Elsevier

Neuropsychologia

Volume 89, August 2016, Pages 119-124
Neuropsychologia

Review article
The problem of being bad at faces

https://doi.org/10.1016/j.neuropsychologia.2016.06.008Get rights and content

Highlights

  • This commentary focuses on ambiguities in concepts about developmental prosopagnosia.

  • Is this condition merely the low end of normal or a product of aberrant development?

  • How is this reflected in our diagnostic criteria, which vary between studies?

  • A set of primary and secondary diagnostic criteria is proposed for discussion.

Abstract

Developmental prosopagnosia has received increased attention in recent years, but as yet has no confirmed genetic or structural markers. It is not certain whether this condition reflects simply the low-end of the spectrum of normal face recognition, an ‘under-development’, or a pathologic failure to develop such mechanisms, a ‘mal-development’. This difference in views creates challenges for the diagnosis of developmental prosopagnosia by behavioural criteria alone, which also vary substantially between studies, with secondary effects on issues such as determining its prevalence. After review of the literature and the problems inherent to diagnoses based solely on behavioural data, we propose as a starting discussion point a set of two primary and four secondary criteria for the diagnosis of developmental prosopagnosia.

Introduction

The definition of developmental prosopagnosia is deceptively simple: a life-long difficulty in recognizing or learning to recognize faces. When the disorder is severe it leads to anecdotes that stand apart from typical human experience: failures to recognize one’s own image in the mirror, mistaking siblings who change their hairstyle for strangers, and an inordinate reliance on voice to identify people, when for most people voices are far inferior to faces as cues to identity (Barsics and Bredart, 2012). Most would agree that subjects who describe such experiences likely have an anomalous mechanism for face recognition. However, operationalizing these impressions and translating the definition into diagnostic criteria has challenges and complexities that cannot be denied.

How is it currently done? Not surprisingly, but no less unfortunate for that, this varies considerably between studies, as can be seen in an illustrative sample of reports spanning recent years (Table 1). Some document the inability to identify famous faces by name, others poor short-term familiarity with recently viewed faces. Some include impaired discrimination between faces, although the ability to do this is no guarantee that one can recognize faces. Some require subjects to complain of problems with face recognition in daily life, and some formalize this with a questionnaire and use this in lieu of behavioural testing. Some studies require meeting only one or two of these various criteria, while others insist on fulfillment of several. Even when the same test is applied, the criterion for diagnosis varies: with the Cambridge Face Memory Test, there are studies that use 1.7 standard deviations, 2 standard deviations, or a set numerical score.

Some of the difficulties created by this diagnostic heterogeneity will be discussed later. However, a more fundamental issue with behavioural tests and questionnaires is the diagnostic inference they afford. All of these instruments claim to indicate a problem when a subject’s score falls below a certain criterion. The crux is what we can infer when that happens.

Section snippets

The normative and the pathologic view

To reflect upon this, we must consider one of the key issues about this diagnosis: its pathogenetic implication. First of all, as with any human ability, face recognition skills vary in the normal population (Bowles et al., 2009, Wilmer et al., 2010, Zhu et al., 2010), and the results of any test of these skills will reflect that variability. Thus there will be both those who never forget a face, the super-recognizers (Russell et al., 2009), and those who are bad with faces. These are

Other aids to diagnosis

Frankly, if one subscribes to the pathologic view, there is no way that one can statistically infer from the fact that someone falls below a performance criterion on any behavioural test of face recognition that they have developmental prosopagnosia rather than being ‘bad with faces’. Hence the challenge is to find some other characteristic that will separate the developmental prosopagnosic from the person bad at faces.

Are there markers in perceptual performance that could potentially segregate

Concluding remarks

Faced with these challenges, what are we to do? Others have recently grappled with this, and their suggestions are worth reviewing (Dalrymple and Palermo, 2016). We agree with them that objective confirmation of poor familiarity for faces on two or more tests seems prudent (Table 2). Most common in recent years has been the Cambridge Face Memory Test (Duchaine and Nakayama, 2006), which probes the ability to become familiar with recently viewed faces, along with a test of famous face

Acknowledgements

Brad Duchaine participated in helpful discussions about this manuscript. JB is supported by a Canada Research Chair 950-228984 and the Marianne Koerner Chair in Brain Diseases. SC is supported by National Eye Institute of the National Institutes of Health under award number F32 EY023479-02 and the Loan Repayment Program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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