Week 3
Larrabee (2017) - Selection of Tests and Batteries for Forensic
Neuropsychological Evaluation
Neuropsychological test findings do not always fully address the legal issue that is being posed.
Bauer (2000) described three general approaches to neuropsychological testing:
1. The fixed battery approach (e.g. Halstead-Reitan Neuropsychological Test Battery; HRB)
2. The flexible core battery
3. The completely flexible approach where test selection is fully dependent on the individual’s
clinical presentation
The most widely used over the past years is the flexible core battery approach.
Common neuropsychological tests for adults:
Wechsler Scales of Intelligence (WAIS)
Minnesota Multiphase Personality Inventory (MMPI)
Trail Making Test (TMT)
Six core domains of ability:
A. Verbal Symbolic Ability
B. Visuo-perceptual and -spatial Judgment and problem solving
On the WAIS–IV, both Block Design and Visual Puzzles produce effect sizes in the of
0.70 to 1.07 in discriminating subjects with TBI and AD from normative subjects.
The Wisconsin Card Sorting Test is a measure of problem solving under conditions of
limited feedback that is sensitive to a variety of lesion locations, including frontal,
diffuse, and nonfrontal areas of the brain.
C. Sensorimotor Skills
includes the Finger Tapping Test, Grip Strength, and the Grooved Pegboard Test. As
a group, these three tests can be sensitive to unilateral brain damage, given the known
contralateral representation of the motor system.
D. Attention-Working Memory
E. Processing Speed
Trail Making Test: consists of two parts in which the subject is instructed to connect
a set of 25 dots as quickly as possible while still maintaining accuracy.
Driving ability has been correlated with performance on the Trail Making Test Part B for severe
TBI.
Stroop Color and Word Test: assesses the ability to inhibit cognitive interference.
F. Learning and Memory
Verbal learning and memory: tests of text recall
Visual learning and memory: more immediate trials tend to be closely associated
with spatial-constructional tasks; but more delayed reproduction shows stronger
association with memory than with spatial ability. Shown sensitivity to acquired brain
impairment.
G. (Executive functions/ tests measuring this loaded largely on other factors)
Measures of processing speed, in combination with memory tests, are among the most sensitive
measures for detecting the presence of impairment.
In forensic practice, it is important to perform redundant assessments in each of the core ability
areas to evaluate for consistency of performance.
Average time of forensic evaluation is 12,7 hours
,The first step in analyzing neuropsychological test data is to determine whether the data are valid,
by considering the embedded or derived PVTs.
Typically, if an examinee fails two or more PVTs (or one at worse-than-chance performance) there is
a high probability of invalid test performance. Meaning that the remainder of the test results may
inaccurately reflect actual ability.
In this case, poor performances on the battery are more likely due to intentional
underperformance rather than acquired impairment.
Normal-range performances are then likely underestimates of ability, and only helpful in
ruling out acquired impairment, for example, when the examinee shows normal memory and
processing speed.
4 types of consistency relevant in forensic field:
1. Within-domain consistency: whether the data are consistent within and between
neuropsychological domains, for example within different sensimotor skills tasks, or between
working memory and verbal memory.
2. Whether the neuropsychological profile is consistent with the suspected etiology of brain
dysfunction.
3. Whether the neuropsychological data are consistent with the medically documented
severity of injury (e.g. mild TBI history -/-> severe TBI complaints)
4. Whether the neuropsychological data is consistent with the examinee/s behavioral
presentation.
Pera-Guardiola et al (2015) - Modulatory Effects of Psychopathy on
Wisconsin Card Sorting Test Performance in male offenders with
ASPD
Neuropsychological deficits in executive functions (EF) are linked to onset and persistence of
severe antisocial and aggressive behavior.
However, in psychopathy, dorsolateral PFC functioning is intact, leading to intact EF.
