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Essentials oftheCaliforniaVerbal LearningTest CVLT-C,CVLT-II,&CVLT3
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Title:EssentialsoftheCaliforniaVerbalLearningTest:CVLT-C,CVLT-2,&CVLT3/editedby ThomasJFarrer&LisaDrozdick.Othertitles:Essentialsofpsychologicalassessmentseries.
Description:FirstEdition. | Hoboken:Wiley,2020. | Series:Essentialsofpsychologicalassessment | Includesindex.
Identifiers:LCCN2019051999(print) | LCCN2019052000(ebook) | ISBN9781119578567 (Paperback) | ISBN9781119578604(AdobePDF) | ISBN9781119578451(ePub)
Subjects:LCSH:Verballearning—Testing—Handbooks,manuals,etc. | Memory—Testing—Handbooks,manuals,etc. | Neuropsychologicaltests—Handbooks, manuals,etc.
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One Overview1
Two HowtoAdministertheCVLT-C,CVLT-II,andCVLT325
Three HowtoScoretheCVLT-C,CVLT-II,andCVLT351
Four InterpretationoftheCVLT75
Five StrengthsandWeaknessesofCVLT105
Six CVLTPerformanceinClinicalPopulations113
Seven IllustrativeCaseReports133
EssentialsoftheCaliforniaVerbal LearningTest OVERVIEW INTRODUCTION Duringdevelopmentinchildhood,verballearningandmemoryarekeytosuccessin schoolandlanguageacquisitionanddevelopment.Alargeportionoftimeisspentinactivitiesrequiringretentionofverbalinformation,suchasconversationswithparentsand peers,reading,andinteractingwithdigitaldevices.Theabilitytoencodeandretainverbal informationremainselementalthroughoutthelifespanasmuchlearningandsocialinteractionrequiresadequateverballearningandmemoryability.Therefore,theassessment ofverbalmemoryisanessentialcomponentofclinicalandneuropsychologicalevaluations.Thisisparticularlyrelevantforevaluationsofindividualswithknownorsuspected cognitiveorlanguageimpairments.Manydevelopmental,neurological,andpsychiatric disordersinvolvedisruptionorimpairmentofmemoryprocesses(e.g.,attention-deficit hyperactivitydisorder,dementia,traumaticbraininjury).Althoughsomeareasofmemorydeclinenormallywithage(Salthouse,1996;Tromp,Dufour,Lithfous,Pebayle,& Després,2015),theprevalenceofmemorydisordersincreaseswithageandmemorycomplaintsareafrequentconcerncitedbyolderadults.Evaluationofmemoryprocessescan assistindifferentiatingnormativedevelopmentanddeclineacrossthelifespanfrommemorydeficitsrelatedtoinsidiousorigins.
TheCaliforniaVerbalLearningTest,ThirdEdition(CVLT3;Delis,Kramer,Kaplan, &Ober,2017)providesadetailedlookintoverballearningandmemoryprocessesfor individualsages16–90.Itintroducedsomemajorscoringchangesandupdatesfromthe CVLT,secondedition(CVLT-II;Delis,Kramer,Kaplan,&Ober,2000).However,since theCVLT-IIisstillwidelyusedinclinicalandresearchsettings,botheditionsaredescribed inthisbook.TheCVLTchildren’sversion(CVLT-C;Delis,Kramer,Kaplan,&Ober, 1994)providesasimilarassessmentofmemoryforindividualsages5–16.Thisbookprovidesaneasy-to-usereferenceforindividualslearningtheessentialsofadministration, scoring,andinterpretationoftheCVLT3,CVLT-II,ortheCVLT-C.Itmaintainsthe direct,systematicapproachtopresentingmaterialthatischaracteristicoftheEssentials series.Inaddition,guidelinesforselectingthebestCVLTproductforaspecificclientand administrativeandinterpretiveguidelinesareprovided.ThelatestresearchontheCVLT productsandonverbalmemoryprocessesisalsoincludedthroughoutthechaptersto assistinapplyingresultsobtainedwiththemostrecentCVLTeditions.
EssentialsofCaliforniaVerbalLearningTest:CVLT-C,CVLT-II,&CVLT3 coverstopics thatemphasizetheappropriateadministration,scoring,interpretation,andapplicationof
eachtest.Eachchapterincludesseveral“RapidReference,”“Caution,”or“Don’tForget” boxestohighlightimportantpointsforeasyreferenceandclarification.Attheendofeach chapter,ashort“TestYourself”quizisprovidedtohelpyousolidifywhatyouhaveread. Theinformationinthisbookisprovidedtohelpyouunderstandthenuancesofeachof theCVLTinstrumentsandbecomeaproficientuser.
HISTORYANDDEVELOPMENT Althoughtheconceptofinvestigatingtheprocessesunderlyingmemoryisstandardin memoryassessmentinstrumentstoday,atthetimetheoriginalCVLT(Delis,Kramer, Kaplan,&Ober,1987)wasdevelopedin1987itwasanovelapproachtoassessment.The authorscombinedresearchandclinicalexperiencewithpatientswithmemorydeficits tocreateanovelapproachtoassessinglearningandmemoryprocesses.Memorydeficits werelinkedtospecifictaskswithina16-wordmemoryrecallandrecognitiontest.The 16wordswerederivedfromfoursemanticcategories,allowingtheexamineetogroup wordssemanticallyasanaidtorecallingthewords.Thisapproachallowsexaminationof notonlyhowmuchanindividualcanlearnandretainbutalsothestrategiesusedtolearn andrecallinformationandthetypesofmemoryerrorsmade.Theseadditionalmeasures providedetailedinformationontheprocessesinvolvedinlearningandmemorytoaidin diagnosisandinterventionplanning.
