A dm inistration and Review C o n d itio n s Comparison o f Average Score Changes (D isreg ard in g Sign) fo r Each S u b test IMder th e Adm^i s t r a t i on and Review C o n d itio n s Standard D eviation o f Changes Between the A dm inistration and Review C onditions fo r Each S u b test fo r A ll T ests G i v e n A Comparison o f D ire c tio n and Mean Size o f Score Changes from A dm inistration to Review o f Verbal and G estural S ubtests f o r Twelve S ubjects D istrib u tio n of Nunbers of Changes over 120 Item s from the Response Level Given During A dm inistration to th a t Given During Review fo r Twelve S u b j e c t s...25 iv

7 LIST OF FIGURES Figure Page 1. T o tal Number of Changes Made f o r Each o f the Twelve Subjects T ested, Related to H is/h er Average Score fo r T O S , Percentage of Response Changes from th a t Assigned During A dm inistration a t Each o f the L evels Used, Over A ll Item s and A ll T ests G iv e n... 2U

8 CHAPTER I INTRODUCTION The Porch Index o f Communicative A b ilitie s (PICA) i s a " c l i n i c a l to o l designed to assess and q u an tify c e rta in læ rb a l, g e s tu ra l, and graphic a b ilitie s " (Porch, 1973» p. 1 ). I t was fu rth e r s ta te d by Porch (1973) th a t the t e s t enables the c lin ic ia n to measure le v e ls of output a b ilily and make in fere n ces about the in p u t and in te g ra tiv e a b i l i t i e s o f the aphasie p a tie n t. The PICA c o n sists o f 18 su b te sts: U v e rb a l, 8 g e s tu ra l, and 6 g rap h ic. I t employs a m ultidim ensional scoring system th a t q u a n tifie s 16 le v e ls of responses in terms o f varying degrees o f accuracy, responsiv e n ess, com pleteness, prom ptness, and e ffic ie n c y. A sin g le score i s assigned to a given response which describ es th e response in varying degrees o f these fiv e dim ensions. This m ultidim ensional system i s viewed as a b in a ry choice system in which th e sc o re r, in ev alu atin g a response from a p a tie n t, makes a s e rie s o f b in a ry choices continuing through a system u n til a d ecisio n y ie ld s a score (Porch, 1971). (See Appendix A.) The PICA c a te g o rie s fo r scoring responses are p resen ted in Table 1. Porch (1973, p. 1) s ta te d th a t a " c r i t ic a l fa c to r in th e usefu ln ess o f the PICA i s th e r e l i a b i l i t y o f the t e s te r." He went on to say th a t once the t e s te r has achieved r e l i a b i l i t y in h is adm in istratio n

9 CD D OQ. C g Q. D CD C/) o' 3 O 8 ( O ' 3. 3" CD CD D OQ. C a o 3 "O o CD Q. D CD C/) o' 3 TABLE 1 THE PICA CATEGORIES FOR SCORING RESPONSES Score Category Dimensional C h a ra c te ris tic s 16 Complex A ccurate, Respwisive, Complex, Prompt, E f fic ie n t 15 Complete A ccurate, Responsive, Complete, Prcmpt, E f fic ie n t Ih D isto rted A ccurate, R esponsive, Complete o r Complex, Prompt, D isto rte d 13 C o m p le te-d e l^ d A ccurate, Responsive, Complete o r Complex, Delayed 12 Incom plete A ccurate, Responsive, Incom plete, Prompt 11 Incomplete -Del ayed A ccurate, Responsive, Incom plete, Delayed 10 C orrected A ccurate, S e lf-c o rre c te d 9 Repeated A ccurate, a f te r in s tru c tio n s are repeated 8 Cued A ccurate, a f te r cue i s given 7 R elated In a c c u ra te, alm ost accurate 6 E rror In accu ra te attem pt a t th e ta sk item 5 I n te llig ib le Comprehensible b u t n o t an attem pt a t the ta sk item U ttiin te llig ib le Incom prehensible b u t d if fe r e n tia te d 3 Minimal Incom prehensible and u n d iffe re n tia te d 2 A tten tio n No response, b u t p a tie n t a tte n d s to the t e s t e r 1 No Response No response, no awareness of task Source: Porch Index o f Communicative A b illty A dm lnistratlon, Scoring, and I n te r p r e ta tio n, Vol.?, p".^17, by Bruce E. Porch (Ï^ T J). ro

10 3 and sco rin g, th e su b te sts are s e n s itiv e to sm all changes In the p a t i e n t 's perform ance. R e lia b ility can be defined as the r e la tiv e absence of e rro r s o f measurement in a measuring Instrum ent (K e rlin g e r, 1973). This d e fin itio n th ere fo re Includes term s such as th e s t a b i l i t y, dependab i l i t y, p r e d ic ta b ility, and accuracy of the m easure. The concem o f th is study centered around the s t a b i l i t y and d epen d ability of scores assigned by an a d m in istrato r o f the PICA to responses produced by a p a tie n t during ad m in istratio n o f the t e s t. The method o f exam ination employed the review through th e use of videotape recording of the o rig in a l evaluation during idiich th e ad m in istrato r rescored the t e s t. S tatem ent o f th e Problem Because o f th e numerous and fre q u e n tly rap id judgments req u ired o f th e t e s t ad m in istrato r during the conduct o f th is t e s t, c<m siderable concem was experienced by the w rite r regarding the ongoing accuracy of the ad m in istrato r o f the t e s t in scoring a continuous stream of r e sponses by the p a tie n t. Subsequent re scoring by n o t only the author b u t by o th er tra in e d a d m in istra to rs, through the media o f videotape reco rd in g s, appeared to support th is concern. I t became a ro u tin e procedure w ith in th e U h iv e rs ity o f Montana, Speech, Language, and H earin g C lin ic, as w ell as a t the Speech Pathology C lin ic a t the H enro se H o sp ita l, Edmonton, A lb e rta, to review assigned scores by means of video and/or audio ta p e. Hence, a study o f th is area was f e l t to be w arranted to explore the u se fu ln ess o f such a procedure.

