PSYC32H3 Chapter Notes - Chapter 1: Clinical Neuropsychology, Neuropsychological Test, Neuropsychology
Chapter 1 Introduction
Clinical neuropsychology: applied science concerned with the behavioural expression of
Neurologists: neurobehaviour specialists who administer tests and test batteries,
tailored for answering specific referral questions.
(Ideally) test battery consists of well-validated, reliable, standardized, and normed
measures that help identify/quantify behavioural changes that may have resulted from
brain injury/other central nervous system disturbances.
Cognitive areas typically assessed are:
•Visuospatial perception and constructional abilities
•Frontal systems/executive function
oSensory and motor functions + general IQ tests are also usually assessed
After administering a test, a neuropsychologist has to make sense of all of the numerical
and qualitative data.
•Optimal use – neuropsychologist must have understanding of what makes a
‘normal’ performance on the tests before they can locate an individual’s strengths
and weaknesses of their capacities.
A test is meaningful when it has an empirical frame of reference.
•Normative data provides this context
•This type of data represents the range of performance on a test of a group of
medically/neurologically healthy individuals with relatively homogenous
o‘Gold standard’ by which an individual’s scores are compared.
•Not complete and sole basis for interpretation of test score
Tests must take into account qualitative observations and a patient’s history
background, present circumstances, motivation, attitudes, and expectations regarding
•Formal evaluation of the patient’s emotional functioning and personality
characteristics is also part of a neuropsychological evaluation
3 main parts for forming a clinical judgement interpretation REPORT
•Observations: Reporting a score with reporting how it was obtained can be
misleading. Did a person get a normal score in a short amount of time or did they
get a normal score after working at the test for a long period? Is also important to
assess attitude, effort, and motivation – is the patient giving their best
•History: along with presenting symptoms, important for understanding test data.
Some medical/psychiatric conditions can influence neuropsychological test
performance – documenting these risk factors is important so that the
neuropsychologist can attribute the contribution of peripheral nervous
system/central nervous system, and/or emotional dysfunction to the clinical
oHistory includes: medical; psychiatric; education; vocational; avocational
•Raw Data, Norms: More than one test should be administered when assessing
performance within a specific functional domain so that the internal consistency
of performance findings can be judged before offering an opinion about function.
In order to obtain the best possible performance from a patient, a neuropsychologist
must develop a rapport with the patient, gain cooperation, and conduct the evaluation in
an environment that is as free as possible from distracting influences.
•‘Ideal’ test environment
Neuropsychological test norms have been standardized under ideal test environment
conditions. Deviation from a standardized test environment should be well documented
because it will almost always adversely affect the reliability and validity of the test data
the reliability and validity of the professional opinions derived from that data.
Allowing others to observe or record the neuropsychological test can modify a patient’s
responses and/or attitude towards the test.
•Also alter the standardized examination test environment this means that the
information can be considered invalid
Recording equipment can place neuropsychologists in potential conflict with laws
regulating the practice of psychology. It can be an issue ethically because psychologists
have to maintain the integrity and security of test materials. However, with recordings,
once they leave the room, the neuropsychologists have limited control over the
•A test can become invalid if it becomes to exposed to the public
There are relatively few large-scale normative reports in psychology.
•They are very expensive and logistically difficult
•Researchers are also have not been supported in conducting normative research
oThese types of studies are descriptive and are not really considered
‘scientific’ because they are not testing a hypothesis
Normative data is mostly found in publications of clinical studies = hard to find
Researchers have to try to choose the appropriate set of data to use as a normative
comparison as they could work for different demographics and time points, thereby not
working for a certain patient.
•May lead to faulty inferences being drawn, maybe resulting in unnecessary
treatment or therapeutic neglect
Patients are often evaluated more than once on the same test (often by different
examiners). Clinicians are urged to document the source of comparison data used to
arrive at conclusions within the body of the report.
Another set of data can be used, beyond just normative data. Clinical comparison data
(abnorms) represent the range of test performances of distinct groups of medically,
psychiatrically, and/or neurologically compromised individuals with relatively
homogeneous demographic characteristics.
•There is a lack of clinical comparison data so neuropsychologists usually depend
on normative data
•This makes it hard to explain how a patient under study differs from a normal
Standard and Experimental
Reasons for standardized measures:
•Patients are frequently re-evaluated over time, often by different examiners
oTests must be familiar and able to be easily referenced
•Very important during initial examinations of patients, to establish a meaningful
oThe baseline is important for subsequent comparison with retest date to
determine whether the treatment has improved or worsened functioning