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Survey results regarding use of the Boston Naming
Test: Houston, we have a problem
Kirsty E. Bortnik
a
, Kyle Brauer Boone
bc
, Johnny Wen
d
, Po Lu
e
, Maura Mitrushina
f
, Jill
Razani
f
& Teresa Maury
g
a
Fuller Graduate School of Psychology, Pasadena, CA, USA
b
California School of Forensic Studies, Alliant International University, Los Angeles,
CA, USA
c
UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA
d
Private Practice, Torrance, CA, USA
e
UCLA Alzheimer’s Disease Center, Los Angeles, CA, USA
f
Department of Psychology, California State University–Northridge, Northridge, CA,
USA
g
Department of Psychology, California State University–Dominguez Hills, Carson,
CA, USA
Published online: 03 Sep 2013.
To cite this article: Journal of Clinical and Experimental Neuropsychology (2013): Survey results regarding use of the
Boston Naming Test: Houston, we have a problem, Journal of Clinical and Experimental Neuropsychology
To link to this article: http://dx.doi.org/10.1080/13803395.2013.826182
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Journal of Clinical and Experimental Neuropsychology, 2013
http://dx.doi.org/10.1080/13803395.2013.826182
Survey results regarding use of the Boston Naming
Test: Houston, we have a problem
Kirsty E. Bortnik
1
, Kyle Brauer Boone
2,3
, Johnny Wen
4
,PoLu
5
, Maura Mitrushina
6
,
Jill Razani
6
, and Teresa Maury
7
1
Fuller Graduate School of Psychology, Pasadena, CA, USA
2
California School of Forensic Studies, Alliant International University, Los Angeles, CA, USA
3
UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA
4
Private Practice, Torrance, CA, USA
5
UCLA Alzheimer’s Disease Center, Los Angeles, CA, USA
6
Department of Psychology, California State University–Northridge, Northridge, CA, USA
7
Department of Psychology, California State University–Dominguez Hills, Carson, CA, USA
Members of the National Academy of Neuropsychology were surveyed in 2005 to assess then current practices
regarding Boston Naming Test (BNT) administration, interpretation, and reporting procedures. Nearly half of
445 respondents followed discontinuation rules that differed from instructions published with the test, and nearly
10% did not administer items in reverse order to achieve the required 8 consecutive item basal. Of further con-
cern, between 40% and 55% of respondents indicated that they did not interpret BNT scores in light of linguistic
and ethnic background, and over 25% reported that they did not consider educational level. Despite the fact
that non-normal distribution of BNT test scores renders use of percentiles misleading, nearly 60% of respon-
dents endorsed using percentiles when reporting BNT data. The implications of these results are discussed, and
recommendations are provided.
Keywords: Boston Naming Test; Naming; Word retrieval; Language; Aphasia.
The Boston Naming Test (BNT) is a visual con-
frontation naming measure used by neuropsychol-
ogists and speech therapists to assess integrity of
word-retrieval skills, and it serves as a diagnos-
tic tool for dementia. The original version was
published in 1978 and consisted of 85 simple line-
drawn pictures for which patients were instructed
to report the common names (Kaplan, Goodglass,
& Weintraub, 1978). In 1983 a shortened 60-
item version was published (Kaplan, Goodglass, &
Weintraub, 1983), and, subsequently, a four-choice
recognition format was added to the 60-item spon-
taneous labeling task for use when examinees fail
to provide correct names (Kaplan, Goodglass, &
Weintraub, 2001).
The BNT has been one of the most commonly
administered neuropsychological tests. Survey
results from 1991 showed that at that time it was
the third most frequently administered measure,
with 63% of survey respondents endorsing use of
the instrument (Butler, Retzlaff, & Vanderploeg,
1991). Approximately a decade later, Camara,
Nathan, and Puente (2000) documented that
the BNT was the eighth most frequently used
assessment measure by neuropsychologists who
conducted assessment services for 5 or more hours
in a typical week. Within the past decade, a study
surveying neuropsychological assessment practices
found that it was the 13th most frequently used
instrument, and the fourth most frequently used
Address correspondence to: Kyle Boone, Alliant International University, 1000 S. Fremont Avenue, Alhambra, CA 91803, USA
(E-mail: kboone@kyleboonephd.com).
