Neuropsychology, Vol 40(5), Jul 2026, 463-464; doi:10.1037/neu0001091
Objective: Stiers (2026) presented a case example of differential diagnosis in clinical neuropsychology wherein standardized testing was not possible, and discussed a structure and process for using history, behavioral observations, and disease base rates to develop a preliminary diagnosis. In response, Basso et al. (2026) state that these alone are not sufficient, and they emphasize the importance of standardized testing. Methods: This article describes a clinical encounter where standardized norm-referenced testing was not possible because appropriate standardized tests or norms did not exist, as can occur with, for example, a patient from a rural country who speaks a local dialect and has not had any formal education, a patient with locked-in syndrome, a patient with receptive and expressive aphasia, or a patient who is poorly cooperative. Results: When standardized testing is not possible because of the lack of appropriate tests and norms, what is a neuropsychologist to do? Is it best to say that we can offer no opinion as to the condition of the patient, or is it best to say that we can offer limited opinions pending further data? Conclusions: My contention is that when testing data are not available, a competent neuropsychologist can still conduct a partial, not full, assessment of brain–behavior relationships and make contributions to patient care based on history, behavioral observations, and disease base rates. (PsycInfo Database Record (c) 2026 APA, all rights reserved)