DEVELOPMENT AND VALIDATION OF

ABBREVIATED CONTEXT PROCESSING

ASSESSMENT IN UNDIFFERENTIATED
SCHIZOPHRENIA (ACPAUS)
JOSEPH C. FRANCISCO, Ph.D.
and MARIE ANN SUNGA-VARGAS, Ph.D.
Lyceum of the Philippines University
University of Santo Tomas
Funded by: DOST-PCHRD & CHED
Research Background
Research Background

Presence of impaired context
Presence of impaired context
processing among schizophrenics
processing among schizophrenics
(Keneda, et al., 2007; Schooler & Roberts, 2008; (Keneda, et al., 2007; Schooler & Roberts, 2008;
Green, et al. 2007) Green, et al. 2007)

To develop an instrument that will
To develop an instrument that will
identify the severity of context
identify the severity of context
processing deficiencies among
processing deficiencies among
schizophrenic patients
schizophrenic patients
ueflnlLlon
ConLexL rocesslng
> lnformaLlon LhaL my be processed
Lhrough Lhe use of:
a. worklng memory (WM),
b. aLLenLlon (A1n), and
c. lnhlblLory process (lnP).
(Schooler and colleagues, 2008, 8raver eL al. 2001,
Cohen eL al. 1999)
u5M-lv-1k ctltetlo fot uoJlffeteotloteJ
5cblzopbteolo
A. CharacLerlsLlc sympLoms: 1wo (or more) of Lhe
followlng, each presenL for a slgnlflcanL porLlon
of Llme durlng 1-monLh perlod (or less lf
successfully LreaLed):
(1) ueluslons
(2) PalluclnaLlons
(3) ulsorganlzed speed
(4) Crossly dlsorganlzed or caLaLonlc
(3) negaLlve sympLoms
uoJlffeteotloteJ 5cblzopbteolo
1he presence of sympLoms LhaL meeL
CrlLerla A of Schlzophrenla buL LhaL do noL
meeL crlLerla for Lhe aranold,
ulsorganlzed, or CaLaLonlc 1ype.
Main Objective
Main Objective
To develop and validate the
To develop and validate the
Abbreviated Context Processing
Abbreviated Context Processing
Assessment in Undifferentiated
Assessment in Undifferentiated
schizophrenia (ACPAUS).
schizophrenia (ACPAUS).
Specific Objectives
Specific Objectives
(1) Identify the item
(1) Identify the item
-
-
composition
composition
and domains of the Abbreviated
and domains of the Abbreviated
Context Processing Assessment
Context Processing Assessment
in Undifferentiated
in Undifferentiated
Schizophrenia (ACPAUS).
Schizophrenia (ACPAUS).
Specific Objectives
Specific Objectives
(2)
(2)
Establish the psychometric
Establish the psychometric
properties of the preliminary form of
properties of the preliminary form of
the ACPAUS in terms of:
the ACPAUS in terms of:
a. Validity;
a. Validity;
b. Reliability; and
b. Reliability; and
c. Item analysis thru item
c. Item analysis thru item
-
-
total
total
correlation
correlation
5peclflc Objectlves
5peclflc Objectlves
(3
(3
)
)
Establish the psychometric
Establish the psychometric
properties of the final form of the
properties of the final form of the
ACPAUS in terms of:
ACPAUS in terms of:
a. Validity; and
a. Validity; and
b. Reliability.
b. Reliability.
Specific Objectives
Specific Objectives
(4) Establish the general normative
(4) Establish the general normative
structure of the ACPAUS; and
structure of the ACPAUS; and
(5) Prepare a manual for
(5) Prepare a manual for
administration, scoring and
administration, scoring and
interpretation of the ACPAUS.
interpretation of the ACPAUS.