IntheoriginalCVLT,theexaminerreadaMondayshoppinglistthatcontained16 itemstotheexaminee.The16itemsconsistedoffourwordsfromfourdifferentsemanticcategories(tools,fruit,clothing,spices,andherbs).TheMondayshoppinglistwas repeatedinfivelearningtrials,followedbyaninterferencelisttrial.ATuesdayshopping interferencelistalsocomprised16wordsfromfourcategories.TwoofthecategoriesoverlappedwithcategoriesfromtheMondaylistandtwowerenovelcategories.Following recalloftheTuesdaylist,theexamineewasaskedtorecalltheMondaylistinbotha free-recallandacued-recalltrial.Duringthecued-recalltrial,theexaminerprovidedeach ofthefoursemanticcategoriesandaskedtheexamineetonametheitemsfromeach. Theexaminerthanwaited20minbeforeadministeringdelayedfree-andcued-recalltrials,aswellasadelayedrecognitiontrial(seeFigure1.1).Theexaminerwasencouragedto administernonverbaltasksduringthis20-mindelay.ScoresderivedontheCVLTassessed attention,learningstrategies,recallaccuracy,interferenceeffects,recallerrors,andrecognition.Theoriginalnormativesampleconsistedof273neurologicallyintactindividuals (104males,169females)recruitedfromotherresearchstudiesbeingconductedatthe timeofdatacollection.
Since1987,threerevisionsandexpansionsoftheCVLThavebeenpublished,although theadministrationhasremainedremarkablystable.Theexpansionandevolutionofthe CVLTreflectthegrowinginfluenceanduseoftheprocessapproachtomemoryassessment.ItswideuseinresearchonmemoryalsoensuresseveraleditionsoftheCVLT willremaininuseforalongtime.ThecurrentlyavailableeditionsincludetheCVLT3 (publishedin2017),theCVLT-II(publishedin2000),andtheCVLT-C(publishedin 1994).Eachoftheeditionsreflectstheknowledgeandtheoriesofmemoryatthetimeof itsdevelopmentaswellasthedevelopmentalneedsofthepopulationassessed.Thischapter providesanoverviewofthecontentofeachofthecurrentlyavailableCVLTinstruments,
Learning trials Interference trialShort-delay
Trial1Free Recall
Trial2Free Recall
Trial3Free Recall
Trial4Free Recall
Trial5Free Recall
ListBFree Recall
Short-Delay FreeRecall
Short-Delay CuedRecall
Long-delay (follows 20-mindelay) Yes/No recognition
Long-Delay FreeRecall
Long-Delay CuedRecall
Forced-choice recognition (follows 10-mindelay)a
Yes/No Recognition
Forced-Choice Recognition a OnlyonCVLT-IIandCVLT3.
Figure1.1.CVLT-C,CVLT-IIstandardandalternate,andCVLT3standardand alternateformsstructure.
andlaterchaptersprovideareviewoftheresearchliteraturerelatedtomemoryandlearningasmeasuredbytheCVLT.
OVERVIEWANDORGANIZATIONOFTHECVLT-C TheCVLTwasexpandedtoyoungerageswiththepublicationoftheCVLT-C.Itnot onlyextendedtheagedownwardto5,italsomodifiedthecontenttobemorerelevantfor children.Thewordlistwasshortenedto15wordsderivedfromthreesemanticcategories. Thesemanticcategoriesreflectcategoriescommoninchildhood.Twoofthesecategories overlapwiththesemanticcategoriescontainedintheadultforms.SimilartotheadministrationoftheoriginalCVLT,thechildisreadthelistof15wordsacrossfivelearningtrials, followedbyaninterferencelisttrial.JustasintheoriginalCVLT,thelistsarepresentedas MondayandTuesdayshoppinglists.Followingtheinterferencetrial,thechildrecallsthe originallistinbothshort-delayfree-andcued-recalltrials.Theexaminerthencompletes nonverbaltestingfor20minbeforeadministeringlong-delayfree-andcued-recalltrials, aswellasadelayedrecognitiontrial(seeFigure1.1).Alltrialsarerequiredtoderivetheprimaryscores.ScoresderivedontheCVLT-Cassessauditoryattention,learningstrategies andcharacteristics,recallaccuracyandconsistency,proactiveandretroactiveinterference, recallerrors,andrecognition.
A T scoreisderivedforthelearningtrials(Trials1–5Total)withameanof50and astandarddeviationof10.TheprocessscoresprovidedintheCVLT-Cprovidedetailed informationaboutthelearningandmemoryprocessesrequiredtorecallverbalinformation.Forthesescores,age-corrected z scoresareprovidedwithameanof0andastandard
deviationof1.ThescoresderivedinCVLT-CarelistedinRapidReference1.1bycondition.DetailedinformationoncalculatingscoresisprovidedinChapter3.
