Neuropsychological assessment: The need for a more pragmatic approach

The development of clinical neuropsychology has shown a gradually changing emphasis, from tests of organicity, through actuarial approaches, towards a more flexible approach, which utilises qualitative observations of patient behaviour. In recent years clinical neuropsychologists have played a greater role in patient management, in addition to diagnosis, particularly in the rehabilitation setting. The emphasis has thus changed gradually from measurement to application. Relationships between test performance and functional efficiency in daily life have not always been addressed, however. The focus tends to be on “impairment” as opposed to “disability”. The limitations of conventional neuropsychological assessment in predicting disabilities have been demonstrated in a number of studies. Possible solutions to this problem are discussed critically. These include the use of behavioural observation, rating scales or checklists. and standardised assessment procedures that simulate everyday activities. Implications for treatment are also addressed. 1988 Australian Psychological Society