8raver and Colleagues 1PLC8lLS Cn
CCCnl1lvL CCn18CL Anu CCn1Lx1
8CCLSSlnC
CCn1Lx1uAL lnlC8MA1lCn
CCn1Lx1 8CCLSSlnC
WC8klnC MLMC8? A11Ln1lCn
lnPl8l1lCn
1heory of Lhe
Mlnd
(1oM)
ueflclenL ConLexL
rocesslng ln undlfferenLlaLed Schlzophrenla
llqote 1
cONcl1uAl lAkAulCM Ol AclAu5
A888LvlA1Lu CCn1Lx1 8CCLSSlnC
ASSLSSMLn1 ln unulllL8Ln1lA1Lu
SCPlZCP8LnlA
8oslc Assomptloo
ueflclLs ln conLexL processlng may accounL for
problems ln lnLerpreLlng and processlng
lnformaLlon ln relaLlon Lo self, oLhers, and Lo
lnLerpersonal lnLeracLlons.
lmpottooce of AclAu5
As basls for developlng
lnLervenLlons, LreaLmenL plan
and LherapeuLlc Lechnlques.
MetboJoloqy
8esearch ueslgn: uescrlpLlve lnsLrumenL
uevelopmenL 8esearch
Sampllng: urposlve Sampllng
arLlclpanLs: undlfferenLlaLed Schlzophrenla
(referred by elLher cllnlcal psychologlsL or
psychlaLrlsL of Lhe pavlllon and verlfled ln Lhe
records of Lhe sub[ecL)
8esearch Locale: naLlonal CenLer for MenLal PealLh
(nCMP)
8esearch LLhlcs: resenLed Lhe sLudy Lo Lhe
lnsLlLuLlonal 8evlew 8oard of nCMP (Approved on
leb. 10, 2011)
llqote 2
5omplloq ltoceJote
lottlclpoots
1he lncluslon crlLerla:
1) Age range 18-40 years, Males and lemales
2) Pave meL Lhe uSM-lv-18 crlLerla for
undlfferenLlaLed schlzophrenla,
3) All sub[ecLs are ln Lhelr lucld lnLervals or
condlLlons aL Lhe Llme of LesLlng,
4) 1he paLlenLs have been recelvlng LreaLmenL wlLh
anLlpsychoLlc medlcaLlons.
lottlclpoots
1he excluslon crlLerla:
1) no demonsLrable braln dlsease (l.e. no loss of
consclousness nor any hlsLory of neurologlcal
condlLlons such as epllepsy, arklnson's dlsease
or braln ln[ury, or head Lrauma),
2) no hlsLory of menLal reLardaLlon,
3) no evldence of currenL subsLance (lncludlng
alcohol) abuse.
SCClC-uLMCC8APlC
8CllLL
lnl1lAL PASL
(n = 13)
8LLlMlnA8? PASL
(n = 40)
llnAL PASL
(n = 90)
n n n
Cender
Male
lemale
Clvll SLaLus
Slngle
Marrled
LducaLlonal
ALLalnmenL
rlmary
Secondary
1erLlary
Age group
23-27
28-32
33-37
11
4
12
3
4
9
2
7
3
3
73
27
80
20
27
60
13
47
33
20
28
12
30
10
10
23
3
17
13
8
70
30
73
23
23
62
13
42
38
20
60
30
70
20
23
60
3
38
33
17
67
33
78
22
28
67
3
42
39
19
1ob/e 1
lkuNcY 4Nu PkcN146 ul51kl8u1lON5 Ol 1n uMO6k4Pnlc PkOllL
Ol 1n P4k1lclP4N15 lN v4klOu5 Pn455 Ol 151 uvLOPMN1
ITEM GENERATION
FACE AND CONTENT
VALIDATION using Fleiss
Kappa
PILOT
TESTING
ITEM ANALYSIS thru Item-
total correlation using
Pearson Point-Biserial
Correlation Coefficient
MEASURING THE RELIABILITY AND
VALIDITY OF THE PRELIMINARY FORM OF
ACPAUS
ADMINISTRATION OF THE FINAL FORM
OF ACPAUS AND ESTABLISHMENTOF ITS
PSYCHOMETRIC PROPERTIES
NORMING AND
STANDARDIZATION
INI1IAL nASL
kLLIMINAk nASL
IINAL nASL
llqote J
lnA55 Ol 1n cON51kuc1lON Ol 1n AclAu5
uomalns Cb[ecLlves 1asks no of lLems of 1oLal
A. Worklng
Memory
8. ALLenLlon
C. lnhlblLory
rocess
1oLal
1hls domaln assesses Lhe
ablllLy of Lhe cllenL Lo
reglsLer, reLaln, and recall
Lhe lnformaLlon glven Lo
hlm.
