SPANS-X FAQs

Please see below FAQs relating to the Short Parallel Assessments of Neuropsychological Status - Extended (SPANS-X). If you have any further questions, please do not hesitate to contact us.

  • SPANS and SPANS-X
  • SPANS-X and other neuropsychological tests
  • Qualification requirements
  • Administration
  • Applications
  • Scoring and reporting
  • Psychometric properties
  • Use in research
  • Further information
  • Contact us

SPANS and SPANS-X

How is the SPANS-X different from the SPANS?

The SPANS-X has several new features, including:

  • Extended norms spanning 18 to 90 years, and a norm for every age.
  • The option of reliable remote administration (validated against in-person administration in an equivalency study).
  • New user-friendly metrics that help with accurate interpretation.
  • Simplified administration and scoring methods, plus expanded interpretation guidance.
  • New validation studies and evidence demonstrating the SPANS-X’s unique capabilities as a neuropsychological assessment.

The 'X' in 'SPANS-X' stands for extended, extra, and exceptional utility: it is a bigger, bolder, and more precise assessment of acquired brain injury, dementia, and other neurological and neuropsychological disorders. This article from the author provides further information on the updates in the SPANS-X.

 

I am an existing SPANS user. Do I need to purchase the SPANS-X kit or is there an upgrade kit?

There are considerable updates in SPANS-X and there is no upgrade kit for existing SPANS users. If you are interested in moving from SPANS to SPANS-X, we advise purchasing the SPANS-X kit and we will be happy to assist any SPANS users looking to make the switch.  

We recommend all SPANS users thoroughly familiarise themselves with SPANS-X and read the SPANS-X manual, because many elements have been revised and new ones introduced in SPANS-X.

SPANS-X and other neuropsychological tests

How is SPANS-X different to other tests of neuropsychological status?

The updated and extended SPANS-X offers various features differentiating it from other tests of brain injury, dementia and general neuropsychological status. These include:

  • More recent norms for more accurate interpretations.
  • A  norm per age, from 18 to 90 years, calculated using an innovative nonlinear polynomial regression (which is explained in full in the test manual).
  • More and briefer subtests overall, and more subtests per index score - making more internally reliable index scores and a more engaging test.
  • An extra score and an extra interpretative metric have been added to create a SPANS-X total score, providing a ‘moving’ critical cut-off score, not a single cut-off score ‘for all’.
  • The option to be administered remotely online with a test taker, as well as face to face. Other cognitive tests have not been adapted in this way (the advice given tends to be to just not use a particular test/task), whereas the e-SPANS-X has been validated against the regular SPANS-X and is the test user can fully administer the SPANS-X to a client or patient remotely.
  • Better alternate-version test-retest reliability across all index scores.
  • The SPANS-X is sensitive and specific to cognitive impairments and provides a wider variety of observations, including screening for neurological conditions that the main competing product does not.

Qualification requirements

What are the qualification requirements?

The SPANS-X can be used by Neuropsychologists, Clinical, Health, Forensic, and Counselling Psychologists, Occupational Therapists, Speech and Language Therapists, and other medical professionals who meet our Level 2 requirements (please see our qualifications page for guidance).

We recommend all users thoroughly familiarise themselves with SPANS-X and read the SPANS-X manual, even if they have previous experience in using SPANS, because many elements have been revised and new ones introduced in SPANS-X. In addition to providing clinical case studies and the evidence base for SPANS-X, Hogrefe can help test users should they have any queries regarding the administration, scoring and interpretation of results.

Administration

How long does the SPANS-X take to administer?

The SPANS-X takes approximately 30 minutes to administer.

 

What does the kit contain?

The complete kit includes: the Test Manual, Stimulus Books A and B, Scoring Booklets A and B (25 of each), Recognition Memory Cards, LNC Scoring Card, Digital Materials USB, Ruler, and Backpack Kit Case.

 

Can the SPANS-X be administered remotely?

Yes, SPANS-X can now be administered remotely, e.g. by videoconference. The SPANS-X kit comes with ‘extra’ remote e-administration materials, e-stimulus books, and instructions on how to carry out remote SPANS-X assessment. An initial validation study conducted during the development of the revised tests has established equivalency between face-to-face and remote administrations across all indexes.

Applications

Can the SPANS-X be used to assess for dementia?

Yes, the SPANS-X can be used to assess for dementia. SPANS-X had its norms extended to include older adults up to the age of 90, and an additional interpretive metric to account for natural and expected decline in cognitive performance with age. This is a useful development for older adult services and memory clinics because SPANS-X would appear to provide advantages over current options for the assessment of older adults and dementia. In comparison to existing measures used with older adults, SPANS-X contains 30 subtests and seven index scores, thus providing a greater number of observations of cognitive skills and behaviours in a wider variety of domains/neurological conditions which are relevant to dementia assessment. Furthermore, the administration and scoring time is brief, taking a total of between 30–45 minutes.

Guidance for using the SPANS-X to assess for dementia is provided in the SPANS-X manual and this case study provides a real-life case example.

 

Can the SPANS-X be used with clients/patients for whom English is an Additional or Second Language?

The SPANS-X is a largely culture-free test. There are a few exceptions to this in certain items (such as ‘Who is the current/last Prime Minister?’, and in the repetition task which requires more complex syntax and the digit forward (but not backward) task).

 

Would SPANS-X be appropriate to use with a forensic population? 

Yes, SPANS-X can be used with a forensic population.  

 

Can the SPANS-X be used with patients with psychosis? Is the test normed with this group? Has any research been done on this? 