11 h These same t e s t a d m in istrato rs in both c lin ic s had reached a le v e l o f p ro fic ie n c y th a t re s u lte d in high in te r-o b s e rv e r r e l i a b i l i t y a t the com pletion of th e i r tra in in g on the PICA, Due to such p o ssib le fa c to rs as in fre q u e n t use o f th e t e s t, speed a t which many responses need to be recorded, and th e f le e tin g n a tu re o f many responses which must be scored, t h is p ro fic ie n c y le v e l was subsequently questioned. E ith e r the audio o r video review was f e l t to supplement the p ro fic ie n c y le v e l. The videotape was f e l t to be most h e lp fu l in th a t i t allowed fo r both audito ry and v is u a l cues to be reviewed in the re scoring p ro cess. From em p irical o b serv atio n, i t appeared th a t the review o f th e videotape supplemented i n i t i a l scoring fo r the follow ing reasons: ( l) i t allowed fo r repeated o b serv atio n s during th e videotape review o f a p a rtic u la r response, (2) the f a c t th a t th e videotape p ic tu re was u su a lly taken fn a i a f ro n t view of the p a tie n t, thus allow ing f o r a view o f the p a tie n t from a d if f e r e n t vantage p o in t than th a t obtained by th e c lin ic ia n during the o rig in a l a d m in istra tio n, and (3) th e elim in a tio n o f the a d m in is tra to r's concem fo r standard p re sen ta tio n o f in s tr u c tio n s, wuch then allowed f o r more a tte n tio n to be given to the p a t i e n t 's response. The videotape review was found to be most h e lp fu l fo r g e stu ra l m d v e rb a l sub t e s t s because responses were o ften f le e tin g. I t appeared th a t graphic su b te st scores could be reviewed w ithout videotape fo r a l l fa c to rs except d elay, s e lf-c o rre c tio n, re p e titio n of in s tru c tio n s, and cued in s tru c tio n s. In a d m in istratio n of the graphic s u b te sts the c lin ic ia n can make note o f t h i s reduced number o f fa c to rs and th u s i t

12 was f e l t th a t th ese s a b te s ts can be rescored w ithout the n e c e s s ity o f video rep la y. The c e n tra l question asked in t h is study was whether th e re was a s u b s ta n tia l d iffe re n c e in scores obtained on th e v erb al and g e stu ra l sub t e s t s daring a d m in istratio n of the t e s t and scores obtain ed when th e t e s t was reviewed through video recordings by th e o rig in a l admini s t r a t o r. Review o f the L ite ra tu re Porch (1967) presented as p a r t o f the c o n stru ctio n of the t e s t an in v e s tig a tio n of sc o rer agreem ents. The method involved a comparison o f th e PICA scores obtained by two tra in e d observers and the ad m in istrato r o f th e t e s t. T h irty p a tie n ts were used fo r th is p a r t of the study and a comparison o f su b te st means and response le v e ls were made. R esults in d ic a te d th a t d iffe re n c e s between th e means o f scores were very sm all (.2 5 o f one p o in t fo r su b te sts and,19 o f one p o in t fo r graphic, g e s tu ra l, v erb al and o v e ra ll response le v e ls ) when the p o te n tia l range o f v a ria tio n (1 5.0 ) was considered. T his w rite r sugg e sts th a t although the p o ssib le range of v a ria tio n i s 15 p o in ts, the g re a te s t probable range would be 10 p o in ts ; e. g., the change from a U type response ( u n in te llig ib le ) to a lu type response ( d is to r te d ). However, even i f th e d iffe re n c e between means o f scores i s compared w ith t h is probable ran g e, i t m ight s t i l l be considered sm all. An a n a ly sis o f su b te st score d iffe re n c e s showed the follow ing; 1, That no v e rb a l su b te st showed s ig n if ic a n t d iffe re n c e s between sc o re rs.

13 6 2. The s ig n ific a n t variances were found m ainly in S u b te st I I I, a g e stu ra l s u b te st, and S ubtest E, a graphic s u b te s t. 3. The lack o f scorer agreement was a ttrib u te d to a b ia s on the p a r t of one o f th e sc o rers and t h i s was n o t c o n siste n t over a l l s u b te s ts. Porch (1971) s ta te d th a t a given sc o re r might be in c lin e d to score s lig h tly, though c o n s is te n tly, high o r low on v a rio u s s u b te s ts, b u t th a t the main th r e a t to sc o rer agreement was an o ccasio n al f a ilu r e to apply the ru le s o f scorin g. Porch (1971, p. 791) also s ta te d th a t "the p a tie n t 's behavior d ic ta te s which scoring category must be used to d escrib e th a t b ehav io r, and th e re fo re, the sc o rer has l i t t l e o pportunity to allow s u b je c tiv ity to e n te r in to h is d e c isio n s." In a d d itio n, he sa id th a t although a few o f th e 180 item s recorded during the ad m in istratio n of th e t e s t allow some freedw i o f in te r p re ta tio n and s u b je c tiv ity, idien and i f d i f ferences occur, they were sm all enough to have l i t t l e e f f e c t on the s u b te s t mean. He concluded by saying: Of course, any d iffe re n c e s between sc o rers, no m atter how sm all, mean one c lin ic ia n i s observing d iffe re n c e s in behavior th a t the o th e r c lin ic ia n i s n o t observing and th e re fo re c l i n i c ia n s who use the system f e e l a g re a t re s p o n s ib ility to e x e rt every e f f o r t to score w ith p re c isio n and s e n s itiv ity. I t i s a system in which c lin ic a l standards are f a r more s trin g e n t than psychom etric stan d ard s (Porch, 1971» p. 791). The PICA b a tte r y o f sub t e s t s was designed to sanç)le a v a rie ty o f communicative s k i l l s a t d iffe re n t le v e ls o f cm nplexlty. The range o f task d if f ic u lty was found to be wide, varying frrwi S u b test A (g ra p h ic ), which was the most d i f f i c u l t ta s k, to S u b test XI (g e s tu ra l), one o f th e e aisiest and l e a s t s e n s itiv e.

