This monograph is the product of many years of work to create an ecological test, the RETEPP™ Test, which can detect a reduction in the higher executive functions:
Examining Higher Executive Functions
in the Formation and Expression of Opinions:
Preliminary Data on the RETEPP™ Test
The project has now been tested in a pilot study and is being published online as a monograph to make its central ideas and considerations available to interested parties.
RETEPP™ consists of two parts, a story section involving 12 descriptions of various everyday events that specifically target demonstrating frontal dysfunctionality, and a section with 12 pictures designed to demonstrate reduced emotional reactivity. The picture section serves as a supplement to the story section.
The number of test subjects was somewhat limited in size for the reference group and especially for the two patient groups. The reference group had 71 subjects, while the two patient groups comprised one with 13 people with multiple sclerosis and the other, 15 people with autism spectrum disorders.
For the reference group, however, there is no reason to assume that the various norms would differ significantly from a study of a much larger population. This is primarily due to the robustness derived from the fact that RETEPP™ basically rests on a binary pass or fail outcome. In this case, a minor displacement in the test scale due to a limited reference group that either functions too well or too poorly in relation to the normal population would not be as crucial as it would be with a continuous scale.
To ensure the quality of the individual item scoring in the story section, RETEPP™ was designed as a norm-referenced test with continuous outcomes (e.g. IQ tests). After the initial scoring, the 12 items are combined, and the sums of the values of the scores are divided into eight intervals or adaptation categories, each describing a specific level of adaptation. The categories are ordinal, with category I referring to the worst level of adaptation and category VIII to the best. After determining a cut-off point for normal functioning on this scale, RETEPP™ uses a binary pass or fail outcome.
Intuitively, the cut-off point should be placed between category IV and V as it no longer makes sense in category IV to say that, despite certain exceptions, the test subject can generally relate to the daily challenges presented: There are too many comments of a poor quality in category IV. The statistical analysis of the test results points to exactly the same cut-off point between categories IV and V.
As a result, four categories are placed under the cut-off point. The lower the test results are, the poorer the test performance, and the more it can be concluded with certainty that the test results demonstrate the breakdown of the test subject’s higher executive functions.
Based on the results, it is justifiable to assert that the pilot study shows that the story section of RETEPP™ is likely highly suitable for detecting a reduction in frontal functions. In that regard, the purpose of the pilot study has been achieved.
Due to the nature of the monograph as a pilot study, it has not been published in a peer-reviewed journal, also because the Real Event Treatment and Emotional Picture Perception (RETEPP™) test remains to be further developed for general use. The monograph has benefited, however, from the feedback provided by various academic journals.
Due to the limited size of the two patient groups, the RETEPP™ test’s results only demonstrate its potential, in that the percentage distribution of patients with or without frontal problems cannot be defined unequivocally as valid. It should be emphasised, however, that for both patient groups, some of the participants had no indication of frontal dysfunction.
Tom J. Andersen