-> ASPD offenders with low PCL-R scores committed more perseverative errors on the
Wisconsin Card Sorting Test (WCST) than controls and those with high PCL-R scores. ASPD
offenders with high PCL-R scores did not differ from controls in their performance.
Scores on Factor 1 were positively correlated with WCST performance, more specifically on
Facet 1: interpersonal. (scores on factor 2 are more general antisocial behaviors that are less
unique to psychopathy)
Executive Functions (EF) encompass cognitive processes like working memory, attention, cognitive
flexibility, and impulse control/inhibition, from which higher-order EFs such as planning, problem-
solving, and organizing and have been linked to frontal lobe function.
dlPFC dysfunction might lead to impaired top-down regulation of limbic areas, resulting in
increased emotional reactivity and impulsivity (i.e. impaired EF).
Generally antisocial individuals show EF deficits. Cognitive flexibility demands the
involvement of multiple processes such as conceptualization, creating and testing hypotheses,
and set-shifting. The latter seems to be especially relevant to the WCST and seems to be
specific to dlPFC function. The increased percentages of perseverative errors found in non-
psychopathic ASPD subjects exhibits their impaired performance in dlPFC-dependent EF tasks.
dlPFC functioning might be specifically related to creating deceptive responses and is thus
highly related to Facet 1.
The presence of an intact/superior cool EF, together with deficits in hot EF (and affective
processing) may facilitate the emergence of manipulative and cunning behaviour.
, The WCST is the prototypical test of EF since accurate performance relies on several executive
domains, such as attention, working memory, and inhibition.
Perseverative responses and errors = number of times in which the participants persist in
responding to an incorrect stimulus characteristics
Notably, ASPD+P subjects' scores were similar to those of controls, after controlling for relevant
confounding factors such as substance abuse.
And notably, another study found no difference between ASPD and ASPD+P performance in 'hot and
cool' EF tasks (with/without aspects of motivation and affect). "hot" EFs are more sensitive to
vmPFC, OFC, and amygdala function.
Methodological issues:
o Heterogeneity of EF processes
(the WCST is thought to specifically be related to set-shifting, dlPFC function)
o Different ways of measuring psychopathy, and different PCL-R cut-off scores.
(in this study, the medium-PCL-R scores group was not significantly different from the
other three)
A suggestion is that "successful" psychopaths, scoring highly on the interpersonal-affective
dimension (Factor 1) outperform unsuccessful psychopaths as well as the control group on EF.
Burgess (2020) - A Brief Review of the Relationship of Executive
Function Assessment and Violence
Errors on Trail Making Test B and various scores from the Wisconsin Card Sorting Test
differentiated violent from nonviolent persons.
Violent offenders also performed worse on tests of verbal fluency and general verbal ability.
Neuropsychological tests of EF:
The Go/No-Go Inhibition Task: Examinee presses a button when a specific stimulus presents
on the screen and abstains when a similar stimulus appears. Evaluation of response speed and
errors committed. This test measures inhibition and impulsivity.
o Study 2 found that psychopathic inmates performed worse on the go/no-go task.
Porteus Maze Test (PMT): Examinee traces a maze and is evaluated on the number of
attempts and time to complete. Test measures problem solving, planning, and foresight
o Study 2 found that psychopathic inmates performed worse on the PMT.
Wisconsin Card Sorting test (WCST),
o Study 3 reported more mistakes among the Impulsive-Aggressive students (all kinds
of errors)
WCST perseverative errors, categories completed, and failure to maintain set
all reflect cognitive flexibility and inhibition.
Trail Making Test (TMT),
o In study 1 the TMT-B significantly distinguished violent from nonviolent groups.
o Study 3 reported more mistakes among the Impulsive-Aggressive students, than the
non-violent ones.
Stroop Test,
tests of verbal fluency, like the Controlled Oral Word Association test (COWAT): The
examinee names as many words as possible, starting with a presented letter, within a fixed
period. Then, words fitting a presented category are named.
o Study 3 reported more mistakes among the Impulsive-Aggressive students.
