Neuropsychological Assessment and Ethical Issues

Neuropsychological assessment (NPA) is a logical analysis of the relationship between the brain and behavior. The motive for performing the neuropsychological assessment is to identify an individual’s cognitive strengths, flaws, and the relationships between the neuropsychological outcomes and psychiatric and medical conditions of a person. The aim of this paper is to provide features, uses, tests, and ethical considerations associated with neuropsychological assessments. NPA is typically used to give further information regarding various developmental disorders. The medical disorders include; recovery from brain tumors/cancer, genetic diseases, neurological conditions such as movement disorder and epilepsy, and traumatic conditions such as brain injury and concussions (Lee & Suhr, 2021). Furthermore, the test is also administered to children who have acquired disorders because of exposure to heavy metals like lead and teratogenic substances.

Failure of specific interventions also leads to neuropsychological assessments. For example, neuropsychological assessments are preferred when interventions for conditions such as autism, fetal alcohol spectrum, ADHD, dyslexia, and spectrum disorder have failed (Lee & Suhr, 2021). Other conditions such as behavioral dysregulation, anxiety, obsessive-compulsive disorder, and depression tend to use neuropsychological assessments to provide further insights into the condition. This helps in potential recommendations that will aid in proposing suitable intervention programs in school or at home (Moroni & Belin, 2021). In a neuropsychological test, the number of questions presented varies depending on the condition of the person. The question posed by the examiner may be repeated twice or even more.

Reliability is a significant aspect of a neuropsychological test, and various reliability tests aid in enhancing the performance of psychological tests. They include test-retest reliability, coefficient of equivalence, and the method of split halves. Firstly, in test-retest reliability, the same test is administered twice to the same group (Sherman et al., 2021). To relate the sets of scores obtained on the two occasions, a correlation coefficient is then computed. The test is considered more reliable as the correlation coefficient closely approximates the value of 1 (Sherman et al., 2021). Under these conditions, the correlation coefficients computed are at times referred to as stability coefficients. A test is less affected by the testee’s internal rate conditions that are unimportant to the measurement purpose or test situation’s conditions (Sherman et al., 2021). Some instruments of assessment measure construct that may not be stable.

Secondly, the equivalence coefficient tests the neuropsychological assessments associated with the construct from a universe of items. The second assessment could come in handy for serial testing practice effects can reduce the usefulness of consecutive testing with the original form. The existence of alternate forms raises the question of whether the forms are equivalent. This type of reliability is assessed by an approach that involves administering both forms of the assessment to the same group and computing an equivalence coefficient (Sherman et al., 2021). It is essential to separate the administration of the two forms by a minimum amount of time. When one wishes to acquire the highest estimate of equivalence reliability between the two tests, the time separating both administrations should be the shortest period possible (Sherman et al., 2021). It is essential to report the time that intervenes between the two assessment occasions to estimate the influence of the time interval on the reliability of equivalence.

Recording a recovery course from an acute brain trauma requires an understanding of the recovery function degree aside from the learning curve that would be demonstrated under the influence of the effects of the practice. Both test forms must contain the same length, difficulty level, psychometric properties, and format for the equivalence coefficient to be interpreted reasonably (Sherman et al., 2021). Attenuation of the correlation coefficient value is due to the differences in these dimensions. Usually, the equivalence coefficient is a coefficient of correlation, which describes the level to which both sets of observations differ, and the two tests scores should co-vary linearly. This condition for an equivalence assessment is necessary but insufficient since the other mentioned dimensions must also be considered.

Thirdly, the split halves method is only used in tests that take on unidimensionality of the construct measures by the assessment; the technique is used for a unidimensional subscale when the test is multi-dimensional. In the split-half method, the test is split in half and correlates from one half of the assessment with the other half’s score (Sherman et al., 2021). The split-half approach cannot be used on speeded tests for obvious reasons. It provides essential data on the tests made of items of almost equal difficulty and which are assumed to tap a single construct. Splitting the test in the middle or carrying out an odd-even split where the sum of actual items is correlated with the sum of odd items is the most preferred method.

The validity of a neuropsychological assessment is significant because it provides the kind of data required for a specific interpretation. The consequence of interest in clinical psychology may be a behavioral disorder or a particular personality style (Block, 2021). The consequence of interest may range from brain impairment to the implications of the test results for adaptive behavior. The clinical utility of a test is the ultimate evaluative validation demonstration. Tests survive to the point that they supply convenient data on average and in single or individual cases (Block, 2021). The different validation forms are signs that show a clinician the relative significance of a performance pattern and the possibility that a specific performance pattern is diagnostically influential to the general understanding of the patient.

