Child neuropsychological assessment: A test of basic assumptions

Interpretations of child neuropsychological assessment findings are based on two largely untested assumptions regarding test validity. First, we assume that test results vary with the integrity of the CNS, or that they have neurological validity. Second, we assume that these results are associated with, or predict, problems in ecologically meaningful aspects of childhood functioning, such as academic learning or behavioral adjustment. Test results have psychological validity to the extent that this second assumption is met. To put these two assumptions to empirical test, the present study examined developmental outcomes in 113 school-age children who had been hospitalized earlier in life for Haemophilus influenzae type b meningitis. Only children without sensorineural hearing loss were considered. Analyses focused on associations of individual neuropsychological measures to acute-phase medical status, social-environmental variables, and behavioral and learning outcomes. Findings document both forms of test validity. Results also underscore the importance of assessing social factors, and highlight considerations involved in attempting to improve test utility.