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Brazilian children performance on Rey’s Auditory Verbal Learning Paradigm

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teste sobre memória verbal, utilizando o teste RAVLT
  Arq Neuropsiquiatr 2008;66(1):40-4440 Brazilian children performance on rey’s auditory VerBal learning paradigm Rosinda Martins Oliveira 1  , Helenice Charchat-Fichman  2 Abstract – The Rey Auditory Verbal Learning paradigm is worldwide used in clinical and research settings. There is consensus about its psychometric robustessness and that its various scores provide relevant information about different aspects of memory and learning. However, there are only a few studies in Brazil employing this paradigm and none of them with children. This paper describes the performance of 119 Brazilian children in a version of Rey´s paradigm. The correlations between scores showed the internal consistency of this version. Also, the pattern of results observed was very similar to that observed in foreign studies with adults and children. There was correlation between age in months and recall scores, showing that age affects the rhythm of learning. These results were discussed based on the information processing theory.KEY WORDS: memory, child, Rey auditory verbal learning, cognitive science, neuropsychology. desempenho e cianças basileias no paaigma e apenizagem auitivo-vebal e rey Resumo – O paradigma de aprendizagem auditivo-verbal de Rey é utilizado em todo o mundo, tanto em pesquisa quanto na clínica. Há consenso sobre sua robustez psicométrica e de que seus vários escores fornecem informações relevantes sobre diferentes aspectos da memória e da aprendizagem. No entanto, existem apenas alguns poucos estudos no Brasil envolvendo este paradigma e nenhum deles com crianças. Este artigo descreve o desempenho de 119 crianças brasileiras em uma versão do paradigma de Rey. As correlações entre escores mostraram a consistência interna desta versão. Além disso, o padrão de resultados encontrado foi muito similar àquele observado em estudos estrangeiros com adultos e crianças. Verificou-se correlação entre idade em meses e os escores de evocação, mostrando que a idade afeta o ritmo de aprendizagem. Estes resultados foram discutidos a partir da teoria do processamento da informação.PALAVRAS-CHAVE: memória, criança, aprendizagem auditivo-verbal de Rey, ciência cognitiva, neuropsicologia. 1 Doutorado pela Universidade de Oxford; Professora do Curso de Psicologia da Universidade Estácio de Sá, Rio de Janeiro RJ, Brasil; 2 Doutorado em Neurociências e Comportamento pela Universidade de São Paulo. Professora do Curso de Psicologia da Universidade Estácio de Sá, Rio de Janeiro RJ, Brasil. Este estudo recebeu nanciamento do Conselho Nacional de Desenvolvimento Cientíco e tecnológico - CNPq.Received 2 August 2007. received in nal form 5 November 2007. Accepted 8 December 2007. Dra. Rosinda Martins Oliveira – Rua Visconde de Pirajá 550 / 616 - 22410-003 Rio de Janeiro RJ - Brasil. E-mail: e  The use of auditory verbal learning paradigms for as-sessment of memory was rst proposed by Claparède in 1919 1,2 . However, their popularization is due to the Rey Au-ditory Verbal Learning Test (RAVLT), srcinally developed for children 3,4  and, subsequently, extended for young and old adults 5 . There are many variations of the paradigm proposed and made popular by Rey 3,4 . The general com-position consists of 4 or 5 learning trials of a 15 words list, presented always in the same order, with immediate re-call tested following each presentation. After this part, in some variations, an interference list is presented and its immediate recall is tested. The interference list attends the objective of assessing the effect of a new set of stim-uli on the consolidation and recall of previously learned information. To attain this objective, the interference list, whenever used, is followed by a new recall of the rst list. Next, after a 20 to 30 minutes delay and with no fur-ther stimuli presentation, there is a free recall test of the rst list. Finally, in many versions, there is a recognition trial, where the subject has to discriminate the words of each one of the lists among a set of words, or imbedded in a story 6 . In its different versions, the auditory verbal learning paradigm, is one of the most widely used learn-ing and memory assessment procedures. With its