2014

In-depth MOXO test analysis

Stage 2
Eran Sandel
Head of Professional Training
A
T
I
H
Attention the ability to locate a target element, evaluate it
properly and respond correctly as instructed.
Timing the ability to respond correctly within the time
allocated for the task.
Impulsiveness acting before thinking, tendency to
respond before fully assessing the situation at hand.
Hyperactivity difficulty in efficient regulation of behavior and
in avoiding unnecessary or undesirable actions (unnecessary key
presses, fidgeting, etc.).
4s 8s
Target Void Non -Target Void
A
T
I
H
-8
-4
-10
-10 -20
50%
30%
15%
5%
0 -0.825 -1.65
( Z > 0 )
( < Z 0 0.825 - )
( 0.825 - < Z 1.65 - )
( 1.65 - Z < )
( 2.55 - Z )
( 2.25 - < Z 2.55 - )
( 1.95 - < Z 2.25 - )
( 1.65 - < Z 1.95 - )
Z=
( )

100-0 errors
90-1 error
84-2 omissions
48-13 omissions
Graph shows low timing score how will it appear when
compared to the norm?
23 year old man
7 year old girl
The behavior of the performance graph for each of the four indices
A, T, I, H, between two or more levels is characterized by the
following three parameters:
Slope The angle of the performance graph and the x axis
between two different test levels.
Power changes between the Y values of two different test levels
(Y).
Frequency The number of points on the performance graph on
which the slope changed from positive to negative and vice versa
(maxima and minima).
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
The principles of analysis are based on the following
four rules:
C
omparison
luctuation
istracters
orrelation
F
D
C
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
This principle evaluates the impact of the duration of the
test on the performance graph for all four indices by
comparing the scores in levels 1 and 8 (no distracters)
Three possible results for comparison:
1. Improvement positive slope + med/high power
2. Deterioration negative slope + med/high power
3. Stability positive/negative/zero slope + low power
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
1. Comparison
1. Improvement positive slope + med/high power
2. Deterioration negative slope + med/high power
3. Stability positive/negative/zero slope + low power
Deterioration
Y=-20
1. Comparison
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
Improvement Y=+40
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
1. Comparison
1. Improvement positive slope + med/high power
2. Deterioration negative slope + med/high power
3. Stability positive/negative/zero slope + low power
1. Improvement positive slope + med/high power
2. Deterioration negative slope + med/high power
3. Stability positive/negative/zero slope + low
power
Stability Y=-8
1. Comparison
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
Evaluates the frequency and power of changes to the slope
of the performance graph between two subsequent test
levels for all four indices.
Four possible results for fluctuation:
1. Strong Fluctuation high power + med/high frequency.
2. Medium Fluctuation medium power + med/high frequency.
3. Low Fluctuation low power + med/high frequency.
4. No Fluctuation low frequency.
Note!
In case of medium frequency without three powers of identical
strength, the lowest power will determine the degree of
fluctuation.
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
2. Fluctuation
1. Strong Fluctuation high power + med/high frequency.
2. Medium Fluctuation medium power + med/high frequency.
3. Low Fluctuation low power + med/high frequency.
4. No Fluctuation low frequency.
0
0
0
0
No Fluctuation
Fluctuation
2. Fluctuation
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
Strong Fluctuation
0
0
0
Strong-Medium-Strong-Strong-Medium
2. Fluctuation
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
1. Strong Fluctuation high power + med/high frequency.
2. Medium Fluctuation medium power + med/high frequency.
3. Low Fluctuation low power + med/high frequency.
4. No Fluctuation low frequency.
Medium Fluctuation
Strong-Strong-Medium-Medium
2. Fluctuation
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
1. Strong Fluctuation high power + med/high frequency.
2. Medium Fluctuation medium power + med/high frequency.
3. Low Fluctuation low power + med/high frequency.
4. No Fluctuation low frequency.
Low Fluctuation
0
0
0
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
2. Fluctuation
1. Strong Fluctuation high power + med/high frequency.
2. Medium Fluctuation medium power + med/high frequency.
3. Low Fluctuation low power + med/high frequency.
4. No Fluctuation low frequency.
No Fluctuation
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
2. Fluctuation
1. Strong Fluctuation high power + med/high frequency.
2. Medium Fluctuation medium power + med/high frequency.
3. Low Fluctuation low power + med/high frequency.
4. No Fluctuation low frequency.
Strong Fluctuation
2. Fluctuation
1. Strong Fluctuation high power + med/high frequency.
2. Medium Fluctuation medium power + med/high frequency.
3. Low Fluctuation low power + med/high frequency.
4. No Fluctuation low frequency.
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
Evaluates the effect of different types of distracters on
the MOXO performance graph for all four indices:
There are two types of distracter effects:
Type of distracter compares each of the scores on
the two levels for each distracter type (visual,
auditory, combined) with the score in level 1, for
each of the four MOXO indices.
