23/08/2017

Cognitive Linguistic Quick Test – Plus

(CLQT+)
• Approx 15 -30 mins to administer

Assessing • Ages 18-89

• The CLQT was designed to quickly assess strengths and weaknesses in five
Cognition using cognitive domains: attention, memory, executive functions, language and visuo-
the Cognitive spatial skills

Linguistic Quick • Option of administering “plus” version for people with aphasia
• 10 subtest in traditional administration, 11 subtests in + (aphasia) administration
Test Plus • Original published in 2001, Plus version in 2017

(CLQT+) • Cost: Complete Kit = $490

Record Forms (25 pack) = $175

CLQT+ Stimulus book (if adding to original kit) = $219

Presented by:
Amy Schulenburg
Pearson Clinical Assessment
2

CLQT(+) Subtests
CLQT Tasks & Cognitive Domains
•Personal facts
•Symbol cancellation*
•Confrontation naming
•Clock drawing
•Story retelling
•Symbol trails*
•Generative naming
•Design memory
•Mazes*
•Design generation
•Semantic comprehension**

*Additional points scored for following

auditory directions within this task for
the Aphasia Administration

**This subtest is only administered

when using the Aphasia Administration

Traditional Aphasia
Picking a tool to help answer…
Administration Administration
• Criterion-referenced
(referral questions)
• Criterion-referenced
• Severity ratings for two age • Severity ratings for two age 1. “I need a screening tool for rehab in acute
categories (ages 18-69 and 70-89) categories (ages 18-69 and 70-89) care prior to Psych evals.” (SLP / OT / PT)
• Severity ratings are mild, moderate, • Severity ratings are mild, moderate,
severe and WNL for each of the 5 severe and WNL for 2. “I need a tool that helps detect early
cognitive domains • Non-linguistic cognition index
• A total Composite Severity Rating
cognitive decline which may present as other
• Linguistic/aphasia index conditions.”
and a Clock Drawing Severity Rating • Separate clock drawing severity
serve as a neurocognitive screener rating
3. “I need a tool that I can use for progress
monitoring.”

4. “I need something that informs intervention

planning.”

5. “I need a tool that can assess cognition in

clients with aphasia.”

1
 23/08/2017

Personal Facts
Traditional vs. Aphasia Administration
1. This task helps to assess memory and language abilities.
When administering the CLQT+ to someone who
has diminished language capability: 2. Examinees with aphasia may respond poorly to these items due to
• Administer the original ten tasks language problems.
• Take note of any modifications indicated • In such cases, the memory severity rating may not accurately
in the instruction banner at the beginning represent memory skills.
of each subtest on the Record Form.
3. Note whether examinees demonstrate better recall of lifelong facts
Also… (date and place of birth) vs. newer facts (current age and address), a
• Complete the examiner-rated items in the pattern seen especially in individuals with dementia and closed head
Symbol Cancellation, Symbol Trails injury.
and Mazes subtests
• Administer the Semantic Comprehension 4. Delayed and/or self corrected responses may indicate milder
task memory problems.
• Calculate the Auditory Comprehension
score

Symbol cancellation: Confrontation Naming:

1. Symbol Cancellation is a non-linguistic task of visual attention and perception. It
also offers information regarding the integrity of the upper and lower quadrants of left 1. Deficits in confrontation naming are a key symptom of aphasia that can
and right visual fields. result from various forms of brain damage (e.g., stroke, head injury,
dementia, tumors, infections).
2. Observe examinees' scanning strategies.
• Are they searching laterally from left to right, down and up, or scanning 2. Delayed responses suggest mild word-retrieval problems. Note
unsystematically? immediate or delayed perseverations, repeated responses for all or part
• Notice if examinees failed to cancel symbols in one or more of the four quadrants. of a previous word.

3. Errors of omission (correct symbols not cancelled) and commission (incorrect 3. Although no points are deducted, an elaborated response may be
symbols cancelled) may be secondary to: symptomatic of verbosity or inability to limit information.
• generalized inattention
• visual discrimination problems 4. Ask the examinee to give a single word response. Use of seldom-used
• partial or full hemianopsia words may be a symptom of word-finding problems. Request a
• visual neglect "common name.” The types of errors examinees make can guide
• inattention to one side or quadrant of space treatment of word-retrieval problems.

