International Journal of the Addictions
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Group Embedded Figures Test Performance as a Predictor of Cognitive Impairment among Alcoholics Dennis M. Donovan, Henne R. Queisser & Michael R. O'leary To cite this article: Dennis M. Donovan, Henne R. Queisser & Michael R. O'leary (1976) Group Embedded Figures Test Performance as a Predictor of Cognitive Impairment among Alcoholics, International Journal of the Addictions, 11:5, 725-739, DOI: 10.3109/10826087609058809 To link to this article: http://dx.doi.org/10.3109/10826087609058809
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The International Journal of the Addictions, I1(5), 725-739, 1976
Group Embedded Figures Test Performance as a Predictor of Cognitive Impairment among Alcoholics Dennis M. Donovan,* M.A. Henne R. Queisser,? B.S. Michael R. O’LearyJ Ph.D. Veterans Administration Hospital University of Washington School of Medicine Seattle, Washington 981 08
Abstract
The present study investigated the sensitivity of the Group Embedded Figures Test (GEFT) as a predictor of cognitive impairment among alcoholics. The GEFT, Shipley-Hartford, and Memory-for-Designs tests were administered to 90 male alcoholics. GEFT performance correlated significantly with measures
* Present address: Department of Psychology, University of Washington, Seattle, Washington. t Present address: Harborview Medical Center, Seattle, Washington. To whom requests for reprints should be addressed. 725
Copyright 0 1976 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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of impairment even when the influence of age and education were controlled. Field-dependent Ss performed at a significantly more impaired level on measures of abstract reasoning, perceptual-motor function, and short-term visual-spatial memory when compared with intermediate and field independent S s ; no differences were found among groups on general verbal ability. The results suggest that the GEFT might profitably be included in screening batteries for impaired cognitive function. A number of tests have been developed to measure perceptual style along the dimension of field dependence-independence, which assess the degree to which an individual is able to make accurate perceptual judgments divorced from the contextual cues of the field. The most commonly employed measures include the Rod-and-Frame Test (RFT; Witkin and Asch, 1948), the individually administered Embedded Figures Test (EFT; Witkin, 1950), and the Group Embedded Figures Test (GEFT; Oltman et al., 1971). Although verbal intelligence does not appear to correlate significantly with these measures (Goldstein and Shelly, 1971 ; Goodenough and Karp, 1961; Gough and Olton, 1972), performance on field dependence-independence tasks has been found to relate to certain measures of cognitive complexity and analytic reasoning ability, particularly to certain performance subtests of the Wechsler scales (Goldstein et al., 1970; Goldstein and Shelly, 1971 ; Goodenough and Karp, 1961 ; Karp, 1963). Since these performance subtests have been used successfully in identifying brain-damaged subjects (Davis et al., 1971; Mackie, 1963), it is not unexpected that some investigators have found individuals with cognitive deficits, such as alcoholic and brain-damaged subjects, to demonstrate impaired performance on field dependence-independence tasks. However, the results of such studies have often been inconsistent. Bailey et al., (1961) found that alcoholic subjects, a clinical population having a high incidence of neuropsychological deficits (Brewer and Perrett, 1971 ; Kleinknecht and Goldstein, 1972; Page and Linden, 1974; Tarter, 1973), performed more field independently on the RFT than brain-damaged subjects; however, both groups were more field dependent than nonalcoholic controls. Goldstein et al. (1970), however, found that individuals defined as markedly field dependent on the RFT, regardless of whether alcoholic or nonalcoholic, performed more like brain-damaged subjects on a series of cognitive-analytic tasks than their markedly field independent counterparts. Furthermore, Neuringer et al. (1975) found that the RFT scores of subjects within the intermediate range of the field dependence continuum were related to impairment in nonverbal problem solving,
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incidental memory, and the appropriate use of tactile and kinesthetic cues. Pisani et al. (1973) found no significant relationship between cognitive deficits as measured by the Shipley Institute of Living Scale (Shipley, 1940) and RFT performance among chronic alcoholics. A small, positive correlation was found between performance on the RFT and error scores on the Bender Visual Motor Gestalt test but when the variance accounted for by age was partialled out, the relationship failed to reach significance. The results of these studies indicate that RFT performance may measure a particular form of intellectual function having high loadings on visual perceptual abilities, but which may be relatively insensitive to changes in mental status (Goldstein et al., 1970; Goldstein and Shelly, 1971). Although the RFT and embedded figures tests purportedly measure the same construct, namely field articulation, Elliot (1961) noted that a marked degree of statistical alienation existed between scores on the two tasks. Subsequent research has shown the amount of variance shared by the RFT and EFT approximates 2074 (Adevai et al., 1968; Gross and Moore, 1970; Witkin et al., 1971). It also appears that the two tasks are related differentially to measures of cognitive impairment. Goldstein and Shelly (l971), in a factor analytic study involving the WAIS, Halstead Neuropsychological Battery, and RFT, found that RFT performance defined a factor relatively independent and separate from other measures of cognitive function. Goldstein et al. (1970) found both the RFT and EFT to correlate significantly with the Block Design and Object Assembly subtests on the WAIS ; however, the EFT correlated significantly higher with these scales than did the RFT. Finally, Elliot (1961) found EFT, but not RFT, performance to be related to scores on a number of ability measures. There is evidence that tasks requiring a great degree of cognitive involvement and integration between visual and motor brain mechanisms may provide a sensitive measure of brain damage (Goldstein et al., 1973). Tests requiring such involvement and integrative skills, such as the Memory-for-Designs Test (Graham and Kendall, 1960) and the Visual Motor Gestalt Test (Bender, 1938), have been used effectively to identify braindamaged individuals (Brilliant and Gynther, 1963; Korman and Blumberg, 1963; Anglin et al., 1965). More recently, Goldstein et al. (1973) found that a visual search task in which subjects were to locate a specified target from among a complex visual array provided an accurate discrimination between brain-damaged and control subjects. The embedded figures tests, both individually and group administered, involve not only a visual search component and the ability to overcome distracting stimulus cues, but also a short-term memory factor (Jackson et al., 1964). There is evidence that such tasks may also be sensitive to
Bailey et al., 1961
Elliot, 1961
1.
2.
Authors
A.
C.
B.
A.
C.
B.
A.
128 male college students
15 BD male alcoholics 15 NBD male alcoholics, sober more than 1 yr 30NBDnonalcoholic males 13 NBD male alcoholics 15 BD male nonalcoholics 15 NBD male psychiatric patients
Subjects
RFT
RFT
Quantitative and linguistic subscales of the School and
A.
B.