© 2013 Taylor & Francis
Downloaded by [kyle boone] at 08:20 05 September 2013
2 BORTNIK ET AL.
measure in the area of memory assessment (Rabin,
Barr, & Burton, 2005). The BNT has also been
commonly utilized by neuropsychologists as part of
forensic evaluations (Lees-Haley, Smith, Williams,
& Dunn, 1996).
Despite the widespread popularity of the BNT,
concerns have been raised regarding inconsistencies
in administration procedures, problematic psycho-
metric properties, and incomplete normative data,
as well as its cultural and language biases.
Studies have pointed to differing administration
and scoring practices for the BNT, in part due
to confusion regarding instructions (e.g., Lopez,
Arias, Hunter, Charter, & Scott, 2003; Nicholas,
Brookshire, MacLennan, Schumacher, & Porrazzo,
1989)—for example, as in what constitutes a cor-
rect response. The test manual indicates that credit
is only to be given for correct labels provided
spontaneously or after stimulus cues, but some
practitioners give credit for correct labels obtained
after phonemic cues. These are not inconsequen-
tial issues given that Ferman, Ivnik, and Lucas
(1998) found that total scores differed in some nor-
mal controls (3%; up to 16-point difference) and
in Alzheimer’s patients (31%; up to 10-point differ-
ence) depending on whether “lenient” (credit given
for correct responses after phonemic cue) or more
“rigorous” (credit given only for correct responses
spontaneously provided or after stimulus cue) inter-
pretation of the discontinuation rule was applied.
A subsequent study by Lopez et al. (2003) cor-
roborated that different approaches to scoring may
result in large differences in total scores. Further
complicating the picture, some test instructions
have changed across versions without explanation;
the 2001 edition indicated that test administration
was to cease after 8 consecutive incorrect responses,
whereas the 1983 version instructed discontinuation
after 6 consecutive incorrect responses.
Regarding BNT psychometric properties, in rela-
tively high functioning populations distribution of
test scores is negatively skewed with extreme kurto-
sis, resulting in limited score variability and small
standard deviations (Mitrushina, Boone, Razani, &
D’Elia, 2005). When z scores and percentiles are
obtained on such scores, performances minimally
below average are overpathologized. For example,
using Boston Naming Test metanorms (Mitrushina
et al., 2005), a score of 52 in a 40-year-old would
be judged to be borderline impaired (i.e., 7th per-
centile; z score = –1.46), although this score is only
8 points from the ceiling. Additionally, test items
do not appear to be ordered consistently in terms of
increasing difficulty, and some items contain redun-
dant information (i.e., have comparable levels of
difficulty) and do not discriminate differing levels
of naming ability (Pedraza, Sachs, Ferman, Rush,
& Lucas, 2011).
Additionally, limited normative data are included
with the test (limited to ages 5 1/2 and 10 1/2, and
ages 18–59 years for the 1983 version), and the nor-
mative data provided in the 1983 60-item edition
of the test were extrapolated from participants who
had been administered the earlier 85-item version
(Nicholas et al., 1989). Given that these norms were
adapted from data published in 1978, the “Flynn
effect” is of concern (i.e., inflation in test scores
over time; Flynn, 1984), leading Strauss, Sherman,
and Spreen (2006) to recommend that only more
recently published norms be employed.
Of particular note, research investigating per-
formance on the BNT has found that Caucasians
typically score higher than ethnic minority individ-
uals (e.g., Boone, Victor, Wen, Razani, & Pontón,
2007), with lowered scores in the latter group
found to be related to linguistic background and
level of acculturation. Roberts, Garcia, Desrochers,
and Hernandez (2002) observed that monolingual
English speakers performed better on the BNT than
either Spanish/
English or French/English
bilingual
speakers, and they documented that even profi-
cient bilingual English speakers score lower on
the BNT than do monolingual English speakers.
This difference in performance remains even for
those bilingual individuals who have resided in the
United States for a significant period of time. While
Boone et al. (2007) observed that BNT perfor-
mance was related to number of years of residence
in the United States, Touradji, Manly, Jacobs, &
Stern (2001) found that foreign-born non-Hispanic
Anglos who rated themselves as speaking English
“very well” scored significantly lower than US-born
subjects on an abbreviated version of the BNT,
despite having lived in the United States for more
than five decades on average. In fact, BNT per-
formance is significantly and negatively related to
age at which conversational English was learned
(Boone et al., 2007). Manly and colleagues (1998)
have shown that BNT scores are lowered even in test
takers born in the United States but who are rela-
tively unassimilated to the Anglo-American culture.
