MEDICO LEGAL M A G A Z I N E
WHY EFFORT TESTS SHOULD BE EMPLOYED AS STANDARD IN NEUROPSYCHOLOGICAL ASSESSMENTS Professor Gus A Baker1 and Dr Perry Moore1,2 1Tribune Neuropsychology Services , 2Peregrine Neuropsychology Solutions Professor Gus Baker is EM Professor of Clinical Neuropsychology and Honorary Clinical Neuropsychologist. He has been practicing as a Clinical Neuropsychologist and an Academic Clinician for 28 years. He served on the BPS guidelines committee for the use of effort testing in clinical practice and is the author of a number of related publications. Professor Baker serves as the Chair of the Professional Standards Unit of the BPS Division of Neuropsychology. Email: g.baker@liv.ac.uk Dr Perry Moore is a Clinical Neuropsychologist with a strong interest in both researching effort testing and its application in clinical practice. He is the chair of the second BPS guidelines committee on effort testing in clinical practice. Dr Moore is Secretary of the Professional Standards Unit of the BPS Division of Neuropsychology. Email: office@psychresults.co.uk Introduction Neuropsychologists are frequently invited to report to the court on the extent of an individual’s level of cognitive impairment. The opinion of the neuropsychology expert on the type and extent of cognitive impairment will typically be informed by a range of evidence, including the available medical records, an interview with the claimant, and the results of objective tests of cognitive functioning. A low score on an objective test might indicate a cognitive impairment directly related to the impact of the index event on brain functioning. However, performance on tests of cognitive functioning may be affected by
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a number of factors, including pre-existing ability level, other aspects of functioning such as sensory or motor ability, medications and so on. The resulting score on a cognitive test may also be a product of how well the individual engaged with the tests. This concept is sometimes referred to as effort but more contemporary terminology favours the concept of performance validity.
Importance of Performance Validity It is widely recognised, that external incentives in terms of financial rewards, compensation or the avoidance of unwanted scenarios increases the likelihood
