Adherence to Validity Testing Recommendations in Neuropsychological Assessment: A Survey of INS and NAN Members (original) (raw)
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Archives of Clinical Neuropsychology, 2005
The present study surveyed assessment practices and test usage patterns among clinical neuropsychologists. Respondents were 747 North American, doctorate-level psychologists (40% usable response rate) affiliated with Division 40 of the American Psychological Association (APA), the National Academy of Neuropsychology (NAN), or the International Neuropsychological Society (INS). Respondents first provided basic demographic and practice-related information and reported their most frequently utilized instruments. Overall, the Wechsler Adult Intelligence Scales and Wechsler Memory Scales were most frequently used, followed by the Trail Making Test, California Verbal Learning Test, and Wechsler Intelligence Scale for Children. Respondents also reviewed a vignette about a traumatic brain injury patient, and then reported the instruments they would use to assess this patient's specific cognitive symptomatology, general cognitive ability, and capacity to return to work. Particular attention was paid to the areas of memory, attention, and executive functioning. The current study represents the largest and most comprehensive test usage survey conducted to date within the field of clinical neuropsychology. Survey results update and greatly expand knowledge about neuropsychologists' assessment practices. Following a review of findings, results are compared to those obtained in prior surveys and implications for the field of neuropsychology are discussed.
Reliability and Validity in Neuropsychology
The Little Black Book of Neuropsychology, 2010
There are now literally hundreds of neuropsychological tests designed for evaluating cognitive abilities in children, adolescents, adults, and older adults. Given this vast library of instruments, how do test users decide which neuropsychological tests to choose? Like most decisions, choosing a test relies on a careful weighing of the relative balance of strengths and weaknesses. Two critical sources of information for making that decision are evidence of a test's reliability and validity. Carefully examining these will help the user make an informed decision as to whether the test is appropriate for a particular purpose, a particular examinee, and a particular setting. This seems like a straightforward task for most neuropsychologists, who have typically covered basic concepts of reliability and validity during undergraduate or graduate training. Yet, a common mistake is to ask an all-or-none question, such as "is this test reliable?" or "has this test been validated?" Reliability and validity often appear deceptively simple, but continue to be complex topics to master.
An Intervention to Decrease the Occurrence of Invalid Data on Neuropsychological Evaluation
Archives of Clinical Neuropsychology
Objective: This study tested whether patients who were given a handout based on deterrence theory, immediately prior to evaluation, would provide invalid data less frequently than patients who were simply given an informational handout. Method: All outpatients seen for clinical evaluation in a VA Neuropsychology Clinic were randomly given one of the two handouts immediately prior to evaluation. The "Intervention" handout emphasized the importance of trying one's hardest, explicitly listed consequences of valid and invalid responding and asked patients to sign and initial it. The "Control" handout provided general information about neuropsychological evaluation. Examiners were blinded to condition. Patients were excluded from analyses if they were diagnosed with major neurocognitive disorder or could not read the handout. Medical Symptom Validity Test (MSVT) was used to determine performance validity. Results: Groups did not differ on age, education, or litigation status. For the entire sample (N = 251), there was no effect of handout on passing versus failing MSVT. However, among patients who were seeking disability benefits at the time of evaluation (n = 70), the Intervention handout was associated with lower frequency of failing MSVT than the Control handout. Conclusions: This brief, theory-based, cost-free intervention was associated with lower frequency of invalid data among patients seeking disability benefits at the time of clinical evaluation. We suggest methodological modifications that might produce a more potent intervention that could be effective with additional subsets of patients.
Improving clinical cognitive testing: Report of the AAN Behavioral Neurology Section Workgroup
Neurology, 2015
To evaluate the evidence basis of single-domain cognitive tests frequently used by behavioral neurologists in an effort to improve the quality of clinical cognitive assessment. Behavioral Neurology Section members of the American Academy of Neurology were surveyed about how they conduct clinical cognitive testing, with a particular focus on the Neurobehavioral Status Exam (NBSE). In contrast to general screening cognitive tests, an NBSE consists of tests of individual cognitive domains (e.g., memory or language) that provide a more comprehensive diagnostic assessment. Workgroups for each of 5 cognitive domains (attention, executive function, memory, language, and spatial cognition) conducted evidence-based reviews of frequently used tests. Reviews focused on suitability for office-based clinical practice, including test administration time, accessibility of normative data, disease populations studied, and availability in the public domain. Demographic and clinical practice data were...
