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Chapter 4.3

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Introduction
❑ A very important growth area in clinical psychology over
the past several decades has been the field of
NEUROPSYCHOLOGY and it has been reflected in:

1. increasing membership in professional neuropsychological

associations;

2. the number of training programs that offer neuropsychology

courses; and

3. the number of papers, books, and journals now published on

neuropsychological topics.

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Definitions
❑ Neuropsychology–The study of the relationship between
brain function and behavior (How do complex brain
properties allow behavior to occur?).

❑ Neuropsychological Assessment–Non-invasive method

of describing brain function based on a patient’s
performance on standardized tests.
▪ Cerebral brain lesions, localization, limitations on educational,
social, or vocational adjustment.
▪ Can aid with assisting the manner in which an illness or injury
progresses.

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Roles of Neuropsychologists
1. Neuropsychologists are called by neurologists to help establish/rule
out a specific diagnosis.
Eg: To rule out a disorder with a neurological/emotional basis
(what is the basis?)

2. Neuropsychologists can make predictions for the prognosis of

recovery (due to understanding functional systems of the brain).

3. Intervention and rehabilitation for treatment—domains of functioning

for rehabilitation.

4. Evaluate patients with mental disorders to help predict the course of

illness and to tailor treatment to patients’ strengths and weaknesses.

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History of Neuropsychology
A.THEORIES OF BRAIN FUNCTIONING
❑ Historical roots of Neuropsychology points to different time periods
from Edwin Smith Surgical Papyrus (document thought to date
between 3000 and 1700 B.C., which discusses localization of function
in the brain) to Pythagoras and his claim that behavior reactions
occur in the brain.

❑ 19th century—damage to cortical areas has been related to

impaired functioning of certain behaviors.
▪ Franz Gall and currently discredited phrenology—differences in
intelligence and personality due to bumps and indentations on the skull.

❑ Localization of Function: Certain brain regions are responsible for

specific functions/behaviors.

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History of Neuropsychology
❑ Work during this period was being conducted by Broca, Pierre
Flourens, Karl Lashley, and others.

❑ Equipotentiality: Though there is the localization of function, the

cortex functions as a whole and not in isolated units. Damage will
impair higher functioning; substitutions can occur for damage.

❑ Functional Model: Integrates localization of function and

Equipotentiality theory, states that areas of the brain interact with
each other to produce behavior. Several functions behavior, and
does not view behavior as the result of discrete brain regions.

❑ Reorganization: Recovery from brain damage can occur.

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History of Neuropsychology
B. NEUROPSYCHOLOGICAL ASSESSMENT
❑ For a long time viewed brain damage as a unitary phenomenon

❑ Benton Visual-Retention Test and the Graham-Kendall Memory-for-

Designs Test—targeted assessment of absence/presence of brain
damage.

❑ Neuropsychology began to grow after WWII due to an extensive

number of head injuries, and the development of the field of clinical
psychology.

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History of Neuropsychology
❑ Wald Halstead—looked at brain damage and characteristics of
subsequent behavior; developed a test battery composed of 10
measures through factor analysis. Revised by Ralph Reitan
➢ Half-Reitan Neuropsychological Test Battery

❑ Flexible battery approach assessment: Allows each assessment to

be tailored to an individual based on the clinical presentation and
the hypothesis of the neuropsychologist.

❑ Standard battery approach assessment: Very structured, time-

consuming, and rarely flexible.

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Brain Structure and Function

❑ Left Hemisphere: Controls right side of the body, involved with
language function, logical inference, detailed analysis.

❑ Right Hemisphere: Controls the left side of the body, involved with
visual-spatial skills, creativity, musical activity & perception of
direction.
➢ Communicate via Corpus Callosum that integrates complex
behavior.

❑ Frontal Lobes: Most developed, allows us to compare our behavior

& reactions of others in order to obtain feedback and alter our
behavior as necessary. Associated with executive functions and
emotional control. Development largely occurs in adolescence.

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Brain Structure and Function

❑ Temporal Lobes: Linguistic expression, reception, and
analysis, interpreting of non-verbal cues.

❑ Parietal Lobes: Tactile and kinesthetic perception, spatial

perception, body awareness, and a little language
understanding.

❑ Occipital Lobes: Visual processing and visual memory.

❑ Cerebellum: Motor coordination, equilibrium control, and

muscle tone functioning.

