Clinical Psychology

tests and adding several others. Subsequently, Reitan
and his colleagues could relate test responses to such
discrete aspects of brain lesions as lateralized motor
deficits. This work culminated in the Halstead-
Reitan Neuropsychological Test Battery. By 1980,
the Luria-Nebraska Neuropsychological Battery had
been developed, and it is now frequently used as an
alternative to the Halstead-Reitan Battery. We’ll
have more to say about these and other neuropsy-
chological tests in a later section.
An additional historical development deserves
mention here. Contemporary clinical neuropsychol-
ogists have increasingly adopted a flexible battery
approach to assessment. Flexible batteries allow
each assessment to be tailored to the individual
based on the clinical presentation and on the hypoth-
eses of the neuropsychologist. Standard batteries,
such as the Halstead-Reitan and the Luria-
Nebraska, may be too time-consuming and are not
easily modified to accommodate specific clinical
situations. We will compare the standard battery
and flexible battery approaches later in this chapter.

THE BRAIN: STRUCTURE,

FUNCTION, AND IMPAIRMENT

Before proceeding, it will be helpful to review some
important aspects of the brain. This will, of necessity,

be a brief excursion. More extensive accounts can be

found elsewhere (e.g., Yudofsky & Hales, 2010;

Zillmer et al., 2008).

Structure and Function

The brain consists of two hemispheres. Theleft

hemispherecontrols the right side of the body and

is thought to be more involved in language func-

tions, logical inference, and detail analysis in almost

all right-handed individuals and a good many left-

handers as well. Theright hemispherecontrols the left

side of the body. It is more involved in visual-spatial

skills, creativity, musical activities, and the percep-

tion of direction. But again, note that some left-

handers may reverse this hemispheric pattern. The

two hemispheres communicate with one another

via the corpus callosum, which helps to coordinate

and integrate our complex behavior.

Each cerebral hemisphere has four lobes: the

frontal, temporal, parietal, and occipital lobes (see

Figure 18-1). Thefrontal lobesare the most recently

developedpartsofthebrain,frombothanevolution-

ary and developmental perspective. They enable us to

observe and compare our behavior and the reactions of

others to it in order to obtain the feedback necessary to

alter our behavior to achieve valued goals. Also associ-

ated with the frontal lobes are executive functions—

formulating, planning, and carrying out goal-directed

initiatives. Finally, emotional modulation—the ability

Lateral fissure
(fissure of Sylvius)

Frontal lobe

Temporal lobe

Parietal lobe

Occipital lobe

Central fissure

(fissure of Rolando)

Cerebellum

Pons Medulla

F I G U R E 18-1 The cerebral cortex

518 CHAPTER 18