help, memory decits have been detected in a great variety of disorders 7-13 , including during infanthood 12-16 . Also, it has been showing extremely robust in terms of its psycho-metric qualities 6 and of the internal consistency of the results pattern, despite of variations in the procedure 17,18 . It is agreed that a great advantage of this paradigm is that  Arq Neuropsiquiatr 2008;66(1) 41 Rey’s auditory verbal learning tests: Brazilian childrenOliveira & Charchat-Fichman many aspects of the performance may provide clinical-ly relevant information 6 . Not only it is possible to com-pute the number of words recalled correctly at each tri-al, but also one may estimate the learning curve, com-pare the recall scores before and after a 20-30 minutes delay (thus assessing forgetfulness), compare the scores of free recall and recognition after a time delay (thus as-sessing the quality of codication attained by the sub- ject) or evaluate the susceptibility of memory processes to interference, comparing performance before and af-ter the interference list (an attentional measure), among other possibilities 12 .There is extense literature on the performance of nor-mal adults in this paradigm 6,12,13 . However, studies about the performance of children are extremely rare, despite the fact that this kind of paradigm was srcinaly devel-opped for healthy children 3,4,19 . A search of the interna-tional literature on this subject, showed only two pa-pers on normal children. Forrester and Geffen 20 , using the American adaptation of Rey’s test, collected repre-sentative data for 7 to 15 years old Australian children. Van den Burg and Kingma 17 , using a shorter version, with-out an interference list or a recognition trial, published data on German children. A search of the Brazilian litera-ture showed that this paradigm has not been used in this country as it has been worldwide. Only two studies were found, one of them about the effects of aging on memo-ry 11  and the other one about the performance of healthy brazilian adults, by Malloy-Diniz and colleagues 21 . How-ever, there is no study about the performance of normal Brazilian children on this paradigm.Taking into account the usefulness of this paradigm in the clinic and for research and the reduced number of studies about children response to that, it was devel-oped a version for children, in Portuguese. In this paper we characterize the performance of 119 children 7 to 10 years old and compare our results with the data from chil-dren in other countries. method Subjects Participated in this study 119 subjects, 59 boys and 60 girls, aged from 7 to 10 years, students of private schools in Rio de Ja-neiro (Table 1). The subjects were from classes C and D, as esti-mated from parents professions and incoming, reported. Were included as subjects all children in the age band of interest, ex-cept those with diagnosed neurological or neuropsychiatric dis-turbances. These information were collected from a question-naire lled in by parents. For all subjects the informed consent was obtained from parents after approved by institutional eth-ics comitee. Procedure The subjects were tested individually in appropriate condi-tions in a separate room inside the schools. The material used was paper, pencil and a tape recorded to register the word evo-cated by the subjects. It was used a modied version of the Rey’s auditory verbal learning paradigm. This version includes: 1) 4 presentations of a 12 words list (list A), followed by free recall attempts (A1, A2, A3 e A4); 2) presentation of another 12 words list - list B - and free recall test of this list (B); 3) a fth recall, without further presen-tation, of list A (A5); 4) a delayed recall of list A, after 20 min-utes (A6) and 5) recognition of lists A and B (recA e recB) (a re-cord sheet is available writing to In the recognition trial of lists A e B it was required that the subjects  judged whether each of a 54 words set belonged to list A or to list B or to none of those. The stimuli words in this part includ-ed all words from lists A and B, and 30 distractor words similar to those on the lists in terms of fonology or semantics. The re-duced number of words per list and the reduction of number of learning trials of list A, compared with Rey’s and other versions, aimed to shorten the duration of testing, making it more suit-able for limitations in sustaining attention expected especially for younger children. To compose the lists, were selected con-crete noums, with 2 or 3 syllables, not belonging to the same se-mantic category, as described in the srcinal paradigm 3,5 . Table 1. Demographic characteristics. 