Neuropsychology: Definition, Research, & History

By Charlie Huntington, M.A., Ph.D. Candidate
​Reviewed by Tchiki Davis, M.A., Ph.D.
Neuropsychology is the study of how the functioning of our nervous systems – and our brains in particular – is related to our behaviors and thinking.
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One of the skills that typically distinguishes a clinical psychologist from nearly every other mental health provider is their knowledge of neuropsychology and ability to conduct neuropsychological testing. In the clinical psychology training I received, few tasks were as complex and intensive as neuropsychological testing. To really understand whether a person’s behavior and thinking fall outside what we call the
“normal range” of functioning usually requires hours of testing – moving through one standardized assessment procedure after another.

When this process is completed with care, thoughtfulness, and thoroughness, the final result is a report documenting how the test subject performs across many measures of cognition and behavior, relative to other people their age. This is a powerful set of knowledge to have. For example, if this testing reveals that you struggle to sustain attention on tasks, make more errors indicating lack of focus than other people do, or respond impulsively to many questions, your ability to regulate your attention may be different enough from that of the average person who takes these tests for the neuropsychologist to say, for example, “You should be diagnosed with ADHD.” These tests can also reveal such an impressive array of high scores that a child or adult may be considered intellectually gifted.

So how do neuropsychologists know what they’re doing? How did this field form? Let’s see what the scientific literature says about the field of neuropsychology.​
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What Is Neuropsychology? (A Definition)​

Neuropsychology is the field of psychology that studies how the behavior of the nervous system – usually the brain, but also the rest of the nerve cells in one’s body – are related to one’s thinking, feeling, and behavior (VandenBos, 2007). Neuropsychology is interested in how both normal as well as dysfunctional thinking and behaving might be related to different kinds of functioning in the nervous system. Regarding dysfunctional patterns, clinical neuropsychology is the subfield of neuropsychology that focuses on assessment of brain functioning and rehabilitation of brain functioning following an injury. Another subfield is cognitive neuropsychology, which concerns itself specifically with thought processes and how they change if a person’s brain experiences damage or significant changes.

Looking specifically at clinical neuropsychology, as we did earlier when I discussed my own training, we can see how neuropsychology has important implications for medical and psychological care. Clinical neuropsychologists are the providers people are sent to when their cognition or behavior seem unusual, but it is not clear exactly what may be going on or more definitive proof is needed. This is because clinical neuropsychologists are experts in assessment of brain functioning, but also experts in psychopathology and how brain functioning and psychopathology are related (Hessen et al., 2018). A clinical neuropsychologist not only conducts assessments and writes reports, but also often presents the findings, as well as recommendations for supporting the test subject, to family members, other medical providers, teachers, and school administrators. A clinical neuropsychologist therefore must be able to keep in mind a vast body of knowledge about how people’s brains can operate atypically and what to do about it.​

Why Is Neuropsychology Important?​

Neuropsychology is an essential field of study and practice because neurological disorders – medical diagnoses related to breakdowns in normal functioning of the nervous system – are one of the most disabling and deadly kinds of medical disorders around (Feigin et al., 2020). These challenges seem to be increasing in prevalence around the world and as the world’s population ages, they will only become more of an issue. Furthermore, many, if not most, people harbor misconceptions about how atypical brain functioning is related to mental health disorders, so neuropsychologists have an important responsibility to educate the public about how the functioning of our brains is involved in mental health.
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I experienced these roles and responsibilities firsthand as a student learning to conduct neuropsychological assessments. For example, I encountered parents who had a hard time believing that their inattentive and rambunctious young children were actually faced with brain-related challenges; they often believed their children were simply being willfully disobedient or lazy. Neuropsychology research has shown that people with Attention-Deficit Hyperactivity Disorder (ADHD) often have brain functioning that looks pretty different from that of people without ADHD – this tells us that people with ADHD may have brains that have a harder time paying attention than the brains of people without ADHD. In other words, their paying attention is far from merely a matter of effort or willpower.

Examples of Neuropsychology

To take one example of where neuropsychology studies the intersection of brain functioning and psychological characteristics, we can look at the concept of executive functioning, sometimes abbreviated as EF (Clancy et al., 2005). EF is a grouping of cognitive skills that, when utilized, make us effective at completing tasks and solving problems. These skills include inhibiting one’s impulses to work on something else, staying focused when distractions come up, and keeping a goal in mind across a task with multiple steps.
 
While other psychologists might think of executive functioning (EF) as a set of cognitive skills, neuropsychologists think about EF as a set of abilities related to the development and healthy functioning of important regions in the brain – in particular, the prefrontal cortex (Clancy et al., 2005). This is the part of your brain right behind your forehead; it is what allows you to engage in complex kinds of thinking. If a person’s prefrontal cortex does not develop in a typical way, they may have difficulty focusing on and completing important tasks, and lots of research indicates that this has serious implications for their academic and professional success, as well as their emotional well-being (Diamond, 2016). This makes it especially important for neuropsychologists to identify children with challenges in executive functioning and help parents and teachers give them additional support and training (Clancy et al., 2005).

Neuropsychology Disorders

Neuropsychologists focus more on mental health disorders that have a clear component of brain functioning looking different. For example, many neuropsychologists study the effects of traumatic brain injuries (TBI) on people’s cognitive and behavioral functioning (Azouvi et al., 2017). They have found that people who sustained brain damage as the result of an injury have more difficulty with their executive functioning, experience more mental fatigue, and can even undergo changes to their personality. Neuropsychologists also know that some people recover from traumatic brain injuries within a few weeks, while others take months to recover or face permanent effects of the injury.
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Neuropsychologists try to use their scientific understanding of what is functioning differently in the brain in order to guide their treatment of people with neurological disorders. For example, a neuropsychologist might assess somebody with epilepsy – another neurological disorder – to identify whether their epileptic episodes have compromised their brain functioning. Then, they would use techniques of cognitive rehabilitation therapy to help the client relearn or strengthen key cognitive abilities (Baxendale, 2020).