14 7 In th e t e s t c o n stru c tio n, 150 p a tie n ts re p re se n tin g varying decrees o f communicative involvem ent were used. The scores w ithin the s u b te sts were found to be w idely d isp ersed fo r t h is group, covering alm ost the e n tire range of the 16-point sc a le. Broad d isp e rsio n of scores was a lso evidenced in the o v e ra ll scores and across a l l m odalit i e s (v e rb a l, g rap h ic, and g e s tu ra l) (Porch, 196?}. The use of videotaping and film s v ersu s liv e p re se n ta tio n in p a s t l it e r a t u r e has been compared by t h is a u th o r, in an a tte n p t to determ ine the e ffic ie n c y o f one type o f p re s e n ta tio n over the o th e r. R esults are in c o n s is te n t and vary according to th e goals o f th e study. The comparisons th a t have been made cover a wide v a rie ty o f su b je c ts. These range from stu d ie s in which the su b je c ts were te s te d on th e co n ten t learned under the two co n d itio n s (T aylor, Lipscomb, and Rosemier, 1969), th e e ffe c tiv e n e ss of videotape recordings in a ttitu d e change versus a liv e p re sen ta tio n o f th e same m a te ria ls (Wall and Boyd, 1971), to the value o f using a v id e o t^ e m onitor in a standard psycholo g ic a l interview ing s itu a tio n (Denoff, Stenmark, and Smith, 1970). T aylor, Lipscomb, and Rosemier (1969) stu d ied the d ifferen c e among th re e g ro tp s. One group in te ra c te d w ith the teach er f o r th ree one-hour sessio n s p e r week fo r e ig h t weeks, another group watched th ese sessions v ia video tape and the th ird viewed th e f i r s t two video tap es o f th e f i r s t g ro ip 's in te ra c tio n and then in te ra c te d w ith the teach e r during one sessio n fo r each o f th e e ig h t weeks. R esults in d i cated th a t th ere was no d iffe re n c e in content learn ed between the liv e in te ra c tio n and th e videotaped in te ra c tio n groups. Denoff, Stenmark, and Smith (1970) looked a t the d iffe re n c e between videotape p re sen ta tio n

15 8 o f standard comments in a psychological in te rv ie w and a fa c e -to -fa c e in te rv ie w using the same standard comments. Temporal d a ta were comp a re d, e. g., frequency and d u ratio n of ta lk in g, by the s u b je c ts. They found th a t normal su b jects responded e q u ally in te rn s of th is tem poral d a ta to the te le v is io n m onitor as to the liv e in te rv ie w e r. The Wall and Boyd (1971) study w ill be discussed fu rth e r in the next paragraph. Although th e re are stu d ie s which show c o n tra d ic to ry r e s u lts, th e emphasis o f these stu d ie s has been considerably d if fe r e n t from th a t of t h is study. C ro ft, S tin^son, Ross, B ray, and B ie g lic (1969) f e l t th a t videotape p re s e n ta tio n s have few er cues a v a ila b le than the liv e p re s e n ta tio n. The study described these l o s t cues as in clu d in g fin en e ss o f f a c ia l fe a tu re s, c o lo r, th re e d im en sio n ality, q u a lity o f v o ic e, and t o t a l s itu a tio n a l g e s ta lt. C roft e t a l. (1969) studied a ttitu d e change and found th a t more change occurred w ith liv e p resen ta tio n of a message. I t was noted th a t c r e d ib ility o f the source was f e l t to be an im portant fa c to r in e ffe c tin g a ttitu d e change. This study was re p lic a te d by Wall and Boyd (1971) who found no d ifferen c e between th e two c o n d itio n s and suggest th a t random assignm ent of subje c ts to c e lls was n o t done by C ro ft e t a l. (1969), uhich may have b iased the r e s u lts. Flynn (1970) examined the development and evalu atio n of videotaped d isc rim in atio n tra in in g program s. The su b je cts were tra in e d to make d isc rim in atio n judgments o f se le c te d phcmeroes in a tra in in g p ro gram f o r the / s / phoneme which was presented on videotape. The su b je cts were given p ro - and p o s t- te s ts o f th e i r d iscrim in atio n a b ility fo r / s / j y r /, w ith p a r t p resen ted v ia videotape and p a r t p resen ted through

16 9 l iv e stlm olus m a te ria ls. S im ilar scores were obtained from b o th these methods o f te s tin g, thus suggesting th a t the two co n d itio n s o f videotap e and liv e p re s e n ta tio n are equal even fo r fin e d isc rim in atio n o f phonemes. C ullinan and P ra th e r (1968) compared the e ffe c tiv e n e ss o f ra tin g s tu tte r in g by liv e conmunicatlon and by audiotape. They then compared th e i r r e s u lts w ith those obtained by W illiam s, Wark, and Wbnifie (1963), vho compared ra tin g s o f s tu tte r in g by audio and audiov is u a l clu es and suggested th a t e q u ally r e lia b le r a tin g of the s e v e rity o f s tu tte rin g can be obtained from liv e r a tin g sessio n s and audiovisual reco rd in g s. The C ullinan and P ra th e r (1968) stu d y, in ra tin g the s t u t te r e r, included th e follow ing item s: th e degree o f tension and/or a sso ciated movements sp e c ific to dysfluencyj r e la tiv e d u ratio n o f dys- flu en cy ; r e la tiv e frequency of d y sflu en ciesj o v e ra ll se v e rity o f s t u t te rin g ; norm ality o f "n o n stu tte red " speech; b o d ily movements n o t sp e c ific to dtysfluency; and communication In te ra c tio n. Each o f th e item s was ra te d on a scale o f In cre asin g abnorm ality from one to seven. V ideotaping has been used e x te n siv e ly w ith the in te n tio n of d e ta ile d an aly sis o f the d a ta f o r c lin ic a l u se. Boone and P re s c o tt (1971) presented a speech and hearing therapy scoring manual, the p u r pose o f which was to q u a n tify the in te ra c tio n between two people or between a c lin ic ia n and a sm all group in therapy. The behavior of the c lin ic ia n and c lie n t are categ o rized in term s o f co n ten t and sequence; e. g., th e c lin ic ia n d escrib in g and explaining the s p e c ific goals o r procedures of th e sessio n would be c la ssed as a category I response. The c lie n t making an in c o rre c t response was categ o rized as 7. The