RapidReference1.1 PrimaryScoresDerivedinCVLT-C,byCondition
LearningtrialsRecallscoresRecognitionscores
Trial1Free-RecallCorrect
Trial5Free-RecallCorrect
TotalTrials1–5(T score)
ListBFree-RecallTrial
ListBRecallvs.ListATrial1
Recall(differencescore)
SemanticClusterRatio
SerialClusterRatio
ExpectedSerialClustering
PercentofTotalRecallfrom PrimacyRegion
PercentofTotalRecallfrom MiddleRegion
PercentofTotalRecallfrom RecencyRegion
LearningSlope
RecallConsistency
Short-DelayFreeRecall
Short-DelayCuedRecall
Short-DelayFreeRecallvs. ListATrial5(difference score)
Long-DelayFreeRecall
Long-DelayCuedRecall
Long-DelayFreeRecallvs. Short-DelayFreeRecall (differencescore)
TotalPerseverations
TotalFree-RecallIntrusions
TotalCued-RecallIntrusions
TotalIntrusions
RecognitionHits
Discriminability
Discriminabilityvs. Long-DelayFreeRecall FalsePositives ResponseBias
Differencescorescompareperformanceononetasktoperformanceonanothertask. OnCVLT-C,differencescoresarederivedusingtwomethods(seeChapter3fordetailed informationoncalculatingthechangescores):rawpercentagechangeandscaledscore difference.Therawpercentagechangescoresarenotnormedduetotheheavyinfluence oftherawscoresonthecalculationofpercentageretained,suchthatlowoverallrecall canresultinhigherretentionpercentages.Difference(orsavings)scoresutilizethe age-correctedscaledscores.Meansandstandarddeviationsforthenormativesampleare providedtoprovidecontextforthesescores.Changeanddifferencescoresshouldnot replacetheprimaryscoresbutareusedtoguidetheinterpretationofdifferencesobserved acrossconditions.Detailedinformationontheinterpretationofscoresisprovided inChapter4.
OVERVIEWANDORGANIZATIONOFTHECVLT-II TheCVLT-IIwasthefirstmajorrevisiontotheCVLT.Therevisionwasguidedby neuropsychologicalandcognitiveresearchonmemory,feedbackfromusersandreviewers oftheCVLT(bothpersonalandpublished),andclinicalexperiencebytheauthors. OneofthemajorcriticismsoftheCVLTwasthesmall,nonrepresentativesampleused forthenorms.Multiplestudiesdemonstratedthatthenormsresultedinlowerthan expectedscoresinindividualswithaveragetoloweducationalattainment(Paolo,Troster, &Ryan,1997;Wiens,Tindall,&Crossen,1994).Alargerepresentativesampleof thepopulationaged16–89wascollectedtoupdatethenormsacrosssevenagebands. Intermsofcontent,the16itemsusedinthewordlistsweremodifiedtobeeasierto understandandwerenotpresentedasashoppinglist.Thewordlistswerederivedusing high-frequencywordscommonlyspokenwithintheUnitedStatesfromfourdifferent semanticcategories.Theinterferencelistalsocomprised16wordsfromfourcategories, twoofwhichoverlappedwiththeoriginallist.Inaddition,aforced-choicerecognition trialwasaddedtoassessinsufficienteffort.Twonewformswerealsointroducedwiththe CVLT-II:anAlternateFormandaShortForm.TheAlternateFormisequatedtothe StandardForm,utilizesthesameadministrationformat,andprovidesthesamescores astheStandardFormbutusesalternatewordlistsfromtheStandardForm.TheShort Formusesanine-wordlistwithashortenedformattoaccommodateuseasascreeneror withindividualsthatcannottoleratelengthytesting.TheStandardandAlternateForms take30mintoadminister(inadditiontothe20-mindelayandanoptional10-mindelay toadministertheforced-choicerecognitioncondition),whereastheShortFormtakes around20min(inadditiontothe10-mindelay).
ThedevelopmentoftheCVLT-IIincorporatedanalysisoftheperformanceofeach scoretoevaluatetheinfluenceofdemographicvariablesandgeneralcognitiveabilityon performance,reliabilityandstability,scorerangeanddistributionforfloorandceiling problems,andclinicalutility.Normsarecorrectedforageandsexbecausethesedemographicfactorscontributedmorethan5%ofthevarianceinprimaryscores.Detailed informationonthepsychometricpropertiesandtheclinicalutilityoftheCVLT-IIare describedinthe CVLT-IIManual (Delis,Kramer,Kaplan,&Ober,2000).
JustasontheoriginalCVLT,fortheStandardandAlternateForms,theexamineeisread alistof16wordsacrossfivelearningtrials,followedbyaninterferencelisttrial.Following theinterferencetrial,theexamineerecallstheoriginallistinbothfree-recallandcued-recall trials.Theexaminerthencompletesnonverbaltestingfor20minbeforeadministering delayedfree-recallandcued-recalltrials,aswellasadelayedyes/norecognitiontrial. Theexaminermaythenadministeranoptionalforced-choicerecognitiontrialfollowing a10-mindelay(seeFigure1.2).Alltrialsexcepttheforced-choicerecognitiontrialare requiredtoderivetheprimaryscores.Itishighlyrecommendedthatexaminersroutinely administertheforced-choicerecognitionconditiontoassessperformancevalidity.
