Performance-based assessments do not rely on the opinion of an observer and are typically highly standardized. Further, these assessments have been refined over time and their psychometric characteristics can be easily quantified and have been investigated in detail over time (Nuechterlein et al., 2008). Thus, these measures will have known ranges of scores and have often been normed in the healthy population. As a result, performance can immediately be interpreted, and improved performance can be quantified with ease. These tests are often administered together as described later in this chapter, and the administration of these tests can be taught to people without advanced degrees, if the interpretation of the scores is performed statistically. Interpretation of the pattern of scores and their clinical meaning usually requires an advanced degree in psychology or at least certification.

History of Performance-Based Assessment Measures

For the past 90 years, performance-based assessment has been a mainstay of measuring the outcomes or impact of interventions aimed at increasing the cognitive functional skills of target populations. Starting with Binet in the early 1900s, performance-based tests were developed to characterize abilities and attempted to match intervention outcomes (in the case of Binet, special education) with individuals. Neuropsychological assessment had its origins in the evaluation of injured soldiers after the First World War when performance-based testing was implemented in order to identify the deficits in function associated with various localized lesions caused by missile wounds (Goldstein, 1995). The history of clinical neuropsychology, which is the origin of many of the assessments that are used today to generate outcome measures in cognitive enhancement research, was partially based on the assessment of individuals with focal brain injuries or strokes as described earlier (Harvey, 2012). Thus, tasks were developed to be sensitive to deficits in specific brain regions when performance is preserved in other regions of the brain. These assessment methods have persisted to this day and are widely used to measure decline after injury or illness (Adams & Grant, 2009) and, recently, gains after cognitive enhancement therapy (Fisher et al., 2009).

After the development of performance-based assessment of cognition, the vocational rehabilitation domain began to use performance-based testing for individuals who had experienced an injury or illness to assess their ability to perform critical vocational, residential, and self-care skills. These assessments range from elaborate laboratories, which contain full-scale simulations of a home or work environment (Menditto et al., 1999), to paper-and-pencil simulations of everyday tasks (Patterson, Goldman, McKibbin, Hughs, & Jeste, 2001). These assessment strategies have been applied as well in other clinical settings, including individuals who have lifelong neuropsychiatric conditions that led to decrements in their functional performance (Harvey, Velligan, & Bellack, 2007).

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