Of note, a recent investigation identified several
BNT test items that were associated with different
correct endorsement rates between healthy African
American and Caucasian older adults, indicating
that a test taker has a significant probability of
responding either correctly or incorrectly on these
items based on racial/ethnic group membership
(Pedraza et al., 2009).
Educational characteristics have also been found
to impact performance on the BNT, with lower
BNT scores associated with decreased educational
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3 BOSTON NAMING TEST
levels (e.g., see listing of studies in Mitrushina et al.,
2005, p. 180; Zec, Burkett, Markwell, & Larsen,
2007a, 2007b), poor educational quality (Manly,
Byrd, Touradji, & Stern, 2004), and extent of edu-
cation obtained outside of the United States (Boone
et al., 2007).
Preliminary data also indicate that geographic
location is associated with performance on the
BNT. Bauer, O’Bryant, Hilsabeck, and McCaffrey
(2004) reported that the mean BNT scores of young
adults living in the South fell at the 10th percentile
of normative data from Canada, and that 67% of
the Southern sample performed at least 1 standard
deviation below the mean of normative data from
California. Additionally, Goldstein and colleagues
(Goldstein et al., 2000), found that individuals liv-
ing in the Midwest outperform those living in the
South on the BNT.
Due to the multiple concerns regarding adminis-
tration, scoring, and interpretation of the Boston
Naming Test, we surveyed the members of the
National Academy of Neuropsychology to assess
how clinicians are currently navigating these
difficulties.
METHOD
Subjects
Permission was granted from the Institutional
Review Board at Harbor-UCLA Medical Center
and from the Board of Directors of the National
Academy of Neuropsychology (NAN) in 2004 to
survey via e-mail the members of NAN. Although
anonymity could not be provided (due to
potentially identifying information on return
e-mail addresses), confidentiality was ensured by
only entering nonidentifying information in the
database and deleting the e-mail addresses. Of the
2969 surveys sent via e-mail between February
2005 and March 2005, 449 were undeliverable due
to incorrect e-mail address. A total of 599 survey
responses were returned. Sixty-three respondents
returned partially completed surveys, and these
individuals were contacted a second time and
were requested to complete only the sections of
the survey that they did not finish; 13 individuals
responded to this request. Seventy-six respondents
stated that they did not administer the BNT, and
their surveys were excluded. Because the focus
was on use of the BNT in experienced clinicians
currently using the test, 25 surveys submitted
by students-in-training and 3 surveys returned
by retired practitioners were also excluded. The
resulting 445 surveys reflected a response rate of
18% for actually delivered e-mail requests. This
response rate is slightly higher than the 15% rate
obtained by Rabin et al. (2005) in their survey of
test usage by NAN members.
Materials
A two-page survey was developed (see the
Appendix) to assess BNT administration pro-
cedures and interpretation strategies, as well as
to examine how respondents incorporated and
described BNT data in their neuropsychological
reports. At the conclusion of the survey, respon-
dents were asked to cite any concerns regarding the
test, to provide suggestions for improving the mea-
sure, and to rate the BNT in terms of importance
within their neuropsychological battery.
RESULTS
Sample characteristics
As shown in Table 1, 72% of respondents who
endorsed using the Boston Naming Test had
completed two years of postdoctoral training, and
TABLE 1
Sample characteristics of BNT survey respondents
Respondents
Characteristic N % Yes (%) No (%) M SD Range
Number of years in practice 437 12.57 8.82 0–51
Postdoctoral training 443 72.0 28.0
Diplomate 443 21.2 78.8
Population served 443
Pediatric 34.1
Adolescent 49.7
Adult 89.8
Geriatric 78.8
Notes. BNT = Boston Naming Test. The percentage totals for the “Population served” category do not sum to 100% because the
categories are not mutually exclusive, and thus many respondents endorsed serving more than one type of population.
