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Third Party Observation of Forensic Neuropsychological Evaluation: Experimental Data is In

Dr. Sam Goldstein

In July of 2000, the National Academy of Neuropsychology provided an official statement in its membership journal, The Archives of Clinical Neuropsychology, concerning the presence of third party observers during neuropsychological testing. They opined that the presence of a third party observer during the administration of any formal psychological or neuropsychological test was inconsistent with the recommendations of the standards for educational and psychological testing of the American Psychological Association as well as the published use of standardized instruments such as intelligence, memory and other neuropsychological scales. The presence of a third party observer was also reported to be inconsistent with the requirements for standardized test administration as set forth by the American Psychological Association, Ethical Principles of Psychologists and Code of Conduct. At the time, the National Academy of Neuropsychology Policy and Planning Committee concluded that "the weight of accumulated scientific and clinical literature with respect to the issues of third party observers in the forensic examination provides clear support for this official position." They advised members of their organization as well as all neuropsychologists to strive to minimize any influence, including the presence of observers that might compromise accuracy of assessments and that members "should make every effort to exclude observers from the evaluation." In the past eight years, considerable attention has been given to research on the effects of third party observers’ neuropsychological test performance. Multiple studies have demonstrated the effects of a third party observer on neuropsychological test performance in groups of individuals. Impa

ired test performance was reported on a broad range of tasks measuring a wide set of cognitive and neuropsychological skills. Impaired performance on such tests have also been noted when the third party observer is an audio or a video tape recorder. Though not all researchers have reported robust findings, the preponderance of the data to this point has broadly reinforced the opinion of the National Academy of Neuropsychology eight years ago.

A recent study by Julie Horowitz and Robert McCaffrey published in the Archives of Clinical Neuropsychology provides further definitive data to take a consistent position against observers during the process of testing at this time. These authors noted that third party observation has been associated with poorer performance on tests of effort, attention, concentration, learning and memory. They designed their study to investigate whether performance on tests of executive function is similarly impaired by the presence of a third party observer. Measures of executive function, including planning, attention, speed of processing and problem solving are often primary targets of investigation in forensic evaluations. These authors also sought to examine the association between the examinee’s level of anxiety, observer presence and overall performance. Horowitz and McCaffrey randomly assigned a large group of college undergraduates to either observation or control conditions and then administered a series of executive function tasks as well as a number of measures of anxiety and emotional functioning. Statistical analyses revealed that performance on the measured variables was significantly associated with observer presence, not just in reducing test performance but also leading to an interaction between anxiety and test performance. Anxiety was found to adversely affect test performance for a significant minority of subjects.

This study adds to and supports a robust literature suggesting that the validity of neuropsychological test results obtained while a third party observer is present can be significantly compromised. The Horowitz and McCaffrey study further adds to previous research by demonstrating that impairments in performance that result from the presence of a third party observer occur not only on tests of effort, attention, concentration, learning and memory but on tests of executive functioning as well. Additionally, this is the first study that demonstrated the effect of anxiety on test performance when a third party is present. These data provide a powerful scientific rationale to convince judges that third party observers should not be allowed during the course of forensic neuropsychological evaluations.

Despite some limitations such as use of self-rating scales, the homogeneous background of the sample population and the contrived assignment of individuals to one condition or another, these data demonstrate that observer presence has an impact on test performance. A number of the attorneys whom I have worked with and discussed this issue with point out, however, that this type of research may not be sufficient to generalize to a real world forensic setting. For example, it has been pointed out that the nature of the evaluation, whether for plaintiff or defense, likely makes a difference in the mindset, anxiety level and possibly effort of the testee. It was suggested that a testee when evaluated by a defense expert might in fact feel less rather than more anxious in the presence of their legal counsel. These real life issues may never be fully addressed in experimental settings. Until further data is generated, it will be my position, based on the current literature and support of professional organizations, that third parties not observe neuropsychological evaluations whether forensic or not, except in special circumstances (e.g., parent accompanying a very young child).

Axelrod, B., Barth, J., Foust, D., Fischer, J.M., Heilbronner, R., Larabee, G., et al. (2000). Presence of third party observers during neuropsychological testing: Official statement of the National Academy of Neuropsychology. Archives of Clinical Neuropsychology, 15, 379-380.

Binder, L.M., & Johnson-Green, D. (1995). Observer effects on neuropsychological performance: A case report. Clinical Neuropsychologist, 9, 74-78.

Constantinou, M., Ashendorf, L., & McCaffrey, R.J. (2002). When the third party observer of a neuropsychological evaluation is an audio-recorder. The Clinical Neuropsychologist, 16, 407-412.

Constantinou, M., Ashendorf, L., & McCaffrey, R.J. (2005). Effects of a third party observer during neuropsychological assessment: When the observer is a video cameral. Journal of Forensic Neuropsychology, 4, 39-47.

Horowitz, J.E., & McCaffrey, R.J. (2008). Effects of a third party observer and anxiety on tests of executive function. Archives of Clinical Neuropsychology, 23, 409-417.

Kehrer, C.A., Sanchez, P.N., Habif, U., Rosenbaum, J.G., & Townes, B.D. (2000). Effects of a significant-other observer on neuropsychological test performance. The Clinical Neuropsychologist, 14, 67-71.

King, G.D., Hanney, H.J., Masek, B.J., & Burns, J.W. (1978). Effects of anxiety and sex on neuropsychological tests. Journal of Consulting and Clinical Psychology, 46, 375-376.

The Experimental Data is In

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