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Henry GK. Response time measures on the Word Memory Test do not add incremental validity to accuracy scores in predicting noncredible neurocognitive dysfunction in mild traumatic brain injury litigants. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:1336-1342. [PMID: 36170848 DOI: 10.1080/23279095.2022.2126320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The objective of the current study was to investigate whether response time measures on the Word Memory Test (WMT) increase predictive validity on determining noncredible neurocognitive dysfunction in a large sample of mild traumatic brain injury (MTBI) litigants. Participants included 203 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity (PVT). Participants failing PVTs exhibited significantly slower response times and lower accuracy on the WMT compared to participants who passed PVTs. Response time measures did not add significant incremental validity beyond that afforded by WMT accuracy measures alone. The best predictor of PVT status was the WMT Consistency Score (CNS) which was associated with an extremely large effect size (d = 16.44), followed by Immediate Recognition (IR: d = 10.68) and Delayed Recognition (DR: d = 10.10).
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2
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Varela JL, Ord AS, Phillips JI, Shura RD, Sautter SW. Preliminary evidence for digit span performance validity indicators within the neuropsychological assessment battery. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:818-824. [PMID: 35603608 DOI: 10.1080/23279095.2022.2076602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The purpose of this study was to evaluate multiple embedded performance validity indicators within the Digits Forward and Digits Backward subtests of the Neuropsychological Assessment Battery (NAB), including Reliable Digit Span (RDS), as no published papers have examined embedded digit span validity indicators within these subtests of the NAB. Retrospective archival chart review was conducted at an outpatient neuropsychology clinic. Participants were 92 adults (ages 19-68) who completed NAB Digits Forward and Digits Backward, and the Word Choice Test (WCT). Receiver operating characteristic (ROC) curves, t-tests, and sensitivity and specificity analyses were conducted. Analyses showed that RDS demonstrated acceptable classification accuracy between those who passed the WCT and those who did not. The area under the curve (AUC) value for RDS was 0.702; however, AUC values for all other digit span indices were unacceptably low. The optimal cutoff for RDS was identified (<8). RDS for the NAB appears to be an adequate indicator of performance validity; however, considering the very small number of participants who were invalid on the WCT (n = 15), as well as the utilization of only one stand-alone PVT to classify validity status, these findings are preliminary and in need of replication.
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Affiliation(s)
- Jacob L Varela
- College of Health and Behavioral Sciences, Regent University, Virginia Beach, VA, USA
| | - Anna S Ord
- College of Health and Behavioral Sciences, Regent University, Virginia Beach, VA, USA
- W.G. Hefner VA Medical Center, Salisbury, NC, USA
- Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, NC, USA
| | - Jacob I Phillips
- College of Health and Behavioral Sciences, Regent University, Virginia Beach, VA, USA
- Independent Private Practice, Virginia Beach, VA, USA
| | - Robert D Shura
- W.G. Hefner VA Medical Center, Salisbury, NC, USA
- Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, NC, USA
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott W Sautter
- College of Health and Behavioral Sciences, Regent University, Virginia Beach, VA, USA
- Independent Private Practice, Virginia Beach, VA, USA
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3
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Turner EM, Wilkening G, Hutaff-Lee C, Wolfe KR. From Evidence-Based Guidelines to Clinical Practice: Pediatric Neuropsychology Care in Multidisciplinary Clinics. Arch Clin Neuropsychol 2024; 39:547-556. [PMID: 38205830 DOI: 10.1093/arclin/acad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE High demand for pediatric neuropsychological care has highlighted the time- and resource-intensive nature of traditional comprehensive evaluations. Emerging care models address these constraints by facilitating tiered neuropsychological services provided in various contexts, including multidisciplinary clinics (MDCs). We aim to demonstrate feasibility and acceptability of tiered neuropsychological care in MDCs through examples from a single institution. METHODS A review of all current MDC practices at a tertiary pediatric care center was conducted to describe clinic workflow, services provided, and triage strategies. Pediatric neuropsychologists (n = 5) and other health care providers (n = 31) completed a survey focused on experience with neuropsychology consultation in MDCs. RESULTS Neuropsychologists provided care in 11 MDCs, including universal monitoring with consultative interviews and questionnaires, as well as targeted screening. Neuropsychologists (89%) and other health professionals (100%) reported that tiered neuropsychological services improved patient care within MDCs. Other health professionals reported utilizing results from neuropsychology MDC care to inform their clinical approach (48-90%), referrals (58%), and treatment or surveillance decisions (55-71%). CONCLUSION Tiered neuropsychological care in pediatric MDCs is feasible, and provider experience ratings indicate high acceptability. Practical steps for development of MDCs are provided, including identifying teams, clinic goals and outcomes, operational logistics, and billing.