Downloaded by [kyle boone] at 08:20 05 September 2013
4 BORTNIK ET AL.
21% were board certified by the American Board
of Clinical Neuropsychology (ABCN) and/or the
American Board of Neuropsychology (APN).
On average, respondents had over 12 years of clin-
ical experience. A large majority of members indi-
cated that they conducted assessments of adult
and geriatric patients, although half indicated that
they evaluated adolescents, and a third conducted
testing on children.
BNT administration procedures
When queried as to test version used, 82%
employed the 1983 60-item version, 20% used the
2001 60-item version with multiple-choice options,
10% used a 15-item version, and less than 3%
employed the original 1978 85-item format; some
respondents endorsed using more than one ver-
sion. (Because there are numerous 15-item versions
of the test, with test administration instructions
differing from those in the 60- and 85-item ver-
sions, data from respondents who endorsed using
only a 15-item version were confined to analyses
examining consideration of demographic informa-
tion in test interpretation and ratings of impor-
tance of the BNT in test batteries.) Only 7% of
respondents indicated that they employed cultur-
ally sensitive adaptations of the BNT, such as
the Pontón–Satz Spanish BNT version (Pontón
et al., 1996).
Although test instructions indicate that latency
of response should be tracked for each item, and
that 20 seconds with no response should elapse
before a cue is provided (unless the subject indi-
cates not knowing the word prior to the 20 seconds
elapsing), almost 60% of respondents indicated that
they did not record response times (see Table 2),
and just over a third reported that they did not
wait for 20 seconds prior to providing a stimulus or
phonemic cue.
Nearly 10% of respondents reported that they
did not administer items in reverse order to obtain
the required basal of 8 consecutive correctly named
items. Of particular concern, the sample diverged
in terms of identification of incorrect responses;
almost 55% of respondents operationalized failure
as an inability to name spontaneously or after a
stimulus cue, while approximately 46% of respon-
dents reserved failure only for those responses
that remained incorrect even after phonemic cuing.
The majority of respondents reported that they
provided immediate feedback regarding response
correctness, while almost 20% indicated that they
waited 20 seconds before providing such feedback.
Of the respondents who provided immediate feed-
back, 97% gave credit for the item if the patient
self-corrected without needing a phonemic cue.
In test/retest situations, 95% readministered the
full test, while just under 5% resorted to an odd–
even strategy across testing situations, and 6% used
unspecified “other” formats.
TABLE 2
BNT administration practices and interpretation strategies of survey respondents
Respondents
Clinical practices N Yes (%)
Administration
Record latencies 431 42.9
Wait 20 seconds for a response 432 63.4
Reverse order administration of test items 436 91.1
Definition of “failure” as: 429
Inability to spontaneously name item 54.3
Inability to name item following phonemic cue 45.7
Feedback 410
Immediate 80.5
After 20 seconds with provision of phonemic cue 19.5
Retesting 369
Readminister full test 95.4
Use even/odd administration 4.6
Interpretation—use of norms
BNT booklet 177 40.7
Spreen and Strauss (1999) 191 43.9
Mitrushina, Boone, and D’Elia (1999) 103 23.7
Heaton, Grant, and Matthews (1991) 78 18.0
Note. BNT = Boston Naming Test.
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5 BOSTON NAMING TEST
BNT interpretation strategies
As shown in Table 2, virtually 100% of respon-
dents reported using normative data for interpret-
ing scores from the BNT. Of these, 44% used norms
provided in Spreen and Strauss (1998), and a nearly
equal number indicated using the norms repro-
duced at the back of the 1983 and 2001 BNT
booklets. Approximately 24% used norms cata-
loged in Mitrushina et al. (1999), and 18% utilized
the norms provided by Heaton et al. (1991).
Over half of the respondents indicated that they
did not consider patient ethnicity in interpretation
of BNT scores (Table 3), 41% reported that they
did not modify interpretation in those patients who
spoke English as a second language, and almost
30% indicated that they did not factor educational
level in interpretation of BNT data.
Citing of BNT data in neuropsychological
reports
As shown in Table 3, slightly more than two
thirds of respondents indicated that they provide a
total BNT score (i.e., number of items correct) in
their neuropsychological reports; just under a third
reported that they report the number of correct
items following phonemic cues, and less than 18%
endorsed reporting the number of correct items fol-
lowing stimulus cues. As also shown in Table 3,
over half of respondents indicated that they include
percentiles for BNT scores in their reports. Over
40% provide infor mation on phonemic paraphasias
in their reports, while less than one half include data
on semantic paraphasias.
