35 - Predicting Everyday Functioning from Neuropsychologist Tests: Ecological Validity, Current Challenges and a Path Forward

Neuropsychologists continue to use traditional neurocognitive tests designed to address issues of lesion localization and clinical diagnosis to answer questions about how an individual with a particular injury or cognitive decline might function in their everyday environment. As defined by Sbordone (1996), ecological validity refers to “functional and predictive relationship between the patient’s performance on a set of neuropsychological tests and the patient’s behavior in a variety of real-world settings.” In this seminar, we will discuss numerous challenges that exist to developing neuropsychological tests that predict real-world function and to relating neuropsychological performance to real-world functioning. These challenges include the lack of agreed-upon best methods for measuring real-world everyday functioning as well as factors that can complicate the relationship between neuropsychological performance and everyday functioning (e.g., comorbidities, environmental factors). We will provide examples of these challenges from the literature and from our own work predicting real-work behavior from neurocognitive tests. We will discuss some of the best current approaches for predicting everyday functioning. We will also address the path forward with an emphasis on how newer technologies can improve our understanding of everyday functioning and ultimately the ability to predict real-world difficulties and provide relevant interventions.