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Affiliation(s)
- Elise M Turner
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Greta Wilkening
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Christa Hutaff-Lee
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Kelly R Wolfe
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO 80045, USA
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Costello R, MacDonald B, Papadakis JL, Jordan LL. Culturally-informed neuropsychological evaluations of patients with spina bifida: Application of the ECLECTIC framework to a complex pediatric medical condition. Clin Neuropsychol 2024:1-27. [PMID: 39044371 DOI: 10.1080/13854046.2024.2372877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 06/23/2024] [Indexed: 07/25/2024]
Abstract
Objective: The pediatric patient populations in the United States are becoming increasingly diverse in culture. In addition to medical factors, a variety of sociocultural factors (including educational systems, language, immigration status, etc.) can impact a child's cognitive development, performance on traditional neuropsychological measures, provider interactions, differential diagnosis, and recommendations. A culturally-informed neuropsychological evaluation aims to understand the impact of sociocultural factors and integrate them into the assessment approach. Fujii's ECLECTIC framework (acronym for Education & Literacy, Culture/Acculturation, Language, Economic Issues, Communication Style, Testing Situation, Intelligence Conceptualization, and Context of Immigration) can be used to guide culturally-informed neuropsychological evaluations of children with complex medical conditions. Method: Using the ECLECTIC framework, this paper describes clinical considerations and offers practical solutions for providing culturally-informed pediatric neuropsychology evaluations. Four diverse patients with spina bifida are reviewed. Results: The case presentations highlight the application of the ECLECTIC framework within a medically complex pediatric patient population. Conclusions: Spina bifida is one example of a pediatric medical population in which both medical and sociocultural factors can impact cognitive development and the evaluation process. The ECLECTIC framework defines a variety of sociocultural factors that can influence cognitive development and multiple aspects of a pediatric neuropsychological evaluation. Pediatric neuropsychologists should use the ECLECTIC framework to provide culturally-informed evaluations for our increasingly diverse patient populations.
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Affiliation(s)
- Rosalia Costello
- Psychology Division, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Beatriz MacDonald
- Psychology Division, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jaclyn L Papadakis
- The Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lizabeth L Jordan
- The Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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5
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Marcopulos BA, Kaufmann P, Patel AC. Forensic neuropsychological assessment. BEHAVIORAL SCIENCES & THE LAW 2024; 42:265-277. [PMID: 38583136 DOI: 10.1002/bsl.2656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 04/08/2024]
Abstract
With its firm establishment as a neuropsychology subspecialty, forensic neuropsychological assessment is integral to many criminal and civil forensic evaluations. In addition to evaluating cognitive deficits, forensic neuropsychologists can provide reliable information regarding symptom magnification, malingering, and other neurocognitive and psychological issues that may impact the outcome of a particular legal case. This article is an overview and introduction to neuropsychological assessment in the forensic mental health context. Major issues impacting the current practice of forensic neuropsychology are summarized, and several examples from case law are highlighted.
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Affiliation(s)
- Bernice A Marcopulos
- Department of Graduate Psychology, James Madison University, Harrisonburg, Virginia, USA
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Paul Kaufmann
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Anisha C Patel
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
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Ashendorf L, Withrow S, Ward SH, Sullivan SK, Sugarman MA. Decision rules for an abbreviated administration of the Test of Memory Malingering. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:382-391. [PMID: 35068279 DOI: 10.1080/23279095.2022.2026948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The present study investigated abbreviation methods for the Test of Memory Malingering (TOMM) in relation to traditional manual-based test cutoffs and independently derived more stringent cutoffs suggested by recent research (≤48 on Trial 2 or 3). Consecutively referred outpatient U.S. military veterans (n = 260) were seen for neuropsychological evaluation for mild traumatic brain injury or possible attention-deficit/hyperactivity disorder. Performance on TOMM Trial 1 was evaluated, including the total score and errors on the first 10 items (TOMMe10), to determine correspondence and redundancy with Trials 2 and 3. Using the traditional cutoff, valid performance on Trials 2 and 3 was predicted by zero errors on TOMMe10 and by Trial 1 scores greater than 41. Invalid performance was predicted by commission of more than three errors on TOMMe10 and by Trial 1 scores less than 34. For revised TOMM cutoffs, a Trial 1 score above 46 was predictive of a valid score, and a TOMMe10 score of three or more errors or a Trial 1 score below 36 was associated with invalid TOMM performance. Conditional abbreviation of the TOMM is feasible in a vast majority of cases without sacrificing information regarding performance validity. Decision trees are provided to facilitate administration of the three trials.
