Reasoning and Problem Solving Through Concept Formation

Reasoning and problem solving are highly related to intellectual functioning. Similar to intellectual function, these abilities tend to be impaired following damage to the CNS. Specific location of injury appears to be less important to reasoning impairments, as does the presence of CNS disturbance. Impairments in reasoning and problem solving result in difficulties in all areas of daily functioning. Patients may be not be able to form generalizations from a given situation and interpret events concretely. Tests of reasoning and conceptualization usually assess verbal or nonverbal abilities.

TESTS OF VERBAL REASONING AND CONCEPT FORMATION

Comprehension.y This subtest of the WAIS-R is a test of verbal conceptualization. Patients are required to answer questions or interpret proverbs that require problem solving (e.g., "What does 'a rolling stone gathers no moss' mean?"). Scoring is based on partial credit on most items for concrete responses and full credit on responses reflecting abstraction of general principles. One advantage of this test is the extensive WAIS-R norms available on performance expectations.

Similarities.y This subtest of the WAIS-R requires the patient to identify the common elements between seemingly uncommon stimuli. The test begins with simple problems (e.g., "How are an orange and banana alike?"), and progress to more difficult problems (e.g., "How are praise and punishment alike?"). Scoring awards full credit for complete abstractions, partial credit for concrete responses, and no credit for incorrect responses. One advantage of this test is the extensive normative data from the WAIS-R standardization sample.

Arithmetic.^ This subtest of the WAIS-R presents the patient with progressively more difficult arithmetic word problems. The test is timed so the patient must attempt to complete each problem as quickly as possible. In addition, bonus points are given for some of the difficult problems when the patient responds very quickly. Since this test is a subtest of the WAIS-R, it benefits from extensive normative data.

TESTS OF NONVERBAL REASONING AND CONCEPT FORMATION

Category Test.y The Category Test is part of the Halstead-Reitan Battery and tests visual concept formation. In this test, patients see slides with four stimuli and are required to identify the concept presented on each slide. The principle remains the same in each of six different sets of slides, but changes between sets. A final set of slides presents pictures viewed in previous sets as a test of memory for the solution. This test can be very frustrating for patient and examiner alike, but is one of the more sensitive measures in the Halstead-Reitan Battery.

Raven's Progressive Matrices.^ These tests (Coloured Progressive Matrices, Standard Progressive Matrices, and Advanced Progressive Matrices) measure visual concept formation and problem solving. Patients are presented with multiple designs that are linked by a common conceptual pattern. The final design is missing, and the patient must choose which of six to eight alternative final designs is correct. The range of abilities this test assesses is very large, from the concrete to extremely abstract. Extensive normative data are available for British norms, and adequate norms are available for U.S. norms.

Wisconsin Card Sorting Test (WCST). y This test of visual concept formation adds cognitive set-shifting to concept formation. Patients are presented with four "target" cards with simple colored designs that can be sorted by three concepts. The patients match probe cards with identical colored design to the target cards according to whatever concept they generate. The only feedback to the

patient after each trial is whether his or her response is correct. The order of sorting concept is fixed, but unbeknown to the patient, changes after a set number of correct responses. Thus, patients must be able to switch the concept they were using for the previous trials.

CLINICAL SITUATIONS FOR TESTS OF REASONING AND PROBLEM SOLVING THROUGH CONCEPT FORMATION

Because reasoning and problem-solving abilities are closely associated with intellectual functioning, testing should be requested in those situations that require intelligence testing.

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