The Clinical neuropsychologist, 2018
Neuropsychological tests undergo periodic revision intended to improve psychometric properties, normative data, relevance of stimuli, and ease of administration. In addition, new tests are developed to evaluate psychological and neuropsychological constructs, often purporting to improve evaluation effectiveness. However, there is limited professional guidance to neuropsychologists concerning the decision to adopt a revised version of a test and/or replace an older test with a new test purporting to measure the same or overlapping constructs. This paper describes ethical and professional issues related to the selection and use of older versus newer psychological and neuropsychological tests, with the goal of promoting appropriate test selection and evidence-based decision making. Ethical and professional issues were reviewed and considered. The availability of a newer version of a test does not necessarily render obsolete prior versions of the test for purposes that are empirically s...
Neuropsychologists' training, experience, and judgment accuracy
Archives of Clinical Neuropsychology, 1988
It is often assumed that judgment accuracy improves as clinical training and experience increase, but the few studies on this topic within neuropsychology have yielded negative findings. In an extension of prior research, we obtained information on background training and experience from a nationally represenlative sample of clinical neuropsychologists and had each practitioner appraise one from among a series of 10 cases. Except for a possible tendency among more experienced practitioners to overdiagnose abnormality, no systematic relations were obtained between training, experience, and accuracy across a series of We wish to thank Jeffrey T. Barth for providing Case 7 reported on below. We are also grateful to Robyn Dawes and Lewis Goldberg for their helpful comments and suggestions on an earlier
Practical neurology, 2018
Neuropsychological testing is a key diagnostic tool for assessing people with dementia and mild cognitive impairment, but can also help in other neurological conditions such as Parkinson's disease, stroke, multiple sclerosis, traumatic brain injury and epilepsy. While cognitive screening tests offer gross information, detailed neuropsychological evaluation can provide data on different cognitive domains (visuospatial function, memory, attention, executive function, language and praxis) as well as neuropsychiatric and behavioural features. We should regard neuropsychological testing as an extension of the neurological examination applied to higher order cortical function, since each cognitive domain has an anatomical substrate. Ideally, neurologists should discuss the indications and results of neuropsychological assessment with a clinical neuropsychologist. This paper summarises the rationale, indications, main features, most common tests and pitfalls in neuropsychological evalu...
Neuropsychological assessment in the Israeli healthcare system: a practitioners’ survey
Israel Journal of Health Policy Research
Background The current study examines self-reported professional practices and attitudes of Israeli neuropsychologists, in an attempt to understand how they contribute to funding of neuropsychological assessment (NPA) through the Israeli healthcare system. Methods Two hundred seventy-nine neuropsychologists (176 board-certified experts and 103 interns) participated in an online survey that targeted characteristics of NPA practice in Israel, attitudes toward NPA, and familiarity with healthcare referral procedures. Results Overall, 68% of respondents conducted NPA, with a smaller proportion of experts (56%) doing so than interns (88%). The most common purpose of NPA was to provide treatment recommendations, and respondents listed indications for NPA that matched indications for neuropsychological rehabilitation. Almost two thirds of respondents reported that none of the NPAs that they performed received healthcare funding. While all practitioners believed that the healthcare system s...
Embedded Symptom Validity Tests and Overall Neuropsychological Test Performance
Archives of Clinical Neuropsychology, 2011
A sample of 314 consecutive clinical and forensic referrals with mild traumatic brain injury was evaluated using the Meyers Neuropsychological Battery (MNB). A comparison was made of the test performance and performance on the embedded Symptom Validity Tests (SVTs) with a control for multicolinearity utilized. Using the nine embedded SVTs in the MNB, the incidence of poor effort fell at 26% of the total sample. Involvement in litigation was related to more failures on the individual SVTs. The correlation between failed effort measures and the Overall Test Battery Mean (OTBM) was consistently negative, regardless of litigation status, in that more failures were associated with lower OTBM scores. The correlation between the number of SVTs failed and the OTBM was 2.77. Our results are similar to those presented by Green, Rohling, Lees-Haley, and Allen (2001); who reported a .73 correlation with the failure on the Word Memory Test and performance on the OTBM. The results of the current study also indicate that 50% of the variance in neuropsychological testing can be accounted by failures on internal SVTs.