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Causes of Brain Damage

1. Trauma

2. Degenerative Diseases

3. Nutritional Deficiencies and Toxic Disorders

4. Chronic Alcohol Abuse

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Causes of Brain Damage

1. Trauma
❑ Brain tumors can grow outside, within the brain, or can be the
result of cells spreading from other body areas.
❑ Increase in tumor size poor memory, affect problems,
judgment issue.
❑ Treatment surgery or radiation

2. Degenerative Diseases
❑ Neuron degeneration in Central Nervous System
❑ Includes Huntington’s, Parkinson’s, Alzheimer’s, and Dementia
❑ Alzheimer’s is most common followed by Parkinson’s and then
Huntington’s
❑ Disturbances—motor, speech, language, memory, judgment

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Causes of Brain Damage

3. Nutritional Deficiencies and Toxic Disorders
❑ Malnutrition can lead to neurological and psychological deficits
❑ Metals, toxins, gases, some plants can be absorbed through the skin
toxic consequences or brain damage
➢ Delirium: Disruption of the consciousness
4. Chronic Alcohol Abuse
❑ Can lead to tolerance and dependence on the substance; changes in
neurotransmitter sensitivity or shrinkage of brain tissue.
❑ Deficits of Limbic system—memory formation, emotional regulation &
sensory integration.
❑ Diencephalon: Region near the center of the brain that includes the
bodies of the hypothalamus.
➢ Shrinkage or lesions in these areas.
❑ Atrophy of the cerebral cortex & damage to the cerebellum

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Consequences and Symptoms of

Neurological Damage
❑Impaired orientation – difficulty recalling the name, day of
the week, surroundings

❑Impaired memory – difficulty recalling loved ones,

memories, filling in gaps, learning issues

❑Impaired intellectual functions – difficulty with

comprehension, speech production, general knowledge

❑Impaired judgment – difficulty with decisions

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Consequences and Symptoms of

Neurological Damage
❑Shallow and Labile Affect –laughing/weeping easily and
switching emotions inappropriately

❑Loss of emotional and Mental Resilience – can function in

daily life but difficulty functioning under stress, emotional
reactions
Eg. fatigue, mental demands

❑Frontal Lobe Syndrome: Personality deficits

Eg. poor impulse control, planning issues, temper tantrums.

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Brain-Behavior Relationships
❑ Important to determine where in the brain the injury occurs, same-
size lesions in different brain regions will produce different
behavior deficits.

❑ Brain damage can lead to deficits in visual perception, auditory

perception, voluntary motor coordination, memory, and other
brain regions.

❑ Clinicians are called to determine the level of intellectual

deterioration—involves comparison to previous levels of
functioning.
➢ Decline due to psychosocial factors (ex: motivation, emotional
issues) or brain injury.

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Methods of Neuropsychological
Assessment
❑ Major Approaches
A. Standard Battery Approach/Fixed Battery Approach
▪ Evaluates patients for all basic neuropsychological abilities.
➢ Very expensive, the possibility of a patient becoming fatigued,
not tailored/inflexible

B. Process/Flexible Approach or Hypothesis-Testing

Approach
▪ Assessment is tailored to the individual patient and the
neuropsychologist chooses specific tests.
➢ Can be very useful but can also lead to the clinician choosing
the wrong test.

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Methods of Neuropsychological
Assessment
❑ Interpretations of Neuropsychological Tests
▪ Interpretation in the context of normative data
Eg. A patient score below the average mean score.

▪ Various methods also include Difference Scores for

impairment, Pathognomonic signs of brain damage
(failing to draw the left side of a picture), Pattern
Analysis & statistical formulas.

▪ Cutoff scores or absolute scores shoved the most

accuracy.

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Methods of Neuropsychological
Assessment
❑ Neurodiagnostic Procedures

▪ Neurodiagnostic Procedures: CAT scans, fMRI’s,

spinal taps, and other procedures for detecting the
presence and location of brain damage. Variation in
expense, sensitivity, the risk for patients.

▪ SPECT & fMRIs assess blood flow changes in the brain;

are useful for assessing brain function.

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Variables That Affect Performance on

Neuropsychological Tests
❑ Includes biological sex, age, and educational level.

❑ Variables like motivational variables (cooperation,

level of arousal).

❑ Malingering: A motivational variable; refers to

faking on psychological tests. It’s difficult to detect
even for the most knowledgeable clinician.

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Intervention and Rehabilitation

❑ Questions of impairment focus on:
1. the nature of the deterioration of damage.
2. Is there any form of brain damage that can account for a
patient’s behavior?
▪ Focal damage—more specific limited effects on behavior
▪ Diffuse damage—wide effects on behavior

❑ Rehabilitation: One of the major functions of

neuropsychologists.
➢ Rehabilitation tasks are generally formulated to treat the
patient’s deficits.

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Conclusion: Training
❑ Specialty training is necessary.
➢ Some psychologists’ training in neuropsychology is
limited so they are not qualified to give assessments.

❑ Clinical neuropsychology is a subspecialty.

➢ Trains individuals to understand both typical brain
function and brain dysfunction effects.

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Conclusion: Future
❑ Developing increasingly more sophisticated individuals tests and
batteries.
❑ Better methods of assessment, therapy, and rehabilitation—focusing
on helping the patient adjust and recover by developing tests that
predict the extent and rate of injury and rehabilitation programs that
offer hope for families and the patient.
❑ Currently relatively few neuropsychologists have obtained training
in rehabilitation.
❑ Neuropsychologists are more likely to currently specialize in
forensic neuropsychology, sports neuropsychology, or military
neuropsychology.

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