1hls secLlon assesses Lhe
cllenL's ablllLy Lo focus and
carry ouL a Lask from slmple
Lo a more complex acLlvlLy.
1hls area assesses Lhe
capaclLy of Lhe cllenL Lo
conLrol and coordlnaLe hls
acLlons for a glven Lask.
1hls ls generally lnvolved wlLh
reLalnlng and recalllng
lnformaLlon ln Lhe form of
leLLers, numbers and flgures LhaL
has Lo be spoken or performed
by Lhe examlnee.
1hls ls prlmarlly lnvolved wlLh Lhe
cllenL's ablllLy Lo focus and Lo
perform a parLlcular Lask llke
followlng a dlrecLlon, copylng
deslgns, and deduclng numbers.
1he lLems ln Lhls domaln are
baslcally aLLrlbuLed Lo Lhe ablllLy
of Lhe cllenL Lo be more preclse
and accuraLe Lo hls acLlons or
declslons. 1he Lasks are lnvolved
wlLh hand and eye coordlnaLlon,
as well as vlsual and verbal
acLlvlLles.
30
33
33
30
33
33
100
1oble 2
1oble of 5peclflcotloo fot tbe AclAu5
llqote J
ulsttlbotloo of 1est ltems
A. Worklng Memory uomaln
1. LeLLers
2. llgures
3. CounLs
4. 8e- counLs
8. ALLenLlon uomaln
1. numbers
2. Work
3. Clrcles
4. Slgns
C. lnhlblLory uomaln
1. 1applng
2. Colors
3. laces
1oble J
loce ooJ cooteot vollJotloo of tbe loltlol ltems
DCMAINS N Item Number Inter-rater I|e|ss
kappa Va|ue
Verba| Descr|pt|on
Memory 8 .23 1,2,3,4,3,6,34,33 0.79 SubsLanLlal
ALLenLlon 13 .42 7,8,9,10,11,12,16,17,
18,19,20,21,22,23,24
0.76 SubsLanLlal
lnhlblLory
rocess
12 .33 13,14,13,23,26,27,28
29,30,31,32,33
0.91 AlmosL erfecL
LoLal
3S 0.73
Substant|a|
1oble 4
coefflcleot voloes ooJ 5tooJotJ ttot of Meosotemeot (5M)
of tbe ltellmlooty lotm of AclAu5 (o=40)
M S.D. SLM kk20
VALUL
VLk8AL
IN1LkkL1A1ICN
28.33
*33 lLems
22.33 9.92 0.81 Plgh level of
8elaLlonshlp
1oble 5
cottelotloo 8etweeo AclAu5 ooJ MOcA-l scotes fot coovetqeot
vlJeoce of vollJlty of tbe ltellmlooty lotm (o= 40)
1CCLS M S.D. r va|ue 1abu|ar
va|ue
Verba| Interpretat|on
MCCA- 18.83 4.6
.86 .30 Plgh
CorrelaLlon
ACAuS
*33 lLems
26.08 3.2
1oble 6
ulsttlbotloo of ltems occotJloq to ltem-totol cottelotloos
(ltem Aoolysls)
Item-1ota|
Corre|at|on
Va|ues
ua||tat|ve
Descr|pt|on
I1LM NUM8Lk N Dec|s|on
WM A1n ln
0.70-0.99 SLrong 2,3,6 11,12,16,
17,18
23,26,
27,28,
29
13 AccepLed
0.30-0.69 ModeraLe 1,4,3,
34,33
9,10,
19,20,
21,22,
23,24
13,14,
13,30,
31,32,
33
20 AccepLed
.001-0.29 Weak 7,8 2 8evlsed or
ulscarded
1ota| 8 13 12 33
1oble 7