17 authors suggest th a t t h is system msy be used to categ o rize therapy fo r any kind o f speech th erapy problem s in clu d in g a rtic u la tio n ^ h earin g, 10 language, and v o ice. Videotape re p la y o f a therapy session was recommended fo r th is purpose. Videotape recordings have also been used to a sse ss a rtic u la tio n pro g ress and as an aid in a rtic u la tio n th erapy (Burkland, 196?), as w ell as a means o f recording b ehavior in fre e p lay s e ttin g s (N orquist, 1971). In view of the above s tu d ie s, and the f a c t th a t the responses scored on the PICA u su a lly involve obvious movements and v e rb a liz a tio n s by th e p a t i a i t, i t seems u n lik e ly th a t the use o f th e videotape record in g s to p re s e n t the review w ill cause, in i t s e l f, a s ig n ific a n t d i f f e r ence in scores between the liv e and review scoring co n d itio n s. T hat i s, the liv e scoring condition and the videotape scoring conditio n may be thought of as e q u a l, and any d iffe re n c e s found in scores under the two co n d itio n s w ill be due to fa c to rs o th e r than liv e versus videotape p re s e n ta tio n. R e lia b ility stu d ie s on standardized speech and language t e s ts as w ell as psychological t e s t s include i n te r - t e s t e r r e l i a b i l i t y or t e s t - r e t e s t r e l i a b i l i t y s tu d ie s, b u t n o t i n t r a - t e s t e r r e l i a b i l i t y on th e same t e s t. I t was f e l t by th e w r ite r th a t the s im ila r itie s o f t e s t and review procedures o u tlin e d above would tend to su p p o rt, a t l e a s t in p a r t, the i n t r a - t e s t e r procedures employed in th is study.

18 CHAPTER I I PROCEDURE S ubjects S ubjects were speech p a th o lo g ists who were employed a t the d e n ro s e H ospital in Edmonton, A lb e rta, Canada, and a t th e V e teran 's A dm inistration H ô p ita l in Denver, Colorado. The su b je c ts were c u r re n tly using the PICA as p a r t o f th e ir d ia g n o stic -th e ra p e u tic program. A ll su b je c ts had f u l f i l l e d the standard number of hours o f tra in in g in th e ad m in istratio n of the t e s t. These are s ta te d by Porch (1973) as fo rty hours of tra in in g which should be used to fa m ilia ris e the scorer thoroughly w ith the scoring method and manual, as w ell as p ra c tic e ad m in istratio n of th e b a tte r y and scoring responses u n t il the scoring c a te g o rie s and t e s t form at are f u lly memorized. Follow ing ü iis, the te s tin g o f a t l e a s t ten p a tie n ts w ith varying degrees o f cœimunicatlve Impairment was c a rrie d out by each o f the c lin ic ia n s. Six c lin ic ia n s, th re e from each o f the above c e n te rs, were used. Each c lin ic ia n te s te d two p a tie n ts. C lin ic ia n experience v aried from a c lin ic ia n who had tau g h t numerous PICA workshops to one who had learn ed th e t e s t only six months p re v io u sly. A ll c lin ic ia n s learn ed the t e s t a t a PICA workshop conducted e ith e r by Bruce Porch o r by one o f h is stu d en ts and, on th e average, had been using th e t e s t f o r a t l e a s t 18 months, 11

19 12 Equipment V ideotaping equipm ent. Including the camera, recording devices (Sony #36S0) and m onitor, was borrowed from the s e ttin g In which th a t p a r t o f the study was c a rrie d o u t. The camera was s e t up to o b tain th e f u l l e s t and c le a r e s t p ic tu re o f the p a tie n t being te s te d w ithout v io la tin g the standard t e s t c o n d itio n s, b u t allowed f o r a complete p ic tu re o f the p a t i e n t 's bod^f and movements, the c lin ic ia n, and th e t e s t Item s. The microphone was s e t as clo se as p o ssib le to the p a tie n t to allow fo r adequate receptio n, w ithout v io la tin g the standard t e s t c o n d itio n s. The microphone placem ent allowed f o r c le a r recep tio n of a l l the p a t i e n t 's vocal r e sponses, and th e c lin i c i a n 's I n s tru c tio n s. Standard T est Conditions The co n d itio n s o u tlin e d In PICA, Volume 2, A dm inistration, Scoring and In te rp r e ta tio n, pages 2-11, were follow ed. E xperim ental Procedures The c lin ic ia n s did n o t know th e n a tu re o f the study n o r did they know th a t th ey would be asked to resco re th e o rig in a l t e s t. 1. The follow ing v erb al In s tru c tio n s, p r io r to te s tin g, were given to each c lin ic ia n. " I f you are w illin g to take p a rt In th e study, I would lik e you to adm inister the PICA to two people and score as you would norm ally. Your se ssio n s w ill be videotaped. I would lik e you to leave two l^g hour s lo ts open In your schedule on e i t h e r o r. The d e ta ils o f the study w ill be a v a il dole and I w ill answer any q u estio n s you may have about I t a f te r the t e s t

20 procedures have been com pleted. P lease s i t to the r ig h t and a t r ig h t angles to the p a tie n t." 2. The score sh eets were c o lle c te d from the c lin ic ia n s follow in g the te s tin g. They d id n o t c a lc u la te any of th e su b te st means. 3. The review occurred a f te r U8 hours had elapsed b u t b efore 72 hours had elapsed follow ing th e i n i t i a l a d m in istra tio n. T his p ro cedure was enployed because i t seemed th a t in th e usual c lin ic s e ttin g, the in te r v a l between the ad m in istratio n and review would approximate th is time in te r v a l. T his range o f tim e was a lso n ecessary because of scheduling d i f f ic u ltie s encountered in th e v ario u s c lin ic a l s e ttin g s. I t was expected th a t th e re would be some r e c a ll o f th e 120 in stan c es of scoring fo r each o f the t e s t s. were given p r io r to th e review* The follow ing v e ib a l in s tru c tio n s "This i s th e videotape o f your session w ith M, on. I want you to re -sc o re the t e s t as you see i t now. I w ill stop the t ^ e any time you need e x tra tim e, and you can review the tape any time you are unsure o f what r e sponse occurred." U. At the com pletion of both ad m in istratio n s and review s, t h is w rite r interview ed each o f the c lin ic ia n s. They were given copies of t h e i r t e s t and r e t e s t score s h e e ts. The c lin ic ia n s were asked to examine these sh e ets and i f th ey changed some o f t h e i r scores, they were asked whether they re c a lle d the reasons fo r the change. In those In sta n ces where th e c lin ic ia n re c a lle d a reason fo r the change, these reasons were recorded. The c lin ic ia n s were also asked n o t to d iscu ss th e study n o r th e content o f th is in te rv ie w u n t il a l l the procedures Involved in th e study were completed in h is o r h e r c lin ic.