7 years8 years9 years10 yearsPN37283420 Sex  Female Male201710181915119 > 0.05 a Education  1 st  grade 2 nd  grade 3 rd  grade 4 th  grade 5 th  grade42310001310000010222001514 < 0.05 b a chi-square analyze comparing sex frequencies between different ages; b chi-square analyze comparing ed-ucation grade frequencies between different ages.  Arq Neuropsiquiatr 2008;66(1)42 Rey’s auditory verbal learning tests: Brazilian childrenOliveira & Charchat-Fichman For each subject, were computed simple and composed scores. The simple scores were: (i) number of words recalled in each of the 6 recall attempts of list A, designated as SA1, SA2, SA3, SA4, SA5 e SA6, (ii) number of words recalled in the immedi-ate recall test of list B (SB), (iii) number of words recognized from lists A e B (SrecA e SrecB), The composed scores were: (i) learning ( ∑ SA1-SA4), (ii) learning rate (SA4-SA1), (iii) retroactive interfer-ence (SA5/SA4), (iv) forgetfulness (SA6/SA5), (v) access to codi-ed list A (SA6/SrecA) and (vi) access to codied list B (SB/SrecB) Statistical analysis Initially, the internal consistency of the all set of results was tested using Pearson´s correlation. The consistency between the pattern of results observed and those presented in the literature was studied through examination of the means and standard de-viation, as well as through the execution of t   tests for repeat-ed measures. Finally, the age effect was tested with Pearson´s analysis of correlation between age in months and the different scores measured. Also, an ANOVA was runned and followed by a LSD (Least Signicant Difference) post hoc test. results Internal consistency Taking together the all set of data, it was observed a signicant correlation (r=0.20, p=0.02) between the scores related to short-term memory (SA1 e SB1). Also, there were signicant correlations (r between 0.18 and 0.71, p < 0.05) between the scores related to long term memory (SA3, SA4, SA5, SA6, SrecA, SrecB). The SA2 was correlated (r be-tween 0.27 and 0.60, p < 0.05) both with measures of short term memory (SA1 e SB1) and those of long term memory (SA3, SA4, SA5, SA6, SrecA). Consistency between the patern of results observed and those presented in the auditory verbal learning litterature Tables 2 e 3 present the results for the learning trials from the present study, side by side with the nds of For-rester and Geffen 20  and those of Van den Burg and King-ma 17 . The means and standard deviations are very simi-lar in the three studies, except for a tendency for slightly smaller scores SA2 to SA4 for the brasilien sample com-pared to the literature. Tables 4 and 5 summarize the results for the Brazilian children in terms of simple and composed scores. Repeat-ed measures t   tests showed that there was learning of list A (SA1 < SA2 < SA3 < SA4), reduction of the number of list A words recalled after introduction of list B (SA4 > SA5), recall of more words in the rst presentation of list A, compared to the recall performance for list B (SA1 > SB1), number of words recognized larger than recalled, both from list A and list B (SrecA > SA6), and recognition of list A better than that of list B (SrecA > SrecB). There was no Table 2. Correct word recall means (SD) according to age and trials comparing to Forrester and Geffen (1991) data. AgesSA1SA2SA3SA4Mean(SD)Mean(SD)Mean(SD)Mean(SD)7–8 5.06(1.5)6.6(2.2)7.6(2.5)8.7(2.0)7–8 a 4.5(1.3)6.7(1.8)8.1(2.2)9.4(2.3)9–10 5.7(1.3)7.5(1.9)8.6(1.7)9.2(1.6)9–10 a 5.8(1.2)8.9(1.6)9.9(1.8)10.9(1.5) a Forrester and Geffen (1991). Table 3. Correct word recall means (SD) according to age and trials comparing to van den Burg and Kingma (1999) data. AgesSA1SA2SA3SA4Mean(SD)Mean(SD)Mean(SD)Mean(SD)7 years4.9(1.5)6.2(1.9)7.2(2.7)8.4(2.1)7 years a 4.5(1.6)6.7(1.8)7.9(2.3)8.4(2.1)8 years5.2(1.6)7.0(2.5)8.0(2.2)9.0(1.8)8 years a 4.9(1.4)7.6(2.0)8.5(2.2)9.6(2.2)9 years 5.7(1.5)7.3(1.8)8.4(1.9)9.0(1.6)9 years a 5.6(1.4)8.2(1.9)9.7(2.2)10.5(2.0)10 years5.3(1.4)7.9(2.0)8.8(1.2)9.6(1.4)10 years a 5.9(1.6)8.6(1.6)10.1(1.9)10.7(2.1) a van den Burg and Kingma (1999).  