Neuropsychology Research

There is so much research being conducted in the field of neuropsychology that it is difficult to summarize even briefly. In neuropsychology research, brain imaging techniques have become ubiquitous and are often even used as outcome measures (Bilder, 2011). For example, a neuropsychologist might scan the brains of patients before and after they receive clinical treatment for depression to see if their brains are activating differently after the treatment. Neuropsychology has always been interested in measuring the brain, whether directly through imaging or indirectly through cognitive and behavioral tasks, but in more recent years it has also begun to focus more on creating assessments and studies that can be widely administered, such as through online resources (Bilder, 2011).

For more of a sense of what the essential elements of neuropsychology research are, I recommend watching this video:​

Video: Neuropsychology Basics​

Neuropsychology Therapy

Neuropsychologists do not provide therapy as most of us conceive of therapy, at least when psychologists are involved (Harvey, 2012). Rather, neuropsychologists primarily provide clinical assessment of people’s brain functioning, which can in turn be used to make recommendations for their psychotherapy or for their cognitive rehabilitation. To make those recommendations, neuropsychologists use assessment tools, collect background information on clients’ lives, and consult the scientific literature to draw conclusions about what is happening for a given client (Harvey, 2012). When people complete the assessment measures or tasks they have been assigned, their scores on these measures are compared to normative scores for thousands of other people. For example, when I administered intelligence tests to children, I would check to see if their performance indicated they were behind, ahead, or right around their same-age peers on that measure.

Neuropsychology History

The field of neuropsychology was formally established in the 1960s when the term itself was first used (Bilder, 2011). This distinction became necessary as psychologists and medical doctors treating people with brain injuries and neurodegenerative diseases started to recognize how closely affected people’s psychological functioning was by their brain functioning. It was also motivated by the growing consensus among researchers that specific parts of the brain seemed to have specific functions, and that pathological activity in those brain regions was associated with breakdowns in cognitive and behavioral functioning (Casaletto & Heaton, 2017). Finally, the field of neuropsychology developed in response to a lack of scientifically validated tools for measuring brain function – while many techniques existed, it was not clear how effective or accurate they were for people of different ages or from different backgrounds.
 
In the 1970s and 1980s, training in the field of neuropsychology became more commonplace and more codified. The specificity and scientific validity of neuropsychological tests also increased as neuropsychologists realized more and more the importance of establishing normative scores on their measures. Nowadays, most clinical psychologists receive training in neuropsychological assessment, as do any and all research psychologists studying the brain directly.

Neuropsychology and Rehabilitation

Neuropsychology views rehabilitation from brain injury as having to focus on the psychological effects of brain injury – to heal one’s brain, one must practice and build strength in core psychological skills (Wilson, 2013). For this reason, rehabilitation following brain injuries often involves psychotherapy as well as cognitive training.

Neuropsychology of Autism

The neuropsychology research conducted on autism spectrum disorder suggests that functioning is different in “social” areas of the brain and in areas related to language processing and production (Ruggeri et al., 2014). I will not go into further detail here because each person with autism is different and the symptoms of autism are not simply a result of abnormal brain activity – we should not draw conclusions about any particular person’s brain based on research conducted on other people.

Neuropsychology of ADHD

​Similar to research on autism, research on people with ADHD has also found abnormal brain functioning, in this case in the brain systems involved in executive functioning and in regulating attention and reward (Mostert et al., 2015). This does not mean every person with ADHD has the exact same brain functioning or psychological challenges, though.

Neuropsychology of Self Discipline

Self-regulation is a key skill facilitated by having a healthy, normally functioning brain (Pokhrel et al., 2013). Neuropsychology research shows that these brain regions and networks do not fully develop until an individual is in their mid-twenties and that abnormal functioning in these networks is associated with many psychological challenges and mental health disorders.

Neuropsychology of Learning Disabilities

Neuropsychologists also know that learning disabilities such as dyslexia are often related to abnormal brain development or functioning (Fletcher & Grigorenko, 2017). This topic is a good example of neuropsychology research showing interesting results: when children with dyslexia participate in training to support them in learning how to read effectively, the brain regions that are most affected in dyslexia show positive changes over time.

Neuropsychology of Schizophrenia

Neuropsychology has also looked extensively at how the brains of people with schizophrenia may function differently (Van Den Heuvel & Fornito, 2014). In broad strokes, this research has shown that the amount of connections between key prefrontal parts of the brain (the areas involved in complex thought) is often different in people with schizophrenia and that some of these brain regions communicate more with each other, while others communicate less with each other, than they do in “neurotypical” people (in other words, people without schizophrenia).

Articles Related to Neuropsychology

​Want to learn more? Check out these articles:

Books Related to Neuropsychology

If you’d like to keep learning more, here are a few books that you might be interested in.

Final Thoughts on Neuropsychology​

It probably seems intuitive to us now that brain functioning and psychological functioning should be very closely related, but the field of neuropsychology is still relatively young and has much to learn about how these two areas are connected. I have seen firsthand the usefulness of high-quality neuropsychology research and assessment; if you are interested in better understanding the implications of how our brains work for our daily lives, this may be a rewarding field of study to consider.

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