ABCN Evaluation Process 2 — Questions and Answers
Question 1: When evaluating a patient with suspected dementia, which source of collateral history is generally considered MOST reliable?
- The patient's self-report
- A close family member who lives with the patient (Correct answer)
- Medical records from 10 years prior
- Employer performance reviews
Correct answer: A close family member who lives with the patient
A co-habitating family member provides the most ecologically valid and current observations of day-to-day functional changes.
Question 2: Which of the following BEST describes the purpose of a clinical interview at the start of a neuropsychological evaluation?
- To administer standardized cognitive measures
- To establish rapport and gather relevant history to guide test selection (Correct answer)
- To provide psychoeducation about the patient's diagnosis
- To review imaging findings with the patient
Correct answer: To establish rapport and gather relevant history to guide test selection
The clinical interview establishes rapport and collects historical, contextual, and referral information that shapes the evaluation plan.
Question 3: A 45-year-old is referred for evaluation after a mild TBI. The neuropsychologist reviews pre-injury academic records. This practice is BEST justified by:
- Legal requirements for all TBI cases
- The need to estimate premorbid intellectual functioning (Correct answer)
- Insurance reimbursement criteria
- The requirement to compare against pediatric norms
Correct answer: The need to estimate premorbid intellectual functioning
Pre-injury records help estimate premorbid functioning so that post-injury deficits can be accurately identified relative to baseline.
Question 4: During a neuropsychological evaluation, which behavior during testing is MOST indicative of poor effort rather than genuine cognitive impairment?
- Slow processing speed on timed tasks
- Floor-level performance on a forced-choice recognition test (Correct answer)
- Impaired verbal fluency
- Reduced immediate recall on a word list
Correct answer: Floor-level performance on a forced-choice recognition test
Forced-choice recognition tests are designed so that genuine impairment still yields above-chance performance; floor-level scores suggest suboptimal effort.
Question 5: Which of the following is the MOST appropriate response when a patient refuses to complete a validity measure?
- Remove all validity data from the report and proceed as if effort was adequate
- Document the refusal and consider its potential impact on the interpretability of results (Correct answer)
- Terminate the evaluation immediately
- Replace the validity measure with an additional cognitive test
Correct answer: Document the refusal and consider its potential impact on the interpretability of results
Refusal to complete a validity measure is itself clinically meaningful and must be documented with discussion of how it affects result interpretation.
Question 6: A neuropsychologist evaluating an elderly patient notices significant hearing loss. The MOST appropriate accommodation is:
- Administering all subtests using written-only instructions
- Ensuring optimal amplification and repeating instructions as permitted by standardized administration (Correct answer)
- Excluding all auditory-dependent measures and not noting this in the report
- Referring the patient to audiology before any neuropsychological testing occurs
Correct answer: Ensuring optimal amplification and repeating instructions as permitted by standardized administration
Standard accommodations for sensory impairment include optimizing amplification and using permitted repetitions, with deviations documented in the report.
Question 7: Which of the following BEST characterizes the 'process approach' in neuropsychological assessment?
- Relying solely on total scores to classify impairment
- Attending to how a patient solves problems, not just whether they succeed (Correct answer)
- Using only process-score norms for interpretation
- Administering the longest possible battery to capture all error types
Correct answer: Attending to how a patient solves problems, not just whether they succeed
The process approach, associated with Edith Kaplan, emphasizes qualitative observation of strategies and error types alongside quantitative scores.
ABCN Evaluation Process 2
When evaluating a patient with suspected dementia, which source of collateral history is generally considered MOST reliable?