Measures of field dependence were significantly intercorrelated but accounted for less than 20% common variance
BD nonalcoholics were significantly more field dependent than NBD alcoholics, NBD nonalcoholics, or NBD psychiatric controls NBD alcoholics had better RFT performance than BD nonalcoholics, but were poorer than NBD nonalcoholics and NBD psychiatric controls; the latter two groups did not differ on the RFT
A.
Diagnostic categories
A.
A.
Results Alcoholics, regardless of presence or absence of brain damage, were more field dependent on RFT than nonalcoholics B. BD inpatient alcoholics did not differ in RFT performance from NBD alcoholics sober for more than 1 yr
Cognitive function A. Diagnostic categories
A. RFT A. B. Witkin EFT C. Thurston EFT
A.
A.
Field dependence
Measures of
Relationship between Measures of Field Dependence and Cognitive Function: Selected Researcha
Table 1
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W N
I .
3. Goldsteinet al., 1970
20 F D male alcoholics B. 20 F D male nonalcoholics C. 20 FI male alcoholics D. 20 FI male nonalcoholics E. 20 BD male nonalcoholics
A.
A. B.
RFT EFT
A.
A. Picture completion, block design, and object assembly subtests of the WAIS
EFT, but not RFT, scores were significantly correlated with the quantitative and linguistic scale scores, with field dependent Ss having lower scores
(continued)
RFT performance of BD Ss was significantly poorer than FI Ss, regardless of presence or absence of alcoholism, but did not differ from that of F D Ss B. F D Ss had significantly poorer EFT scores than F1 Ss. No difference was found between alcoholics and nonalcoholics on the EFT. L. F D Ss, regardless of presence or absence of alcoholism, had significantly lower scores on all three WAIS subtests than F1 Ss D. Alcoholics, regardless of field orientation, had significantly lower scores on picture completion and block designs than nonalcoholics. E. RFT performance correlated with only object assembly, whereas EFT was significantly correlated with all three WAIS subscales F. In general, performance of BD Ss more closely approximated that of FD Ss than FI Ss
B.
College Ability Test
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0
W 4
Goldstein et al., 1973
Parsons, 1972
6. Jonesand
5. Goldsteinand Shelly, 1971
4.
Authors
B.
A.
A.
C.
A. B.
26 NBDmale alcoholics 26 NBD male nonalcoholics
50male alcoholics
17 BD males 17 NBD male psychiatric 17 NBD nonhospitalized males
Subjects
A.
A.
E m
RFT
A. Visual Search Task
Field dependence
C.
B.
A.
A.
A.
Measures of
Halstead Category Test ShipleyHardford Advanced Raven’s Matrices
Halstead NeuroPsychological Battery
Diagnostic categories
Cognitive function
Table 1 (continued)
The alcoholic Ss’ RFT scores were in the FD direction Factor analysis derived five primary factors : language, abstractionproblem solving, perceptual-motor skills, spatial relations memory, and numerical. RFT performance defined a relatively separate factor with minimal contributions to the others.
BD Ss required significantly longer time to locate target stimulus than either NBD control groups
Results
A. F D Ss within the alcoholic sample had abstracting and category test scores in the direction of significant impairment B. Alcoholics were significantly more impaired than nonalcoholics on the category test and Raven’s matrices C? Alcoholics and nonalcoholics did not differ in EFT performance or verbal, abstracting, or conceptual quotient scores of the Shipley-Hartford
B.
A.
A.
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4 L W
64BDnonalcoholic Illales 64NBDnonalcoholic males
36 male alcoholics
54 female college students
RFT
RFT
A. Gottschaldt Hidden Figures Test
A.
A.
ShipleyHartford Bender Visual Motor Gestalt
Halstead NeuroPsychological Battery
A. Diagnostic categories B. Army General Classification Test
B.
A.
A.
A.
B.
A.
B.
A.
BD Ss, regardless of lesion location, performed more field dependently on the hidden figures than did NBD Ss; this difference remained significant even when the level of general intelligence was controlled.
When age was controlled, no correlation was found between RFT and Bender Gestalt performance
There was no relationship between RFT performance and the conceptural quotient of the Shipley-Hartford
RFT scores in the intermediate range of the field-dependence continuum were significantly correlated with ratings of impairment on the Halstead battery Minimally FD RFT performance was related to impairment of function in nonverbal problem solving, incidental memory, and ability to employ tactile and kinesthetic cues
'BD=brain damaged; NBD=nonbrain damaged; FD=field dependent; FI =field independent; RFT= Rod-and-Frame Test; EFT=Embedded Figures Test; Ss &subjects.
B.
A.
A.
Pisani et al.. 1973
8.
9. Teuberand Weinstein, 1956
A.
Neuringer et al., 1975
7.
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brain damage. Goldstein et al. (1970) suggest that if embedded figures tasks are sensitive to cognitive impairment, then individuals along the field dependence-independence dimension, whether alcoholic or nonalcoholic, represent points along a brain dysfunction continuum. This contention is supported by Teuber and Weinstein (1956), who found that brain-lesioned subjects had significantly poorer scores on a perceptual task similar to the GEFT than did controls, even when general intelligence was statistically controlled. The EFT scores of chronic alcoholics have also been shown to correlate significantly with error scores on the Halstead category test and with abstracting age (Jones and Parsons, 1972). A summary of the selected research cited above, dealing with the relationship between measures of field dependence and cognitive function, is found in Table 1. The purpose of the present study was to determine the sensitivity of the Group Embedded Figures Test in predicting cognitive impairment among alcoholics. It was hypothesized that GEFT performance would be significantly related to commonly employed measures of cognitive dysfunction. Further, it was hypothesized that alcoholics defined as field dependent would perform in a more impaired range on these cognitive tasks than would field-independent alcoholics.