21 Explanation o f the purpose o f the study was given to the su b je c ts and a l l q u estio n s they had were answered a t th e com pletiw of I l the study. When the r e s u lts o f th e study have been c a lc u la te d, copies o f th e r e s u lts w ill be forwarded to each c lin ic ia n. 6. Each c lin ic ia n was asked to f i l l in a q u e stio n n a ire f o l lowing both a d m in istra tio n s. The questicm naire covered inform ation concerning the experience and tra in in g of the c lin ic ia n s in the adminis t r a t i o n and scoring o f the PICA, vdiether the p a tie n t had been te s te d p re v io u sly, and th e em otional s ta te of the p a tie n t during the adm inistr a tio n o f the t e s t. (See Appendix B.)

22 CHAPTER m RESULTS The d a ta f o r th is study co n sisted o f PICA t e s t r e s u lts from the g e stu ra l and v e r ta l su b te sts (VGS), fo r 12 p a tie n ts, obtained during adm in istratio n and, again, during review v ia v id eo tap e, Six c lin ic ia n s were used, each te s tin g two p a tie n ts. Average Scores The p o te n tia l range o f v a ria tio n fo r th e follow ing scores was lî> p o in ts, b u t the probable range, as noted e a r l i e r, was 10 p o in ts. The average score fo r a l l o f the 12 su b jects (VOS) given to th e p a tie n ts employed in t h is study i s presented in Table 2. I t should be noted th a t the d iffe re n c e s fo r each o f the t e s ts under the two c o n d itio n s ranged from 0 to.18 o f one p o in t. The mean scores fo r the e ig h t g e stu ra l su b te sts fo r the 12 p a tie n ts under the two conditio n s are p resen ted in Table 3. The d i f feren ces range from.01 to.36, a s lig h tly la rg e r range than fo r the average o f 12 su b te st scores rep o rted p rev io u sly. R esults o f the mean scores fo r the fo u r v erb al su b te sts fo r the 12 p a tie n ts under the two co n d itio n s are p resen ted in Table U. The range o f d iffe re n c e s fo r th ese s u b te sts was.03 to.50, which was s lig h tly la rg e r than th e range obtained fo r th e g e stu ra l su b te sts as w ell as fo r th e VGS. 15

23 1 6 TABIE 2 DIFFERENCES BETWEEN AVERAGE SCORES FOR VGS UNDER THE ADMINISTRATION AND REVIEW CONDITIONS C lin ic ia n P a tie n t Adtnini s t r a t i on Review D ifference 1 a IL.18 l b b c d b l.03 3 e 1 3.U f h 10.3k h 11.6b 11. b i U.28 b k ll.b S -. l b TABLE 3 DIFFERENCES BETWEEN AVERAGE SCORES FOR EIGHT GESTURAL SUBTESTS UNDER THE ADMINISTRATION AND REVIEW CONDITIONS FOR EACH TEST GIVEN C lin ic ia n T est Admini s t r a t i on Review D ifference 1 a l b. 25 l b. 2b.01 b b.01 2 c d 13.5b e 13.2b f 13. b6 13.b U f h $ i j l b 6 k 13. b l b

24 17 TABLE U DIFFERENCES BETWEEN AVERAGE SCORES FOR FOUR VERBAL SUBTESTS UNDER THE ADMINISTRATION AND REVIEW CONDITIONS C lin ic ia n T est A dm inistration Review D ifference 1 a 1U b c d e U f U g h i j 6.U k U I t i s stiggested th a t the g re a te r range o f d iffe re n c e s found under th e two c o n d itio n s, VOS and v erb al sub t e s t s, might have been co n trib u ted to by th e g re a te r number o f su b te sts involved in obtaining the average VGS sc o res. That i s, w ith th e obtained VGS averages, 12 su b te st scores co n trib u ted to the mean score o b tain ed. In the case of th e v erb al sub t e s t s mean sco re, only four t e s t s c o n trib u te d. T his m ight suggest th a t the g re a te r number o f su b te st scores may have le n t them selves to a more normal d is tr ib u tio n. In th e case o f the g e stu ra l s u b te s ts, t h is same argument might also be extended. I t should be noted th a t the g re a te s t range o f d iffe re n c e s was found between the v erb al su b te st means (.03 to.50 o f a p o in t) w ith the l e a s t range being

25 18 found between th e VGS means (O to.18 of a p o in t). The g e stu ra l means f e l l between these two scores (.0 1 to.36 o f a p o in t). Sc o re Changes The score changes fo r each o f the s u b te sts were c a lc u la te d from th e d iffe re n c e between su b te st means under the a d m in istratio n and review. (See Appendix C.) These were to ta le d f o r th e 12 su b jects w ithout regard to sig n. That i s, th e sum o f th e d iffe re n c e s between su b te st means fo r each of the su b te sts was c a lc u la te d. The t o t a l numb e r o f score changes fo r each su b te st fo r a l l 12 t e s t s given was found. (See Appendix D.) The average score change f o r each su b te st fo r a l l t e s t s given was obtained by d iv id in g the t o ta l number o f score changes fo r each su b te st in to the sum of d iffe re n c e s fo r each s u b te s t. These r e s u lts are presented in Table From th is ta b le, th e follow ing fe a tu re s appeared s a lie n t: (a) th e average score change fo r each sub t e s t v aried frcwi.2$ to.08 of one p o in t; (b) the t o ta l number of changes fo r each o f th e su b te sts fo r a l l su b je cts ranged from 39 to 2; (c) the s is e and t o ta l number o f changes fo r the verbal su b te sts tended to be g re a te r than fo r th e g e stu ra l su b te sts: Average Sum o f D ifferen ces (d isreg ard in g sig n ) fo r Four Verbal Sub t e s t s... = U.03 Average Sum o f D ifferences (d isreg ard in g sig n ) fo r E ight G estu ral Sub t e s t s...» 2.38 Average Number o f Changes f o r th e Four Verbal Sub t e s t s...= 26. 7$ Average Number of Changes fo r th e E ight G estural Sub t e s t s... = 16.87