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Affiliation(s)
- Lee Ashendorf
- Mental Health Service Line, VA Central Western Massachusetts, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Susanne Withrow
- Behavioral Health Service Line, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Sarah H Ward
- Mental Health Service Line, VA Central Western Massachusetts, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sara K Sullivan
- Psychology Service, VA Bedford Healthcare System, Bedford, MA, USA
| | - Michael A Sugarman
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
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van Horn JE, van der Schoot A, Wilpert J, Engelbregt HJ, Brand N. A Pilot Study of the Convergent and Discriminant Validity of the Dutch Version of the Parametric Go/No-Go Task. Cogn Behav Neurol 2024; 37:62-72. [PMID: 38051015 DOI: 10.1097/wnn.0000000000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 07/17/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The parametric go/no-go (PGNG) task is a computerized task that is designed to measure cognitive flexibility, response inhibition, and working memory. The PGNG task has been shown to measure core executive functions (EFs) in a psychometrically sound, brief, and ecologically valid manner. OBJECTIVE To analyze the psychometric properties of the Dutch version of the PGNG task in a convenience sample of nonclinical adults. METHOD The sample consisted of 74 highly educated adults, with an average age of 36 years. Forty-two participants completed test battery A to investigate the task's convergent validity; 36 participants completed test battery B to investigate the task's discriminant validity. The results were analyzed using a repeated-measures ANOVA, Friedman's test, paired-samples t test, and correlation analyses. RESULTS Level 3 of the PGNG task places increased demands on sustained attention, response inhibition, and set-shifting. Several moderate correlations between level 3 and a complex EFs measure supported the convergent validity of this level of the PGNG task. The convergent validity of levels 1 and 2 was not supported. No significant correlations were found between PGNG levels and non-EF tests, supporting discriminant validity. CONCLUSION Our study included a rather homogenous sample of highly educated participants, which might explain the convergent validity of level 3 of the Dutch version of the PGNG task. Hence, to overcome these potentially confounding factors, the Dutch version of the PGNG task should be investigated in a larger and more heterogeneous population in terms of age and educational level.
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Affiliation(s)
- Joan E van Horn
- The Forensic Care Specialists, de Waag Utrecht, Utrecht, The Netherlands
| | | | - Julia Wilpert
- The Forensic Care Specialists, de Waag Utrecht, Utrecht, The Netherlands
| | - Hessel J Engelbregt
- GGZ Research, Hersencentrum Mental Health Institute, Amsterdam, The Netherlands
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Nico Brand
- Department of Health Psychology, Utrecht University, Utrecht, The Netherlands
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Kiselica AM, Karr JE, Mikula CM, Ranum RM, Benge JF, Medina LD, Woods SP. Recent Advances in Neuropsychological Test Interpretation for Clinical Practice. Neuropsychol Rev 2024; 34:637-667. [PMID: 37594687 DOI: 10.1007/s11065-023-09596-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/28/2023] [Indexed: 08/19/2023]
Abstract
Much attention in the field of clinical neuropsychology has focused on adapting to the modern healthcare environment by advancing telehealth and promoting technological innovation in assessment. Perhaps as important (but less discussed) are advances in the development and interpretation of normative neuropsychological test data. These techniques can yield improvement in diagnostic decision-making and treatment planning with little additional cost. Brooks and colleagues (Can Psychol 50: 196-209, 2009) eloquently summarized best practices in normative data creation and interpretation, providing a practical overview of norm development, measurement error, the base rates of low scores, and methods for assessing change. Since the publication of this seminal work, there have been several important advances in research on development and interpretation of normative neuropsychological test data, which may be less familiar to the practicing clinician. Specifically, we provide a review of the literature on regression-based normed scores, item response theory, multivariate base rates, summary/factor scores, cognitive intraindividual variability, and measuring change over time. For each topic, we include (1) an overview of the method, (2) a rapid review of the recent literature, (3) a relevant case example, and (4) a discussion of limitations and controversies. Our goal was to provide a primer for use of normative neuropsychological test data in neuropsychological practice.
