Given recent events, in particular, the disturbing news that two Black men were found hanging from trees in Southern California (currently being investigated), we wanted to encourage members to consider alternative administration procedures of the Boston Naming Test (BNT). Many of us have long acknowledged that the BNT’s noose item is culturally insensitive. We are particularly concerned that it can be a trigger for unnecessary emotional distress for our patients, especially now in the current sociopolitical climate. There are also issues related to cultural and educational bias in the BNT (and other neuropsychological tests), which we plan to cover in more detail at another time. Information about alternative administration procedures of the BNT and different naming tests is included below.
Some providers choose to omit the noose item (but still give credit) when administering the full version of the BNT. It may be appropriate to primarily rely on qualitative observations of BNT performance (such as retrieval issues bolstered by phonemic cueing) as well as use the label “Within Normal Limits” for scores that roughly fall above the 16th percentile, even when the noose item is eliminated. Another option is to administer short forms of the BNT that do not include the noose item. The modified BNT Chinese version does not include the noose item.
An alternative confrontation naming measure is the Neuropsychological Assessment Battery (NAB) Naming Test, which has demonstrated adequate psychometric properties and has been cross-validated with the BNT. Some have found the NAB Naming Test to be more culturally sensitive in regards to item content and normative groups. Of note, scores generated by the NAB Naming Test and BNT may differ in certain populations (e.g., Durant et al. (2019) found in a direct comparison that NAB Naming produced higher scores on average than the BNT in a neurodegenerative disease clinic population).
Two other alternatives to consider are the Expressive Vocabulary Test (EVT) and the Expressive One-Word Picture Vocabulary Test–Fourth Edition (EOWPVT-4). Both of these measures require confrontational naming skills, though they are typically considered measures of vocabulary. They have not been cross-validated with other confrontational tests such as BNT or NAB naming to our knowledge and so their incremental value as naming measures remains unknown.
The Verbal Naming Test is a verbal, nonvisual measure of word finding ability that was developed for use with visually impaired populations. It shows promise in detecting dysnomia in older adults with or without visual impairment.
The Multilingual Naming Test (MINT) was developed for use in a number of languages (e.g., English, Spanish, Mandarin) and has been validated as a test of bilingual proficiency. It has also been found to detect differences in naming ability at different stages of cognitive impairment associated with Alzheimer’s disease.
Other measures can include the Columbia Auditory and Visual Naming Test, which has two parts including auditory responsive naming and visual confrontation naming of high frequency words. The Repeatable Battery for the Assessment of Neuropsychological Status Naming subtest has multiple alternate forms and is translated into Spanish.
Manly, J.J., Byrd, D.A., Touradji, P., & Stern, Y. (2004). Acculturation, reading level, and neuropsychological test performance among African American elders. Appl Neuropsychol, 11(1), 37-46.
Mack, W. J., Freed, D. M., Williams, B. W., & Henderson, V. W. (1992). Boston Naming Test: shortened versions for use in Alzheimer’s disease. Journal of gerontology, 47(3), P154-P158.
Kent, P. S., & Luszcz, M. A. (2002). A review of the Boston Naming Test and multiple-occasion normative data for older adults on 15-item versions. The Clinical Neuropsychologist, 16(4), 555-574.
Fillenbaum, G. G., Huber, M., & Taussig, I. M. (1997). Performance of elderly White and African American community residents on the abbreviated CERAD Boston Naming Test. Journal of Clinical and Experimental Neuropsychology, 19(2), 204-210.
Fastenau, P. S., Denburg, N. L., & Mauer, B. A. (1998). Parallel short forms for the Boston Naming Test: psychometric properties and norms for older adults. Journal of Clinical and Experimental Neuropsychology, 20(6), 828-834.
Messerly, J., & Marceaux, J. C. (2020). Examination of the reliability and validity of the NAB Naming Test in a diverse clinical sample. The Clinical Neuropsychologist, 34(2), 406-422.
Yochim, B. P., Kane, K. D., & Mueller, A. E. (2009). Naming test of the Neuropsychological Assessment Battery: Convergent and discriminant validity. Archives of clinical neuropsychology, 24(6), 575-583.
Durant, J., Berg, J.-L., Banks, S. J., Kaylegian, J., & Miller, J. B. (2019). Comparing the Boston Naming Test With the Neuropsychological Assessment Battery–Naming Subtest in a Neurodegenerative Disease Clinic Population. Assessment. [epub ahead of print]
Verbal Naming Test
Yochim, B.P., Beaudreau, S.A., Kaci Fairchild, J., et al. (2015). Verbal naming test for use with older adults: development and initial validation. J Int Neuropsychol Soc, 21(3), 239-248.
Gollan, T. H., Weissberger, G. H., Runnqvist, E., Montoya, R. I., & Cera, C. M. (2012). Self-ratings of Spoken Language Dominance: A Multi-Lingual Naming Test (MINT) and Preliminary Norms for Young and Aging Spanish-English Bilinguals. Bilingualism (Cambridge, England), 15(3), 594–615.
Sheng, L., Lu, Y., & Gollan, T. H. (2014). Assessing language dominance in Mandarin-English bilinguals: Convergence and divergence between subjective and objective measures. Bilingualism (Cambridge, England), 17(2), 364–383.
Stasenko, A., Jacobs, D. M., Salmon, D. P., & Gollan, T. H. (2019). The Multilingual Naming Test (MINT) as a Measure of Picture Naming Ability in Alzheimer’s Disease. Journal of the International Neuropsychological Society : JINS, 25(8), 821–833.
Columbia Auditory and Visual Naming Test
Hamberger, MJ & Seidel WT (2003). Auditory and visual naming tests: Normative and patient data for accuracy, response time, and tip-of-the-tongue. Journal of the International Neuropsychological Society, 9, 479-489.
Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
Randolph, C., Tierney, M. C., Mohr, E., & Chase, T. N. (1998). The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): Preliminary clinical validity. Journal of Clinical and Experimental Neuropsychology, 20(3), 310–319