Neuropsychologists have a plethora of tests and procedures from which to choose. The use of batteries has seen some decline over time, with a trend toward use of flexible batteries, though test batteries which, as a whole, may have less problems in meeting Daubert standards. Nevertheless, the Wechsler Scales and the Halstead-Reitan Battery continue a long history of favored use found in historical surveys of neuropsychology practice. The published survey has implications for the courts under the Frye Test.
Trends toward using briefer or more limited measures are in part likely driven by cost concerns, managed care influences, Medicare and other insurance limitations and obstacles which make it difficult for psychologists to complete more complete or time-consuming assessments. The trend toward briefer tests or measures may become a concern, since well-constructed tests with more items tend to be more reliable. Reliability places an upper limit of validity of the test or battery. Patient variables such as age, fatigue, cooperation, and tolerance for lengthy procedures may necessitate briefer approaches. Different and usually briefer approaches are also often necessary when rapid decisions must be made in hospital settings or when bedside assessment is needed. Conversely, short-forms and less than complete assessments are usually inappropriate in forensic contexts.
A 2000 survey cited below notes that the most frequent referral questions are one of diagnosis or forensic determinations. This is an interesting finding, since in some state courts, neuropsychological testimony about diagnosis or etiology is sometimes limited or precluded despite the apparent fact that this is a well established area of practice.
A survey of randomly selected neuropsychologists who were members of the International Neuropsychological Society, National Academy of Neuropsychology and Div. 40 of the American Psychological Association, the major national organizations of neuropsychologist in the United States was published by Rabin et. al. in the January 2005 Archives of Clinical Neuropsychology. This reflected common practices and frequently used neuropsychological tests.
The Wechsler Scales including the Wechsler Adult Intelligence Scales, Wechsler Intelligence Scale for Children, and Wechsler Memory Scales were among the most frequently used tests. The Trail-Making Test, which is a test used in the Halstead-Reitan Battery and the California Verbal Learning Test, a test of auditory supraspan memory were also amongst the most used tests. The Halstead-Reitan Battery (HRB)was the most frequently used neuropsychological test battery, being utilized by approximately 15% of the neuropsychologists surveyed. Some psychologists used only portions of the HRB. Other tests within the top 10 tests administered were the Rey Ostereith Complex Figure Test, which is a test of construction, planning and visual memory, the Wisconsin Card Sort Test, a test of executive functioning, and tests of supraspan auditory learning, such as the Rey Auditory Verbal Learning Test. The only other test which was used by more than 10% of the neuropsychologists surveyed was a test of personality and adjustment, the MMPI (now the MMPI-2).
The most common memory tests used for children were the Wide Range Assessment of Memory and Learning (WRAML) and the Children’s Memory Scales (CMS). Commonly used tests of language function were the Boston Naming Test and the Controlled Oral Word Association Test. While there are likely regional variations, a review of tests administerd at thePennsylvania Head Injury Program indicated that the Wechsler Intelligence and Memory Scales and the WRAML were also amongst the most frequently administered tests in neuropsychologial evaluations of adults and children. They also found that all or portions of the Halstead-Reitan Battery were amongst the most frequently administered tests for adults and children. The Boston Naming Test, Wisconsin Card Sort Test and portions of the Woodcock-Johnson and the Wide Range Achivement Test were also frequently used by children.
The survey indicated that the most frequent referral question was determination of diagnosis followed by rehabilitation planning and forensic determinations. Educational planning and assessments of capacity to work also were also amongst the top five most frequent types of referrals.
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Rabin, L.A., Barr, W.A., Burton, L.A., Assessment practices of clinical neuropsychologists in the United States and Canada: A survey of INS, NAN, and APA Division 40 members. Archives of Clinical Neuropsychology 20(1) 33-65, 2005