Trained Third Party Presence During Forensic Neuropsychological Evaluations
John J. Blase, Ph.D., ABPN*
I read with great interest the article in The Florida Psychologist (Summer 2007) by Laura
Howe, J.D., Ph.D., Warren Rice, Ph.D., and Valerie Hoese, Ph.D.. concerning
“Psychological Ethics and Third Party Observers (TPO): We’ve Observed Their Effects
and Now Need To Act”. Having conducted a review of much of the available literature
on this subject, I find that the authors have made many observations and statements that
are not in agreement with that literature.
At the outset, it is important to realized that there is a substantial difference between a
third party observer or TPO (attorney, parent, spouse, etc.) and a trained third party
observer (another neuropsychologist and/or a trained technician). The concern for test
security is solved in the trained third party condition. Unfortunately, the authors refer to
involved third party observers described as one who, in civil litigation, has an interest in
the outcome of a specific plaintiff’s evaluation, usually an attorney or someone working
for them and an uninvolved third party observer which is described as a student in
training or an interpreter. Actually, an uninvolved third party observer is neither an
interpreter nor a student in training. An uninvolved third party observer needs to be
someone very familiar with the procedures being used so that verification of standardized
administration of the tests can occur. Interpreters are merely third party observers and
students in training have not developed the expertise to be uninvolved or trained third
party observers.
The issue of trained third party observers during forensic neuropsychological assessments
requires:
1. The evaluation is a forensic rather than clinical assessment.
2. The trained observer is a third party in addition to the examiner who is clearly
performing some evaluative process.
3. The trained observer is a professional who is knowledgeable about the testing
to be administered and is not a family member, attorney, or any other
individual without specific knowledge about test procedures.
4. The evaluee is advised prior to the evaluation that the observer is an ally who
is present only to evaluate the examiner to make sure that testing is
administered in a standardized manner.
5. The evaluee understands that his/her performance on testing is not being
evaluated.
* John J. Blase, Ph.D. is a board certified neuropsychologist in Southfield, Michigan and
the past president of the American Board of Professional Neuropsychology
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To claim that scientific validity, which is considered part of the clinical validation
process, is at stake in a forensic evaluation simply doesn’t conform with the conditions of
this type of evaluation. Trained third party observers are requested in order to confirm
the very thing that the authors claims is necessary for a reliable evaluation; the
standardized administration of various tests. In reality, it is impossible to replicate the
exact conditions under which various measures were standardized in the clinical setting.
These standardization examinations occur in many different settings with subtle as well
as not so subtle differences in each. This author talked with the director of test
standardization for a major test producer who stated that he did not believe that third
party observers were present during standardization but that he could not guarantee this
was, in fact, true. The standardization of a procedure is in the wording used for each test
administered and the proscribed scoring criteria. Little else is standardized from one
location to another. For example, how many tests were standardized in a prison setting,
in the presence of an interpreter, in a forensic setting, or at a hospital bedside?
Fortunately, other factors are of less significance and all test administrations can be valid
procedures depending on the training, expertise, and ethical behavior of the evaluator.
To claim that scientific validity, which was part of the clinical validation process, is at
stake in a forensic evaluation simply doesn’t conform with the conditions of this type of
evaluation. Trained third party observers are requested in order to confirm the very thing
that the authors claims is necessary for a reliable evaluation; the standardized
administration of various tests. In reality, it is impossible to replicate the exact conditions
under which various measures were standardized in the clinical setting. There are
examinations that occur bedside, in private offices, in prisons, on the battlefield, etc. and
all can be valid procedures depending on the training, expertise, and ethical behavior of
the evaluator.