FortheShortForm,theexamineeisreadalistofninewords(fromthreesemantic categories)acrossfourlearningtrials,followedbya30-sdistractortask.Followingthe distractiontask,theexamineeisaskedtorecallthelistinashort-delayfree-recalltrial.The examinerthancompletesnonverbaltestingfor10minbeforeadministeringlong-delay free-andcued-recalltrials,aswellasadelayedyes/norecognitiontrial.Theexaminer maythenadministeranoptionalforced-choicerecognitiontrialfollowinga5-mindelay (seeFigure1.3).Alltrialsexcepttheforced-choicerecognitiontrialarerequiredtoderive
Learning trials
Trial1Free Recall
Trial2Free Recall
Trial3Free Recall
Trial4Free Recall
30-second distractor taskShort-delay
Short-Delay FreeRecall
Long-delay (follows 10-mindelay) Yes/No recognition
Long-Delay FreeRecall
Long-Delay CuedRecall
Figure1.2.CVLT-IIandCVLT3structure,briefform.
Yes/No Recognition
Forced-choice recognition (followsa 5-mindelay)
Forced-Choice Recognition
theprimaryscores.SeeRapidReference1.2foranoverviewofdifferencesbetweenthe Standard/AlternateFormsandtheShortForm.
RapidReference1.2 Administration
16-wordlistfrom4categories
5LearningTrials
InterferenceListandRecall
Short-DelayFreeandCuedRecall
20-mindelay
Long-DelayFreeandCuedRecall
Long-DelayYes/NoRecognition
10-minDelay
Forced-ChoiceRecognition
Scoring
18Hand-ScoredVariables
66NormedVariables(Software)
MultipleRawScores(Software)
9-wordlistfrom3categories
4LearningTrials
30-sdistractiontask
Short-DelayFreeRecall
10-mindelay
Long-DelayFreeandCuedRecall
Long-DelayYes/NoRecognition 5-minDelay
Forced-ChoiceRecognition
15Hand-ScoredVariables
51NormedVariables(Software)
ScoresderivedontheCVLT-IIassessattention,learningstrategies,recallaccuracyand consistency,proactiveandretroactiveinterference,recallerrors,recognition,andperformancevalidity.Normativedataareprovidedfor27primaryscoresand39expandedscores inthescoringsoftware.Eighteenoftheprimaryvariablescanbehandscored.FortheShort Form,23primaryscoresareprovidedalongwith28expandedscoresinthescoringsoftware.Fifteenoftheprimaryvariablescanbehandscored.Inaddition,thescoringsoftware providesrawdatafornumerousnonnormedvariablesinaresearchreport.
A T scoreisderivedforthelearningtrials(Trials1–5forStandard/AlternateForms andTrials1–4fortheShortForm)withameanof50andastandarddeviationof10. TheprocessscoresprovidedintheCVLT-IIprovidedetailedinformationaboutthelearningandmemoryprocessesrequiredtoencode,recall,andrecognizeverbalinformation. Forthesescores,age-andgender-corrected z scoresareprovidedwithameanof0anda standarddeviationof1.Inaddition,cumulativepercentagesareprovidedforsomescores withhighlyskeweddistributions.ThenormativescoresderivedinCVLT-IIarelistedin RapidReference1.3bycondition.
Trial1Free-RecallCorrect
Trial3Free-RecallCorrect
Trials1–5Free-Recall Correct(Tscore)a
ListBFree-RecallCorrect
ListBvs.Trial1(contrast score)
SemanticClustering (Chance-Adjusted)
SemanticClustering Bidirectional (Chance-Adjusted)
Short-DelayFree-Recall Correcta
Short-DelayCuedRecall Correcta, b
Short-DelayFreeRecallvs Trial5(contrastscore)
Long-DelayFree-Recall Correcta
Long-DelayCuedRecall Correcta
Long-DelayFreeRecallvs. Short-DelayFreeRecall (contrastscore)
Free-RecallIntrusionsa Cued-RecallIntrusionsa
Long-DelayYes/No RecognitionTotalHitsa
Long-DelayYes/No RecognitionTotalFalse Positivesa
TotalRecognition Discriminability(d’)
TotalRecognition Discriminabilityvs. Long-DelayFreeRecall (contrastscore)
TotalResponseBias
Long-DelayForced-Choice RecognitionPercentTotal Accuracya (continued)
LearningtrialsRecallscoresRecognitionscores
SubjectiveClustering (Chance-Adjusted)
PercentRecallfromPrimacy
PercentRecallfromMiddle
PercentRecallfromRecency
TotalLearningSlopeTrials 1–5
Across-TrialRecall Consistency
TotalIntrusionsa
TotalRepetitionsa
TotalRecallDiscriminability
a Scoresthatareeasilyhandscored.
b ScoresnotontheShortForm.
Differencescorescompareperformanceononetasktoperformanceonanothertask. OnCVLT-II,difference(orsavings)scoresarederivedusingthesex-andage-corrected z-scores.Changeanddifferencescoresshouldnotreplacetheprimaryscoresbutareused toguideinterpretationofdifferencesobservedacrossconditions.Detailedinformationon theinterpretationofscoresisprovidedinChapter4.
OVERVIEWANDORGANIZATIONOFTHECVLT3 TheCVLT3isthemostrecentrevisiontotheCVLT.Therevisionwasguidedbythe needforupdatednormativedata,feedbackfromusersandreviewersoftheCVLT-II (bothpersonalandpublished),andresearchutilizingtheCVLT-II.Intermsofcontent,theadministrationinstructionsandwordlistswerenotmodifiedbutremainthe sameasintheCVLT-II.However,afewitemsontheforced-choicerecognitiontrial weremodifiedtoincreasesensitivityasameasureofperformancevalidity.Thealternate andshortformswerealsoretainedwithsimilarmodificationsmadetotheforced-choice recognitiontrial.
