Developmental prosopagnosia and the Benton Facial Recognition Test

Abstract

Abstract-The Benton Facial Recognition Test is used for clinical and research purposes, but evidence suggests that it is possible to pass the test with impaired face discrimination abilities. The authors tested 11 patients with developmental prosopagnosia using this test, and a majority scored in the normal range. Consequently, scores in the normal range should be interpreted cautiously, and testing should always be supplemented by other face tests. NEUROLOGY 2004;62:1219 -1220 The Benton Facial Recognition Test (BFRT) is a commercially available test used by neurologists and neuropsychologists to assess face recognition abilities.1 Because the test is easy to administer and has extensive normative data, it is commonly used for clinical and research purposes.1 However, multiple lines of evidence suggest that individuals with impaired face recognition can score in the normal range on the test. To investigate this possibility, we have tested a relatively large sample of patients with developmental prosopagnosia using the BFRT.The BFRT has a short form with 27 possible points and a long form with 54 possible points. On each item, subjects are presented with a target face above six test faces, and they are asked to indicate which of the six images match the target face. Male and female faces are used, and the faces are closely cropped so that no clothing and little hair are visible. The faces are centered within a black background, and the entire image is~6.5 cm ϫ 6.5 cm. For the first six items, only one of the six test faces displays the target individual, and the target image and the test image are identical. In the next seven items, three of the test faces match the target face, and the poses for the test images are different from the target image. When the long form is administered, subjects are presented with nine more items. There are three matches per item and test faces are presented with different lighting conditions. There is a table for converting short form scores to long form scores, and scores of Ն41 are classified as normal. No time limits are placed on individual items or the test as a whole.Studies of patients with prosopagnosia and normal subjects suggest that normal scores on the BFRT do not require normal face recognition abilities. Two patients with prosopagnosia were reported who scored in the normal range on the BFRT, 2,3 and these subjects reported that their performance relied heavily on feature matching rather than the holistic processing used by individuals with normal face recognition. 4 Both subjects required more time than most subjects.2,3 In another study, normal subjects scored in the normal range despite the occlusion of most of the facial information. 5 The subjects were presented a modified version of the BFRT in which only the eyebrows and hairlines were visible. Despite the limited information available, 59% of the subjects achieved normal scores on the short form, whereas 41% scored in the normal range on the long form.

N170 asymmetry as an index of inferior occipital dysfunction in patients with symptomatic occipital lobe epilepsy

“…The previous studies demonstrated that the capability to discriminate faces from other objects is not affected in temporal lobe lesions, supporting the thesis that such processing is done in the ventral temporal-occipital areas (Allison et al, 1994;Haxby et al, 1996;Kanwisher et al, 1997;Steeves et al, 2006;Pitcher et al, 2007). The neuropsychological tests presently available have nevertheless been unable to detect reliably abnormalities in face recognition (Duchaine and Weidenfeld, 2003;Duchaine and Nakayama, 2004), making it difficult to produce strong inferences about the localizations of occipital lesions from the obtained results.…”

A cross-syndrome study of the development of holistic face recognition in children with autism, Down syndrome, and Williams syndrome

“…However, in some experimental conditions, participants with WS were at floor level, rendering interpretation of results more difficult. And while performance on the Benton test was predominantly in the normal range for the WS group, the Benton test does not guarantee that recognition is achieved via normal processes since many of the items may be solved by featural processing alone (Duchaine & Nakayama, 2004).…”

“…This test has not been standardised against a full normal sample and has limitations as a test of face recognition ability since accurate performance can be achieved using feature-based strategies (Duchaine & Nakayama, 2004). Nevertheless, it is often used in the literature and raw scores provide an indication of the relative abilities of the groups.…”

Normative data for accuracy and response times at the computerized Benton Facial Recognition Test (BFRT-c)

“…For this reason, Benton always stated that low performance at the BFRT was not diagnostic of (acquired) prosopagnosia (Benton, 1980). Duchaine and Nakayama (2004;2006b) reached the same conclusion for people diagnosed with a long-life impairment in individual face recognition, i.e. developmental prosopagnosia, showing that 73% of their group of participants could perform at normal accuracy levels at the BFRT.…”

“…It has sometimes been claimed that the traditional neuropsychological BFRT would be invalid because of a lack of sensitivity to individual face processing difficulties: individuals presenting (developmental) prosopagnosia would be frequently falsely diagnosed as normal (Bowles et al, 2009;Duchaine & Nakayama, 2004, 2006a and typical participants could achieve reasonable scores even when most of the internal part of the face is masked, preventing normal processing of the face stimuli (Duchaine & Weidenfeld, 2003). In fact, as mentioned in the introduction, Benton himself noted that some patients with acquired prosopagnosia could achieve relatively normal or borderline accuracy scores at this test (Benton, 1980;Benton & Van Allen, 1972; see e.g., Delvenne et al, 2004;De Renzi et al, 1991;Gainotti, 2013;McNeil & Warrington, 1991).…”