METHOD Subjects
The Ss were 90 male alcoholic veteran inpatients who had volunteered to participate in a larger research project from 1973 to 1974. The Ss had a mean age of 47.88 (SD = 8.09) and a mean educational level of 11.81 years (SD = 2.77). None of the Ss were diagnosed as having significant psychiatric disorders nor did any exhibit physical or cognitive residuals of acute intoxication at the time of testing. Materials
The Group Embedded Figures Test (GEFT; Oltman et al., 1971) was used to assess the level of field dependence-independence. The GEFT consists of three timed sections. The first section (2 min) contains seven practice items. Each of the subsequent two sections consists of nine items for which the S is given a maximum of 5 min to complete. The Ss are to
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locate and trace the outline of designated geometrical forms embedded within more complex stimulus patterns. Higher scores on the test indicate a more field-independent level of functioning. Two measures of cognitive functioning were employed as criterion variables. The first was the Memory-for-Designs Test (MFD; Graham and Kendall, 1960). The MFD, requiring Ss to reproduce simple geometric forms from immediate memory following a brief exposure, has demonstrated a high degree of accuracy as a diagnostic tool for brain damage (Anglin et al., 1965; Korman and Blumberg, 1963). Utilizing a cutting point between 5 and 6 on MFD raw scores, Korman and Blumberg (1963) were able to predict the absence as well as the presence of cerebral damage with 90°/, accuracy, respectively. The MFD in the present study was scored by two independent raters with a high degree of interrater reliability ( r = .83, p < .Ol); the average of the scores assigned by the two raters was used as the criterion measure. The second measure of cognitive function employed was the Shipley Institute of Living Scale (SH; Shipley, 1940). The Shipley scale has been used as a brief intelligence scale (Bartz and Loy, 1968) as well as a measure of cognitive deterioration (Lewinsohn, 1963). Three basic scores derived from the SH were utilized in the present study: verbal raw score (VRS), abstraction raw score (ARS), and conceptual quotient (CQ). The latter score, based upon a ratio between verbal and abstraction scores, provides a rough index of cognitive impairment (Shipley, 1940). Since the CQ has been shown to be significantly affected by age, vocabulary scores, and educational level (Jansen and Hoffmann, 1973; Kish and Ball, 1969; Lewinsohn, 1963), a fourth measure, the residual abstraction score (RAS; Lewinsohn, 1963) was also employed. The RAS, found to be related to clinical observations of conceptual disorganization, represents the discrepancy between a S’s obtained abstraction score and an expected level of abstracting ability based upon his age and vocabulary level. The more highly negative the RAS, the greater the degree of impairment. Procedure The GEFT was administered to Ss in small groups approximately 14 weeks following their admission to an alcoholism treatment unit. All subjects had been completely detoxified prior to the test administration. The MFD and SH scales were given 5 days later as part of the routine psychological screening battery.
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RESULTS The means, standard deviations, and correlation coefficients for age, education, GEFT, MFD, and Shipley scale scores are found in Table 2. The correlations between GEFT performance and measures of cognitive impairment are particularly relevant to the present study. It can be seen that the GEFT was related significantly to each of these measures in the expected direction. However, these results are confounded by the influence of both age and education. When the variance contributed by these factors are partialled out (Nunnally, 1967), as shown in Table 3, the relationships between GEFT and the measures of impairment remain relatively high and statistically significant. Table 2 Means, Standard Deviations, and Correlation Coefficients for Education, Age, GEFT, MFD. and Shipley Scale Scores" Educ Educ Age
Age GEFT VRS .01
.35 -.26
GEFT
.49 .I8 .37
.51
-.I2 .61 .63
VRS ARS CQ RAS MFD a
ARS
CQ RAS .40 -.21 .60 .33 -92
.31 .14 .45 .13 .82 .91
< .05; r significant at p < .01; df= 88. r = *.21 significant at p
=
MFD Mean -.33 .18 -.50
--.I9 -.37 -.35 -.30
11.81 47.88 7.16 29.74 19.60 79.50 0.03 3.08
SD 2.77 8.09 4.69 5.56 9.49 14.45 7.09 4.16
f.27
Table 3 Correlation Coefficients between GEFT and MFD and Shipley Scale Scores Corrected for Age, Education, and the Combined Influence of These Two Factors"
Uncorrected Education Age Age and education
'r
VRS
ARS
CQ
RAS
MFD
.37 .24
.61 .53 .60 .52
.60
.45 .38 .51 .45
-.50 - .44 - .41 -.40
.44 .32
= rt.21 significant at p < .05; r significant at p < .01; df = 88.
=
k.27
.53 .58 -50
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A second correlational analysis was conducted to determine the relationship between embedded figures performance and the presence of significant cognitive impairment. Significant cognitive impairment was defined as error scores greater than 5 on the MFD (Korman and Blumberg, 1963), conceptual quotients equal to or less than 75 on the Shipley (which represents the normative categories of “very suspicious” and “probably pathological”; Shipley, I940), and negative residual abstraction scores. The point-biserial correlations between GEFT scores and the presence of cognitive impairment as defined by the MFD, CQ, and RAS criteria were - .42, - .44, and - .36, respectively ( p < .01). Thus field-dependent performance on the GEFT is indicative of significant impairment in other cognitive functions. The distribution of GEFT scores was trifurcated to form three groups: Field Dependent (GEFT < 4, n = 31), Intermediate ( 5 >, GEFT < 9, n = 31), and Field Independent (GEFT 2 9, n = 28). A series of simple randomized analyses of covariance were conducted on each of the cognitive impairment variables with educational level statistically controlled (Winer, 1971). Table 4 presents the adjusted criterion means as well as resultant F ratios. Significant differences were found among the groups on the abstraction raw score, conceptual quotient, residual abstraction score, and M F D error scores; no differences were found on the vocabulary scores. Subsequent analyses (Lindquist, 1953) between adjusted group means showed the field dependent Ss to have scores indicative of greater impairment on the ARS, CQ, RAS, and MFD than either the intermediate (p < .025) or field independent Ss ( p < .01). The latter two groups differed significantly on the ARS and CQ measures ( p < .Ol), but no differences were found between them on the RAS and MFD ( p > .05). Table 4 Adjusted Means and F-Ratios for Field- Dependent, Intermediate, and Field-lndependent Groups on MFD and Shipley Scale Scores with Education as Covariantsa
VRS ARS CQ RAS MFD
Field dependent
Intermediate
Field independent
F-ratio
28.20 14.95 72.64 -2.78 5.61
29.87 19.69 79.20 0.61 2.27
31.32 24.64 87.43 2.48 1.19
2.80 11.29 9.73 4.41 I 1.41
F 2 3.15 significant at p < .05; F 2 4.98 significant at p < .01; df
=
2/87.
