Journal of the International Neuropsychological Society

Research Articles

Impairment versus deficiency in neuropsychological assessment: Implications for ecological validity


a1 G.F. Strong Rehab Centre, Vancouver, British Columbia, Canada

a2 Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, Michigan


Neuropsychological test interpretation has relied on pre- and postmorbid comparisons, as exemplified by the use of demographically adjusted normative data. We argue that, when the assessment goal is to predict real-world functioning, this interpretive method should be supplemented by “absolute” scores. Such scores are derived from comparisons with the general healthy adult population (i.e., demographically unadjusted normative data) and reflect examinees’ current ability, that is, the interaction between premorbid and injury/disease-related factors. In support of this view, we found that substantial discrepancies between demographically adjusted and absolute scores were common in a traumatic brain injury sample, especially in participants with certain demographic profiles. Absolute scores predicted selected measures of functional outcome better than demographically adjusted scores and also classified participants’ functional status more accurately, to the extent that these scores diverged. In conclusion, the ecological validity of neuropsychological tests may be improved by the consideration of absolute scores. (JINS, 2009, 15, 94–102.)

(Received March 10 2008)

(Reviewed September 26 2008)

(Accepted September 29 2008)


c1 Correspondence and reprint requests to: Noah Silverberg, G.F. Strong Rehab Centre, 4255 Laurel Street, Vancouver, British Columbia V5Z 2G9. E-mail: