Effort testing – Worth the effort? (Part 1 of 3)

Every neuropsychological assessment should include a test of effort?

Dr Fraser Morrison, Clinical Director, Alba Psychology

Part one

The purpose of a neuropsychological assessment is to assess the level of cognitive functioning in an individual, ordinarily within the context of identifying a neuropsychological deficit. A neuropsychological assessment can comprise of a number of assessment methods including clinical judgement, feedback from significant others and cognitive testing (Hebben & Milberg, 2002). The assessment process is used with the assumption that it will improve the understanding of an individual’s neuropsychological functioning and offer an explanation for the observed deficit and behavioural presentation of brain dysfunction (British Psychological Society, 2009).


Within the context of a Personal Injury Claim, neuropsychological assessments are used ordinarily in cases that involve brain injury, possibly as a result of an incident such as Road Traffic Accident. Other cases involving potential negligence such as medical procedures or industrial accidents that have led to cognitive impairment can also necessitate the use of a neuropsychological assessment.


As is the case with any assessment, it is crucial that the process is based on valid and relevant pieces of information. In the context of cognitive testing a basic assumption of testing principles is that an individual will attempt to perform at their best level, or with maximum effort. If they do not then it would categorise an assessment as an inaccurate measure of cognitive abilities. In the case of cognitive testing, one assumes that test scores will reflect test performance, which in turn offers an accurate reflection of neuropsychological domains of functioning. If, for whatever reason, performance in cognitive testing is deemed to be an inaccurate reflection of actual neuropsychological functioning then the assessment process is worthless. Thus the accuracy of test performance must be examined to ensure this is reflective of actual neuropsychological functioning.


In order to determine whether neuropsychological test results are valid there must be evidence that clinical presentation during testing in consistent with an individual’s history. It is equally important that the observed pattern of results fit with a model of disease or neuropsychological disorder (Lezak et al., 2004). In examples where this is not the case it offers evidence that an individual may be performing at a level below their optimum performance and implies that the assessment process and test results have questionable validity.


Part two to follow next week……….