26 19 TABLE 5 COMPARISON OF AVERAGE SCORE CHANGES (DISREGARDING SIGN) FOR EACH SUBTEST UNDER THE ADMINISTRATION AND REVIEW CONDITIONS S ubtest Sum o f D ifferences T otal Number o f Changes Average Score Change I 38*.lU I I g.o 37.lU I I I lb IV L.8* 29*.17 V U.? 2U.18 VI VII V III IX 3.9* 27*.l b X.8 U.20 XI x n 1.9* 13*.15 * V e ita l su b te sts In g e n eral, the v e rb a l su b te sts also showed g re a te r d isp ersio n of siz e o f score changes than the g e stu ra l su b te sts (see Table 6 ), These d a ta were c a lc u la te d from Appendix C. Average Standard D eviation fo r Verbal S u b tests =,U8 Average Standard D eviation f o r G estural S u b tests =.33 Figure 1, showing th e t o ta l number o f changes made f o r each p a tie n t te s te d, re la te d to h is /h e r average score f o r VGS, appeared to

27 20 TABLE 6 STANDARD DEVIATION DP CHANGES BETWEEN THE ADMINISTRATION AND REVIEW CONDITIONS FOR EACH SUBTEST FOR AIL TESTS GIVEN S u b test standard D eviation I.61* n.37 I I I.61 IV.6U* V VI.17 VII.26 v n i.16 IX.LI* X.L9 XI.10 x n.26* * Vert)al 8 ü b tests suggest th a t the low er the le v e l of o v e ra ll fu n ctio n in g, the g re a te r the number o f score changes th a t o ccu r. However, a number of c au tio n ary fa c to rs asso c iated w ith th is fin d in g need to be noted: (1) Only two o f th e 12 p a tie n ts te s te d functioned below an o v e ra ll le v e l of 10 fo r VOS; (2) the same c lin ic ia n te s te d both p a tie n ts who functioned below th is le v e l; (3) the only p a tie n t whose em otional s ta te was judged by h is c lin ic ia n to have s ig n if ic a n tly in te rfe re d w ith the adm inistratio n and scoring o f the t e s t was the one whose average fo r the 12

28 CD D OQ. C g Q. D CD C/) C/) FIGUHE 1 TOTAL NUMBER OF CHANGES MADE FOR EACH OP THE TWELVE SUBJECTS TESTED, RELATED TO HIS/HER AVERAGE SCORE FOR " CD CD D O Q. C a o 3 "O o CD Q. D CD C/) C/) n S) 8 UO CO CVI CK <V OO to! w % o I I no col OO vo CVl -=t VO I H JC colcol VO CM CM I n i t i a l d ig its r e f e r to Average Score fo r VOS F in a l d ig its r e f e r to Number of Changes E.g., in (8.29 / UO), 8.29 r e fe rs to th e Average Score f o r VGS and UO r e fe rs to the Number o f Changes. la CM o m -=î CM CO f - s CAOO H ' CM -=r fa M rh OO 1A m g fa rh O s H ih I cc CO I COj C O! COj II I J III I I Average VGS Score fo r the 12 S ubjects X I *0 <D^ colcolcoj o lu d b 15 5

29 2 2 su b te sts was F o rty scoring changes, th e h ig h est number througho u t the study were made between th e two t e s t co n d itio n s f o r t h is p a tie n t, A comparison o f the d ire c tio n and mean siz e of score changes under a d m in istratio n and review o f v e ib a l and g e stu ra l su b te sts f o r a ll su b je c ts te s te d i s presented in Table 7. I t can be seen th a t score changes moved in both p o s itiv e and n egative d ire c tio n s f o r both the v erb al and g e stu ra l m o d a litie s. However, on th re e o u t o f th e four TABLE 7 A COMPARISON OP DIRECTION AND MEAN SIZE OF SCORE CHANGES FROM ADMINISTRATION TO REVIEW OF VERBAL AND GESTURAL SUBTESTS FOR TWELVE SUBJECTS M odality S u b test D irectio n and Size o f Change S u b test I Verbal S u b test IV +.02 S ubtest IX +.06 S u b test XII +.0U S ubtest H S ubtest H I +.20 S ubtest V -.02 G estural S ubtest VI S u b test VII.oU S ubtest V In -.0 $ S u b test X S u b test XT -.ou

30 23 V B rt> a l 8übt e s t s (S u b test IV, S u b te st IX, and S ubtest XII) score changes were in a p o s itiv e d ire c tio n, w hile on seven out o f the e ig h t g e stu ra l sub t e s t s (S u b test I I, S ubtest V, S u b test VI, S ubtest V II, S ubtest V U I, S u b test X, and S ubtest XI) score changes were in a n eg ativ e d ire c tio n. The mean siz e of score changes from the a d m in istratio n to the review, fo r the 12 su b je cts f o r each of th e s u b te s ts, ranged from.02 o f one p o in t to.23 o f one p o in t. T his i s sm all i f conpared w ith th e p o ssib le range o f 15 p o in ts o r the probable range of 10 p o in ts. The d ire c tio n and s iz e of score changes under the conditions o f ad m in istratio n and review were independent of th e d if f ic u lty of the s u b te s t. (See Appendix E.) Types o f Changes Over a l l item s and a l l t e s ts given, 2U.07 p e rc en t o f the scores assigned during a d m in istratio n were changed during th e review. From Figure 2 i t can be seen th a t an 11 type response (a delagred incom plete) was a lte re d most o fte n U6 p e rc en t o f the t o t a l number of tim es i t occurred. The score th a t changed th e l e a s t cong>ared w ith the t o ta l number of tim es o f occurrence was 15 (a complete resp o n se), which was a lte re d 6 p e rc en t of th e tim e. In the exam ination of Table 8, which shows th e d is tr ib u tio n of changes o ver 120 item s from th e response l e v e l given d u rin g adm inistr a tio n to th a t given during the review f o r th e 12 s u b je c ts, i t should be noted th a t th e communicative a b ility o f th e p a rtic u la r 12 su b je cts te s te d may have skewed th e r e s u l ts. However, i t i s of in te r e s t to note th a t the m ajor type o f score changes involved a d ecisio n re la te d to delay (score changes o f 15 to 13, 13 to l 5, 12 to 11, and 11 to 1 2 ).