Perceived importance of BNT and
suggestions/concerns
In addition to surveying the ways in which
respondents administered and interpreted the
BNT and incorporated the test results into
their neuropsychological reports, respondents were
asked to rate the importance of the BNT in their
assessment batteries and were also requested to
share their concerns and suggestions regarding the
test. On average, respondents rated the importance
of the BNT as 4.90 (SD = 1.47) on a 7-point scale
(with 1 reflecting “irrelevant” and 7 “extremely rel-
evant”), with some respondents indicating that test
relevance depended on the referral question and
type of patient tested. A variety of concerns were
expressed, including poor quality of the drawings
and out-of-date items (such as stilts and yoke), and
cultural bias; in this regard, several respondents
suggested that the picture of the noose be elimi-
nated due to its association with slavery and racial
segregation. Suggestions also included improved
normative data as well as credit given for accept-
able label synonyms and/or acceptance of mispro-
nounced words.
DISCUSSION
These survey results characterize clinical usage of
the BNT in members of the National Academy
TABLE 3
BNT reporting practices
Reporting practices N Yes (%)
In your neuropsychological report, do you report:
Total score (correct without phonemic cue) 435 66.9
Number correct following phonemic cues 435 29.7
Number correct following stimulus cues 435 17.5
Percentiles 435 57.5
Phonemic paraphasias 435 43.2
Semantic paraphasias 435 42.5
Do you make adjustments for:
Ethnicity 441 46.9
English as a second language 440 58.6
Education level 440 71.8
Do you use cultural adaptations of the BNT 437 7.6
Rate the importance of the BNT in your neuropsychological battery, 439
with “1” being the most irrelevant and “7” being extremely relevant
Mean 4.90
Median 5.00
Mode 5.00
Note. BNT = Boston Naming Test.
Downloaded by [kyle boone] at 08:20 05 September 2013
6 BORTNIK ET AL.
of Neuropsychology as of 2005. The respondents
reported an average of 12 years of experience and a
board certification rate of 21%, and over 70% cited
completion of 2 years of postdoctoral training; thus
this sample is likely representative of clinical usage
of the BNT in the mid-2000s. Whether these data
reflect current test usage is unknown, but given that
no updated test guidelines have been published in
the interim, it is reasonable to assume that clini-
cal administration and interpretative practices have
changed little.
Analyses of survey responses revealed prominent
inconsistencies in administration procedures across
respondents. Specifically, while the test instructions
indicate that response latencies are to be recorded,
only slightly more than 40% of respondents indi-
cated that they followed this procedure. This finding
no doubt reflects the reality that many patients
respond so rapidly to test pictures it is not feasi-
ble to time responses, and that, on the other hand,
waiting for a full 20 seconds for a response seems
unduly long. Allowing 20 seconds for responses
undoubtedly results in more spontaneous correct
responses, and it can be argued that this makes
the test less sensitive to true word retrieval prob-
lems in that individuals who require 5 to 20 seconds
to recall picture names likely do have at least sub-
tle word-retrieval difficulties. However, the problem
with discarding or shortening time requirements for
responses is that normative data were presumably
collected using 20-second response time cutoffs.
Nearly 10% of respondents reported that they did
not administer items in reverse order to obtain the
required basal of 8 sequential spontaneously cor-
rect trials; failure to obtain the basal could result
in inflation of the test scores (i.e., with the clin-
ician incorrectly assuming that all items prior to
#30 would have been answered correctly by the
patient). This error is of particular concern given
that data show that test items are not correctly
sequenced in terms of an increasing gradient of dif-
ficulty (Pedraza et al., 2009); thus, it is relatively
likely for errors to occur prior to #30.
Also of note, the sample disagreed regard-
ing determination of what constitutes a correct
response. Test instructions published with the
1983 version state that the test is to be discon-
tinued after 6 sequential incorrect responses (and
after 8 incorrect responses in the 2001 version),
with failure defined as an inability to “respond cor-
rectly either spontaneously or following a stimulus
cue.” However, only slightly more than half of sur-
vey respondents reported following this procedure
(54%), while 46% indicated that they gave credit
for responses following a phonemic cue. This latter
alteration in standardized testing procedures would
have the effect of inflating total test scores, and in
fact published data show that differences of up to
16 points can occur across the two different scoring
procedures (Ferman et al., 1998).