McCaffrey, et al. (1996) present several reasons to oppose the presence of observers
during neuropsychological examinations. The main position McCaffrey espouses is
based on the theory of social facilitation and an extensive bibliography on the subject is
offered. Objections cited include (a) the compromise of test security and misuse of tests,
(b) potential ethical violations because tests were not standardized with a third party
present, and (c) the impact of ethical and professional standards on a request to a
neuropsychologist to be a third party observer. Since the appearance of McCaffrey’s
article in 1996, there has been a published opinion by McSweeney (1999) and a policy
statement made by the National Academy of Neuropsychology (1999). Neither appears
to rely on an independent review of the literature but, rather, on McCaffrey’s analysis and
a reiteration of the Ethical Principles of Psychologists and Code of Conduct (1992).
McCaffrey, et al. (1996) state further that “the literature on social facilitation provides
empirical evidence to suggest that the presence of an observer(s) alters cognitive/motor
performance” and “the social facilitation literature provides a theoretical framework to
support arguments that the presence of a third party observer during neuropsychological
evaluation may alter the results of the evaluation” (p. 441). The question that needs to be
addressed is just how the presence of a third party during neuropsychological evaluation
alters the result of the evaluation.
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Social facilitation is a concept that has been part of the social psychology literature for
nearly a century. Zajonc (1965, 1980) championed an instinct theory of social facilitation
by proposing that the mere presence of others was the sufficient condition to bring about
a change in another person’s behavior. He proposed further that the presence of another
produced an increased drive state resulting in social facilitation on simple tasks and
socially mediated impairment on complex tasks. Cottrell (1972) proposed a revision to
Zajonc’s theory by suggesting that the presence of others is a learned source of drive,
rather than a source of drive that is innate or “wired-into” the organism. He designed
experiments that allowed for the presence of another during an experiment but had the
third party blindfolded. Since the mere presence of the blindfolded third party did not
have the predicted influence proposed by Zajonc, Cottrell concluded that the presence of
others will enhance the emission of dominant responses only when the spectators can
evaluate the individual’s performance.
A review of the extensive bibliography provided by McCaffrey, et al. (1996) will reveal
that the vast majority of the research refers to studies in which the experimental design
provided for a comparison of an individual working alone in contrast to an individual
working with an examiner/experimenter. The process of social facilitation in either the
drive theory proposed by Zajonc or the learning theory proposed by Cottrell refers to the
influence upon the examinee by the mere presence of the examiner (Zajonc) and/or the
evaluative characteristic of the examiner (Cottrell). Manstaed and Semin (1980) note
“While it might be argued that an experimenter does not constitute an audience, it is
difficult to see how, from the perspective of a mere presence theorist, our experimenter
did not satisfy the conditions of being ‘merely present’, since to suggest that there is
some phenomenological difference between the mere presence of an experimenter and
that of a third party is to invoke the very cognitive processes which mere presence must
by definition not involve” (p.131). In other words, social facilitation occurred by virtue
of the presence of an examiner; not the presence of a third party. Thus, since social
facilitation already exists by virtue of the fact that neuropsychological examinations
involve the presence of both an examinee and an examiner, what is the possible effect on
the examinee by introducing another person into the testing situation?
Knowles (1983) measured the effects of audience size and distance on social judgments
and behavior. The audience size varied from 2 to 4 to 8 members and distances varied
from 3 to 10 to 24 feet. The distance of the audience had no reliable effects on the driverelated measures, even though subjects accurately recalled the distance of the audience
and were influenced by it in judging their crowdedness. Laughlin and Wong-McCarthy
(1975) designed an experiment requiring the solving of three concept-attainment
problems in an orthogonal design. The variables to be manipulated were the number of
observers comparing the examiner alone with an additional observer. Videotaping,
audiotaping and task complexity did not differ in the ability to effect poorer performance
when compared to the control condition of no observer. The presence of an additional
observer had no effect on performance. They point out that previous findings in which
the presence of an observer degrades performance may be due to the observer as recorder
of information about performance, rather than to his physical presence per se.