31 21 H CJ H o po ra g I «N 0 V) 1 fi paâizeqo sasuodsan j o s a8aq.uao j a j CM

32 TABLE 8 DISTRIBUTION OF NUMBERS OF CHANCES OVER 120 ITEMS FROM THE RESPONSE LEVEL GIVEN DURING ADMINISTRATION TO THAT GIVEN DURING REVIEW FOR TWELVE SUBJECTS Review lu U ' H * Change re la te d to a d ecisio n about d elay. Number of tim es no changes in score occurred.

33 26 I t a lso îppears th a t th e m ajo rity of score changes were approxim ately 1 o r 2 p o in ts in magnitude except fo r 7 (re la te d response) which changed 5 p o in ts 11 tim es, L p o in ts 10 tim es, w ith th e maximum change o f 8 p o in ts occurring tw ice. These 8 -p o in t changes were the la r g e s t th a t occurred under the two co n d itio n s in th e study. In a d d itio n, score changes tended to c lu s te r a t the 10 type score and above, a t the 6 type score and below, and throughout th e 7 type sco re. However, as evidenced by the averages rep o rted e a r l ie r, most o f the la rg e numbers o f changes tended to cancel out each o th e r. This can be seen from the r e la tiv e ly equal d is trib u tio n o f score changes on e ith e r side o f th e diagonal in Table 6. S ubjects and C lin ic ia n s Four o f th e 12 su b je c ts in th e study were te s te d fo r th e f i r s t tim e. A comparison of th e number and s iz e of score changes w ith t h is v a ria b le o f whether the su b je c t had p rev io u sly been te s te d did not suggest any re la tio n s h ip. (See Appendix F.) No îpparent d iffe re n c e was found in consisten cy o f scores under the co n d itio n s o f a d m in istratio n and review and th e amount of tra in in g or experience o f th e c lin ic ia n. (See Appendix G.) From the in te rv ie w, one o f th e c lin ic ia n s f e l t th a t th e videotape review scoring was most a c c u ra te, one f e l t th a t th e liv e p resen ta tio n was most a c c u ra te, and th e o th e r fo u r v aried in th e ir opinions depending on a p a r tic u la r p a tie n t o r asp ect o f h is b ehavior. Only th e em otional s ta te o f one of th e 12 p a tie n ts te s te d was judged by h is c lin ic ia n to have in te rfe re d w ith th e a d m in istratio n and scoring o f the t e s t. (See Appendix H.)

34 CHAPTER IV DISCUSSION This study stemmed from th e observation th a t In resco rin g the PICA using v id eo tsp e, th e c lin ic ia n o ften a lte re d a number of assigned response sc o re s. The aim, th e re fo re, was to c o lle c t and analyze d a ta to explore the p o ssib le cau ses, magnitude and consequences o f these response sc o re changes. A n aly sis o f Average Scores Porch (1967, p. 37) compared th e d iffe re n c e between su b te st means and m odality means o f 30 p a tie n ts f o r th re e sc o rers to e s ta b lis h in te r-o b se rv e r r e l i a b i l i t y. I f th e i n i t i a l 12 su b te sts are tak en, the average d iffe re n c e f o r th ese 12 s u b te sts c a lc u la te d from the d iffe re n c e between the h ig h e st and low est o f the th re e sc o rers was.17 p o in ts. The range of d iffe re n c e s between th e average scores fo r the 12 su b te sts under th e a d m in istratio n and videotape review c o n d itio n s, obtained in th is stu d y, was.18 p o in ts. Hence, using the average fo r 12 s u b te s ts, the change is very sm all and i s alm ost equal to the fin d in g s in the in te r-o b se rv e r r e l i a b i l i t y stu d ie s conducted by Porch ( I 967). A comparison o f d a ta frcan t h is stud^ on the v e ita l and g e stu ra l su b te sts under th e a d m in istratio n and review c o n d itio n s, w ith th e above mentioned r e l i a b i l i t y d a ta (Porch, 1967), showed th a t f o r the v erb al m odality, the range between the h ig h e st and low est d iffe re n c e s (from 27

35 .03 to.^0 p o in ts on th is sttady) was s lig h tly la r g e r than th a t found 28 by Porch (196?) (from.12 to.29 p o in ts ). For th e g e stu ra l m odality, the range between th e h ig h est and low est d iffe re n c e s (from.01 to.36 p o in ts on th is stu^y) was s lig h tly sm aller than th a t found by Porch (1967) (from.05 to,61 p o in ts ). However, th e d iffe re n c e in m odality scores under the two co n d itio n s could s t i l l be considered as minimal >rtien the t o ta l p o ssib le range o f d iffe re n c e (15 p o in ts ) i s noted. Score Changes The r e s u lts of the average score change under adm in istratio n and review were s im ila r fo r each o f th e s u b te s ts, and were a l l le s s than.25» o f one p o in t. T his was a sm aller d iffe re n c e than th a t found by Porch (196?). The v erb al s u b te sts on th e average in th is study showed more and la r g e r changes than did th e g e s tu ra l. This was contr a r y to the fin d in g s o f Porch (1967), where sc o rer disagreem ent on th e v erb al item s was found to be low er than on g e stu ra l item s, as noted in th e prev io u s paragraph. I t should be noted th a t in a l l o f th e above comparisons made between t h i s study and th e fin d in g s of Porch (1967), th a t t h is study was one o f in tra -o b se rv e r r e l i a b i l i t y under two conditio n s (ad m in istra tio n and review ), w hile Porch (1967) in v e stig a te d in te r-o b se rv e r r e l i a b i l i t y in d ir e c t observation of t e s t ad m in istratio n. Thus, i t may be argued th a t th e conparisons were n o t v a lid. However, as no o th e r c r i t e r i a f o r th e sig n ific a n c e o f th e siz e o f score changes was a v a ila b le, th e r e s u lts of P o rc h 's (1967) r e l i a b i l i t y study were se le c te d as a re fe re n c e. In s p ite o f th e sm all d iffe re n c e s found between th e average scores discussed e a r l i e r, over 2U p e rc e n t o f the tim e assigned scores