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DISCUSSION The present results indicate that although field dependent and independent alcoholics do not differ in general verbal abilities when education is controlled, marked differences exist in other areas of cognitive function. Subjects defined as field dependent on GEFT performance evidence significant impairment in the areas of abstract reasoning ability, perceptualmotor function, and short-term visual-spatial memory when compared with intermediate and field-independent subjects. Goldstein et al. (1970) postulated that if embedded figures tasks are sensitive to brain dysfunction, then groups ranging from field independent to field dependent represent points along a continuum from intact to deteriorated cognitive, perceptual, and motor function. The present results substantiate both premises of this contention. Group embedded figures test performance was found to be a sensitive measure of cognitive impairment, evidenced by moderately high, statistically significant correlations between GEFT and other cognitive measures. The second portion of the contention was supported by a consistent trend in the abstraction, conceptual quotient, residual abstraction, and memory-for-design scores from a nonpathological level for field-independent subjects to a pathological level of function for field-dependent subjects. The discrepancy between the present results and those of Pisani et al. (1 973) in predicting cognitive impairment among alcoholics may be related to differences in the measures of field dependence-independence employed. The latter investigators found no relationship between Rod-and-Frame Test performance and CQ scores; further, when the influence of age was controlled, the correlation between RFT performance and error scores on a test similar to the MFD failed to reach significance. Previous research (Goldstein and Shelly, 1971) has shown that RFT performance defines a relatively independent factor with minimal loadings from other cognitive measures and appears to be relatively insensitive to changes in mental status. The present results support the previously hypothesized sensitivity of embedded figures performance as a measure of cognitive dysfunction (Goldstein et al., 1970; Teuber and Weinstein, 1956). The Group Embedded Figures Test appears to be particularly relevant for the screening of cognitive impairment among alcoholics. The GEFT contains a visual search component, which has been shown to be effective in the identification of brain-damaged subjects (Goldstein et at., 1973). Further, the GEFT appears to require abstract problem-solving ability, short-term visual-spatial memory, and perceptual-motor skills. These
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particular cognitive areas are ones in which alcoholic subjects have been shown to demonstrate marked deficits (Goldstein and Shelly, 1971 ; Jones, 1971 ; Jones and Parson, 1972). These psychometric characteristics of the GEFT, coupled with the minimal administration and scoring time requirements (Witkin et al., 1971), appear to justify the test’s inclusion in screening batteries for cognitive impairment among alcoholics. The results of the present investigation, as well as previously cited findings, suggest a number of areas of continued research attempting to delineate the relationship between measures of field dependence and cognitive function. First, it is necessary to determine further the validity of GEFT as a predictor of impairment. This would require additional correlation and factor analytic studies defining the relationship of GEFT performance with other, more sensitive measures of cognitive function than those employed in the present study. Second, within an alcoholic population, it appears clinically relevant to develop multiple regression equations, utilizing both developmental and replication samples, in an attempt to predict scores on brain damage criterion measures from subjects’ ages, educational levels, and GEFT scores. A third consideration is based upon the findings that the GEFT and RFT measure different factors of cognitive dysfunction. This suggests that further research is necessary to determine the extent to which a more broadly based assessment approach, employing both measures of field dependence, is more reliable and accurate in detecting the presence or absence of brain damage than either of these tests administered separately. REFERENCES ADEVAI, G., SILVERMAN, AS., and McGOUGH, W.E. Perceptual correlates of the Rod-and-Frame Test. Percept. Mot. Skills 26: 1055-1064, 1968. ANGLIN, R., PULLEN, M., and GAMES, P. Comparison of two tests of brain damage. Percept. Mot. Skills 20: 977-980, 1965. BAILEY, W., HUSTMYER, F., and KRISTOFFERSON, A. Alcoholism, brain damage, and perceptual dependence. Q.J . Stud. Alcohol, 22: 387-393, 1961. BARTZ, W.R., and LOY, D.L. The Shipley-Hartford as a brief I.Q. screening device. J . Clin. Psychol. 24: 74-75, 1968. BENDER, L. A Visual Motor Gestalt Test and Its Clinical Use (Research Monograph, No. 3), American Orthopsychiatric Association, 1938. BREWER, C., and PERRETT, L. Brain damage due to alcohol consumption: An air-encephalographic, psychometric, and electroencephalographic study. Br. J. Addict. 66: 170-182, 1971. BRILLIANT, P.J., and GYNTHER, M.D. Relationships between performance on three tests for organicity and selected patient variables. J . Consult. Psychol. 27: 47-79, 1963.
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NUNNALLY, J.C. Psychometric Theory. New York: McGraw-Hill, 1967. OLTMAN, P.K., RASKIN, E., and WITKIN, H.A. Group Embedded Figures Test. Palo Alto, California: Consulting Psychologists Press, 1971. PAGE, R.D., and LINDEN, J.D. “Reversible” organic brain syndrome in alcoholics: A psychometric evaluation. Q. J . Stud. Alcohol. 35: 98-107, 1974. PISANI, V.D., JACOBSON, G.R., and BERENBAUM, H.L. Field dependence and organic brain deficits in chronic alcoholics. Int. J . Addict. 8: 559-564, 1973. SHIPLEY, W.C. Shipley-Hartford Retreat Scale, Manual of Directions and Scoring Key. Hartford, Connecticut: Hartford Retreat, 1940. TARTER, R.E. An analysis of cognitive deficits in chronic alcoholics. J . Nerv. Ment. D ~ s 157: . 138-147, 1973. TEUBER, H.L., and WEINSTEIN, S. Ability to discover hidden figures after cerebral lesions. Arch. Neurol. Psychiatry 26: 369-379, 1956. WINER, B.J. Statistical Principles in Experimental Design (2nd ed.). New York: McGraw-Hill, 1971. WITKIN, H.A. Individual differences in ease of perception of embedded figures. J. Pers. 19: 1-15, 1950. WITKIN, H.A., and ASCH, S.E. Studies in space orientation: IV. Further experiments on perception of the upright with displaced visual fields. J . Exp. Psychol. 38: 762782, 1948.
WITKIN, H.A., OLTMAN, P.K., RASKIN, E., and KARP, S.A. A Manualfor the Embedded FiEwes Tests. Palo Alto, California: Consulting Psychologists Press, 1971.
