Remote vs In-Person Testing
While the COVID-19 pandemic has transformed many clinical services, neuropsychologists have adapted to seeing patients remotely, many performing full evaluations completely online. Remote testing options have expanded greatly with testing companies offering many measures adapted to online administration. Studies show that many tests administered remotely is comparable to in-person testing in terms of accuracy and validity. However, most validation studies with neuropsychological tests have been done using in-person assessments and the web-based versions of the same tests may not produce the same results. So should you have a full neuropsychological evaluation done online, in person, or some combination of the two? Here are some factors to consider:
Age – age and developmental level of the patient are among the most important factors in determining whether the remote evaluation would be feasible and provide accurate results. Studies have found that testing older adults may be particularly affected by remote administration. Very young children would not be likely to engage with the examiner consistently on-screen and would need more support from their caregivers than they would during in-person testing. This in turn can impact the accuracy and consistency of the results.
Access to technology- slower internet connection was, along with age, found to be one of the key factors that could negatively impact the findings. Many tests are timed and slower connection can make a big difference in scores. Some test instructions cannot be repeated so a poor connection can greatly affect the ability to administer tests in a standardized fashion. Any break in standard administration again creates challenges in interpreting the results.
Testing Environment – in the office, the examinee is provided with a quiet, free of distractions environment for test-taking to ensure that extraneous factors do not affect the results. Finding a quiet, private place at home where the optimal testing environment can be assured may be a challenge for many patients.
Urgency of the testing – is testing necessary right now? If the patient’s treatment, educational plans, or accommodations are hinging on the results of a neuropsychological evaluation, putting off testing for a few months may simply not be feasible. On the other hand, if testing is needed in the next year or so to update the current treatment goals, it may be wise to wait a few months until in-person testing is safer.
Type of tests – some tests are simply better suited for online administration. Research shows that untimed tests and tests where repetition is allowed show results much more consistent with in-person administration than timed tests or those with a motor component. Tests assessing visual-motor or fine motor skills, for instance, require manipulating blocks, pegs, and boards that simply do not have a good online equivalent. Many neuropsychologists tackle this issue by simply avoiding certain tests, and in circumstances where online testing is the best option available, incomplete data may be better than no data at all when the testing is needed and waiting for safe in-person administration is simply not an option. Others minimize the in-person testing sessions just to such tests and administer others remotely.
Health and Risk Status - for high risk patients, such as those with underlying medical conditions, and older adults, remote testing may remain the best option available for now. For others, such as those who are fully vaccinated, or children whose families are vaccinated and do not have regular contacts with others who are high risk, a combination of remote and in-person testing may be the best option.
My personal approach at this time is a combination of online and in-person testing whenever it can be done safely. At the very least, clinical interviews, self-report forms, and final feedback are completed remotely. In many cases, a good part of testing can be done remotely without compromising the validity of the results. As most psychologists and more and more patients are getting vaccinated, a combination of remote and in-person testing with the highest levels of safety maintained is becoming the best option for many. For others, fully remote testing will continue to be the most feasible way to be evaluated at this time.