David J. Schretlen, PhD, ABPP and Tracy D. Vannorsdall, PhD, ABPP
The CIFA, a test of ideational fluency, requires the examinee to generate verbal or visuoconstruction material as quickly as possible while adhering to specified rules (i.e., letter or category cues, designs consisting of certain elements). Success on these tasks requires speeded productivity as well as the skills of self-monitoring, working memory, strategy generation, and creative or divergent thinking.
Comprising two subtests-Design Fluency and Verbal Fluency-the CIFA is helpful in the differential diagnosis of many neuropsychiatric and neurological disorders, including schizophrenia, bipolar disorder, Alzheimer's disease, subcortical dementias, Parkinson's disease and traumatic brain injury.
The Design Fluency task asks the examinee to draw as many unique designs as possible in 4 minutes, with each design containing only four parts. Following Jones-Gotman and Milner's (1977) research, each part can be a circle, straight line, or an arc. The Design Fluency subtest is scored by tallying the total number of designs, the number of acceptable designs and the number of unacceptable designs produced.
The purpose of the Verbal Fluency task is to evaluate the spontaneous oral production of words under restricted conditions. In the first subtest, Letter Word Fluency, clients are asked to produce as many words as possible beginning with the letter S in 1 minute. This task is repeated with the letter P. For Category Word Fluency, clients are asked to name as many different animals as they can in 1 minute. This task is repeated with the category of supermarket items. The Verbal Fluency subtests are scored by tallying the number of correct words generated across all four trials (i.e. two Letter Word Fluency trials and two Category Word Fluency trials) to calculate the Word Fluency Total score.
The normative data for the CIFA allows for comparison of an examinee's performance across three tasks in a co-normed data set while also providing an overall index of speeded generativity, the Ideational Fluency Composite score.
- The Ideational Fluency Composite score is calculated by summing the obtained T scores for the Acceptable Designs, Letter Word Fluency, and Category Word Fluency scores and converting this sum of T scores to a standard score and corresponding percentile.
- Base rates for discrepancies between the Letter Word Fluency and Category Word Fluency scores and between the Word Fluency Total and Acceptable Designs scores are provided.
- The CIFA was co-normed with the Calibrated Neuropsychological Normative System(CNNS); 327 healthy participants made up the standardization sample.
- Two case examples illustrate the use of the CIFA with patients.
- Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs) by having five raters score 50 Design Fluency protocols. This yielded excellent ICCs for all the Design Fluency scores, with average ICCs of .97 for Acceptable Designs and .94 for Unacceptable Designs.
- Test-retest stability was evaluated using ICCs in a broadly representative sample of 87 healthy adults who were tested twice over an average of 5.5 years. These results consistently showed that the Acceptable Designs score has good test-retest stability (ICC = .67). Test-retest correlations on Letter Word Fluency and Category Word Fluency tasks are generally observed to be relatively high, with both yielding correlations of .70 or greater for intervals lasting from weeks to years. The Category Word Fluency variable showed the highest test-retest reliability (ICC = .88), similar to that of the Word Fluency Total (ICC = .87).
- Using the total number of words generated for the letters S and P combined and for animals and supermarket items combined, Letter Word Fluency had slightly greater internal consistency (alpha = .82) than Category Word Fluency (alpha = .73). These values for Letter Word Fluency are markedly similar to those reported for other letters used in verbal fluency tasks, including F, A, and S (r = .83 Tombaugh, Kozak, & Rees, 1999) and C, F, and L (r = .83; Ruff, Light, Parker, & Levin, 1996).
- Diagnostic criterion validity was examined in connection with several clinical groups, including adults with Parkinson's disease, schizophrenia, bipolar disorder, and probable/possible dementia and a mixed clinical group.
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