The goal of the current study was to demonstrate a possible neurological deficit that underlies the inability of many chronically homeless adult individuals to make behavioral changes necessary to transition toward stability. Specifically, the medial area of prefrontal cortex (PFC), including orbital and anterior cingulate regions, is strongly associated with modulation of emotional reaction (Davidson, Putnam and Larson, 2000), "intuitive" decision-making and risk-taking (Damasio, 1994), empathy (Assington, 1993) and spontaneity (Zangwill, 1966). Neuropsychological tests designed to assess this area were administered to homeless participants.

In this study, 30 chronically homeless individuals were compared to 30 controls (matched for age, race and gender) on cognitive tests of PFC ability. The Iowa Gambling Task is the current standard for measuring medial function (e.g. Happeney, Zelazo and Stuss, 2004), through a procedure of risk-taking and strong sensory reinforcement. The Burglar's Story has been used in a number of studies to indicate the demonstration of Theory of Mind, in terms of empathy and perspective (e.g. Happe et al., 1996). Finally, the familiar Word Fluency Test ("FAS") elicits potential difficulty with spontaneity, a frontal medial function, but also semantic memory problems, an indication of frontal dorsolateral impairment, as well as more generalized cognitive deficit such as that associated with head trauma and dementia (e.g. Benton, 1968).

The results showed that, as a group, the homeless individuals performed significantly more poorly than the controls on all three tests (p <.01). Moreover, the Gambling Task was very sensitive in classifying 93.3% of the homeless participants by their risky performance (while revealing 27% of controls as risk-takers). FAS well differentiated homeless from control participants at levels of 90%. The Burglar's Story demonstrated that Theory of Mind function is well intact amongst healthy controls (90%), but possibly problematic with a significant number (40%) of the homeless.

The robust differentiation elicited by the battery of tests begs consideration of chronic homelessness as a strong indicator of potential neuropsychological deficit, and cognitive challenge as a significant precipitator and/or result of homelessness.