TheCVLT3addressedmanyneedsidentifiedintheresearchliteratureandcustomer feedback.RevisionsmadeintheCVLT3included:
• updatednormsforages16–90,usinganationallystratifiedsamplematchedtothe U.S.population;
• applicationofascaledscoremetric(mean = 10,SD = 3)overthe T scoreand z-score metrictoalloweasiercomparisontoothermeasures;
• introductionofindexscores(mean = 100,SD = 15)onthekeymemoryandlearning scores(Trials1–5,totaldelayedrecall,totalrecall);
• updatedintrusionmeasurestoreflectdifferenttypesofmemoryerrors;
• digitaladministration,recording,andscoring;and
• provisionofdemographicadjustmentstoage-adjustedscoresforeducationandsex presentedas T scoresinthescoringsoftware.
Detailedinformationonthemodificationsandimprovementstothecontent,psychometricproperties,andclinicalutilityoftheCVLT3aredescribedinthe CVLT3Manual. AnoverviewofthechangesisprovidedinRapidReference1.4.
RapidReference1.4 ChangesfromCVLT-IItoCVLT3 •Newnormativesamplereflectiveof2015U.S.Censusdata
•Increasedagerangeto90
•Indexscoresonstandardscoremetric(mean = 100,SD = 15)
•Primaryscoresonscaledscoremetric(mean = 10,SD = 3)
•Trials1–5TotalscorecomputedbysummingscaledscoresforTrials1–5
•Normsprovidedareagecorrectedonly
•Demographicadjustmentstonormativescoresavailableforsexandeducation,presented as T scores
•Forced-choicerecognitionitemsmodifiedtoincludeonlyconcretedistractors(abstract distractorswereremoved)
•Newmeasuresofacross-andwithin-trialintrusions
•Newmeasuresofintrusionerrortypes
•Newyes/norecognitionscoresthatdescribethetypesofrecognitionerrors
TheCVLT3introducedsignificantchangestothescoringoftheCVLT-II.Although scoresstillmeasuretheprocessesunderlyingattention,learning,andmemory,the traditional T scoreand z-scoremetricswerechangedtostandardandscaledscores. Thisallowsdirectcomparisontoothermeasurescommonlyusedinevaluations.Three indexscoresarederivedbysummingthescaledscoresforthelearningtrials(Trials 1–5),forthedelayedrecalltrials(freeandcuedrecall),andforallrecalltrials(learning, interference,shortdelay,andlongdelay).Fortheprimaryprocessscores,age-corrected scaledscoreswerederivedwithameanof10andastandarddeviationof3.Inaddition, cumulativepercentagesareprovidedforsomescoresthathadhighlyskeweddistributions.ThenormativescoresderivedinCVLT3arelistedinRapidReference1.5by condition.
ContrastscoresareutilizedfordifferencescoresinCVLT3.Contrastscaledscoresprovideinformationaboutperformanceononetaskadjustedforperformanceonanother relevanttask.Similartothemannerinwhichdemographicadjustmentsarederivedfor normativescores,onescoreisadjustedtoaccountforperformanceonarelatedbutseparatescore.Forexample,theLong-DelayFree-RecallCorrectvs.Short-DelayFree-Recall
CorrectContrastScaledScoreadjuststhelong-delayscorebasedonperformanceon short-delayrecall.Thisaccountsfordifferencesinperformanceondelayedmemorydue todifferencesinimmediaterecall.Thenewscorerepresentstheexaminee’sperformance ondelayedmemoryincomparisontoindividualsofsimilarimmediatememoryability. Becausecontrastscoresutilizeage-adjustedscaledscores,theyarenotfurtheradjusted byage.Contrastscaledscoresareprovidedatthescaledscorelevelandarepresentedas scaledscoreswithameanof10andastandarddeviationof3.Contrastscoresareused tointerpretscoresinrelationtosimilarabilitypeers;theydonotreplacesubtestscaled scoresandshouldnotbesubstitutedforprimaryscoresinreportsortocomputeindex scores.Detailedinformationontheinterpretationofcontrastscaledscoresisprovidedin Chapter4.
TheCVLT3introducestheuseofdemographicadjustmentstonorms.Inaddition totheage-adjustednormativescores,education,andsexadjustmentsareprovidedinthe scoringsoftware.Thedemographicadjustmentsareappliedtothenormativescoresto produce T scoresthataccountforeducationandsexdifferences.
ListBCorrectvs.Trial1 Correct(contrastscore)
Short-DelayFree-Recall Correcta
Short-DelayCued-Recall Correcta, b
Short-DelayFree-Recall Correctvs.Trial5Correct (contrastscore)
Long-DelayFree-Recall Correcta
Long-DelayCued-Recall Correcta
DelayedRecallCorrect (standardscore)
TotalRecallCorrect (standardscore)
TotalRecallResponses (standardscore)
Long-DelayYes/No RecognitionTotalHitsa
Long-DelayYes/No RecognitionTotalFalse Positivesa
RecognitionDiscriminability (d’)
RecognitionDiscriminability Nonparametric
Long-DelayFree-Recallvs. RecognitionDiscriminability (d’)(contrastscore)
Long-DelayForced-Choice RecognitionHitsa
Long-DelayFree-Recall Discriminabilityvs. RecognitionDiscriminability (d’)(contrastscore)
Long-DelayFree-Recall Correctvs.Trial5Correct (contrastscore)
Long-DelayFree-Recall Correctvs.Short-Delay Free-RecallCorrect (contrastscore)
TotalIntrusionsa
a Scoresthatareeasilyhandscored.
b ScoresnotontheShortForm.
