Forensic psychology: Part 4: Chapter 11: Assessing offender populations

Chapter 11

Neuropsychological Assessment and Program Guidelines

by Gary W. Fischer, Ph.D., C. Psych.Footnote 1

Objectives

  1. To identify specific referral concerns for neuropsychological evaluation.
  2. To provide guidelines to focus europsychological assessment and intervention.

Practical and theoretical issues

Neuropsychology studies the relationship between brain dysfunction or damage and the behavioural, social or emotional consequences resulting from this damage. The incidence of brain impairment and learning disability is found to be higher in a correctional setting than in the general population. Consequently, a high proportion of offenders present with a deficit pattern. These cognitive processing limitations affect an offender's adjustment to incarceration, ability to benefit from programming and treatment, and interactions with others. An offender's vocational and educational aptitude may also be affected.

Neuropsychological deficits can arise from a variety of traumas, including pregnancy/birth complications, head injury, substance abuse, exposure to toxins, and as a consequence of disease. Typically, deficits will affect an individual's capacity to learn new information and to apply that information in current situations. Impairments in offenders are often detected in their levels of attention and concentration, memory, abstract reasoning, visual spatial/ perceptual organization, and in motor coordination. Depending upon the type of deficit, or region of the brain affected, specific patterns of cognitive processing strengths and weaknesses are observed.

Given that brain dysfunction results in learning difficulties and difficulties in applying learned information, identifying offenders with brain dysfunction can allow for correctional programming to be modified to take these impairments into account.

Neuropsychology constitutes a branch of clinical psychology which requires specialized training and clinical experience. Given the degree of specialization required, it is unlikely that each institution would have staff psychologists on site who could provide neuropsychological evaluation and consultation. It is suggested that these evaluations be performed by community psychologists on a contractual basis, as needed, if institutional psychologists do not have sufficient background to ensure a delivery of service comparable to a community level.

Neuropsychological evaluations are costly due to lengthy test administration and interpretation. Therefore, issues related to appropriate referral selection have particular importance and the use of screening measurement to assess the need for more in-depth evaluation should be undertaken.

Referral questions

Specific guidelines should be established to identify individuals for referral. In general, it is suggested that neuropsychological evaluations be conducted when an individual presents with a combination of the following:

Typically, these problems will emerge within an institution. For instance, an individual may show an inability to understand or comprehend new information, impaired social interaction, behavioural outbursts, poor memory, impaired concentration, difficulties with orientation, or a failure to learn adequately in academic or vocational settings.

Referrals made primarily to provide information related to the presence of brain impairment, in the absence of an identified and apparent behavioural or learning consequence, should be discouraged. Inmates should not be referred or assessed if they are functioning satisfactorily, despite the potential presence of cognitive limitations.

Information gathering

Current trends in neuropsychology are moving away from the rote administration of test batteries. Instead, a flexible approach in which test selection is more directly based upon the referral concern is more time efficient, and focuses the assessment on the identified areas of concern.

Given the needs of neuropsychological evaluation in a correctional setting, assessments should adopt a "functional," as opposed to "structural," approach. In this sense, the goal of the assessment process should be to identify cognitive processing strengths and weaknesses and indicate the functional consequences for programming purposes.

A more structural approach, in contrast, focuses on identifying and localizing brain lesions, and on formal diagnoses. These have limited impact upon correctional programming, and thus should be of secondary concern.

Initially, information should be gathered from collateral sources such as case management, school or workplace supervisors, and unit staff to ascertain an understanding of the individual's behaviour on a day-to-day basis. Prior to extensive and formal testing, a brief screening process may be suitable to determine whether more in depth evaluation is warranted. For this purpose, the following tests are generally suitable:

Beyond initial screening, tests should be selected by the clinician which focus specifically on areas of referral concern. Appropriate areas of identification might include factors such as:

Selected bibliography

Grant, I, & K. Adams. (1986). Neuropsychological Assessment of Neuropsychiatric Disorders. New York: Oxford.

Heilman, K. & E. Valenstein. (1985). Clinical Neuropsychology. New York: Oxford.

Kolb, B. & I. Whishaw. (1990). Fundamentals of Human Neuropsychology. New York: W.H. Freeman and Co.

Lezak, M. (1983). Neuropsychological Assessment. New York: Oxford.

McCarthy, R. & E. Warrington. (1990). Cognitive Neuropsychology: A Clinical Introduction. New York: Academic Press.

Spreen, O. & E. Strauss. (1991). A Compendium of Neuropsychology Tests: Administration, Norms and Commentary. New York: Oxford.

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