Impairmentversusdeficiency in neuropsychological assessment: Implications for ecological validity

Abstract

Neuropsychological test interpretation has relied on pre- and postmorbid comparisons, as exemplified by the use of demographically adjusted normative data. We argue that, when the assessment goal is to predict real-world functioning, this interpretive method should be supplemented by "absolute" scores. Such scores are derived from comparisons with the general healthy adult population (i.e., demographically unadjusted normative data) and reflect examinees' current ability, that is, the interaction between premorbid and injury/disease-related factors. In support of this view, we found that substantial discrepancies between demographically adjusted and absolute scores were common in a traumatic brain injury sample, especially in participants with certain demographic profiles. Absolute scores predicted selected measures of functional outcome better than demographically adjusted scores and also classified participants' functional status more accurately, to the extent that these scores diverged. In conclusion, the ecological validity of neuropsychological tests may be improved by the consideration of absolute scores. (JINS, 2009, 15, 94-102.).

Verbal learning differences in chronic mild traumatic brain injury

“…In daily interactions such as conversations, lectures, and work-place instructions, individuals are often presented with information one time, rather than being given the benefi t of repeated "trials." For this reason and others, studies have questioned the ecological validity of composite learning and memory domain scores in elucidating the nature of memory complaints following TBI (Silver, 2000 ;Silverberg & Millis, 2009 ;Wood, 2009 ;Yeates & Taylor, 2005 ) Consistent with our hypothesis, participants with a history of chronic mild TBI did differ signifi cantly from the control participants on a measure of initial verbal learning (acquisition). Furthermore, there was no signifi cant group difference on the total composite learning score or delayed memory variables.…”

An Evaluation of the Evidence that Methamphetamine Abuse Causes Cognitive Decline in Humans

“…For example, low average performance for individuals with a high school degree likely relates to much lower functional ability than low average performance for individuals who graduated college (of which, MA-dependent individuals typically have lower educational attainment than their peers). For this reason, evidence suggests that scores normed to the average performance of healthy adults, without consideration of demographic characteristics (ie, 'absolute' scores), have a tighter relationship with everyday functioning than scores that are normed to the specific demographic characteristics of the individual (Silverberg and Millis, 2009).…”

Cognitive functioning following traumatic brain injury: A five-year follow-up

“…Future research should incorporate assessment of real world functioning along with a comprehensive assessment of cognitive functioning. This would allow researchers to establish the ecological validity of neuropsychological assessment thereby significantly increasing the utility of the process to the person with TBI and their family (Silverberg & Millis, 2009). To develop a full understanding of the consequences of TBI as a process requires information on multiple aspects of patient functioning throughout their life span following the injury (Masel & DeWitt, 2010).…”

“…Despite these developments there is also evidence that these hypothesised constructs may overlap (Clune-Ryberg et al, 2011). However consideration of cognitive functioning from a domain perspective continues to provide useful insights into improving rehabilitation practices and understanding the impact of cognitive impairment on real-world functioning and quality of life (DeLuca, Schultheis, Madigan, Christodoulou, & Averill, 2000;Silverberg & Millis, 2009). …”