THEORETICALFOUNDATION Learningandmemoryhavelongbeenofinteresttopsychologists,withWilliamJames firstproposingtheconceptsofshort-termandlong-termmemoryin1890.Short-term memorywasdescribedasfinitewithlowdurabilityunlessitwasencodedintolong-term memorythatwasmorelastingandofinfinitecapacity.Ebbinghaus’(1885)famousexperimentsonmemorydescribedtheprocessesoflearningandforgettingandintroducedthe conceptsofthelearningcurve(rateatwhichinformationisacquiredoverrepeatedtrials), serialpositioneffects(howpositionwithinaseriesofwordsimpactsrecall),andtheforgettingcurve(rateatwhichoneforgetsinformationwithmostdecayoccurringwithinthe first20minafterlearning).Theseearlydescriptionsandinvestigationsintomemorylaid thegroundworkformodernmemoryassessment.
DespiteEbbinghaus’experimentsontheprocessesoflearningandmemory,theassessmentoftheseconceptshashistoricallyfocusedontheamountofinformationanindividualcouldencode,consolidate,andrecall. Encoding istheprocessoftakingexternal informationandtransformingitintomentalrepresentationsormemories. Consolidation istheprocessthroughwhichinformationinimmediatememoryismovedintolong-term memory,and retrieval istheprocessofrecallinginformationfromstorage.Focusonthe amountofrecalledinformationallowsaglobalpictureofmemoryability,includingthe determinationofthepresenceofmemorydisorders.
Withtheuseofimmediateanddelayedrecall,memoryassessmentsoftenprovidescores forshort-termmemoryandlong-termmemory,againmeasuringtheamountofinformationretained. Short-termmemory isthemomentarystorageofinformation,lastingfroma fewsecondstoafewminutes.Memorieslastingfromhourstoyearsareconsideredstored in long-termmemory.Long-termmemorycanbecategorizedaseither implicit or explicit memory. Implicit orproceduralmemoryinvolvesinvoluntarylearningfromexperiences withoutconsciousawareness,suchaslearningtorideabikeordriveacar. Explicit or declarativememoryinvolvesthepurposefulstorageandretrievalofinformation.Explicit memorycanfurtherbedividedinto semantic (factual)and episodic (personaleventsand
context)memory.Whendescribedintheseterms,theCVLTversionsaremeasuresof explicitepisodicverbalmemory.
ProcessesofMemory EdithKaplanandcolleaguesintroducedtheprocessapproachtocognitiveassessment (Kaplan,1988;Libon,Swenson,Ashendorf,Bauer,&Bowers,2013)throughtheirwork attheBostonVeteransAdministrationMedicalCenter.Thisapproachplacesimportance onassessingnotjust what anindividualisabletodobutalso how theydoit.Theapproach utilizesoveralltestscorestoassesstheseverityofimpairmentbutemphasizestheanalysis oftheprocessthroughwhichtestscoresareachievedanderrorsmade.Similaroveralltest scorescanbeobtainedthroughverydifferentprocesses.ThedevelopmentoftheCVLT appliedthisprocessapproachtolearningandmemory.Throughstudiesinvolvingindividualswithbraininjuriesordisorders,strengthsandweaknessesofmemoryprocesses wereidentifiedthatdifferedacrossandwithinclinicalpopulations.Theinstrumentwas refinedtocapturetheseprocessesandallowfurtherinvestigation.So,althoughimportance isplacedontheprimarymeasuresofrecallaccuracy;criticalattentionisalsogiventothe processesunderlyingperformance.
Performanceonmemoryspecificmeasuresisnotonlyinfluencedbylearningandmemoryprocessesbutalsobyothercognitivefunctions.Forexample,attentionalprocesses andlearningstrategieshaveanimpactontheencodingandretrievalofverbalinformation.Theinterrelatednatureofprocessesutilizedacrosscognitiveabilitiesrequiresthat theassessmentofmemoryincludetheassessmentoftheserelatedprocesses.TheCVLT versionsmeasurethespecificprocessesoflearningandmemoryandprocessesrelatedto thesuccessandfailureofencodingandretrievalofinformation.Thisallowsexaminersto examinedifferencesinperformanceduetospecificcognitivedeficits.Figure1.3displays theprocessesmeasureddirectlywithintheCVLTeditions.
Theabilitytoencodeinformationishighlydependentupontheabilitytoperceiveand attendtoinformation.Auditoryattentionisakeyprecursorforadequatememoryretention.Individualswhohavedifficultyfocusingoninformationlongenoughtoencodeit willnotbeabletoretainthatinformationovertime.ThefirsttrialoftheCVLTprovides informationonauditoryattentionspan.Itcorrelateshighlywithothermeasuresofattentionandisimpairedinclinicalgroupswithknownattentionaldeficits,suchasthosewith anxietyormooddisorders.Mostindividualsimproveinoverallrecallacrossthelearning trials,socomparisonofperformanceacrosstrialscanassistinteasingouttheinfluenceof attentiononmemoryproblems.
