Synonyms

BDAE

Description

Boston Diagnostic Aphasia Examination (3rd ed.) (BDAE-3) Authors: Harold Goodglass, Edith Kaplan, Barbara Barresi, 2001, Publisher: Pro-Ed, 8700 Shoal Creek Blvd, Austin, TX 78757–6897, http://www.proedinc.com. The complete BDAE-3 test kit includes stimulus cards, test booklets for Standard and Short forms, the 60-item Boston Naming Test with record booklets, a DVD, and a hardbound text that contains the test manual.

The Boston Diagnostic Aphasia Examination-3 (BDAE-3; Goodglass et al. 2001a) is a comprehensive, multiple subtests instrument for investigating a broad range of language impairments that are common consequences of brain damage. It is designed as a comprehensive measure of aphasia. The examination provides materials and procedures to evaluate five language-related sections and an additional section on praxis. The five language domains include conversational and expository speech, auditory comprehension, oral expression, reading, and writing. In addition to individual subtest scores, the test yields three broader measures: the Severity Rating Scale (a rating of the severity of observed language/speech disturbance), the Rating Scale Profile of Speech Characteristics (a rating of observed speech characteristics and of scores in two main language domains), and the Language Competency Index (a composite score of language performance on BDAE-3 subtests). The extended version includes a sixth section, “Praxis,” which examines natural and conventional gestures, use of pretend objects, and bucco-facial and respiratory movements. The test manual is part of the text by Goodglass et al. (2001b). It provides suggestions for administering, scoring, and interpreting performance on subtests, as well as directions for plotting and interpreting patient profiles. Percentiles or standard scores can be derived for each subtest.

Administration

The 44-page test booklet provides instructions for test administration. The short form and extended form items are specified in the test booklet and are also presented in different typeface; the short form items are presented in bold typeface, and the extended form items appear in italics. The standard administration includes all of the bold short form items in addition to regular typeface items.

Historical Background

The BDAE is designed to meet three goals: to enable diagnosis of aphasia syndromes, to measure the breadth and severity of aphasic disturbance, and to provide a comprehensive assessment of language to guide therapy. Initially published by Goodglass and Kaplan in 1972, it was revised in 1983 and again in 2001. Changes from the previous edition include the addition of abbreviated and expanded testing formats, incorporation of the Boston Naming Test, addition of a Language Competence Index, and clarification of scoring procedures and definitions. The revision also was designed to integrate recent advances in neurolinguistics research, including methods to assess narrative and discourse complexity, category-specific dissociations in lexical production/comprehension, syntax comprehension, and analysis of grapheme-phoneme conversion during reading. The ultimate goal for the authors in developing the test was clinical utility.

The BDAE-3 consists of more than 50 subtests that can be administered in three different formats: standard, short, and extended. The standard format most closely resembles earlier versions of the BDAE. The new short form of the test provides a brief assessment. The extended version offers a comprehensive neurolinguistic profile that includes evaluation of spontaneous narrative, processing of word categories, syntax comprehension, and reading/writing. The BDAE-3 allows both a quantitative and a qualitative evaluation of language. The examination is based on an assumption that the nature of the aphasic deficit is determined by (1) organization of language in the brain, (2) the location of the lesion causing the aphasia, and (3) interactions among parts of the language system.

The BDAE has been adapted and translated for use in many languages including Spanish, French, German, Italian, Dutch, Greek, Hindi, Finnish, Mandarin Chinese, Japanese, and Portuguese.

Psychometric Data

Norms

Standardization of the BDAE-3 is based on a population of individuals with aphasia (IwA) who were referred concurrently by field examiners working in inpatient, outpatient, and private practice settings. Means and standard deviations for the BDAE-3 subtests for IwA are provided in the test manual. The number of IwA administered the 50 subtests varies from a maximum of 85 to a low of 31. Means are also provided for 15 nonclinical individuals who, on average, failed less than one item per subtest. Rosselli et al. (1990) and Pineda et al. (2000) provide norms for the Spanish version of the BDAE-2 (Goodglass and Kaplan 1986) that is based on 156 healthy individuals living in Columbia, South America.

