Limitations of Neuropsychological Assessments

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  • 0:05 Brain and Behavior
  • 1:56 Assessment
  • 3:36 Limitations
  • 6:35 Lesson Summary
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Lesson Transcript
Instructor: Natalie Boyd

Natalie is a teacher and holds an MA in English Education and is in progress on her PhD in psychology.

Psychological disorders that spring from a brain problem are diagnosed with neuropsychological tests. But, how accurate are those tests? We'll look at some of the limitations and issues surrounding neuropsychological assessments.

Brain and Behavior

Phineas Gage was a normal guy. He lived and worked in the 19th century, laying explosives to clear the way for the railroad to be laid. His friends and family described him as nice and considerate, and his employers at the railroad thought he was a good guy. But then one day, an accident changed Phineas forever. The explosives he was setting went off too soon, and an iron spike he was using to help set them was blown upward. The spike, which was almost two inches in diameter, shot straight through Phineas' head, destroying a large part of the front left part of his brain.

To everyone's surprise, Phineas was able to walk and talk and he sat up and remained conscious for the ride into town. But, something had changed: Phineas was no longer the mild-mannered guy his family and friends knew. A few months after the accident, his doctor described him as someone whose animal instincts were not controlled. Phineas was rude when he wanted to be and did and said things that were not acceptable to proper society.

Our brains are powerful tools, responsible for regulating our bodies, thoughts, feelings, and behaviors. Someone like Phineas Gage could seem to change his personality just because part of his brain was destroyed. And, though Phineas Gage is an extreme example, things like head trauma, disease, and brain tumors can change the way people function.

Neuropsychologists study the intersection of the brain and people's thoughts, feelings, and behaviors. For patients like Phineas Gage, a neuropsychologist could help them deal with the changes to their life and personality. Other patients might need help due to problems with motor movement, speech, problem-solving, or other skills.


Phineas Gage's head injury was obvious. When he came to the doctor, he had a large hole in his head. But, what about patients that might have other problems, such as a disease or a hemorrhage in the brain? Their injuries might not be immediately visible to doctors. Neuropsychologists have a number of tests they can do to try to figure out what is wrong with a person's brain and how that's affecting his life. They can look at images of the brain taken via MRI, CT scan, or other imaging equipment; this is called neuroimaging. In these images, a neuropsychologist can see if there is a mass, like a brain tumor, or other problems with the brain.

But, there are other types of assessments, too. A neuropsychologist might ask a series of questions or ask a patient to perform a task. Based on the patient's response, the neuropsychologist can figure out what's going on in the brain and body that might be affecting their behavior. For example, imagine that you are a neuropsychologist who is examining a patient. You ask the patient, 'How's everything going?' Instead of a normal response, the patient replies, 'Oh, it's a flower jumble, and his desk fern up in me.'

Uh-oh! Obviously, there's something wrong. Based on the response you just got, you know that there's most likely a problem in one of the two main language areas of the brain. But which one? By asking additional questions and listening to your patient's responses, you can figure out what his problem is, which part of his brain is affected, and how best to treat him.


Obviously, neuropsychological testing is very important. Without it, many people would never be diagnosed or treated for serious problems. But, there are some issues with neuropsychological assessments.

The biggest problem is that neuropsychological assessments require doctors to make inferences, or educated guesses, about what is happening in the brain and the mind. Remember Phineas Gage? Knowing that his personality changed and the location of the damage to his brain gave his doctor a big clue. Perhaps the front of the brain helped control personality. After all, that's where Phineas' damage was, and his personality changed.

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