Over half of respondents indicated that they did
not modify interpretation of BNT scores based
on ethnicity of patients, with 41% reporting that
they did not consider impact of English as a
second language on test scores. It is possible,
depending on the geographic location, that some
of the survey respondents may not have been test-
ing ethnic minority patients. However, given the
cultural diversity in most regions of the United
States, it would be expected that such respondents
would comprise a relatively small percentage of
total practitioners. Thus, the survey results sug-
gest that many neuropsychologists, when evaluating
ethnic minorities and English as a second lan-
guage individuals, are not appropriately weighing
the impact of these variables on test performance,
which arguably is out of compliance with American
Psychological Association (2010) Ethical Standards
(9.06: Interpreting Test Results). Of further concern,
28% of those surveyed indicated that they did not
take into consideration the educational level of the
patient in their interpretation of BNT scores.
As summarized in the introduction section of
this manuscript, available data suggest that eth-
nic minorities perform substantially poorer on the
BNT than Caucasian subjects. Subjects who speak
English as a second language score lower, but even
ethnic minorities who are fully bilingual in English,
or who are only English speaking, score lower
(Boone et al., 2007), indicating that more pervasive
cultural factors than solely linguistic are impact-
ing BNT performance. For example, when Hispanic
patients were divided into English as a sec-
ond language and native English-speaking groups,
the Hispanic native English-speaking patients still
scored on average 10 points lower on the BNT than
did Caucasian patients. Lowered educational level
has also been found to be predictive of lowered
BNT performance (Mitrushina et al., 2005)and
may have a major impact of test scores; for exam-
ple, in individuals aged 75–59 years with <12 years
of education, mean BNT score was 36.6, but in indi-
viduals in the same age group with 12 or more years
of education, mean BNT score was 53.4 (Welch,
Doineau, Johnson, & King, 1996). Further com-
plicating the picture, where education is completed
is critical; research suggests an inverse relationship
between the amount of education completed out-
side of the United States and BNT scores (Boone
et al., 2007
). Failure to adjust for the effects of
these
variables will result in overpathologizing of
cognitive function in ethnic minority, immigrant,
Downloaded by [kyle boone] at 08:20 05 September 2013
7
and low-education populations. Further, as dis-
cussed earlier, there may even be regional differ-
ences in BNT performance, with individuals in
the Southern portion of the United States scor-
ing more poorly than those from the Midwest and
West (California) and Canada (Bauer et al., 2004;
Goldstein et al., 2000). Thus, appropriate selection
of BNT normative data may involve matching for
geographic location. Of concern, norms included
with the 1983 and 2001 versions of the test contain
no information regarding ethnicity or geographic
location, requiring that clinicians who wish to
examine these issues employ normative data from
other published resources (Mitrushina et al., 2005;
Strauss et al., 2006). Finally, some populations are
under-represented in available norms (e.g., young to
middle-age adults and low education levels).
Almost 60% of respondents indicated that they
included percentiles when reporting performance
on the BNT. This is concerning because test scores
on the BNT are generally not normally distributed,
and questions have been raised concerning the
asymmetry and extreme kurtosis of the test (e.g.,
Hawkins & Bender, 2002; Mitrushina et al., 2005).
The small standard deviations associated with the
markedly skewed scores result in markedly low
percentile scores even when scores only deviate
slightly from normative means (e.g., a score of 50 is
associated with a percentile rank of 3 in 45–49-
year-olds even though the normative mean is only
56.75; meta-norms for BNT, Mitrushina et al.,
2005).
Recommendations
Survey respondents indicated that while they gener-
ally viewed the BNT as an important component of
their neuropsychological batteries (rated as nearly
a “5” on a 7-point scale), they expressed concerns
regarding the poor-quality drawings on the test,
out-of-date and culturally insensitive items, and the
lack of information regarding credit for acceptable
label synonyms. Surveys of test usage have shown
consistent decline in use of the BNT over the past
two decades, which is likely driven by the limitations
of the test, including unsophisticated test stimuli
and confusing test instructions.