ISSN: 0020-773X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/isum19
Group Embedded Figures Test Performance as a Predictor of Cognitive Impairment among Alcoholics Dennis M. Donovan, Henne R. Queisser & Michael R. O'leary To cite this article: Dennis M. Donovan, Henne R. Queisser & Michael R. O'leary (1976) Group Embedded Figures Test Performance as a Predictor of Cognitive Impairment among Alcoholics, International Journal of the Addictions, 11:5, 725-739, DOI: 10.3109/10826087609058809 To link to this article: http://dx.doi.org/10.3109/10826087609058809
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The International Journal of the Addictions, I1(5), 725-739, 1976
Group Embedded Figures Test Performance as a Predictor of Cognitive Impairment among Alcoholics Dennis M. Donovan,* M.A. Henne R. Queisser,? B.S. Michael R. O’LearyJ Ph.D. Veterans Administration Hospital University of Washington School of Medicine Seattle, Washington 981 08
Abstract
The present study investigated the sensitivity of the Group Embedded Figures Test (GEFT) as a predictor of cognitive impairment among alcoholics. The GEFT, Shipley-Hartford, and Memory-for-Designs tests were administered to 90 male alcoholics. GEFT performance correlated significantly with measures
* Present address: Department of Psychology, University of Washington, Seattle, Washington. t Present address: Harborview Medical Center, Seattle, Washington. To whom requests for reprints should be addressed. 725
Copyright 0 1976 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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of impairment even when the influence of age and education were controlled. Field-dependent Ss performed at a significantly more impaired level on measures of abstract reasoning, perceptual-motor function, and short-term visual-spatial memory when compared with intermediate and field independent S s ; no differences were found among groups on general verbal ability. The results suggest that the GEFT might profitably be included in screening batteries for impaired cognitive function. A number of tests have been developed to measure perceptual style along the dimension of field dependence-independence, which assess the degree to which an individual is able to make accurate perceptual judgments divorced from the contextual cues of the field. The most commonly employed measures include the Rod-and-Frame Test (RFT; Witkin and Asch, 1948), the individually administered Embedded Figures Test (EFT; Witkin, 1950), and the Group Embedded Figures Test (GEFT; Oltman et al., 1971). Although verbal intelligence does not appear to correlate significantly with these measures (Goldstein and Shelly, 1971 ; Goodenough and Karp, 1961; Gough and Olton, 1972), performance on field dependence-independence tasks has been found to relate to certain measures of cognitive complexity and analytic reasoning ability, particularly to certain performance subtests of the Wechsler scales (Goldstein et al., 1970; Goldstein and Shelly, 1971 ; Goodenough and Karp, 1961 ; Karp, 1963). Since these performance subtests have been used successfully in identifying brain-damaged subjects (Davis et al., 1971; Mackie, 1963), it is not unexpected that some investigators have found individuals with cognitive deficits, such as alcoholic and brain-damaged subjects, to demonstrate impaired performance on field dependence-independence tasks. However, the results of such studies have often been inconsistent. Bailey et al., (1961) found that alcoholic subjects, a clinical population having a high incidence of neuropsychological deficits (Brewer and Perrett, 1971 ; Kleinknecht and Goldstein, 1972; Page and Linden, 1974; Tarter, 1973), performed more field independently on the RFT than brain-damaged subjects; however, both groups were more field dependent than nonalcoholic controls. Goldstein et al. (1970), however, found that individuals defined as markedly field dependent on the RFT, regardless of whether alcoholic or nonalcoholic, performed more like brain-damaged subjects on a series of cognitive-analytic tasks than their markedly field independent counterparts. Furthermore, Neuringer et al. (1975) found that the RFT scores of subjects within the intermediate range of the field dependence continuum were related to impairment in nonverbal problem solving,
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incidental memory, and the appropriate use of tactile and kinesthetic cues. Pisani et al. (1973) found no significant relationship between cognitive deficits as measured by the Shipley Institute of Living Scale (Shipley, 1940) and RFT performance among chronic alcoholics. A small, positive correlation was found between performance on the RFT and error scores on the Bender Visual Motor Gestalt test but when the variance accounted for by age was partialled out, the relationship failed to reach significance. The results of these studies indicate that RFT performance may measure a particular form of intellectual function having high loadings on visual perceptual abilities, but which may be relatively insensitive to changes in mental status (Goldstein et al., 1970; Goldstein and Shelly, 1971). Although the RFT and embedded figures tests purportedly measure the same construct, namely field articulation, Elliot (1961) noted that a marked degree of statistical alienation existed between scores on the two tasks. Subsequent research has shown the amount of variance shared by the RFT and EFT approximates 2074 (Adevai et al., 1968; Gross and Moore, 1970; Witkin et al., 1971). It also appears that the two tasks are related differentially to measures of cognitive impairment. Goldstein and Shelly (l971), in a factor analytic study involving the WAIS, Halstead Neuropsychological Battery, and RFT, found that RFT performance defined a factor relatively independent and separate from other measures of cognitive function. Goldstein et al. (1970) found both the RFT and EFT to correlate significantly with the Block Design and Object Assembly subtests on the WAIS ; however, the EFT correlated significantly higher with these scales than did the RFT. Finally, Elliot (1961) found EFT, but not RFT, performance to be related to scores on a number of ability measures. There is evidence that tasks requiring a great degree of cognitive involvement and integration between visual and motor brain mechanisms may provide a sensitive measure of brain damage (Goldstein et al., 1973). Tests requiring such involvement and integrative skills, such as the Memory-for-Designs Test (Graham and Kendall, 1960) and the Visual Motor Gestalt Test (Bender, 1938), have been used effectively to identify braindamaged individuals (Brilliant and Gynther, 1963; Korman and Blumberg, 1963; Anglin et al., 1965). More recently, Goldstein et al. (1973) found that a visual search task in which subjects were to locate a specified target from among a complex visual array provided an accurate discrimination between brain-damaged and control subjects. The embedded figures tests, both individually and group administered, involve not only a visual search component and the ability to overcome distracting stimulus cues, but also a short-term memory factor (Jackson et al., 1964). There is evidence that such tasks may also be sensitive to
Bailey et al., 1961
Elliot, 1961
1.
2.
Authors
A.
C.
B.
A.
C.
B.
A.
128 male college students
15 BD male alcoholics 15 NBD male alcoholics, sober more than 1 yr 30NBDnonalcoholic males 13 NBD male alcoholics 15 BD male nonalcoholics 15 NBD male psychiatric patients
Subjects
RFT
RFT
Quantitative and linguistic subscales of the School and
A.
B.
Measures of field dependence were significantly intercorrelated but accounted for less than 20% common variance
BD nonalcoholics were significantly more field dependent than NBD alcoholics, NBD nonalcoholics, or NBD psychiatric controls NBD alcoholics had better RFT performance than BD nonalcoholics, but were poorer than NBD nonalcoholics and NBD psychiatric controls; the latter two groups did not differ on the RFT
A.
Diagnostic categories
A.
A.
Results Alcoholics, regardless of presence or absence of brain damage, were more field dependent on RFT than nonalcoholics B. BD inpatient alcoholics did not differ in RFT performance from NBD alcoholics sober for more than 1 yr
Cognitive function A. Diagnostic categories
A. RFT A. B. Witkin EFT C. Thurston EFT
A.
A.
Field dependence
Measures of
Relationship between Measures of Field Dependence and Cognitive Function: Selected Researcha
Table 1
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W N
I .
3. Goldsteinet al., 1970
20 F D male alcoholics B. 20 F D male nonalcoholics C. 20 FI male alcoholics D. 20 FI male nonalcoholics E. 20 BD male nonalcoholics
A.
