Neurbehavioral Medicine Consultants
Psychological and Neuropsychological Testing

Testing and Evaluation Techniques

Psychology is the scientific study of mental processes and behavior. Because scientific investigation requires quantitative and reproducible results, techniques have been devised for making quantitative measurements of such characteristics as behavior, personality and cognition. Clinical psychologists have a wide range of tests available to measure properties such as personality, intelligence and various aspects of a patient's ability to function. Some, such as the Rorschach inkblot test, are sufficiently well known that references to them are part of popular culture, but many others have been formulated as well. Most tests are quantitative, and have been scientifically validated by gathering data from some normative standard. If the norms are based on age and educational achievement, valid comparison can be made between an individual's performance and that of persons considered normal. The tests can generally be placed in two groups according to the type of assessment in which they are used although, since some tests may be used in either type, a degree of overlap exists.

Psychological Testing

Psychological tests are used in the evaluation of a patient's intelligence, personality and academic function and may also be used to determine dimensions of psychopathology, attitudes and behavior.

So-called IQ tests provide relative assessments of overall intelligence. A person's score must be evaluated in the context of the specific test used to measure it. Many different tests have been developed, including several which are nonverbal; these are useful in cases where some sort of language barrier might interfere with administration of one of the more traditional tests. Tests of memory are incorporated into many of the intelligence tests, although tests are also available which focus specifically on memory.

Numerous assessment tools are available for measuring aspects of personality. Certain traits are shared by all people, but in different combinations which account for the wide range of personalities occuring in the general population. Some tests are intended to determine the way normal traits occur in individuals, and others can be used to identify abnormal personality patterns and specific personality disorders. The problems which might evolve in a relationship because of differences in personality, values or attitudes between partners may also be assessed with specific tests designed for couples. Psychologists can also measure the factors which may be most important in motivating an individual.

Various psychological problems can be evaluated with specific tests which measure such conditions as depression and anxiety, as well as stress, which may be closely related to these two conditions. Other tests can be used for determination of abnormal patterns such as paranoia and schizophrenia. In a family where one or both parents have been victims of abuse, the psychologist may measure the risk that children in that family will also be abused.

Psychological testing is useful in a wide range of circumstances, including forensics and the screening of applicants for certain types of employment. However, it is also a useful tool to help direct psychotherapy so that the psychologist may provide effective intervention as early in the process as possible.


Bedlam Puzzle

Neuropsychological Testing

Neuropsychological tests are designed to assess an individual's cognitive ability and underlying brain function and are important in the diagnosis or exclusion of developmental, degenerative and acquired disorders of brain function. In practice, these tests are most often used to evaluate neurological or neuropyschiatric disorders such as traumatic brain injury, multiple sclerosis, dementia, language disturbance, learning disabilities, attention deficit and hyperactivity disorder, and stroke. Specific tests are designed to evaluate such factors as concentration, memory, reading comprehension, judgment and ability to interpret and process information. Other tests evaluate functions such as visual perception, movement and coordination.

puzzle pieces

Bedlam Puzzle Pieces

Neuropsychological tests are administered by a neuropsychologist, a psychologist with specific expertise in the relationship between the brain and mental functions such as memory, language, and perception. He or she will review the patient's medical history, specifically noting any traumatic head injury or neurological symptoms. Some neuropsychological tests are administered in written form, with the subject reading a question or looking at a picture and then selecting a response. Other tests are given orally, with the subject being asked to respond to a question or perform a skill, such as putting items in a specific order, while the neuropsychologist records the responses.

Many techniques for medical evaluation of the brain and central nervous system have been developed. Imaging studies such as computed tomography (CAT scan), magnetic resonance imaging (MRI) and positron emission tomography (PET scan) examine the structural, physical and metabolic condition of the brain. Electroencephalography (EEG) measures the brain's electrical activity. However, neuropsychological tests provide the only methods for clinical evaluation of actual brain and cognitive function over a range of processes from simple motor performance to complex reasoning and problem solving. The scientific validation of these tests includes the generation of norms from groups of people who do not have a diagnosis of brain injury or other known brain disease or disorder.

brain image

MRI Scan Image

The neuropsychologist is likely to tailor the selection of tests to be administered to the condition being evaluated and the specific clinical questions which have been posed. When designing the test regimen for a particular subject, the psychologist will seek to sample a wide range of cognitive functions so that the various results may be correlated with one another. Once data gathering has been completed and each of the tests has been interpreted, the practitioner integrates the test results, an analysis of the consistency of the test results and observations of the patient, along with the history obtained from the patient and any other available records, to synthesize a comprehensive neuropsychological assessment. The neuropsychological assessment complements the neurological examination and studies such as MRI and PET scans and contributes to the formulation of a treatment plan for the patient. This plan will address whatever deficits are detected in any of the tests, as well as any other psychological factors such as depression or anxiety which may also be present.

Because of the psychologist's need to examine a wide range of functions, the testing process is time-consuming, and may require from three to 12 hours for testing and a similar amount of time for evaluation of the results and preparation of the final report. Obtaining the history and other information may be performed during a separate session as well. Neuropsychological testing is considered to be a medical diagnostic procedure by most insurance companies, with these costs reimbursed at the same rate as other medical examinations.

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