Ecological Validity in Virtual Reality-Based Neuropsychological Assessment

Over 25 years ago, Paul Meehl (1987) called for clinical psychologists to embrace the technological advances prevalent in our society: “It would be strange, and embarrassing, if clinical psychologists, supposedly sophisticated methodologically and quantitatively trained, were to lag behind internal medicine, investment analysis, and factory operations control in accepting the computer revolution” (p. xv). Ten years later (15 years ago), Sternberg (1997) described the ways in which clinical psychologists failed in meeting Meehl’s challenge as is apparent in the discrepancy between progress in cognitive assessment measures like the Wechsler scales and progress in other areas of technology. Sternberg used the example of the now obsolete black and white televisions, vinyl records, rotary-dial telephones, and the first commercial computer made in the United States (i.e. UNIVAC I) to illustrate the lack of technological progress in the standardized testing industry. According to Sternberg, currently used standardized tests differ little from tests that have been used throughout this century. For example, while the first edition of the Wechsler Adult Intelligence Scale appeared some years before UNIVAC, the Wechsler scales (and similar tests) have hardly changed at all (aside from primarily cosmetic changes) compared to computers. Although one may argue that innovation in the computer industry is different from innovation in the standardized testing industry, there are still appropriate comparisons. For example, whereas millions of dollars spent on technology in the computer industry typically reflects increased processing speed and power; millions of dollars spent on innovation in the testing industry tends to reflect the move from multiple-choice items to fill-in-the-blank items. Sternberg’s statements are as true now as they were 15 years prior to the publication of this manuscript. While clinical psychology emphasizes its role as a science, its technology is not progressing in pace with other clinical neurosciences. Sternberg also points out cognitive testing needs progress in ideas, not just new measures, for delivering old technologies. Over the course of the last several decades, clinical neuropsychology has gained increasing recognition as a discipline with relevance to a number of diverse practice areas (e.g., neurology, neurosurgery, psychiatry, and family medicine) as well as neuroscience specific research areas (e.g., behavior, learning, and individual differences). Although today’s neuropsychological assessment procedures are widely used, clinical neuropsychologists have been slow to embrace technological advancements. Two essential limitations have resulted from this refusal of technological adaptation: First, current neuropsychological assessment procedures represent a technology that has barely changed since the first scales were developed in the early 1900s. Second, while the historical purpose of clinical neuropsychology was differential diagnosis of brain pathology, technological advances in other clinical neurosciences have changed the neuropsychologist’s role to that of making ecologically valid predictions about the impact of a given patient’s neurocognitive abilities and disabilities on everyday functioning. Recently, scholars have been discussing the potential for a paradigm shift in clinical neuropsychology (Bilder, 2011; Dodrill, 1997; Green, 2003; Parsons and Courtney, 2011; Parsons, 2011; 2012; Puente, 1992; Perry, 2009). The historical development of neuropsychology has resulted in a “normal science” that is informed by developments in psychology, neuroscience, neurology, psychiatry, and computer science. Each of these “informing disciplines” has gone through changes that challenge theory and praxes of neuropsychological assessment. These changes are what Kuhn (1962/1996) describes as paradigm shifts, in which new assumptions (paradigms/theories) require the reconstruction of prior assumptions and the reevaluation of prior facts. For psychology, the paradigmatic shifts are found in Thomas D. Parsons University of North Texas, USA