There is no research available to date (October 2022) but the author can think of no reason why not to use it though as the design of the SPANS-X is to take a 'map of the brain', and to be sensitive and specific, in other words to function at the level of making reliable judgements of 'normal' and 'non-normal'. The SPANS-X is brief and comprehensive and generally enjoyable for clients, so he thinks it would have appeal, and particularly because it includes tests of perception, attention, and abstraction / conceptual flexibility, it does something other brief batteries do not do, and these are important measures in psychosis, when trying to understand the worldview and processing functions/dysfunctions of people with psychosis. In addition to this there's practical application items, such as making mental calculations and remembering a shopping list, while also reliably assessing memory and learning ability, and dysfunctions of comprehension and language.

Scoring and reporting

Are reports generated?

The SPANS-X is a hand-scored test so there are no reports. There are extensive notes on how to interpretate scores in the test manual, with text that can be used in reports, and case studies and examples which can aid interpretation and help test users.

Psychometric properties

How was SPANS-X normed?

The SPANS-X has with a norm for every age from 18 to 90 years, calculated using an innovative nonlinear regression, for precise and accurate interpretation. Percentiles, confidence intervals, critical values or ‘cut-off scores’, and base rates are provided for greater precision.

 

What was the size of the norm group? And was there a clinical group?

The standardisation norming sample was 258 and the mixed neurological clinical sample group was 148. Both groups were ages 16–64.

 

How was reliability and validity established?

There is extensive evidence provided in the SPANS-X test manual which represents many years of work both on SPANS and on the revised version of the test.

Reliability:

  • Internal consistency and unique variance of SPANS-X index and total scores (.72–.94).
  • Alternate version equivalency, test-retest reliability (.96) and excellent inter-rater reliability.

Validity:

  • Convergent and divergent validity:
    • WAIS Verbal IQ (.08–.66); WAIS Performance IQ (.23–.70); WMS (.34–.71); Rey (-.37–.69); Trail Making Test (-.18 – -.90)
    • ABI and healthy groups; SPANS sensitivity to lateralised damage
  • Older adult validation studies SPANS-X use as a screening measure for the detection of dementia in adults aged 75 and above (including additional scores which are not present in other measures and enhancing accuracy for this group). (Using the ACE-III: .33–.53).
  • SPANS-X performance for those with intellectual disabilities is now better understood, with results of a mixed method design study and interpretative guidelines provided in the manual. Assessment of individuals with mild-to-moderate intellectual disability (small to medium effect sizes found).
  • Additional studies exploring the effects of English as a second language on SPANS-X performance.

 

What does SPANS-X offer in terms of validity, sensitivity with regards to cognitive impairment after stroke. What would be useful for an ESD team to know?

The evidence is from the clinical sample used in the Manual’s validation studies, which included stroke patients (7%), along with other ABIs including a significant number of haemorrhage (25%). 

The Language Index (LAI) screens for aphasia type, includes naming, repetition, comprehension, reading, writing, and mathematical calculations. 

Visual-Motor Index (VMI) screens for object agnosia and spatial and constructional deficits. Unilateral neglect can be detected from multiple subtests within the VMI. Advice is included in the Manual how to interpret neglect, and praxis, along with advice of any further bedside screening. 

The Memory/Learning Index (MLI) assesses visual and verbal learning / memory, including recall and recognition of each type. 

SPANS-X contains a conceptual flexibility (executive functioning) index, an efficiency (processing speed) index, attention/concentration index, and an orientation index, therefore providing further information other tests do not.

ANOVA study significantly discriminated between a much ‘messier’ clinical sample than would have been the case with stroke patients, those with primarily left or right hemisphere damage. 

ROC study confirmed discriminatory power of SPANS-X to differentiate those with ABI from healthy controls. 

The LAI, VMI, and memory/learning (MLI), and efficiency (ECI) indexes have internal reliability coefficients (Cronbach’s alpha) of over .80. This provides the most trust / evidence that the index measures what it is labelled as. 

SPANS-X indexes all show better and more theoretically-aligned convergent and divergent validity with ‘gold standard’ tests than the lead competing test does, therefore providing further support to SPANS-X, ‘what’s on the label is what the index measures’. 

SPANS-X has a more precise, ‘norm by age’, and ‘confidence interval by age’, and ‘clinical cut-off by age’, uses percentiles for index scores, and base rates and percentiles for subtest level interpretation. 

SPANS-X alternate-version test-retest reliability, and absolute score difference, is exceptionally better than the lead competing test, adding trust that Time 1 and Time 2 differences have to do with changes in the patient, not design faults of the test. 

It takes 30 minutes to administer. Patients engage with well with SPANS-X, enjoy it, 30 subtests retains their interest and minimises fatigue. SPANS-X includes face valid items furthermore that also support engagement, e.g., memorise a shopping list, make change from a monetary exchange. 

Use in research

I would like to use the SPANS-X in a research study. How might Hogrefe support me?

Hogrefe actively encourages the use of Hogrefe products for research purposes and are keen to hear from any interested academic or professional user undertaking such studies. Please see guidance on this page and feel free to contact us should you require any further assistance.

Further information

How can I find out more about the SPANS-X?

An ‘Introduction to the SPANS-X’ webinar was held on 10 February 2022 and a recording of this is available on request by emailing marketing@hogrefe.co.uk. You can also visit this page for further information and resources. This article from the author also gives an introduction to the measure. Alternatively, you are welcome to contact us with any questions you may have.

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