Content of Observations

Relevance
It is OK to describe, automatically, typical features of test behavior (e.g., “He used a normal, right-handed tripod pencil grip…”) in a learning disability assessment. Or, say “No Parkinsonian features were observed” in a dementia evaluation. Again, we are not always looking for deficits to describe. The absence of deficits can be meaningful.

Having said this, most of what you include in the the Observations should be relevant to the questions you are trying to answer from the problem statement. Offering irrelevant observations is of little help. The rule of thumb, as in all report writing, is if it germane to the results then comment on it. For example, commentary such as:

During the interview Mrs. Smith evidenced some suspiciousness. For example, when she walked into the testing room she immediately questioned if she was being recorded. She made several comments throughout the interview and testing about having the need to keep her guns close by, in case the need arose to use them…

These were appropriate observations since the evaluation looked at differentiating problems as due to a long-standing personality trait vs. new onset paranoia related to the Mild NCD seen in the test findings. Recommendations could then be offered about more interview of this in follow-up family therapy. In sum, when you give the report a final proof reading, if you find observations not relevant to the findings in the Summary delete them. There is a good deal in the Write it Backwards section, here, about eliminating details in the Background and Observations, that don’t correspond to findings stated in the Summary.

Writing up Performance Validity Testing (PVT)
The use of PVT is important in neuropsychological evaluation of people claiming work related psychological injury (think Workers’ Compensation Insurance), to demonstrate they were not “faking bad” on test results. Worker’s Comp. evaluations require PVT, and PVT is recommended in all NP evaluations as there can be implicit bias, not due to conscious effort, as often seen in people with low confidence who give up too easily during testing. While this is not common in cognitive impairment testing (few patients try to fake dementia!), PVT can still be useful in determining level of effort. Most tests of PVT are deceptively simple tasks (like counting dots) made to look difficult (the examiner mentions s/he is about to give a difficult test), so when a person does poorly it is easy to see they are faking bad to gain some benefit from falsely claiming a deficit.

Often PVT is written up in Observations, as this is the section where a statement about the examiner’s opinion of the validity of the test results often goes. Consider the following statement in a report’s Observations section:

Virginia, and 85-year-old woman, showed frustration when she was unable to remember details on a test. She repeated herself and complained that her mind went blank, confabulating excuses when she perceived herself not doing well. Her responses in interview were confused and not in temporal sequence. She seemed focused on not being able to play pickleball, mentioning this several times throughout the evaluation. During the interview and testing she was friendly, upbeat, and cooperative. However, performance validity testing on both the 15-item Test and the Rey Dot Counting (DCT) indicated suboptimal effort. The results that follow may not be representative of her true capacity.

It is doubtful that the results of testing, based on these observations, is invalid. Lack of effort does not always equate with invalid results, especially with a person with a degree of NCD (like Virginia showed on testing) as the NCD might be the problem with the performance validity tests she did not do well on.

A better way to phrase this might be: The following results should be viewed as minimal estimates of her ability… This qualifies the results rather than invalidating the entire assessment’s findings. Keep in mind that people with scores of ≤20 on the MMSE almost always do poorly on PVT due to trouble with the cognitive requirements of the task, even though simple, rather than putting forth poor effort.