Memory Assessment

[smalltownpsych]

Hello all. In my current practice, we are getting a lot of referrals for disability evals. One issue that I am having is that whenever a patient checks memory problems, then the referral form requires a WMS-IV. I find the test difficult to administer and time-consuming and the evals don't pay that well. Most of my experience prior was with the WMS-III which I preferred. My question is, what measure would some of you recommend as an equivalent measure that might be more practical to administer. I already placed an order for the PAI because that has several advantages over the MMPI-2 (especially regarding reading level) and I prefer it for some referral questions. Also, is it appropriate to post questions like this in the forum? I am a little past the student status, but I really enjoy the exchange of information here and in the psychiatry section and have not seen the equivalent for non-student doctors.

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[WisNeuro]

If the referral requires a WMS-IV, why are you looking for another measure?

 

[Therapist4Chnge]

A few years back I attended a talk on disability evaluation and the takeaway msg was it was only worthwhile if you see a high volume of cases. I can't recall the exact reimbursement for one eval, but I remember it being really low. If you are req. to do a WMS-IV, I can't see that being worthwhile because it takes too long.

 

[thewesternsky]

The WRAML-2 is similar in some ways, but I actually prefer the WMS-IV... The WMS-IV is also co-normed with the WAIS, which is often helpful.

 

[WisNeuro]

No real reason to use a full WMS, maybe just the LM portion combined with a CVLT. Also, make sure you're getting a WMT in there. You'll get a lot of failures on that if base rates hold.

 

[PsyDr]

just use the WMS-IV flexible approach (LM, CVLT, VR). The 5 factor model of memory has some problems anyway.

 

[WisNeuro]

Major problems. I don't see the necessity of including a "visual" memory measure here unless the pt has some kind of expressive language problem that would make verbal measures difficult. There is no compelling research establishing visual memory as a separate construct. And, what good factor analytic studies exist suggest that differences in visual memory exist, may be simply due to visuoperceptual/constructional deficits rather than due to an encoding/consolidation problem.

 

[PsyDr]

I would think the major problem would be the lack of PVTs in forensic cases.

 

[WisNeuro]

I would think the major problem would be the lack of PVTs in forensic cases.

Oh, I meant major problems with the 5 and 3 factor structures of memory. But yes, lack of PVT/SVT's in forensic cases is a HUGE problem. One of the reasons comprehensive assessment is best left to those trained to do it.

 

[Therapist4Chnge]

I always require the use of SVTs on any assessment I administer, as the "head in the sand" approach is not helpful to anyone.

 

[AcronymAllergy]

Also, re: the MMPI-2 reading level, I believe Ben-Porath went back and said that the discrepancy between it and the PAI wasn't actually based on the difficulty of the items, but on the software/algorithm used to calculate the reading level. Supposedly when they re-ran it through the same thing the PAI used, the reading levels were comparable, which is I believe the reason that the MMPI-2-RF (which I prefer for a variety of reasons to the 2) has a lower reading level.

 

[PsyDr]

Wis,

I undrstand what you are talking about, but you should consider factoring in the visual memory's effect size on the OTBM if just to measure praxis so that the OTBM is not mismeasured.

 

[WisNeuro]

The OTBM isn't really used in clinical contexts. Considering that, at best, memory itself correlates roughly 50% with IQ, and less so with some other abilities, comparing it to an overall battery mean may cloud the clinical picture.

*Edit. This only really makes sense in a co-normed battery. I know the Meyers system uses it. But, in many clinical contexts, the flexible battery approach rules the day.

 

[PsyDr]

I use OTBM everyday of my practice.

 

[WisNeuro]

I don't dispute that. I'm just wondering how widely it is used. I have never seen it in a clinical report in any of the five hospitals that I have worked/interned/externed at, nor have I seen it in a report from an outside provider.