Reliability

Kuder-Richardson reliability coefficients for subtests reflect variability, ranging between <0.65 and <0.95 with about two-thirds of the coefficients reported in the manual (Goodglass et al. 2001a), ranging from 0.90 upwards. No stability coefficients for test-retest are provided. The authors state that test-retest reliability is difficult to attain with IwA. The current reliability coefficients demonstrate very good internal consistency in terms of what the items within the subtests are measuring (Goodglass et al. 2001b). For most subtests, correlations are very high between the short and standard forms (>0.90; Goodglass et al. 2001b). No reliability information is provided in the BDAE-3 manual regarding the Severity Rating Scale, Language Competency Index, praxis assessment, or Spatial-Quantitative Battery.

Validity

A correlation matrix was obtained for all the scores in the BDAE-3 battery, and the correlation coefficients 0.60 or greater are displayed in the manual (Goodglass et al. 2001a), with severity partialled out, showing intercorrelations between subtests for the standardization sample. Based on these, “a number of sharply defined clusters” are indicated by the authors (p. 16). Strauss et al. (2006), however, pointed out that the lack of data on the entire correlational matrix makes it “difficult to estimate convergent and discriminant validity within and across BDAE-3 clusters” (p. 896) especially given the fact that the more than 50 subtests were administered to just 31–85 subjects. Based on data for earlier versions of the BDAE, Goodglass and Kaplan (1972) found a strong general language factor and factors covering spatial-quantitative-somatagnostic, articulation-grammatical fluency, auditory comprehension, and paraphasia domains. Goodglass and Kaplan (1983) described a second factor analysis using a sample of 242 adults with aphasia, concluding that auditory comprehension, repetition-recitation, reading, and writing were factors of equal importance. Similar findings in normal individuals were reported by Pineda et al. (2000) for the BDAE-2 Spanish version.

Correlations between earlier versions of the BDAE and other measures have been described. For example, the BDAE oral apraxia task has been correlated with other articulation tasks (Sussman et al. 1986); correlations for the auditory comprehension measure on the BDAE and the Token Test and with respective measures of the Porch Index of Communicative Ability (PICA) have been reported (Divenyl and Robinson 1989). Brookshire and Nicholas (1984) found the BDAE auditory comprehension subtest did not predict auditory paragraph comprehension of independent standardized material.

Goodglass and Kaplan designed the BDAE to assess various components of language function for the purpose of discriminating among different patterns of CNS lesions indicative of types of aphasia. Studies to date have not determined decision rules for the diagnosis of individual subtypes of aphasia (Crary et al. 1992; Reinvang and Graves 1975).

Ecological validity of the BDAE for predicting progress with aphasia therapy has been described by various authors (e.g., Davidoff and Katz 1985; Marshall and Neuburger 1994).

Clinical Uses

The BDAE is derived from samples of 85 adult individuals with stroke and 15 elderly nonclinical volunteers. Therefore, it is most useful when assessing adult populations with language impairments resulting from strokes, but it may be used effectively with persons who have sustained traumatic brain injury (e.g., Theodoros et al. 2008) and forms of dementia (e.g., Tsantali et al. 2013). The BDAE offers a comprehensive look at language function from a neuropsychological perspective. Complete administration of this battery requires approximately 90 min. The short form requires approximately 40–60 min. The BDAE is one of the most popular batteries for use by speech-language pathologists for evaluation of aphasia and other neurologic language impairments. In addition to its strength as a comprehensive assessment of language, the BDAE provides useful instructions for observing and recording specific types of error responses (e.g., paraphasia) found in individuals with aphasia, reflecting what has been termed the “Boston school” approach to aphasia classification. The detailed examination of conversational and expository speech is an important and unique aspect of the BDAE and is well described in the manual (Goodglass et al. 2001b).

BDAE results can be used to guide aphasia treatment programs (Helm-Estabrooks et al. 2014) and to measure the effects of treatment (Robey 1998).

Cross-References