coefflcleot voloes ooJ 5tooJotJ ttot of Meosotemeot (5M)
of tbe llool lotm of AclAu5 (o=90)
M S.D. SLM kk20
VALUL
VLk8AL IN1LkkL1A1ICN
28.33
33 lLems
22.33 8.80 0.83 Plgh level of
8elaLlonshlp
1oble 8
cottelotloo 8etweeo AclAu5 ooJ MOcA-l scotes fot
coovetqeot vlJeoce of vollJlty of tbe llool lotm (o= 90)
1CCLS M S.D. r va|ue 1abu|ar
va|ue
Verba| Interpretat|on
MCCA- 18.90 4.26
.88 .2030 Plgh
CorrelaLlon
ACAuS
*33 lLems
26.36 6.12
norms
SLanlne scores were used Lo evaluaLe Lhe
parLlclpanLs' scores.
90 undlfferenLlaLed schlzophrenlcs were
used ln Lhe developmenL of Lhe norms.
1hree classlflcaLlons were esLabllshed from
mlld, moderaLe, Lo severe conLexL
processlng.
1oble 9
CNkAl u5ckll1lON lOk 1n kAw 5cOk5 Ol AclAu5
8A5u ON 51ANlN .
kAW SCCkLS DLSCkI1ICN
(D|ff|cu|ty |n process|ng
|nformat|on accord|ng to the
sever|ty of ACAUS resu|ts)
26 and above
17- 23
16 and below
Mlld
ModeraLe
Severe
1oble 10
AclAu5 CNkAl 5cOklNC Culu
ulMLnSlCnS 1ASkS Cln1S 1esL 1aker's
8aw Score
l. Worklng
Memory
llgures
LeLLers
CounL
8ecounL
3
1
2
2
Max: 8
ll. ALLenLlon numbers
Work
Clrcles
Slgns
4
4
1
4
Max: 13
lll. lnhlblLory
rocess
Colors
laces
1applng
3
6
3 Max: 12
1C1AL SCC8L 33 polnLs
CCnCLuSlCnS:
-1he ACAuS ls a psychomeLrlcally sound
lnsLrumenL slnce lL revealed hlgh rellablllLy and
subsLanLlal valldlLy.
-1he ACAuS ls capable of dlscrlmlnaLlng
severe, moderaLe, Lo mlld conLexL processlng
among undlfferenLlaLed schlzophrenla.
SelecLed 8eferences:
8raver, 1.S., & 8arch, u. M. (2002). A Lheory of CognlLlve ConLrol, Aglng
CognlLlon, and neuromodulaLlon. neurosclence and 8lobehavloral 8evlews,
26, 809-817
Chan, 8., eL al. (2008). AssessmenL of LxecuLlve luncLlons: 8evlew of
lnsLrumenL and ldenLlflcaLlon of CrlLlcal lssues. Archlves of Cllnlcal
neuropsychology, 23, 201-216
kaneda, eL al. (2007) A 8rlef AssessmenL of CognlLlve ln Schlzophrenla:
valldaLlon of Lhe !apanese verslon. sychlaLry and Cllnlcal neurosclences, 61,
602-609.
Slm, !. & WrlghL, C.C. (2003) 1he kappa sLaLlsLlc ln rellablllLy sLudles: use,
lnLerpreLaLlon & Sample slze requlremenLs. hyslcal 1herapy, 83 (3), 237-268.
velllgan, u.l., eL al. (2007) 1he rellablllLy & valldlLy of Lhe LesL of adapLlve
behavlor ln schlzophrenla. sychlaLry 8esearch, 131, 33-66.
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