4. Observe whether there are similar visual field deficits on Clock Drawing, Symbol
Trails, and Mazes tasks.
9 10

Clock Drawing: Story retelling:

1. Clock Drawing serves as a mini-screening tool for all cognitive domains. 1. Story Retelling helps to assess auditory memory and
comprehension, working memory, and language output skills.
2. This task can be re-administered to sample and monitor examinees
progress, deterioration, or stability across several cognitive domains. 2. Unrelated responses may indicate loss of topic or memory problems.

3. Watch carefully as examinees draw the dock and note the strategies used. 3. If partially correct information is provided, note whether recall is
better for initial, medial, or final parts of the story as indications of
4. 11 elements get scored to get a total score arousal, attention, and storage capacity.

4. Story Retelling is an easy way to assess narrative skills.

5. Although no points are deducted for retelling the story out of

sequence, you can analyze for recall of consecutive events building
to the story conclusion by numbering each item recalled

11

2
 23/08/2017

Symbol Trails: Generative Naming:

1. Symbol Trails is a nonlinguistic task used to help assess planning, self 1. In addition to quantifying word search and retrieval skills by one
monitoring, working memory, and visual attention even in examinees with superordinate semantic category (Animals) and one phonetic category (m
compromised language skills. Words), the Generative Naming task enables you to qualitatively assess
performance. Observe if examinees subcategorize animals (e.g., farm, zoo,
pets) to aid word retrieval.
2. The two trial items introduce the concepts of graduating size and then
alternating shapes. Examinees are required to manipulate both concepts in
the Scored Item. 2. Perseveration Ratio: A ratio of 0.08 or greater indicates notable
perseveration, which is indicative of brain damage.
3. As you observe examinees perform the task, check to see whether there is
inattention to one side or quadrant of space and/or impulsivity. Also note Example: 3 perseverations divided by 13 total Animals responses = 0.23
whether examinees self-monitor and correct errors. (notable perseveration). Abnormal perseveration ratios may have diagnostic
value for mild/borderline dementia.

13 14

Design Memory: Mazes:

1. Design Memory is a non-linguistic task that can provide information
about visual discrimination and analysis, attention, and visual memory 1. Satisfactory performance on this task requires planning, mental
even in examinees with severe aphasia. flexibility, self-monitoring, and visual discrimination.

2. Examinees with brain damage confined to the left hemisphere may 2. Poor planning and/or impulsivity will be reflected in lines going down
perform normally, whereas those with right-hemisphere damage may incorrect paths and/or crossing walls.
perform poorly.
3. Look for the ability to self-correct errors. Note neglect or inattention to
3. This information can guide choice and use of treatment stimuli. one side of space. Compare performance on this task with that on the
Symbol Trails task
4. In analysing errors, look for impulsive choices and/or perseverations
(e.g., pointing to designs in the same position across trials).

15

Design Generation: Semantic comprehension

1.This is a nonlinguistic task of creativity and mental flexibility.
(Aphasia Administration Only):
2.Look for perseverative responses, failure to maintain four straight lines 1. Follow the instructions presented on the CLQT+ Record Form and use
connecting four dots, and/or neglect of stimuli on one side of space. CLQT+ Stimulus book to show page with line drawings

2. Present the verbal description of each object and wait up to 10 seconds for
the examinee to respond.

3. The examinee must indicate his or her choice by pointing to the stimulus.

4. If the examinee responds in any way other than pointing, a prompt should
be given to the examinee to point to the correct stimulus.

5. You may repeat a question one time, as needed.

17 18

3
 23/08/2017

CLQT(+) Scoring
Scoring – Worksheet 1
• Use scoring worksheet on back of form to calculate the adjusted domain/index
score and then determine severity rating based on chart.

