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Chapter 6

PSYC31H3 Chapter Notes - Chapter 6: Neuropsychological Test, Test Data, Psychological Testing

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Konstantine Zakzanis

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PSYC31 Ch. 6: The Neuropsychological Examination Interpretation
The basic data of psychological examinations, like any other psychological data, are behavioural
In order to get a broad & meaningful sample of the patient’s behaviour from which to draw diagnostic
inferences or conclusions relevant to patient care and planning, the psychological examiner needs to
have made or obtained reports of many different kinds of observations, including historical and
demographic information
Different Kinds of Examination Data
Background Data
Background data are essential for providing the context in which current observations can be best
In most instances, accurate interpretation of the patient’s examination behaviour and test responses
requires at least some knowledge of the developmental and medical history, family background,
educational and occupational accomplishments (or failures), and the patient’s current living situation
and level of social functioning
The examiner must take into account a number of patient variables when evaluating test performance,
including sensory & motor status, alertness cycles and fatigability, medication regimen, and
drug/alcohol dependency
An appreciation of the patient’s current medical and neurological status can guide the examiner’s search
for a pattern of neuropsychological deficits
The importance of background information in interpreting examination observations is obvious when
evaluating a test score on school-related skills such as arithmetic and spelling
The contributions of such background variables as age or education to test performance have not always
been appreciated in the interpretation of many different kinds of tests, including those purporting to
measure neuropsychological integrity
Behavioural Observations
Naturalistic observations can provide useful information about how the patient functions outside the
formalized, usually highly structured, and possibly intimidating examination setting
Psychological examiners rarely study patients in their everyday setting yet reports from nursing
personnel or family members may help set the stage for evaluating examination data or at least raise
questions about what the examiner observes or should look for
The value of naturalistic observations may be most evident when formal examination findings alone
would lead to conclusions that patients are more or less capable than they actually are
o Such an error is most likely to occur when the examiner confounds observed performance with
How patients conduct themselves in the course of the examination is another source of useful
o Their comportment needs to be documented and evaluated as attitudes toward the examination,
conversation or silence, the appropriateness of their demeanor and social responses, can tell a lot
about their neuropsychological status and enrich the context in which their responses to the
examination proper will be evaluated
Test Data
Testing differs from these other forms of psychological data gathering in that it elicits behaviour
samples in a standardized, replicable, and more/less artificial and restrictive situation
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Its strengths lie in the approximate sameness of the test situation for each subject, for it is the sameness
that enables the examiner to compare behaviour samples between individuals, over time, or with
expected performance levels
Its weakness too lie in the sameness, in that psychological test observations are limited to the behaviours
prompted by the test situation
To apply examination findings to the problems that trouble the patient, the psychological examiner
extrapolates from a limited set of observations to the patient’s behaviour in real-life situations
o Extrapolation from the data is a common feature of other kinds of psychological data handling as
well, since it is rarely possible to observe a human subject in every problem area
o Extrapolations are likely to be as accurate as the observations on which they are based are
pertinent, precise, and comprehensive, and the situations are similar, and as the generalizations
are apt
In most instances examiners rely on their common sense judgments and practical experience in making
test-based predictions about their patients’ real-life functioning
o Studies of the predictive validity and ecological validity of neuropsychological tests show that
many of them have a good predictive relationship with a variety of disease characteristics
Quantitative and Qualitative Data
Every psychological observation can be expressed either numerically as quantitative data or
descriptively as qualitative data
Each of these classes of data can constitute a self-sufficient data base as demonstrated by two different
approaches to neuropsychological assessment
o An actuarial system elaborated by others exemplifies the quantitative method
It relies on scores, derived indices, and score relationships for diagnostic predictions
Practitioners using this method may have a technician examine the patient so that, except
for an introductory or closing interview, their data base is in numerical, often computer-
proceed, form
o The clinical approach is built upon richly described observations without objective
These clinicians documented their observations in careful detail, much as neurologists or
psychiatrists describe what they observe
Both approaches have contributed significantly to the development of contemporary neuropsychology
together they provide the observational frames of reference and techniques for taking into account
documenting, and communicating the complexity, variability, and subtleties of patient behaviour
Some believe that reliance on actuarial evaluation of scores alone provides the best approach to clinical
Nor is it appropriate for manyperhaps most assessment questions in neuropsychology, as only
simple diagnostic decision making satisfies the conditions necessary for actuarial predictions to be more
accurate than clinical ones: (1) that there be only a small number of probable outcomes (e.g., left cortical
lesion, right cortical lesion, diffuse damage, no impairment); (2) that the prediction variables be known
(which limits the amount of information that can be processed by an actuarial formula to the information
on which the formula was based); and (3) that the data from which the formula was derived be relevant
to the questions asked
Proponents of purely actuarial evaluations overlook the realities of neuropsychological practice in an era
of advanced neuroimaging and medical technology: most assessment are not undertaken for diagnostic
purposes but to describe the patient’s neuropsychological status
Quantitative Data
Scores are summary statements about observed behaviour
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