Presence of Third Party Observers During Neuropsychological Testing
Official Statement of the National Academy of Neuropsychology Approved by the Board of Directors 5/15/99
(Reprinted from NAN Website)
Forensic neuropsychological evaluations are often constrained by the demand that a third party observer be present during the course of interview and formal testing. This demand may originate from counsel’s desire to ensure that the neuropsychologist does not interrogate or unfairly question the plaintiff with respect to issues of liability and to ascertain if test procedures are accurately administered. In general, neuropsychologists should have the right to carry out their examination in a manner that will not in any way jeopardize, influence or unduly pressure their normal practice.
The presence of a third party observer during the administration of formal test procedures is inconsistent with recommendations promulgated in The Standards for Educational and Psychological Testing (APA, 1985) and Anastasi (1988), that the psychological testing environment be distraction free. More recently, standardized test manuals (for example, The WAIS-III, WMS-III Technical Manual, 1997) have specifically stated that third party observers should be excluded from the examination room to keep it free from distraction. The presence of a third party observer in the testing room is also inconsistent with the requirements for standardized test administration as set forth in the APA’s Ethical Principles Of Psychologists and Code Of Conduct (APA, 1992) in that it creates the potential for distraction and/or interruption of the examination (McSweeny, Becker, Naugle, Snow, Binder & Thompson, in press).
A second issue that relates to the potential influence of the presence of a third party observer is the reliance upon normative data. Neuropsychological test measures have not been standardized in the presence of an observer. In fact, neuropsychological test measures have been standardized under a specific set of highly controlled circumstances that did not include the presence of a third party observer. The presence of a third party observer introduces an unknown variable into the testing environment which may prevent the examinee’s performance from being compared to established norms and potentially precludes valid interpretation of the test results (McCaffrey, Fisher, Gold, & Lynch, 1996). Observer effects can be such that performance on more complex tasks declines, in contrast to enhanced performance on overlearned tasks, leading to a spuriously magnified picture of neuropsychological deficit (McCaffrey et al., 1996). Likewise, observation of an examination being conducted for a second opinion may fundamentally alter the test session, in comparison to the initial examination that the patient has already undergone, potentially creating an adversarial atmosphere, and increasing the risk of motivational effects related to secondary gain. Observer effects can be magnified by the presence of involved parties who have a significant relationship with the patient (e.g. legal representatives who have a stake in the outcome of the examination; cf. Binder and Johnson-Greene, 1995). Thus, the presence of a third party observer during formal testing may represent a threat to the validity and reliability of the data generated by an examination conducted under these circumstances, and may compromise the valid use of normative data in interpreting test scores. Observer effects also extend to situations such as court reporters, attorneys, attorney representatives, viewing from behind one-way mirrors and to electronic means of observation, such as the presence of a camera which can be a significant distraction (McCaffrey et al., 1996). Electronic recording and other observation also raises test security considerations that are detailed in the National Academy of Neuropsychology’s position statement on Test Security.
It should be noted that there are circumstances that support the presence of a neutral, non-involved party in nonforensic settings. One situation might be when students or other professionals in psychology observe testing as part of their formal education. These trainees have sufficient instruction and supervision in standardized measurement and clinical procedures, such that their presence would not interfere with the assessment process. Other situations might include a parentÕs calming presence during an evaluation of a child.
The weight of accumulated scientific and clinical literature with respect to the issue of third party observers in the forensic examination provides clear support for the official position of the National Academy of Neuropsychology that neuropsychologists should strive to minimize all influences that may compromise accuracy of assessment and should make every effort to exclude observers from the evaluation.
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American Psychological Association (1992). Ethical Principles of Psychologists and Code of Conduct. , , 1597-1611.
Annastasi, A. (1988). , New York: Macmillan Publishing Company.
Binder, L.M., & Johnson-Greene, D. (1995). Observer effects on neuropsychological performance: A case report. , 74-78.
McCaffrey, R.J., Fisher, J.M., Gold, B.A., & Lynch, J.K. (1996). Presence of third parties during neuropsychological evaluations: Who is evaluating whom? , , 435-449.
McSweeny, A.J., Becker, B.C., Naugle, R.I., Snow, W.G., Binder, L.M. & Thompson, L.L. (in press). Ethical issues related to third party observers in clinical neuropsychological evaluations. . (1997). San Antonio: The Psychological Corporation.
The NAN Policy and Planning Committee:
- Bradley Axelrod, Ph.D.
- Jeffrey Barth, Ph.D., Chair
- David Faust, Ph.D.
- Jerid Fisher, Ph.D.
- Robert Heilbronner, Ph.D.
- Glenn Larrabee, Ph.D.
- Neil Pliskin, Ph.D., Vice Chair
- Cheryl Silver, Ph.D.