Distracter load evaluates the effect of the
distracter load on the performance graph for each
of the four MOXO indices.
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
3. Distracters
Three possible results of the effect of distracter type:
1. Improvement positive slope + med/high power in
each comparison.
2. Deterioration negative slope + med/high power in
each comparison.
3. Cannot be determined (CBD) when the conditions
for improvement/deterioration do not exist.
3. Distracters
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
Visual
Auditory
Combined
Y=+40
Improvement
Cannot be determined
Cannot be determined
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
3. Distracters
Three possible results of the effect of distracter type:
1. Improvement positive slope + med/high power in each
comparison.
2. Deterioration negative slope + med/high power in each
comparison.
3. Cannot be determined (CBD) when the conditions for
improvement/deterioration do not exist.
Visual
Auditory
Combined
Deterioration
Cannot be determined
Cannot be determined
3. Distracters
Three possible results of the effect of distracter type:
1. Improvement positive slope + med/high power in each
comparison
2. Deterioration negative slope + med/high power in each
comparison
3. Cannot be determined when the conditions for
improvement/deterioration do not exist
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
Visual
Auditory
Combined
Deterioration
Deterioration
Deterioration
3. Distracters
Three possible results of the effect of distracter type:
1. Improvement positive slope + med/high power in each
comparison
2. Deterioration negative slope + med/high power in each
comparison
3. Cannot be determined when the conditions for
improvement/deterioration do not exist
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
Three possible results of the effect of distracter load:
1. Improvement increase between each odd level compared to the even level
that precedes it (indicated by the slope only)
2. Deterioration decrease between each odd level compared to the even level
that precedes it (indicated by the slope only)
3. Cannot be determined when the conditions for improvement/deterioration
do not exist
Positive slope
(improvement) x3
3. Distracters
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
Three possible results of the effect of distracter load:
1. Improvement increase between each odd level compared to the even level
that precedes it (indicated by the slope only)
2. Deterioration decrease between each odd level compared to the even level
that precedes it (indicated by the slope only)
3. Cannot be determined when the conditions for improvement/deterioration
do not exist
3. Distracters
Negative slope
(deterioration) x3
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
Cannot be determined
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
3. Distracters
Three possible results of the effect of distracter load:
1. Improvement increase between each odd level compared to the
even level that precedes it (indicated by the slope only)
2. Deterioration decrease between each odd level compared to the
even level that precedes it (indicated by the slope only)
3. Cannot be determined when the conditions for
improvement/deterioration do not exist
Evaluates the relationship between the performance graph
slopes for two different indices throughout the duration of the
test.
There are two types of correlations between indices:
Correlation between levels 1 and 8 based on
comparison results
General correlation evaluated over all levels of the test
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
4. Correlation
Three possible results for correlation between levels 1 and 8:
1. Positive correlation identical slope (including zero-zero)
between the two indices
2. Negative correlation inverse slope between two indices
3. Cannot be determined no positive/negative correlation
Negative correlation
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
4. Correlation between two indices when
comparing levels 1 and 8
Positive Correlation
Three possible results for correlation between levels 1 and 8:
1. Positive correlation identical slope (including zero-zero)
between the two indices
2. Negative correlation inverse slope between two indices
3. Cannot be determined no positive/negative correlation
4. Correlation between two indices when
comparing levels 1 and 8
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
Cannot be determined
Three possible results for correlation between levels 1 and 8:
1. Positive correlation identical slope (including zero-zero)
between the two indices
2. Negative correlation inverse slope between two indices
3. Cannot be determined no positive/negative correlation
4. Correlation between two indices when
comparing levels 1 and 8
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
Three possible results for general correlation
1. Tendency towards positive correlation identical slopes
between index A and index B for at least 4 of the 7
performance graph segments.
2. Tendency towards negative correlation inverse slopes
between index A and index B for at least 4 of the 7
performance graph segments.
3. Cannot be determined no tendency towards
positive/negative correlation
Positive (1 of 7)
Negative (5 of 7)
Cannot be determined
(1 of 7)
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
4. General Correlation
Comparing Timing and Impulsiveness:
Positive correlation
tendency
Negative correlation
tendency
4. General Correlation
Cannot be determined
Timing vs. Impulsiveness
4. General Correlation
Timing vs. Hyperactivity
Negative correlation
tendency
Positive correlation
tendency
4. General Correlation
Timing vs. Attention
Negative correlation
tendency
Positive correlation
tendency
4. General Correlation
Hyperactivity vs. Impulsiveness
Negative correlation
tendency
Positive correlation
tendency
4. General Correlation
Impulsiveness vs. Attention
Negative correlation
tendency
Positive correlation
tendency
4. General Correlation
Name: John Smith
Age: 9
Gender: Male
Reasons for referral: referred for evaluation by his parents due to
academic, emotional and social difficulties
Questionnaire reports DSM 4 criteria:
Previous evaluations:____________________________________________
Type of treatment/s (if relevant): ________________________________
Clinical diagnosis: ______________________________________________
Parent Questionnaire Teacher Questionnaire
Attention Hyperactivity/
Impulsiveness
Attention Hyperactivity/
Impulsiveness
7/9 1/9 8/9 3/9
Conduct during evaluation:
John was accompanied by his mother and parted from her easily. He is a tall,
attractive child and his physical development is compatible with his chronological
age. He is pleasant, polite and shy, but connected well and shared his experiences
at home and at school. He spoke openly about his difficulties at school. He
claimed that writing was difficult and that he enjoyed reading and mathematics.