The main types of validity in the neuropsychological assessment include construct, content, and criterion validity. Firstly, construct validity is the level to which the test score for an individual correlates to the theoretical concept (Block, 2021). The assessment is aimed to measure that is the evidence that the test scores correlate relatively poorly with scores on theoretically different measures and relatively correlate highly with scores or theoretically like measures. Secondly, content validity is the extent to which the items being tested objectively represent the whole domain under the study (Block, 2021). Thirdly, criterion validity measures the extent and fitness of one measure predicting another measure’s result. This is significant in predicting the behaviors of the examinee by the therapist.

When administering or interpreting the results of a neuropsychological assessment, several ethical considerations should be considered. Firstly, when beginning a neuropsychological evaluation, informed consent should be first considered before begging the tests. This is an ethical obligation that reflects the good practices of a clinic. The client has a right to receive the information and decide concerning the psychological assessments; this enhances maximum cooperation and participation in the assessment (Knauss, 2019). The principles of informed consent include voluntary participation and knowledgeable decisions, and the person conducting the assessment should have the capacity to make decisions. The consenting person has to understand whatever they are consenting to, and also, they should have good faith to give out the required information to make informed choices (Knauss, 2019). However, there are situations where the psychologists may not provide the examinee with complete information regarding the tests. Still, it is obligatory to explain the potential uses and implications of the tests conducted.

Secondly, the confidentiality of the information provided by the examinee is paramount in enhancing the relationship between the psychologist and the examinee. Information provided by the examinee should be confidential and should not be disclosed to any third parties unless required (Bush & Pimental, 2017). Such cases include situations where the information provided by the examinee is required to make informed decisions either by a court of law or by education institutions (Knauss, 2019). For example, in a neuropsychological test, information concerning the stability of the examinee may be used by the school administration to enhance the student’s performance in school. However, if the information is not required, then the neuropsychological assessment information should be confidential.

Thirdly, it is crucial to provide the examinee with indirect warnings before performing the exact test when administering the tests. It is significant to warn patients that poor efforts and checking for exaggerations are also used in the evaluation (Bush & Pimental, 2017). For example, it is inappropriate to warn the examinee by saying how other people find the tests very easy and appealing or telling the patients that the tests are designed to detect poor effort. Direct warning of the patient significantly impacts the sensitivity of the effort test.

Fourthly, the psychologist should not assume that the examinee who succeeds in the neuropsychological test provided complete effort during evaluation. When an examinee passes the effort test, this does not mean that the person gave out full effort in the neuropsychological evaluation. The generalization of a single test to other tests is inappropriate as it does not conceptualize a person’s effort (Bush & Pimental, 2017). Some participants make a reasonable effort in faking the effort test and are not detected by the effort procedure. Furthermore, a person may decide to underperform in some tests and not in others. This effort is difficult to detect when handling such examinees (Knauss, 2019). The psychologist performing neuropsychology assessment has to be responsible as the literature used to interpret the outcomes of the patients keeps on changing with time (Bush & Pimental, 2017). One should consider enhancing the results from a given test by applying various tests such as word memory tests to understand body language.

In conclusion, neuropsychological assessments provide further information on various disorders and enhance information whenever specific tests have failed. It provides information on traumatic conditions, epilepsy, genetic disorders, and disorders resulting from heavy metals exposure. Neuropsychological assessments help in other conditions such as anxiety and depression whenever their specific interventions have failed. Reliability and validity are significant when performing neuropsychological assessments. Various methods are used to check the reliability, including the test-retest method, coefficient of equivalence, and split halves method. When detecting validity, the three main types of validity have to be considered: content, criterion and construct validity. Ethical considerations have to be considered when administering or interpreting the results of a neuropsychological assessment. It includes the provision of consent, confidentiality, indirect warnings, avoiding assumptions, and generalizations on effort tests.


Block, C. (2021). The neuropsychologist’s roadmap (1st ed.). American Psychological Association.

Bush, S., & Pimental, P. (2017). Ethical Issues and Solutions in Pediatric Neuropsychological Assessment. Journal of Pediatric Neuropsychology, 4(1-2), 4-15. Web.

Knauss, L. (2019). Ethical and professional issues in assessment. The Cambridge Handbook of Clinical Assessment and Diagnosis, 38-48. Web.

Lee, G., & Suhr, J. (2021). Principles and practices of Neuropsychological assessment. Reference Module in Neuroscience and Biobehavioral Psychology. Web.

Moroni, C., & Belin, C. (2021). Contribution of the neuropsychological assessment in concussion. Neurochirurgie, 67(3), 244-248. Web.

Sherman, E., Tan, J., & Hrabok, M. (2021). A compendium of neuropsychological tests (4th ed.). Oxford University Press.

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PsychologyWriting. "Neuropsychological Assessment and Ethical Issues." September 15, 2023.