36 2 9 were changed from the ad m in istratio n to th e review c o n d itio n. Hence, th ese changes must tend to cancel each o th e r o n t. That i s, score changes tended to move in both a p o s itiv e and negative d ire c tio n and th e magnitude o f th ese changes were about equal in e ith e r of these d ire c tio n s over th e VGS fo r each o f th e 12 s u b je c ts. Another fa c to r was th a t the magnitude o f changes was u su a lly only one o r two p o in ts. Even though score changes tended to cancel each o th e r o u t, i t appeared th a t over a l l t e s t s given, v erb al su b te st changes tended to move in a p o s itiv e d ire c tio n w hile g e stu ra l su b te st changes tended to move in a negativ e d ir e c tio n. T his would suggest th a t verbal responses appeared le s s im paired to the c lin ic ia n on the videotape review w hile the g e stu ra l responses appeared more im paired. V erbal responses tend to be more d is c re te than g e s tu ra l resp o n ses, e.g., to th e q u estio n, "As cqdpletely as p o s s ib le, t e l l me what you do w ith each of th e s e," fo r a 1$ (com plete) sc o re, th e p a tie n t may answer, "I brush my te e th w ith a to o th b ru sh." However, to th e q u e stio n, "As com pletely as poss ib le, show me what you do w ith t h i s," th e p a tie n t must p a r t h is l i p s, exposing h is te e th and dem onstrate a brushing motion fo r a 15 sco re. Hence, because g e stu ra l responses are more fle e tin g and more complex, the c lin ic ia n may have overestim ated th e p a tie n t s response during the liv e ad m in istratio n and t h i s would tend to ex p lain id y g e s tu ra l re sponses were scored low er on th e videotape review. I t i s suggested by th e w rite r th a t v e ib a l responses were more e a s ily re c a lle d from the liv e p re se n ta tio n to the review because th e re are fewer o f then (fo u r v e ib a l sub t e s ts to every e ig h t g e s tu ra l) and th is may have been an aid in the second sc o rin g, e. g., th e sco res became more i n te l lig i b le.

37 3 0 Type o f Response An 11 response i s d escrib ed as " in c o n p le te -d e l^ e d, th a t i s, two dim ensions o f d e fe c tiv e communication a b ility are involved. These re q u ire two d e c isio n s, one reg ard in g promptness and one regarding comp le te n e s s. None of th e o th e r PICA scores involves a double d ecision s im ila r to th is one, which may account fo r th e r e la tiv e ly high number o f the tim es the score changed (U6 p e rc e n t o f th e tim e ). A conplete, a c c u ra te, resp o n siv e, prtm pt and e f f ic ie n t sc o re, a 1$, was the most c o n siste n t score under th e two c o n d itio n s. T his would suggest th a t c lin ic ia n s have most d if f ic u lty judging im paired communicative a b ility, p a r tic u la r ly i f more than one dimension o f judgment i s involved. One o f th e m ajor reasons f o r change in scores between th e two co n d itio n s appeared to be re la te d to d e c isio n s concerning deleys (see Table 8 ), b u t the caution regarding the communicative a b ility o f the su b je c ts in t h is study i s rep e ate d, th a t i s, 10 of th e 12 su b jects functioned a t an o v e ra ll le v e l of 10 o r above and the judgment o f delay i s a m ajor dimension in the assignm ent of score a t th is le v e l, compared w ith su b jects fu n ctio n in g below 10 where a delay in response i s no longer recorded. The c r i t e r i a fo r sco rin g delays vary according to the s u b te s t. As an example, f o r sub te s ts involving readin g, th e c lin ic ia n was in s tru c te d to read th e in s tru c tio n s over to him self tw ice and i f the p a tie n t had n o t responded, a d e lsy was scored; fo r sub t e s t I I, however, delgy ir&b d efined as "any o f th e above responses, b u t delayed"; fo r su b te st I, delay was defined as "response types th a t are s ig n ific a n tly delayed, suggesting th a t th e p a tie n t needs some additio n a l processing tim e b efo re he can respond" (Porch, 1973). During

38 31 th e a d m in istratio n o f th e t e s t, a delay in response can vary up to 30 seconds in d u ra tio n, a t idiich time a re p e a t of th e in s tru c tio n i s given and another score assigned. From the in te rv ie w s w ith the c lin ic ia n s involved, delay was judged according to a number o f sta n d a rd s: (1) ccanparison w ith p e r formance o f a su b je c t w ith normal communicative a b ility, (2) according to th e general ra te o f response f o r th a t p a r tic u la r p a tie n t, o r (3) a combination of (1) and (2 ). I t i s suggested th a t the la rg e number o f d elay changes may be a f a c to r o f inadequate d e fin itio n o f a d e l ^ r e sponse. During the videotape review the c lin ic ia n s appeared to be s lig h tly more s t r i c t in t h e i r assessm ent o f d elay than during the adm in is tra tio n. The w rite r also sp ecu lates th a t th ey became more cons is te n t during th e review when o th e r p ressu res o f t e s t adm in istratio n were n o t p re s e n t. From Table 8, th e score 7 (re la te d response) showed r e la tiv e ly la r g e r changes under th e two c o n d itio n s than o th er scores and th is suggests th a t c lin ic ia n s may have d if f ic u lty d iffe re n tia tin g between in cœ ip lete and re la te d resp o n ses. C lin ic ia n s appeared to recognize re la te d responses more e a s ily under co n d itio n s o f videotape observatio n. Again, i t m ight be suggested th a t when the c lin ic ia n i s fre e of the p ressu re o f t e s t a d m in istra tio n, he may be more s e n s itiv e to the p a tie n t 's response. Another score th a t appeared to change under th e two conditio n s was re la te d to a d ecisio n on th e i n t e l l i g i b i l i t y o f scores (score changes between th e response le v e ls of S, i n t e l lig i b le, and 2, a tte n tio n ). I t i s o f i n te r e s t to n o te th a t the tren d was fo r th ese scores involving i n t e l l i g i b i l i t y to In crease during th e videotape