Given evidence of widespread inconsistencies
in BNT test administration, it is strongly recom-
mended that clinical reports and research papers
specify the BNT version administered and the
discontinuation rule employed, as well as any
deviations in test administration from standard
instructions. If shortened test administration times
are necessary, rather than altering standard test
BOSTON NAMING TEST
administration procedures (e.g., failing to docu-
ment a basal of 8 correct), evaluators may want
to consider abbreviated BNT versions (see Graves,
Bezeau, Fogarty, & Blar, 2004). Also, due to the
limited norms provided with the test, clinicians
are encouraged to utilize norms published else-
where (such as those found in Heaton et al., 1991;
Mitrushina et al., 2005; etc.), which consider lin-
guistic, ethnic, educational, and geographic back-
ground. Finally, due to the asymmetry and kurtosis
of the test data, it is recommended that clinicians
refrain from including percentiles in their reports
and instead comment as to whether scores are
within normal limits after consideration of demo-
graphic factors.
Original manuscript received 25 March 2013
Revised manuscript accepted 14 July 2013
First published online 3 September 2013
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9 BOSTON NAMING TEST
APPENDIX
Boston Naming
Test (BNT) Survey
Please provide check mark(s) where appropriate.
Number of Years in Practice_______ Neuropsychological Post Doc Training (2 years) __Yes __ No
Memberof__ABPNor__ABCN
Population you serve __ Pediatrics __ Adolescents __ Adults __Geriatrics
Administration
(1) Which language measure(s) do you include in your neuropsychological battery? __ BNT
__ WAIS–III (Vocabulary) __ PPVT versions __ BDAE sections __ Verbal Fluency __
other________________________________________________________________________
(2) Do you administer the BNT? __ Yes __ No If yes, which version? __ 60-item (BNT, 1983)
__ 60-items with multiple choices (BNT–II, 2001) __ any 15-item version __ 85-item __
other ________________________
(3) Do you record latencies? __Yes __ No
(4) Do you wait a full “20 seconds” before providing a stimulus or phonemic cue? _ Yes _ No
(5) If a patient does not achieve 8 in a row correct without phonemic cues starting at item #30, do you work
backwards to obtain 8 correct consecutive responses? __ Yes __ No
(6) Administration is to be discontinued after 6 consecutive failures (1983 version). Do you understand
“failure” to mean,
__ unable to name spontaneously (but may generate correct name with phonemic cues) OR
__ unable to name a picture even with phonemic cue
(7) If a patient provides an incorrect label (e.g., lock for latch), do you
__ A. provide immediate feedback (e.g., I’m looking for a different word”)
If A, if the patient self corrects (e.g., “oh, it’s a latch”) without phonemic cue, do you count as
__ correct or __ failed
__ B. wait 20 seconds without giving feedback and then provide phonemic cue
__ Other ___________________________________________________________________
(8) For test–retest situations, do you ___ re-administer the full test ___ use even/odd administration
other______________________________________________________________________
Interpretation
(1) Do you use norms for the BNT? _Yes _No If not, how do you interpret the raw score?
If yes, which norm(s) do you use?
__Norms from the back of BNT booklet
__Norms from Spreen and Strauss (1999); (specify:)__________________________________
__Norms from Mitrushina, Boone, and D’Elia (1999); (specify:) _______________________
__other _____________________________________________________________________
Reporting
(1) In the neuropsychological report, do you report
__ total score (i.e., # correct without phonemic cue)
__ number correct following phonemic cues
__ number correct following stimulus cues
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__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
10 BORTNIK ET AL.
__ percentiles
__ phonemic paraphasias
__ semantic paraphasias
(2) Do you make adjustments for _ ethnicity? _ English as a second language? _ educational level?
(3) Do you use cultural adaptations of the BNT? (e.g., Ponton–Satz Spanish Version)? __ Yes __ No
Suggestions/Concerns
(1) Do you have concerns regarding specific BNT items (e.g., acceptable synonyms including use of regional
terms, culturally biased items, quality of drawings)? If so, please list and describe
(2) What suggestions do you have for making this a better test?
(5) Rate the importance of the BNT in your neuropsychological battery
irrelevant1 2 3 4 5 6 7 extremely relevant
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