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Assessment of aphasia
  1. D Howard

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    Edited by Otfried Spreen and Anthony H Risser. Published by Oxford University Press, Oxford, 2003, pp 320, £32.50. ISBN 0-19-514075-3

    This book surveys existing tests for people with aphasia, with particular emphasis on reporting studies that address their reliability and validity. In this it is admirably comprehensive, at least for the tests it covers. These are exclusively tests published in English, with, within this, a strong bias towards those originating in the United States. Many tests widely used in the United Kingdom with people with aphasia, in both research and clinical practice—for example the Graded Naming Test1—do not warrant consideration. Those used in Europe, including the Aachen Aphasia test that has the best psychometric properties of any aphasia test, get only the briefest mention.

    For the tests they do consider, Spreen and Risser are admirably comprehensive in surveying the literature on reliability and validity. But, as they point out, in the development of these tests “psychometric development has been less than optimal in many instances and neglected in others”(p 33). These weaknesses are serious. They report a number of tests where the reported test-retest reliability is around 0.7 or even less. The authors do not point this out, but any test with a test-retest correlation coefficient this low is seriously compromised. The implication is that around 50% of score variance is error. As a result the test will be almost useless in monitoring change, and any of its scores will need to be treated with real scepticism.

    Many of the interesting issues in the assessment of aphasia are not really addressed. Many clinicians assess people with aphasia in order to identify the nature of both their impairments and their intact processes because that provides the basis for devising treatments that are directed at the impaired functions and use the strengths of the intact processes. This book provides no guidance on how that might be done.

    Many existing aphasia tests, including the two most widely used, the Boston Diagnostic Aphasia Examination and the Western Aphasia Battery, aim to classify people with aphasia into “diagnostic groups”—for example those with Wernicke’s aphasia and Broca’s aphasia. Sadly Spreen and Riser never explore whether assigning syndrome labels in this way has any impact on patient management.

    This book is an excellent source of references addressing the validity and reliability of American aphasia assessments, but less satisfying on the many complex issues that surround the uses of assessments for different purposes with people with aphasia.

    Edited by Otfried Spreen and Anthony H Risser. Published by Oxford University Press, Oxford, 2003, pp 320, £32.50. ISBN 0-19-514075-3