Learningistheacquisitionofnewinformation.Historicallyithasbeenmeasured throughoverallrecallacrosslearningtrialsorbyassessingthelearningslope,theamount ofinformationgainedaftertheinitiallearningtrial.Thesemeasuresareincludedinthe CVLTeditionsbuttheCVLTeditionsgofurthertoevaluatelearningstrategiesandcharacteristicsandconsistencyofrecall.Learninginvolvesbothpassiveandactivestrategies. Roterepetitionisapassivestrategyforrecallinginformationthatincreasesconsolidation butdoesnotinvolveincreasingefficiencyofencodinginformation.Repetitionrequires thatinformationisrepeatedmultipletimesforencodingtooccur.Thistypeoflearning
Auditory Attention
Trial 1 Free Recall
Learning (Encoding and Retrieval)
Trial 1 Free Recall
Trial 2 Free Recall
Trial 3 Free Recall
Trial 4 Free Recall
Trial 5 Free Recall
Learning Strategies
Semantic Clustering
Serial Clustering
Primacy/Recency
Recall Scores
List B Free Recall
Auditory/Verbal Episodic Memory
Rate of Learning
Learning Slope Recall Consistency
Interference
List B vs Trial 1
Recall Errors
Intrusions Repetitions
Short-term Memory
Short-Delay Free Recall
Short Delay Cued Recall
Long-term Memory
Long-Delay Free Recall
Long Delay Cued Recall
Yes/No Recognition
Forced Choice Recognition
Figure1.3.MemoryprocessesmeasuredintheCVLT.
strategyisrepresentedinserialclusteringorrecallingwordstogetherthatwerecloseserially intheoriginallist.Alternatively,activestrategiesoforganizinginformationintomeaningfulgroupsaidtheencodingandretrievalofinformation.Thesemanticgroupingofwords byanexamineerepresentsutilizationofthisactivelearningstrategy.Informationonstrategiesusedtoencodeinformationcanaidindevelopinginterventionsforimprovingactive learning.
Inadditiontoevaluatinglearningstrategies,dataontherecallofwordsfromdifferent sectionsofthewordlistareprovided.Itistypicalforindividualstorecallmoreinformationfromthebeginningofalist(primacyeffect)andfromtheendofalist(recency effect)thanfromthemiddleofalist.Theprimacyeffectisgenerallyattributedtogreater rehearsaltimeforinformationwhereastherecencyeffectispotentiallyrelatedtothelast wordsbeingheldinrecentorworkingmemory.Examineeswithencodingdeficitsoften showhigherrecencyeffectsthanobservedinthenormativesample.Finally,consistencyof recallprovidesinformationontheconsistentapplicationofrecallstrategiestoretrievalof information.Individualswithexecutivefunctioningdifficulties(e.g.,poorplanning,poor organization)oftenproduceinconsistentprofilesofresponding.Whilethisaffectsoverall recall,executivefunctioningmaybeakeydeficitinthesecases.
Theintroductionofasecondwordlistintroducesactiveinterferenceintotheassessmentofmemory.Othermeasuresutilizeunrelatedtaskstofillinbetweenimmediate anddelayedrecallbuttheCVLTactivelyintroducesasecond,similarlisttoexplicitly assessinterference.Twoofthefoursemanticcategoriesoverlapacrossthetwolistsfurther elicitinginterferenceeffects.ComparisonofperformanceonTrial1andtheinterference trialprovidesameasureofproactiveinterference,thedeclineinperformanceonlearning materialduetopriorlearning.
Whereasthelevelofrecallontheimmediateanddelayedrecalltrialsreflectsoverall retrieval,errorsinrecallprovideinsightintospecificmemorydysfunctionandareinvaluableindifferentialdiagnoses.Repetitionsorrepeatedresponsesarecommoninindividuals withnormalmemoryfunctioningwhentherepetitionisusedasself-cueingtopromote furtherrecall.However,repetitionscanalsobeasignofperseverativeresponding,thefailuretoinhibitpreviousresponses,orpoorself-monitoring.Intrusions,responsesnotfrom thecurrentwordlist,arerelativelyuncommoninindividualswithoutmemorydifficulties. Examinationofthespecifictypesofintrusions,whichtrialstheyoccuron,theirsemantic relationshipstotheitemsinthewordlists,andwhethertheyarerepeatedacrossorwithin trialsiscriticaltodifferentiatingclinicalgroups.Allclinicalgroupsdemonstratedeficitsin memoryrecall;however,intrusionsprovidespecificinformationaboutperformancethat aidsindifferentiatingclinicalgroups.
PerformanceValidity Theassessmentofperformancevalidityhasbecomestandardpracticeinforensicand neuropsychologicalevaluationsinbothadultandpediatricpopulations(Brooks,Ploetz, &Kirkwood,2016;Heilbronneretal.,2009;Holcomb,2018;Martin,Schroeder,& Odland,2015).Theforced-choicetaskontheCVLT-IIandCVLT3wasdevelopedas anembeddedmeasureofperformancevalidity.Inaddition,Lichtenstein,Holcomb,and Erdodi(2018)presenteddataonaforced-choicemeasuredevelopedforusewiththe CVLT-C.Severalotherscoresacrossallthreeinstrumentshavealsodemonstratedworthas indicatorsofperformancevalidity,includingrecognitiondiscriminability,Trials1–5Correct,Long-DelayCuedRecall,andYes/NoRecognitionHits(Bauer,Yantz,Ryan,Warden, &McCaffrey,2005;Brooks&Ploetz,2015;Shura,Miskey,Rowland,Yoash-Gantz,& Denning,2016;Whitesideetal.,2015).Itisimportanttonotethatlowscoresonthese measuresalonedonotindicateinvalidperformancebutsuggestthepossibilityofsymptom exaggerationorotherfactorsthatcouldinfluenceperformance.
