Ecological validity of neuropsychological assessment: The roles of vocational assessment and employment in aging HIV+ adults
Neuropsychological tests are often used to make predictions regarding 'real-world' functioning (e.g., vocational function, activities of daily living, etc.) in younger adults, but not in older adults. One illness associated with potentially significant neuropsychological and functional sequelae is HIV infection. Further, as the HIV/AIDS population ages, a unique opportunity is provided to evaluate the joint impact of neurologic disease and typical neurodevelopment in an aging population on neuropsychological and functional outcomes. In addition, research providing a model to describe the process or the influence of aging and HIV status on neuropsychological functioning, vocational functioning and employment has not yet been established. Thus, the purpose of this study was threefold: (1) to investigate the utility of clinical ratings of neuropsychological test performance in predicting vocational test performance for younger and older HIV+ adults, (2) to examine particular associations between specific domains neuropsychological and vocational functioning, and (3) to investigate the relationship between age, HIV immune status, neuropsychological functioning, vocational functioning, and employment. Methods. The sample (N = 110) included 72 younger participants (≤35 years) and 38 older participants (≥50 years). All participants underwent comprehensive neuromedical evaluations, neuropsychological, and vocational evaluations. The neuropsychological evaluations evaluated functioning in terms of a global neuropsychological functioning (i.e., global clinical ratings). The vocational assessment was the Valpar Vocational Assessment, which determines specific ability areas as determined by the DOT. Results. Overall, older participants were not more impaired on global neuropsychological functioning (t (1,109) = -1.94, p = 0.06) but were on vocational functioning (t (1,109) = -3.57, p = 0.001) when compared to the younger sample. However, correlational analyses found global neuropsychological functioning was comparably associated with vocational functioning in both the younger and older groups (Z = 0.882, p > .05). Correlational analyses indicated that the a priori hypothesized associations between specific domains of neuropsychological and vocational functioning were all moderately associated. A series of path analyses found a model with age and HIV status associated with neuropsychological functioning, and in turn with vocational functioning and employment was a good fit to the data when direct paths from age to vocational functioning and HIV-related immune status to employment were included. Conclusions. Consequently, the current study supports the validity of using neuropsychological test measures in the prediction of vocational function among both younger and older HIV+ adults. A model is presented to reflect the relationship between age, HIV immune status, neuropsychological functioning, vocational functioning, and employment.
Henninger, Debra E, "Ecological validity of neuropsychological assessment: The roles of vocational assessment and employment in aging HIV+ adults" (2006). ETD Collection for Fordham University. AAI3216913.