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Cottrell (1972) opined that humans are trained by their past experience in that other
persons who watch them as spectators often praise or criticize them. He cites several
authors who produce research findings akin to his demonstrating that when anticipations
of praise or criticism are eliminated, the presence of others does not increase the
individual's drive level. When a nonrivalrous coaction arrangement is encountered, the
presence of coactors does not serve to increase the individual’s drive level. Sasfy and
Okun (1974) concluded that audience characteristics and the form of evaluation could be
considered interactive determinants of evaluation potential. Their findings supported
Cottrell’s notion that the potential for evaluation characterized a social situation that is
the chief source of audience and coaction effects in humans. Markus (1978) had
observed that even among mere presence theorists there is no argument with the idea that
evaluation apprehension can be a very significant factor in social facilitation in humans.
Zajonc (1980) reports the effects of stress on performance. He concludes that stress often
elicits fixed response patterns and different stress conditions elicit different responses in
different species. Furthermore, to the extent that stress responses conflict with the
behavior under observation, the presence of others will interact with the performance of
this observed behavior accordingly. The level of stress in companions promoting
efficient behavior is unimportant; and implied evaluative threats may increase stress.
McCaffrey, R.J., Lynch, J.K., Yantz, C.L., Constantinou, M., Ashendorf, L., Gavett,
B.E., Duff, K., and Fisher, J.M. recently authored a series of articles presented in the
Journal of Forensic Neuropsychology, Vol. 4(2) 2005. In the first article, McCaffrey, et.
al. reference some of the literature pertaining to social facilitation but fail to point out that
this research is largely based on a comparison of an individual being tested in isolation
compared to being tested by an examiner. In fact, the social facilitation research says
very little about the presence of a third party and in the few studies where this issue is
addressed, the majority found no significant influence on the examinee even when the
observer was not a trained observer.
Yantz, C.L and McCaffrey, R.J. (2005) reported the findings of a study designed to
examine the effects of a supervisor’s observation on memory test performance. The
performance of observed group members was attended by the examiner’s supervisor
during test administration. The subjects were informed before the start of testing that the
observer was the examiner’s supervisor, present solely to monitor the consistency of the
examiner’s test administration and that she would not be evaluating the subject’s
performance in any way. On memory testing, two of the four summary scores were
found to have significant relationship with supervisory observation. Both verbal memory
and global memory scores were significantly higher for the unobserved group while there
was no difference in scores for visual memory or short term memory. Seventeen
additional variables were examined and there was no significant difference between the
observed and unobserved groups. Since the two effected memory summary scores were
in the normal range of performance for both the observed and the unobserved group, the
authors could only conclude that “the supervisor’s evaluative presence could have
effected the examiner’s concentration and/or anxiety level which impacted test
administration procedures.” (p. 36). The supervisor in this study was a colleague of the
examiner and not an ally of the examinee involved in a forensic assessment. Even with
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this departure from recommended criteria for a trained third party examination, the
significant findings appear to be not that two summary scores (both falling in the normal
range) were statistically different but that the vast majority of analyzed scores
demonstrated no significant difference and the vast majority of scores demonstrated none
or very small effect size.
Social facilitation research does posit some interesting questions concerning the
instructions given to an examinee regarding the presence of a trained third party observer
and how this perception could actually enhance test performance. Advising evaluees that
an observer, either a person or a recording device, will be present to observe the examiner
may have a beneficial effect on those evaluees anticipating a negative outcome. It is
reasonable to conclude that the presence of a trained third party observer who is
perceived as a monitor of the examination process could raise the examinee’s drive level
and thereby improve test performance. Also, the presence of a perceived neutral party
observing the process in a forensic Independent Medical Examination (IME) evaluation
could help to reduce the anticipated negative evaluation in this sometime adversarial
situation. While it is not reasonable to conclude that all IME evaluations are biased or
will generate negative expectations from evaluees, this is a common enough perception
that it may warrant the recommendation for a trained third party observer in many
situations. Social facilitation research would suggest that other IME evaluations in
addition to neuropsychological assessments are likely candidates for some type of
observation. What forensic neuropsychologist has not heard of the 10-minute complete
and comprehensive neurology or orthopedic examination? Because we have little or no
scientific research that supports an objection to trained third party observation during
forensic evaluations, it is recommended that neuropsychologists utilize trained third party
observers in order to adhere to the principles of freedom of information and full
disclosure. At the same time, neuropsychologists would be preventing distribution of the
tests in the public domain that would jeopardize the validity of our instruments. Future
research pertaining to the effects of trained third party observers on the evaluation
process could investigate the (1) advising that the focus of attention is on the evaluator
versus the evaluee and (2) the effect of advising the evaluee that the evaluator is a biased
versus an impartial IME evaluator.