RESEARCHFOUNDATION StandardizationandPsychometricProperties PriortoevaluatingthereliabilitydataontheCVLTeditions,itisimportanttonotethat estimatesofreliabilityposeparticulardifficultiesinmeasuresoflearningandrecall.Measuresofinternalreliabilitydonotaccuratelydescribethereliabilityofmemorymeasures duetoitemscoreinterdependence.Recallingonewordonatrialinfluencestherecallof
otherwordsonatrialandalsoincreasesthelikelihoodofrecallingthesamewordon furthertrials.Forthisreason,measuresoftest-retestreliabilityoralternateformreliability providegreaterinsightintothereliabilityofmemorymeasures,althoughtheyareinfluencedbypracticeeffects.Errormeasuresorscoreswithlimitedvariabilityalsoproduce lowerreliabilitiesduetoskeweddistributions.Theselimitationsoftraditionalmeasures ofreliabilityshouldbeconsideredwheninterpretingthereliabilitiesdescribedforthe CVLT-C,CVLT-II,andCVLT3.
CVLT-C:ThestandardizationsamplefortheCVLT-Cconsistedof920children selectedtoformarepresentativesampleoftheU.S.population,basedonMarch1988 U.S.Censusdata.Itwasstratifiedbasedonage,sex,race/ethnicity,educationlevel,and geographicregion.Twelvenormativeagebandswerecreated,eachincluded1yearofage. Eachagebandforages5–12included80childrenandbandsforages13–16included70 children.Sexwasroughlyequalwithineachagegroup;allotherdemographicvariables roughlymatchedtheU.S.Censusdata.
Duetotheinterdependentnatureofresponsesonwordlistrecall,theCVLT-Cutilizedseveralmeasuresofinternalconsistency.Internalconsistencywasevaluatedusing threeapproaches:comparingoverallperformanceonoddandevennumberedlearning trials,across-semanticcategoryconsistency,andacross-wordconsistency.Theodd-even andacross-wordapproachesyieldedaveragecorrelationsof0.88and0.83,respectively, forTrials1–5.Theacross-semanticcategoryapproachyieldedanaveragecorrelationof 0.72.Detailedinformationonhowtheseconsistencyestimatesweredefinedandderived isprovidedinthe CVLT-CManual.
Thetest-retestsampleconsistedof106childrentestedbetween10and42daysapart. Resultsarereportedforthreeagegroups:8-,12-,and16-year-olds.Memoryandlearning measuresareparticularlysusceptibletopracticeeffectsthatlowertest-retestcorrelations (Strauss,Sherman,&Spreen,2006)duetorepeatedexposureofthestimulitoberecalled. Stabilitycoefficientsfor13CVLT-CscoresarelistedinRapidReference1.6.Test-retest coefficientsrangedfrom0.61to0.73fortheTrials1–5 T score,from0.26to0.77forthe recall z-scores,andfrom0.17to0.90fortheerror z-scores.
CVLT-II:ThestandardizationsamplefortheCVLT-IIconsistedof1,087individualsselectedtoformarepresentativesampleoftheU.S.population,basedontheMarch 1999U.S.Censusdata.Itwasstratifiedbasedonage,sex,race/ethnicity,educationlevel, andgeographicregion.Sevennormativeagebandswerecreated:16–19,20–29,30–44, 45–59,60–69,70–79,and80–89.Eachagebandincludedbetween107and200individuals.Sexwasevenlyrepresentedforages16–59;inages60–89morefemaleswere includedthanmales,reflectingthesexdistributioninthepopulationattheolderages.
Internalconsistencywasevaluatedusingthethreeapproachesintroducedinthe CVLT-C:comparingoverallperformanceonoddandevennumberedlearningtrials, across-semanticcategoryconsistency,andacross-trialwordconsistency.Theodd-even andacross-semanticcategoryapproachesyieldedaveragecorrelationsof0.94and0.83, respectively,forTrials1–5.Theacross-trialwordconsistencyapproachyieldedanaverage correlationof0.79.Estimatesobtainedinaclinicalsampleof124neuropsychiatric patientsproducedsimilarreliabilitycoefficients.Detailedinformationonhowthese consistencyestimatesweredefinedandderivedisprovidedinthe CVLT-IIManual
RapidReference1.6 Standardizationdatafromthe CaliforniaVerbalLearningTest,Children’sVersion(CVLT-C). Copyright©1994NCSPearson,Inc.Usedwithpermission.Allrightsreserved.
Thetest-retestsampleconsistedof78individualstestedbetween9and49daysapart. Stabilitycoefficientsfor18CVLT-IIscoresarelistedinRapidReference1.7.Test-retest coefficientswere0.82fortheTrials1–5 T score,rangedfrom0.57to0.88fortherecall z-scores,andfrom0.27to0.86fortheerror z-scores.
DuetotheadditionoftheAlternateForm,alternateformreliabilitywasalsoprovided.TheAlternateFormsampleconsistedof288nonclinicaladultstestedbetween0 and77daysapart.Theadministrationswerecounterbalanced,with155receivingtheStandardFormfirstfollowedbytheAlternateFormand133receivingtheAlternateFormfirst followedbytheStandardForm.Correlationcoefficientsforthe18scoresthatcanbehand scoredarelistedinRapidReference1.8.Correlationcoefficientswere0.79fortheTrials 1–5 T score,rangedfrom0.51to0.76fortherecall z scores,andrangedfrom0.27to 0.76fortheerror z scores.
