This chapter is devoted to the current position of neuropsychological assessment in the South African context. With this in mind, a short overview defining the field and the profession is presented, followed by a review of neuropsychological assessment. A discussion follows of the major issues facing neuropsychological assessment in the South African context, including test adaptation. A brief discussion of the way forward concludes the chapter.

Defining neuropsychology

The term ‘neuropsychology’ may have its origins in the 16th century (Boeglin & Thomas, 1996), but general consensus is that the first modern use of the term can be attributed to William Osler in 1931 and later Donald Hebb in 1949 (Kolb & Whishaw, 1996). Neuropsychology is frequently defined as the relationship between brain functioning and behaviour, but with the collapse of Cartesian dualism, this focus has been expanded to include the study of the mind (Wilkinson, 2004). With the mind today seen as the output of the brain's neuronal connectivity (Le Doux, 2002), it is therefore available for objective consideration as well. Although open to debate, modern neuropsychology thus encompasses not only the understanding and interpretation of structural/functional brain systems, particularly in neuropathology, but includes broader understandings such as the effect of psychotherapy on brain functioning (Gabbard, 2000; 2006), the neurobiology of personality (Bergvall, Nilsson & Hansen, 2003; Blair, 2003), and the neurobiology of sense of self (Solms, 2006).

There have been two dominant traditions in neuropsychology: a syndromebased clinical approach and a cognitive neuroscientific approach. Clinical neuropsychology as understood today was first practised in the late 19th century with the cortical localisation of function by Dax, Broca, Wernicke and Charcot (Solms, 2008; Zillmer, Spiers & Culbertson, 2008). It is dependent upon a clinico anatomical analysis, using the medical model as its theoretical basis. Cognitive neuropsychology, first named in the late 1970s (Gazzaniga, Ivry & Mangun, 2009), grew out of cognitive psychology and neuroscience and assumes that mental activities operate in terms of specialised subsystems or modules that can be separated out (dissociated) from each other (Gazzaniga et al., 2009; Sternberg, 2009). It maintains close links to information processing and artificial intelligence (Reed, 2010).