Rationale:
Assessment of naming is a core component of pediatric neuropsychological evaluations, particularly in patients at risk for subtle symptoms of aphasia and poor processing speed, such as those with epilepsy. Confrontation naming tests assess basic word knowledge, the ability to articulate what is perceived, and lexical-semantic retrieval (Baron, 2018). Several naming tests exist which vary in how they assess these constructs and their degree of cultural and socio-economic bias. We identified tests commonly administered to children referred for epilepsy surgery, compared scores, examined relationships with tests of vocabulary and retrieval, and compared performances based on racial identity and insurance type (private/public).
Methods:
Data comprised 640 naming assessments of 462 patients (age 0-22 years,
M=11.97) from the pediatric epilepsy research consortium (PERC) epilepsy surgery database. Demographic variables were examined. In patients over six, mixed effects models were run controlling for Wechsler IQ score to assess whether 1) naming performance differed by measure, 2) performance varied by race for different measures, and 3) performance varied by insurance type for different measures. We also ran correlations between each measure with IQ, Wechsler vocabulary, and D-KEFS/NEPSY semantic fluency.
Results:
Measures included the Boston Naming Test (BNT, n=278), Expressive One Word Vocabulary Test (EOWPVT, n=164), Expressive Vocabulary Test (EVT, n=84), Differential Ability Scales Picture Naming (DAS-PN, n=37), Wechsler Preschool and Primary Scale of Intelligence Picture Naming (WPPSI-PN, n=25), and Hamberger Auditory and Visual Naming Tests (HA/VNT, n=15). For patients over 6 with a Wechsler IQ score, scores differed by naming measure (
p< .001), with the lowest scores on EOWVT and highest scores on EVT. There were no significant differences based on race. Patients with private insurance performed better than patients with public insurance (
p< .001). There was an interaction effect of test and insurance type (
p=.03) with larger differentials in scores for BNT and HVNT.
BNT had the weakest association with IQ (r=.53) and HVNT total score the highest (r=.81); HVNT summary score had the weakest association with vocabulary (r=.49) and EVT the highest (r=.82); and BNT had the weakest correlation with semantic fluency (r=.35) and HVNT summary score the highest (r=.83).
Conclusions:
Results suggest notable differences among naming tests. The most common test, the BNT, is moderately related to IQ and vocabulary but weakly related to semantic retrieval. Limited HVNT data strongly correlated with IQ, vocabulary, and semantic fluency, suggesting that it may assess both vocabulary and retrieval. Patients with public insurance, which can be considered a proxy for a lower resourced family had lower naming performance, particularly on measures that assess both vocabulary and retrieval (BNT, HVNT) suggesting that some measures may have more sensitivity related to social determinants of health.
Findings may aid in neuropsychologists’ naming test selection.
Funding:
This study was funded by the pediatric epilepsy research foundation.