A. B.
RFT EFT
A.
A. Picture completion, block design, and object assembly subtests of the WAIS
EFT, but not RFT, scores were significantly correlated with the quantitative and linguistic scale scores, with field dependent Ss having lower scores
(continued)
RFT performance of BD Ss was significantly poorer than FI Ss, regardless of presence or absence of alcoholism, but did not differ from that of F D Ss B. F D Ss had significantly poorer EFT scores than F1 Ss. No difference was found between alcoholics and nonalcoholics on the EFT. L. F D Ss, regardless of presence or absence of alcoholism, had significantly lower scores on all three WAIS subtests than F1 Ss D. Alcoholics, regardless of field orientation, had significantly lower scores on picture completion and block designs than nonalcoholics. E. RFT performance correlated with only object assembly, whereas EFT was significantly correlated with all three WAIS subscales F. In general, performance of BD Ss more closely approximated that of FD Ss than FI Ss
B.
College Ability Test
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0
W 4
Goldstein et al., 1973
Parsons, 1972
6. Jonesand
5. Goldsteinand Shelly, 1971
4.
Authors
B.
A.
A.
C.
A. B.
26 NBDmale alcoholics 26 NBD male nonalcoholics
50male alcoholics
17 BD males 17 NBD male psychiatric 17 NBD nonhospitalized males
Subjects
A.
A.
E m
RFT
A. Visual Search Task
Field dependence
C.
B.
A.
A.
A.
Measures of
Halstead Category Test ShipleyHardford Advanced Raven’s Matrices
Halstead NeuroPsychological Battery
Diagnostic categories
Cognitive function
Table 1 (continued)
The alcoholic Ss’ RFT scores were in the FD direction Factor analysis derived five primary factors : language, abstractionproblem solving, perceptual-motor skills, spatial relations memory, and numerical. RFT performance defined a relatively separate factor with minimal contributions to the others.
BD Ss required significantly longer time to locate target stimulus than either NBD control groups
Results
A. F D Ss within the alcoholic sample had abstracting and category test scores in the direction of significant impairment B. Alcoholics were significantly more impaired than nonalcoholics on the category test and Raven’s matrices C? Alcoholics and nonalcoholics did not differ in EFT performance or verbal, abstracting, or conceptual quotient scores of the Shipley-Hartford
B.
A.
A.
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4 L W
64BDnonalcoholic Illales 64NBDnonalcoholic males
36 male alcoholics
54 female college students
RFT
RFT
A. Gottschaldt Hidden Figures Test
A.
A.
ShipleyHartford Bender Visual Motor Gestalt
Halstead NeuroPsychological Battery
A. Diagnostic categories B. Army General Classification Test
B.
A.
A.
A.
B.
A.
B.
A.
BD Ss, regardless of lesion location, performed more field dependently on the hidden figures than did NBD Ss; this difference remained significant even when the level of general intelligence was controlled.
When age was controlled, no correlation was found between RFT and Bender Gestalt performance
There was no relationship between RFT performance and the conceptural quotient of the Shipley-Hartford
RFT scores in the intermediate range of the field-dependence continuum were significantly correlated with ratings of impairment on the Halstead battery Minimally FD RFT performance was related to impairment of function in nonverbal problem solving, incidental memory, and ability to employ tactile and kinesthetic cues
'BD=brain damaged; NBD=nonbrain damaged; FD=field dependent; FI =field independent; RFT= Rod-and-Frame Test; EFT=Embedded Figures Test; Ss &subjects.
B.
A.
A.
Pisani et al.. 1973
8.
9. Teuberand Weinstein, 1956
A.
Neuringer et al., 1975
7.
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DONOVAN, QUEISSER, AND O'LEARY
brain damage. Goldstein et al. (1970) suggest that if embedded figures tasks are sensitive to cognitive impairment, then individuals along the field dependence-independence dimension, whether alcoholic or nonalcoholic, represent points along a brain dysfunction continuum. This contention is supported by Teuber and Weinstein (1956), who found that brain-lesioned subjects had significantly poorer scores on a perceptual task similar to the GEFT than did controls, even when general intelligence was statistically controlled. The EFT scores of chronic alcoholics have also been shown to correlate significantly with error scores on the Halstead category test and with abstracting age (Jones and Parsons, 1972). A summary of the selected research cited above, dealing with the relationship between measures of field dependence and cognitive function, is found in Table 1. The purpose of the present study was to determine the sensitivity of the Group Embedded Figures Test in predicting cognitive impairment among alcoholics. It was hypothesized that GEFT performance would be significantly related to commonly employed measures of cognitive dysfunction. Further, it was hypothesized that alcoholics defined as field dependent would perform in a more impaired range on these cognitive tasks than would field-independent alcoholics.
METHOD Subjects
The Ss were 90 male alcoholic veteran inpatients who had volunteered to participate in a larger research project from 1973 to 1974. The Ss had a mean age of 47.88 (SD = 8.09) and a mean educational level of 11.81 years (SD = 2.77). None of the Ss were diagnosed as having significant psychiatric disorders nor did any exhibit physical or cognitive residuals of acute intoxication at the time of testing. Materials
The Group Embedded Figures Test (GEFT; Oltman et al., 1971) was used to assess the level of field dependence-independence. The GEFT consists of three timed sections. The first section (2 min) contains seven practice items. Each of the subsequent two sections consists of nine items for which the S is given a maximum of 5 min to complete. The Ss are to
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locate and trace the outline of designated geometrical forms embedded within more complex stimulus patterns. Higher scores on the test indicate a more field-independent level of functioning. Two measures of cognitive functioning were employed as criterion variables. The first was the Memory-for-Designs Test (MFD; Graham and Kendall, 1960). The MFD, requiring Ss to reproduce simple geometric forms from immediate memory following a brief exposure, has demonstrated a high degree of accuracy as a diagnostic tool for brain damage (Anglin et al., 1965; Korman and Blumberg, 1963). Utilizing a cutting point between 5 and 6 on MFD raw scores, Korman and Blumberg (1963) were able to predict the absence as well as the presence of cerebral damage with 90°/, accuracy, respectively. The MFD in the present study was scored by two independent raters with a high degree of interrater reliability ( r = .83, p < .Ol); the average of the scores assigned by the two raters was used as the criterion measure. The second measure of cognitive function employed was the Shipley Institute of Living Scale (SH; Shipley, 1940). The Shipley scale has been used as a brief intelligence scale (Bartz and Loy, 1968) as well as a measure of cognitive deterioration (Lewinsohn, 1963). Three basic scores derived from the SH were utilized in the present study: verbal raw score (VRS), abstraction raw score (ARS), and conceptual quotient (CQ). The latter score, based upon a ratio between verbal and abstraction scores, provides a rough index of cognitive impairment (Shipley, 1940). Since the CQ has been shown to be significantly affected by age, vocabulary scores, and educational level (Jansen and Hoffmann, 1973; Kish and Ball, 1969; Lewinsohn, 1963), a fourth measure, the residual abstraction score (RAS; Lewinsohn, 1963) was also employed. The RAS, found to be related to clinical observations of conceptual disorganization, represents the discrepancy between a S’s obtained abstraction score and an expected level of abstracting ability based upon his age and vocabulary level. The more highly negative the RAS, the greater the degree of impairment. Procedure The GEFT was administered to Ss in small groups approximately 14 weeks following their admission to an alcoholism treatment unit. All subjects had been completely detoxified prior to the test administration. The MFD and SH scales were given 5 days later as part of the routine psychological screening battery.
