Impairment versus deficiency in neuropsychological assessment: Implications fo ecological validity

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Reference Type:
Journal Article
Accession No.:
Journal of the International Neuropsychological Society
Year, Volume, Issue, Page(s):
2009, vol. 15, issue 1, pp 94-102
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Neuropsychological test interpretation has relied on pre- and postmorbid comparisons, as exemplifi ed 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 refl ect examinees’ currentability, 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 braininjury sample, especially in participants with certain demographic profi les. Absolute scores predicted selected measures of functional outcome better than demographically adjusted scores and also classifi ed participants’ functional statusmore 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.)
Silverberg, N.D., & Millis, S.R.
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