References
Constantinou, M., Ashendorf, L., & McCaffrey, R. (2005). Effects of a Third Party
Observer During Neuropsychological Assessment: When the Observer is a Video
Camera. Journal of Forensic Neuropsychology, 4(2), 39-63.
Cottrell, N. B. (1972). Social facilitation. In C. G. McClintock (Ed.), Experimental
Social Psychology (pp. 185-236). New York: Holt.
Duff, K. & Fisher, J.M. (2005) Ethical Dilemmas with Third Party Observers. Journal of
Forensic Neuropsychology, 4(2), 65-81.
Gavett, B.E., Lynch, J.K., & McCaffrey, R.L. (2005) Third Party Observers: The Effect
Size Is Greater Than You Might Think. Journal of Forensic Neuropsychology, 4(2),
49-63
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Knowles, E. S. (1983). Social Physics and the effects of others: Tests of audience size
and distance on social judgment and behavior. Journal of Personality and Social
Psychology, 45, 1263-1279.
Laughlin, P.R., & Wong-McCarthy, W. J. (1975). Social inhibition as a function of
observation and recording of performance. Journal of Experimental Social
Psychology, 11, 560-571.
Lynch, J.K. (2005) Effect of a Third Party Observer on Neuropsychological Test
Performance Following Closed Head Injury. Journal of Forensic Neuropsychology,
4(2), 17-25.
Manstead, A. S. R., & Semin, G. R. (1980). Social facilitation effects: Mere
enhancement of dominant responses? British Journal of Social and Clinical
Psychology, 19, 119-136.
McCaffrey, R. J., Fisher, J. M., Gold, B. A., & Lynch, J. K. (1996). The Presence of
third parties during neuropsychological evaluations: Who is evaluating whom? The
Clinical Neuropsychologist, 10(4), 435-449.
McCaffrey, R. J., Lynch, J.K. & Yanyz, C.L. (2005). Third Party Observers: Why All
The Fuss? Journal of Forensic Neuropsychology, 4(2), 1-15.
McSweeny, A.J., Becker, B.C., Naugle, R.I., Snow, W.G., Binder, L.M. & Thompson,
L.L. (in press). Ethical issues related to third party observers in clinical
neuropsychological evaluations. The Clinical Neuropsychologist.
Official Statement of the National Academy of Neuropsychology (Summer, 1999).
Presence of Third Party Observers During Neuropsychological Testing. National
Academy of Neuropsychology Bulletin, 10(3), 15-16.
Sasfy, J., & Okun, M. (1974). Form of evaluation and audience expertness as joint
determinants of audience effects. Journal of Experimental Social Psychology, 10,
461-467.
Yantz, C.L. & McCaffrey, R.L. (2005) Effects of a Supervisor’s Observation on Memory
Test Performance of the Examinee: Third Party Observer Effect Confirmed. Journal of
Forensic Neuropsychology, 4(2), 27-37.
Zajonc, R. B. (1965). Social facilitation. Science, 149, 269-274.
Zajonc, R. B. (1980). Compresence. In P. Paulus (Ed.), Psychology of group influence
(pp. 35-60). Hillsdale, NJ: Lawrence Erlbaum.