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RESULTS The means, standard deviations, and correlation coefficients for age, education, GEFT, MFD, and Shipley scale scores are found in Table 2. The correlations between GEFT performance and measures of cognitive impairment are particularly relevant to the present study. It can be seen that the GEFT was related significantly to each of these measures in the expected direction. However, these results are confounded by the influence of both age and education. When the variance contributed by these factors are partialled out (Nunnally, 1967), as shown in Table 3, the relationships between GEFT and the measures of impairment remain relatively high and statistically significant. Table 2 Means, Standard Deviations, and Correlation Coefficients for Education, Age, GEFT, MFD. and Shipley Scale Scores" Educ Educ Age
Age GEFT VRS .01
.35 -.26
GEFT
.49 .I8 .37
.51
-.I2 .61 .63
VRS ARS CQ RAS MFD a
ARS
CQ RAS .40 -.21 .60 .33 -92
.31 .14 .45 .13 .82 .91
< .05; r significant at p < .01; df= 88. r = *.21 significant at p
=
MFD Mean -.33 .18 -.50
--.I9 -.37 -.35 -.30
11.81 47.88 7.16 29.74 19.60 79.50 0.03 3.08
SD 2.77 8.09 4.69 5.56 9.49 14.45 7.09 4.16
f.27
Table 3 Correlation Coefficients between GEFT and MFD and Shipley Scale Scores Corrected for Age, Education, and the Combined Influence of These Two Factors"
Uncorrected Education Age Age and education
'r
VRS
ARS
CQ
RAS
MFD
.37 .24
.61 .53 .60 .52
.60
.45 .38 .51 .45
-.50 - .44 - .41 -.40
.44 .32
= rt.21 significant at p < .05; r significant at p < .01; df = 88.
=
k.27
.53 .58 -50
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A second correlational analysis was conducted to determine the relationship between embedded figures performance and the presence of significant cognitive impairment. Significant cognitive impairment was defined as error scores greater than 5 on the MFD (Korman and Blumberg, 1963), conceptual quotients equal to or less than 75 on the Shipley (which represents the normative categories of “very suspicious” and “probably pathological”; Shipley, I940), and negative residual abstraction scores. The point-biserial correlations between GEFT scores and the presence of cognitive impairment as defined by the MFD, CQ, and RAS criteria were - .42, - .44, and - .36, respectively ( p < .01). Thus field-dependent performance on the GEFT is indicative of significant impairment in other cognitive functions. The distribution of GEFT scores was trifurcated to form three groups: Field Dependent (GEFT < 4, n = 31), Intermediate ( 5 >, GEFT < 9, n = 31), and Field Independent (GEFT 2 9, n = 28). A series of simple randomized analyses of covariance were conducted on each of the cognitive impairment variables with educational level statistically controlled (Winer, 1971). Table 4 presents the adjusted criterion means as well as resultant F ratios. Significant differences were found among the groups on the abstraction raw score, conceptual quotient, residual abstraction score, and M F D error scores; no differences were found on the vocabulary scores. Subsequent analyses (Lindquist, 1953) between adjusted group means showed the field dependent Ss to have scores indicative of greater impairment on the ARS, CQ, RAS, and MFD than either the intermediate (p < .025) or field independent Ss ( p < .01). The latter two groups differed significantly on the ARS and CQ measures ( p < .Ol), but no differences were found between them on the RAS and MFD ( p > .05). Table 4 Adjusted Means and F-Ratios for Field- Dependent, Intermediate, and Field-lndependent Groups on MFD and Shipley Scale Scores with Education as Covariantsa
VRS ARS CQ RAS MFD
Field dependent
Intermediate
Field independent
F-ratio
28.20 14.95 72.64 -2.78 5.61
29.87 19.69 79.20 0.61 2.27
31.32 24.64 87.43 2.48 1.19
2.80 11.29 9.73 4.41 I 1.41
F 2 3.15 significant at p < .05; F 2 4.98 significant at p < .01; df
=
2/87.