• Traditional administration yields severity ratings based on criterion cut scores

for 5 domains (attention, memory, executive functioning, language and
visuospatial skills) as well as a composite severity rating and a separate clock
drawing severity rating

• Aphasia administration yields severity ratings based on criterion cut scores for
a non-linguistic cognition index and a linguistic/aphasia index as well as a
separate clock drawing severity rating

19 20

Scoring – Worksheet 2 (optional) Scoring – Worksheet 3

21 22

Scoring – Transfer to front of form Development of new tasks

1. Picture stimuli for the Semantic Comprehension task
were taken from the Confrontation Naming task
• Verbal stimuli were developed to elicit
nonverbal responses so that examinees can
demonstrate their knowledge free from the
requirements of expressive language.

2. CLQT users participated in a study to collect

responses on the Semantic Comprehension task, as
well as the other CLQT+ tasks.
• Clinicians were asked to target people
diagnosed with only a left hemisphere stroke
and probable aphasia.

3. A split-half reliability estimate was calculated for the

Auditory Comprehension task using the Spearman-
Brown formula (r = .91).

23 24

4
 23/08/2017

Task Means and Standard Deviations of the

CLQT Aphasia Sample and Nonclinical
Research Sample

25 26

Interpreting CLQT+ Index Scores for

Clinical Sample of Individuals With
Aphasia Administration
Aphasia Compared to Matched Control
Semantic Comprehension task & Auditory
Comprehension
• Developed to enhance the assessment of
individuals with diminished language
capabilities/aphasia.
• No cut score (because the development of the
task occurred after the initial release of the
CLQT).
• However, expect results cut scores at or near
perfect performance for non-clinical group.
• Auditory Comprehension task score much
lower than 19
• Individual likely experiencing difficulty
understanding what they hear, and
further evaluation might be warranted.

27 28

Non-Linguistic Cognition
Index (NLCI) Linguistic/Aphasia Index
• Provides an estimate of cognitive functioning that is
(L/AI)
free of language demands when responding to task
items. • L/AI includes scores from Personal Facts,
Confrontation Naming, Story Retelling, Generative
• Intended to provide a more appropriate estimate of Naming, and Auditory Comprehension.
cognitive ability for those individuals with diminished
language skills. • The Auditory Comprehension score plays a primary
role in the L/AI score; it contributes up to approximately
• The severity ratings (i.e., Within Normal Limits, Mild, one-third of the score’s total raw score points (i.e., up
Moderate, Severe) for this domain are based on the to 19 of 56 total points).
same representative population used to evaluate the
other CLQT domain scores (i.e., Attention, Memory, • The L/AI includes expressive and receptive language
Executive Functions, Language, Visuospatial Skills). components, both of which are important when working
with individuals who have diminished language
• The tasks included in the NLCI are the same as the capacity.
Visuospatial Skills domain score (i.e., Symbol
Cancellation, Symbol Trails, Design Memory, • Severity Rating cut scores for this index score are
Mazes, Design Generation). based on a population of individuals with aphasia.

• Contribution of each task score to the overall NLCI • Lower L/AI scores (i.e., more severe scores) indicate
varies somewhat (compared to Visuospatial Skills), and more significant problems with language
are based on the author’s clinical experience. comprehension and language expression.
29 30

5
 23/08/2017

Clinical utility of the Strengths and weaknesses

CLQT(+)
Strengths
• Quick assessment of cognitive function • Provides a quick way to screen cognition
• Monitor changes over time without requiring additional items (can be
• Improvements for non-progressive completed bedside)
disorders (e.g. CVA, ABI) • Aphasia administration allows for
• Declines in progressive disorders differentiation between cognitive delays and
(e.g. dementia) language delays
• Can be used to identify specific areas of • Sensitive to change (improvement or decline)
cognition that require further assessment
• To guide intervention planning and goal Weaknesses
setting • Not a comprehensive assessment – would
• Can be used as part of an off-road driving need to do more in depth assessment based
assessment on outcome
• Can be used as a competency assessment • A few of the items require drawing so might
to differentiate cognitive ability from be difficult if client has hemiplegia on
language disorder in clients with aphasia dominant side

31 32

Thanks for your attention!

Any questions?

amy.schulenburg@pearson.com
0407 259 317
angela.kinsella-ritter@pearson.com
0408 511 110 33