Effects of handcuffs on neuropsychological testing: Implications for criminal forensic evaluations

Abstract

Neuropsychological evaluations are increasingly performed in forensic contexts, including in criminal settings where security sometimes cannot be compromised to facilitate evaluation according to standardized procedures. Interpretation of nonstandardized assessment results poses significant challenges for the neuropsychologist. Research is limited in regard to the validation of neuropsychological test accommodation and modification practices that deviate from standard test administration; there is no published research regarding the effects of hand restraints upon neuropsychological evaluation results. This study provides preliminary results regarding the impact of restraints on motor functioning and common neuropsychological tests with a motor component. When restrained, performance on nearly all tests utilized was significantly impacted, including Trail Making Test A/B, a coding test, and several tests of motor functioning. Significant performance decline was observed in both raw scores and normative scores. Regression models are also provided in order to help forensic neuropsychologists adjust for the effect of hand restraints on raw scores of these tests, as the hand restraints also resulted in significant differences in normative scores; in the most striking case there was nearly a full standard deviation of discrepancy.

Neuropsychological Assessment in The Forensic Context: A Scoping Review

“…It is important to highlight that restricting detainees' hands (through the use of handcuffs) during the execution of neuropsychological tests can affect the performance of the assessed individuals 51 . Therefore, the generalization of forensic neuropsychological assessments and their results must be considered with caution and properly contextualized.…”