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DISCUSSION The present results indicate that although field dependent and independent alcoholics do not differ in general verbal abilities when education is controlled, marked differences exist in other areas of cognitive function. Subjects defined as field dependent on GEFT performance evidence significant impairment in the areas of abstract reasoning ability, perceptualmotor function, and short-term visual-spatial memory when compared with intermediate and field-independent subjects. Goldstein et al. (1970) postulated that if embedded figures tasks are sensitive to brain dysfunction, then groups ranging from field independent to field dependent represent points along a continuum from intact to deteriorated cognitive, perceptual, and motor function. The present results substantiate both premises of this contention. Group embedded figures test performance was found to be a sensitive measure of cognitive impairment, evidenced by moderately high, statistically significant correlations between GEFT and other cognitive measures. The second portion of the contention was supported by a consistent trend in the abstraction, conceptual quotient, residual abstraction, and memory-for-design scores from a nonpathological level for field-independent subjects to a pathological level of function for field-dependent subjects. The discrepancy between the present results and those of Pisani et al. (1 973) in predicting cognitive impairment among alcoholics may be related to differences in the measures of field dependence-independence employed. The latter investigators found no relationship between Rod-and-Frame Test performance and CQ scores; further, when the influence of age was controlled, the correlation between RFT performance and error scores on a test similar to the MFD failed to reach significance. Previous research (Goldstein and Shelly, 1971) has shown that RFT performance defines a relatively independent factor with minimal loadings from other cognitive measures and appears to be relatively insensitive to changes in mental status. The present results support the previously hypothesized sensitivity of embedded figures performance as a measure of cognitive dysfunction (Goldstein et al., 1970; Teuber and Weinstein, 1956). The Group Embedded Figures Test appears to be particularly relevant for the screening of cognitive impairment among alcoholics. The GEFT contains a visual search component, which has been shown to be effective in the identification of brain-damaged subjects (Goldstein et at., 1973). Further, the GEFT appears to require abstract problem-solving ability, short-term visual-spatial memory, and perceptual-motor skills. These
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particular cognitive areas are ones in which alcoholic subjects have been shown to demonstrate marked deficits (Goldstein and Shelly, 1971 ; Jones, 1971 ; Jones and Parson, 1972). These psychometric characteristics of the GEFT, coupled with the minimal administration and scoring time requirements (Witkin et al., 1971), appear to justify the test’s inclusion in screening batteries for cognitive impairment among alcoholics. The results of the present investigation, as well as previously cited findings, suggest a number of areas of continued research attempting to delineate the relationship between measures of field dependence and cognitive function. First, it is necessary to determine further the validity of GEFT as a predictor of impairment. This would require additional correlation and factor analytic studies defining the relationship of GEFT performance with other, more sensitive measures of cognitive function than those employed in the present study. Second, within an alcoholic population, it appears clinically relevant to develop multiple regression equations, utilizing both developmental and replication samples, in an attempt to predict scores on brain damage criterion measures from subjects’ ages, educational levels, and GEFT scores. A third consideration is based upon the findings that the GEFT and RFT measure different factors of cognitive dysfunction. This suggests that further research is necessary to determine the extent to which a more broadly based assessment approach, employing both measures of field dependence, is more reliable and accurate in detecting the presence or absence of brain damage than either of these tests administered separately. REFERENCES ADEVAI, G., SILVERMAN, AS., and McGOUGH, W.E. Perceptual correlates of the Rod-and-Frame Test. Percept. Mot. Skills 26: 1055-1064, 1968. ANGLIN, R., PULLEN, M., and GAMES, P. Comparison of two tests of brain damage. Percept. Mot. Skills 20: 977-980, 1965. BAILEY, W., HUSTMYER, F., and KRISTOFFERSON, A. Alcoholism, brain damage, and perceptual dependence. Q.J . Stud. Alcohol, 22: 387-393, 1961. BARTZ, W.R., and LOY, D.L. The Shipley-Hartford as a brief I.Q. screening device. J . Clin. Psychol. 24: 74-75, 1968. BENDER, L. A Visual Motor Gestalt Test and Its Clinical Use (Research Monograph, No. 3), American Orthopsychiatric Association, 1938. BREWER, C., and PERRETT, L. Brain damage due to alcohol consumption: An air-encephalographic, psychometric, and electroencephalographic study. Br. J. Addict. 66: 170-182, 1971. BRILLIANT, P.J., and GYNTHER, M.D. Relationships between performance on three tests for organicity and selected patient variables. J . Consult. Psychol. 27: 47-79, 1963.
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DAVIS, W.E., BECKER, B.C., and DEWOLFE, AS. Categorization of patients with personality disorders and acute brain trauma through WAIS subtest variations. J. Clin. Psychol. 27: 358-360, 1971. ELLIOT, R . Interrelationships among measures of field dependence, ability, and personality traits. J. Abnorm. SOC.Psychol. 63: 27-36, 1961. GOLDSTEIN, G., NEURINGER, C., and KLAPPERSACK, B. Cognitive, perceptual and motor aspects of field dependency in alcoholics. J . Genet. Psychol. 117: 253266, 1970. GOLDSTEIN, G., and SHELLY, C.H. Field dependence and cognitive, perceptual, and motor skills in alcoholics: A factor analytic study. Q. J . Stud. Alcohol 32: 29-40, 1971. GOLDSTEIN, G., WELCH, R.B., RENNICK,P.M., and SHELLY, C.H. The validity of a visual searching task as an indicator of brain damage. J. Consult. Clin. Psychol. 41 : 434-437, 1973. GOODENOUGH, D., and KARP, S.A. Field dependence and intellectual functioning. J . Abnorm. SOC.Psychol. 63: 241-246, 1961. GOUGH, H.G., and OLTON, R.M. Field independence as related to non-verbal measures of perceptual performance and cognitive ability. J. Consult. Clin. Psychol. 38: 338-342, 1972. GRAHAM, F.K., and KENDALL, B.S. Memory-for-designs test: Revised general manual. Percept. Mot. Skills 1 1 : 147-188, 1960. GROSS, S.J., and MOORE, S.F. The portable rod-and-frame test and the short-form embedded-figures test : A combined index of the field-dependence dimension. Psychonomic Sci. 20: 213-214, 1970. JACKSON, D.N., MESSICK, S., and MYERS, C.T. Evaluation of group and individual forms of embedded-figuresmeasures of field-independence. Educ. Psychol. Meas. 24: 177-192, 1964. JANSEN, D.G., and HOFFMANN, H. The influence of age, intelligence, and educational level on Shipley-Hartford conceptual quotients of state hospitalized alcoholics. J. Clin. Psychol. 29: 468-470, 1973. JONES, B., and PARSONS, O.A. Specific vs. generalized deficits of abstracting ability in chronic alcoholics. Arch. Gen. Psychiatry 26: 380-384, 1972. JONES, B.M. Verbal and spatial intelligence in short and long term alcoholics. J. Nerv. Ment. Dis. 153: 292-297, 1971. KARP, S.A. Field dependence and overcoming embeddedness. J. Consult. Psychol. 27: 294-302, 1963. KISH, G.B., and BALL, M.E. Low education level as one factor producing a verbalabstract disparity on the Shipley-Institute of Living Scale. J. Clin. Psychol. 25: 183-184, 1969. KLEINKNECHT, R.A., and GOLDSTEIN, S.G. Neuropsychological deficits associated with alcoholism: A review and discussion. Q. J. Stud. Alcohol 33: 999-1019, 1972. KORMAN, M., and BLUMBERG, S. Comparative efficiency of some tests of cerebral damage. J . Consult. Psychol. 27: 303-309, 1963. LEWINSOHN, P.M. Use of the Shipley-Hartford conceptual quotient as a measure of intellectual impairment. J. Consult. Psychol. 27: 444-447, 1963. LINDQUIST, E.F. Design and Analysis of Experiments in Psychology and Education. Boston: Houghton Mifflin, 1953.
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MACKIE, J.B. A comparative study of brain damaged and normal individuals on tests of intelligence, perception, and rigidity, Diss. Ahstr. 24: 1700-1701, 1963. NEURINGER, C., GOLDSTEIN, G . , and GALLAHER, R.B., JR. Minimal field dependency and minimal brain dysfunction. J . Consult. Clin. Psychol. 43 : 20-21,
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