 

[DynamicDidactic]

Hello all. In my current practice, we are getting a lot of referrals for disability evals. One issue that I am having is that whenever a patient checks memory problems, then the referral form requires a WMS-IV.

Disability Evals is a pretty broad term. I think it would be much easier for us to assist if you told us what you are actually looking to measure when it comes to memory? Everything?

FWIW, I thoroughly enjoy the WMS-IV. It was awkward to administer at first but now I find it to be one of the simpler assessments. Co-norms with the WAIS are very handy. I often find that the WMS subtests are more informative than similar subtests from other assessment tolls.

 

[Chevere]

I am a disability examiner who was recently accepted into grad school. First, not every memory complaint requires memory testing, that is up to the disability examiner. Second, if memory testing's been ordered, SS regulations require that you use WMS-4 testing. There is no equivalent test you can use.

 

[bcliff]

RBANS is quick and looks at various types of short term and delayed memory

 

[WisNeuro]

The RBANS works in some settings. I'll use it if I have a fairly old individual who I think is fairly low functioning. It has a ceiling effect in people with fairly normal functioning.

 

[smalltownpsych]

Thanks for all of your great feedback. Unfortunately, when I reviewed the documentation, it clearly stated that only the WMS is an acceptable tool for assessing memory for their purposes. Since these are being paid for by the government, they determine what is appropriate. My colleague had used the RBANS previously and we were going to order it, but not now. 🙁
As far as what type of disability evaluations these are, they are being required for people to qualify for SSDI. The psychologists and other staff here have had a lot of discussions about these and the use and abuse of federal disability so that is a whole other topic.

 

[smalltownpsych]

The RBANS works in some settings. I'll use it if I have a fairly old individual who I think is fairly low functioning. It has a ceiling effect in people with fairly normal functioning.

That actually might be appropriate for our purpose since it would seem to me that if someone had fairly normal functioning, then wouldn't that mean that they are not disabled? In other words, I am not looking for a test with fine discriminant properties as opposed to one that can easily detect impaired functioning. Anyway as mentioned previously, we are stuck with the whole WMS and get paid barely enough to cover admin time.

 

[WisNeuro]

That actually might be appropriate for our purpose since it would seem to me that if someone had fairly normal functioning, then wouldn't that mean that they are not disabled? In other words, I am not looking for a test with fine discriminant properties as opposed to one that can easily detect impaired functioning. Anyway as mentioned previously, we are stuck with the whole WMS and get paid barely enough to cover admin time.

Depends on your definition of disabled. It is usually not a dichotomous variable. I'd prefer other tests with more possible variability, better norms, and embedded effort indicators (The RBANS has an effort index, but it's "meh").

 

[smalltownpsych]

I am a disability examiner who was recently accepted into grad school. First, not every memory complaint requires memory testing, that is up to the disability examiner. Second, if memory testing's been ordered, SS regulations require that you use WMS-4 testing. There is no equivalent test you can use.

I didn't see your reply earlier, but I found this out reviewing the guidelines from Social Security. Thanks for the info.

 

[smalltownpsych]

Depends on your definition of disabled. It is usually not a dichotomous variable. I'd prefer other tests with more possible variability, better norms, and embedded effort indicators (The RBANS has an effort index, but it's "meh").

The definition of disabled that they use is that the impairment must interfere with basic job related activity. Talk about vague and subjective.

 

[erg923]

Unless a person is substantially cognitively impaired, inpatient in a needed treatment program, or floridly psychotic, I am not sure I could ever say a person is "disabled" and thus unable to work from a psychiatric perspective. Then again, I have never sought out doing diability evals for this very reason...I guess I just dont buy into most of it.

"Idle hands are the devils playground...?" More harm than good if you ask me.

 

[WisNeuro]

"Idol hands are the devils playground...?" More harm than good if you ask me.

Sorry, your typo made me visualize a funny picture. Someone with Tiki idols for hands.

 

[erg923]

Freaking spell check...