He dislikes most school subjects except for gym and mathematics. He claims that
school is difficult because he is very forgetful and that noise in the classroom
caused by talking, yelling and children fidgeting makes it difficult for him to
learn. He prefers to sit at the back of the classroom, in the corner near the
window. After school, he enjoys playing outside with his brother. He told me in
great detail about the campsite that they built and how they flew airplanes.
MOXO Findings
Observation during testing:
The child was cooperative during the test and initially seemed to enjoy the task.
After several minutes, though, he began to complain that it was too difficult and
that he did not want to continue. Intensive persuasion was required to convince
him to proceed. At the end of the test, when asked what he found so difficult, he
answered that it was the monotonous key presses. He also noted that the noises
made by the distracters bothered him very much.
Attentiveness Profile: A1T4S4I1H2
Table of cognitive-attentiveness measures per age and gender:
Degree of severity
according to ADHD norms:
Performance graph analysis:
1. Comparing levels 1 and 8
A - Stability
T- Improvement
I - Stability
H - Stability
Comparing levels 1 and 8:
1. Improvement positive slope + med/high power
2. Deterioration negative slope + med/high power
3. Stability positive/negative/zero slope + low power
Rules
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
2. Fluctuation:
A - Medium
T - Medium
I - Low
H - Strong
Fluctuation:
1. Strong fluctuation high power+ med/high frequency
2. Medium fluctuation medium power + med/high frequency
3. Low fluctuation low power + med/high frequency
4. No fluctuation low frequency
Rules:
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
3. Distracters:
Visual Auditory Combined Load
A CBD CBD CBD CBD
T CBD CBD deteriorated CBD
I CBD CBD CBD CBD
H CBD CBD CBD deteriorated
Distracters:
1. Improvement positive slope + med/high power in each
comparison
2. Deterioration negative slope + med/high power in each
comparison
3. Cannot be determining the conditions for
improvement/deterioration do not exist
Rules:
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
4. Correlation
Comparing levels
1 and 8 General
A-T Positive
A-I Positive
A-H Negative
T-I Positive
T-H Negative
I-H Negative
Correlation between 2 indices when comparing levels 1 and 8:
1. Positive correlation (pos-pos, neg-neg, zero-zero)
2. Negative correlation (pos-neg, neg-pos)
3. Cannot be determined (zero-pos/neg, pos/neg zero)
Rules:
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
4. Correlation
Comparing levels General
1 and 8
A-T Positive positive
A-I Positive CBD
A-H Negative CBD
T-I Positive CBD
T-H Negative negative
I-H Negative CBD
General Correlation:
1. Tendency towards positive correlation identical slope between index A and
index B in at least 4 of 7 segments
2. Tendency towards negative correlation reverse slope between index A and
index B in at least 4 of 7 segments
3. Cannot be determined no tendency towards negative/positive correlation
Rules:
Slope Power(Y) Frequency
Positive (>0) Low (10) Low (1)
Negative (<0) Medium (10<Y20) Medium(=2)
Zero (=0) High (>20) High(3)
General Compare levels 1 and 8
Tendency to positive Positive A -T
CBD Positive A-I
CBD Negative A-H
CBD Positive T-I
Tendency to negative Negative T-H
CBD Negative I-H
Load Combined Auditory Visual
CBD CBD CBD CBD A
CBD Deteriorated CBD CBD T
CBD CBD CBD CBD I
Deteriorated CBD CBD CBD H
1. Comparing levels 1 and 8:
A Stability
T Improvement
I Stability
H - Stability
Summary
2. Fluctuation:
A Medium
T Medium
I Low
H - Strong
Exhaustion was not displayed over time, and
the timing score even improved.
Strong fluctuation in any index generally
indicates internal instability. Fluctuation in the
hyperactivity index can indicate emotional
difficulties.
Combined distracters cause slower response
time and distracter overload caused the
hyperactivity score to deteriorate
The negative correlation between T-H can
indicate increased fidgeting which causes an
improvement in timing and vice versa
3. Distracters:
4. Correlation:
Thanks for your Attention