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The Neuropsychological Impairment Scale (NIS)
The Neuropsychological
Impairment Scale
MANUAL
Additional copies of this manual (W-298C) may be purchased from WPS.
Please contact us at 800-648-8857, Fax 310-478-7838, or www.wpspublish.com.
William E. O'Donnell, Ph.D., M.P.H., Clinton B. DeSoto, Ph.D., Janet L. DeSoto, Ed.D., Don McQ. Reynolds, Ph.D.
Western Psychological Services • 12031 Wilshire Blvd., Los Angeles, CA 90025-1251
(NIS)
Manual
William E. O’Donnell, Ph.D., M.P.H., Clinton B. DeSoto, Ph.D.,
Janet L. DeSoto, Ed.D., and Don McQ. Reynolds, Ph.D.
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INTRODUCTION
provides three summary measures—the Global Measure of
Impairment (GMI), the Total Items Circled (TIC), and the
Symptom Intensity Measure (SIM)—and subscale scores in
seven areas of impairment: Critical Items (CRIT), Cognitive
Efficiency (COG), Attention (ATT), Memory (MEM),
Frustration Tolerance (FRU), Learning-Verbal (L-V), and
Academic Skills (ACD). Validity checks are also provided:
Defensiveness (DEF), Affective Disturbance (AFF), and
Response Inconsistency (INC). A Subjective Distortion
Index (SDI) can be computed. Standard scores are provided
based on data obtained from 1,000 individuals in nonclinical
settings. Separate norms based on 534 neuropsychiatric patients are also provided.
The NIS Observer Report form is a nonstandardized
way to allow family members or other individuals familiar
with the patient to describe how they perceive him or her in
terms of neuropsychological symptoms or cognitive impairment. Because the items are essentially the same ones used
on the Self-Report Form, the observer’s perceptions can be
directly compared with the patient’s own report.
A Senior Interview form is available for use with
older patients who have trouble completing a self-report
form. It is described in the supplemental chapter at the end
of this manual. Computer scoring is also available, as described in the “PC-Based Scoring for the NIS” chapter at the
back of this manual.
Responses on the NIS should always be viewed as
subjective information requiring objective verification.
Although the NIS can be used as a single, efficient introductory measure of an individual’s experience of neuropsychological symptoms, it should never be considered a final or
definitive estimate of neuropsychological impairment or of
any illness. Moreover, it should not be considered a substitute for individually administered clinical neuropsychological test batteries. In the clinical setting, the NIS is best used
in combination with neuropsychological performance tests.
Malingering or symptom pretense may color an individual’s self-report of neuropsychological symptoms.
Diagnosis of malingering is a complex clinical decision that
must be based upon information from a variety of sources.
In this context, agreement or lack of agreement between
neuropsychological performance test findings and the infor-
The Neuropsychological Impairment Scale (NIS) is a
self-report, paper-and-pencil measure of neuropsychological symptoms. It is a screening instrument designed to serve
as an “early warning system” (Lezak, 1983, p. 135), which
may be used to identify areas for inquiry, to focus treatment
efforts, or to determine service efficacy as patients enter and
progress through treatment.
Individuals, for a variety of reasons, frequently do not
report symptoms or histories that may be diagnostically important. The routine clinical examination, with its emphasis
upon specific test performance, may overlook or fail to elicit certain kinds of information relevant to neuropsychological impairment. The structured, easily administered NIS
inventory addresses both global impairment and specific
symptom areas, including attention, memory, and linguistic
functioning, and therefore has inherent advantages over informal clinical interviews (Robins, 1980).
General Description
The NIS contains 95 items; 80 describe neuropsychological symptoms, 10 measure affective disturbance, and 5
gauge test-taking attitudes. Items are rated on a 5-point scale
ranging from 0 (Not At All) to 4 (Extremely). The test can
be completed in 15 – 20 minutes. Both Self-Report and
Observer Report forms are available. The NIS is intended
for use with individuals aged 18 and older, who are able to
cooperate with testing and can read at a fifth-grade level or
above. It can be administered by a trained technician, although the resulting scores should be interpreted by a professional with advanced clinical training. The test can be
used for screening purposes in nonclinical settings. In clinical settings, it can be filled out by patients while they are in
the waiting room. The optimum use of the NIS in clinical
settings is as an intake measure, or as a measure to supplement comprehensive psychological or neuropsychological
assessment batteries.
On the Self-Report form of the NIS, individuals are
asked to indicate whether a statement describes their experience or applies to them. Some items refer to experiences
during the past few days or weeks, and others refer to experiences at any time in the past. When it is scored, the NIS
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The Neuropsychological Impairment Scale (NIS)
mation obtained with the NIS can be extremely useful. Still,
the NIS is not primarily designed to be used with individuals
who are unwilling to respond frankly.
Changes From the
1983 Research Edition of the NIS
The research edition of the NIS (O’Donnell &
Reynolds, 1983) consisted of 50 items that resulted in eight
derived scores. The current edition has been expanded to 95
items with 14 derived scores, allowing exploration of a
greater range of symptoms. Table 1 lists the scores derived
from the 1983 research edition of the NIS along with the
corresponding scores and additional scores provided by the
current edition of the test. Three of the neuropsychological
items from the research edition (Items 10, 30, and 41) have
been deleted; the other 47 original items have been retained.
Thus, in the current edition of the NIS, 48 of the 95 items
(51%) are new.
The response format has been expanded from 4 to 5
points, which allows for better symptom description. Three
impairment subscales—Attention (ATT), Memory (MEM),
and Academic Skills (ACD)—have been added, expanding
the scope of inquiry. The Affective Disturbance (AFF) scale
has been added to provide a check for the degree to which
affective disturbance may be influencing an individual’s responses. The current edition of the NIS also includes a procedure for determining a Subjective Distortion Index (SDI),
a measure of the individual’s objectivity in reporting neuropsychological symptoms. Additionally, the Response
Inconsistency (INC) score evaluates the consistency of the
individual’s responses.
Chapter 5 of this Manual reports on new reliability
and validity studies of the NIS, incorporating some of the
suggestions made by Franzen (1989). All of the subjects
used in the psychometric studies of the present edition of the
NIS, nonclinical and clinical, are entirely different from the
1983 subjects.
Table 1
Scores Derived From the NIS Research Edition and Current Edition
1983 Research Edition (50 items)
Current Edition (95 items)
Validity Scores
Lie (LIE)
Defensiveness (DEF)
Affective Disturbance (AFF)
Response Inconsistency (INC)
Subjective Distortion Index (SDI)
Summary Scores
Global Measure of Impairment (GMI)
Total Items Checked (TIC)
Symptom Intensity Measure (SIM)
Global Measure of Impairment (GMI)
Total Items Circled (TIC)
Symptom Intensity Measure (SIM)
Impairment Scores
Pathognomonic (PAT)
General (GEN)
Frustration (FRU)
Learning-Verbal (L-V)
Critical Items (CRIT)
Cognitive Efficiency (COG)
Attention (ATT)
Memory (MEM)
Frustration Tolerance (FRU)
Learning-Verbal (L-V)
Academic Skills (ACD)