Arq Neuropsiquiatr 2008;66(1) 43 Rey’s auditory verbal learning tests: Brazilian childrenOliveira & Charchat-Fichman lost of information after the 20 minutes delay for list A (SA5=SA6). For the comparisons where the mean scores showed different, t values have been between 8.64 and 17.41 and p < 0.001. Age effects It was observed statistically signicant positive cor-relation between age in months and: (a) the number of words recalled in the learning trials (SA1, SA2, SA3 and SA4), (b) the learning score ( ∑ SA1-SA4) and (c) the number of words recognized from list B (SrecB). The correlation coefcients were between 0.18 and 0.29 and p < 0.05. An ANOVA was runned to investigate the age effect on the simple and composed scores. It was observed sig-nicative age effect on the number of words recalled on the learning trials SA1, SA2 and SA3 and also on the learn-ing score ( ∑ SA1-SA4) (F between 2.31 and 5.39, p < 0.05). The LSD post hoc analysis has shown that 7 years old re-call less words, compared to 9 to 10 years old, on each of the learning trial (SA1, SA2, SA3 and SA4) and show small-er learning scores ( ∑ SA1-SA4). The 10 years old recognized more words from list A (SrecA) than 7 and 8 years old. discussion The auditory verbal learning paradigm is a very usefull tool for the assessement of several aspects of memory and learning in the clinical setting as well as in research 6 . There is only one pair of studies on this paradigm in por-tuguese speakers and none of them with children 11,21 . Thus, this study aimed to describe the performance of 119 chil-dren 7–10 years old on a shortened version of this para-digm, and also to compare these data with other studies with children from other countries 17,20 .The data from the Brazilian sample showed strong internal consistency, as demonstrated by signicant cor-relations between short-term scores on one side, and be-tween long-term scores on the other. It was interesting the nding that the scores for the second learning trial SA2 correlated both with short and long-term memory scores. It is possible that, along the learning trials, one will recruit progressively more the long-term stores than the working memory, because the amount of information gradually exceeds the capacity of this temporary store 22 .The means and stardard deviations for this Brazilian sample, both for simple and composed scores, were very similar to those from the two existing normative studies for German 17  and Australian 20  children. There was only a tendency for slightly smaller scores SA2 to SA4 for the Brazilian children compared to the others. This might be an effect of the reduced number of words in the shortened version of the paradigm used in this study. It is conceivable that, since less nodes (words) were activated in memory (by the hearing of the list), the number of words available to recall was smaller and so was the chance of recalling.The pattern of results found in this study was also consistent with the immense literature on this paradigm on healthy and not healthy adults and children 6 . There was learning of list A along the four rst trials as well as a small reduction of words recalled from that list, after list B was introduced. Also, after the 20 minutes delay, there was no signicant lost of information from list A and the recognition score was larger than the recall score for list A. Finally, recognition of list A was better than for list B. Only one result differed from the pattern regularly found with this paradigm: the recall scores for the rst presentation of list A and for list B were different, sug-gesting that list B was more difcult to store on working memory than list A. It would be expected no difference Table 4. Correct word recall means (SD) according to age and trials. AgesSA1SA2SA3SA4SB1SA5SA6SrecASrecB7 4.9(1.5)6.2(1.9)7.2(2.7)8.4(2.1)4.6(1.2)6.7(2.4)7.1(2.0)10.3(2.0)6.5(2.6)85.2(1.6)7.0(2.5)8.0(2.2)9.0(1.8)4.5(1.4)7.5(1.5)7.9(1.8)10.3(1.7)6.7(2.0)95.7(1.5)7.3(1.8)8.4(1.9)9.0(1.6)4.7(1.2)7.8(1.7)7.7(1.9)10.7(1.7)7.6(2.7)105.3(1.4)7.9(2.0)8.8(1.2)9.6(1.4)5.2(1.3)7.6(1.7)8.1(1.7)11.5(0.7)7.2(2.4) Table 5. Mean (SD) of composed scores according to age. Ages  ∑ SA1SA4SA4-SA1SA5/SA4SB1/SA1SrecA/A6SrecB/B17 26.84(5.8)3.5(2.5)0.96(0.1)1.04(0.5)1.56(0.5)1.47(0.6)829.32(6.1)3.8(2.0)0.86(0.2)0.96(0.5)1.34(0.3)1.57(0.6)930.47(4.3)3.3(2.1)0.89(0.2)0.86(0.3)1.44(0.3)1.68(0.7)1032.15(3.5)3.9(2.5)1.08(0.2)0.97(0.4)1.5(0.4)1.41(0.5) ∑  SA1SA4 – Sum of trials 1, 2, 3 e 4.
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