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Affiliation(s)
- Andrew M Kiselica
- Department of Health Psychology, University of Missouri, 115 Business Loop 70 W, Columbia, MO, 65203, USA.
| | - Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Cynthia M Mikula
- Institute of Human Nutrition, Columbia University, New York, NY, USA
| | - Rylea M Ranum
- Department of Health Psychology, University of Missouri, 115 Business Loop 70 W, Columbia, MO, 65203, USA
| | - Jared F Benge
- Department of Neurology, University of Texas-Austin, TX, Austin, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
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Steel SA, Rolin SN, Davis JJ. Relatively undervalued: Comparing the work relative value units of neuropsychological evaluation to other services. Clin Neuropsychol 2024; 38:907-921. [PMID: 37881944 DOI: 10.1080/13854046.2023.2272788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023]
Abstract
Objective: We examined work relative value units (wRVUs) and associated revenue of current procedural terminology (CPT) codes for evaluation and management (E&M) services, neuropsychological evaluation (NPE), psychological evaluation (PE), and psychotherapy. Method: CPT code wRVUs were aggregated for E&M (99202-99215), NPE (96116, 96132, 96133, 96136, and 96137), PE (90791, 96130, 96131, 96136, and 96137), and psychotherapy (90791 and 90832-90837 with and without the complexity modifier, 90785). Per minute wRVUs were calculated for each CPT code. The Centers for Medicare and Medicaid Services 2023 conversion factor ($33.8872) was multiplied by wRVUs to examine reimbursement per hour and per prototypical four-hour clinic slot. Results: The wRVUs per minute showed the following ranges: 0.032-0.07 for E&M services, 0.015-0.063 for NPE, 0.015-0.124 for PE, and 0.043-0.135 for psychotherapy. Average hourly revenue ranged from $72 for NPE to $132 for psychotherapy with the complexity modifier. Revenue for prototypical four-hour clinics ranged from $283 for NPE to $493 for psychotherapy with the complexity modifier. PE and psychotherapy services were valued at 124-184% of NPE. Conclusions: E&M code wRVUs increase with case complexity reflecting greater work intensity, and a modifier to PE and psychotherapy captures additional effort needed in complex cases. In contrast, NPE codes lack a complexity modifier, and NPE wRVUs are lower than those of PE and psychotherapy, the latter of which can be billed by master's level providers. NPE is undervalued compared to PE and psychotherapy based on wRVUs currently assigned to the CPT codes used for the respective services.
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Affiliation(s)
- Sarah A Steel
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Summer N Rolin
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jeremy J Davis
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Boone KB, Kaufmann PM, Sweet JJ, Leatherberry D, Beattey RA, Silva D, Victor TL, Boone RP, Spector J, Hebben N, Hanks RA, James J. Attorney demands for protected psychological test information: Is access necessary for cross examination or does it lead to misinformation? An interorganizational* position paper. Clin Neuropsychol 2024; 38:889-906. [PMID: 38418959 DOI: 10.1080/13854046.2024.2323222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
Objective: Some attorneys claim that to adequately cross examine neuropsychological experts, they require direct access to protected test information, rather than having test data analyzed by retained neuropsychological experts. The objective of this paper is to critically examine whether direct access to protected test materials by attorneys is indeed necessary, appropriate, and useful to the trier-of-fact. Method: Examples are provided of the types of nonscientific misinformation that occur when attorneys, who lack adequate training in testing, attempt to independently interpret neurocognitive/psychological test data. Results: Release of protected test information to attorneys introduces inaccurate information to the trier of fact, and jeopardizes future use of tests because non-psychologists are not ethically bound to protect test content. Conclusion: The public policy underlying the right of attorneys to seek possibly relevant documents should not outweigh the damage to tests and resultant misinformation that arise when protected test information is released directly to attorneys. The solution recommended by neuropsychological/psychological organizations and test publishers is to have protected psychological test information exchanged directly and only between clinical psychologist/neuropsychologist experts.
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Affiliation(s)
| | | | - Jerry J Sweet
- NorthShore University HealthSystem, Evanston, Illinois, USA
| | - David Leatherberry
- Leatherberry Law, a Professional Corporation, San Diego, California, USA
| | - Robert A Beattey
- University of California, Davis School of Medicine, Sacramento, California, USA
| | - Delia Silva
- Independent Practice, San Diego, California, USA
| | - Tara L Victor
- California State University, Dominguez Hills, California, USA
| | | | - Jack Spector
- Independent Practice, Baltimore, Maryland, USA
- Independent Practice, Alexandria, Virginia, USA
- Independent Practice, Charlotte, North Carolina, USA
| | - Nancy Hebben
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Independent Practice, Newton, Massachusetts, USA
| | - Robin A Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Joette James
- Alina Assessment Services, Washington, District of Columbia, USA
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Henry GK. Ability of the Wisconsin Card-Sorting Test-64 as an embedded measure to identify noncredible neurocognitive performance in mild traumatic brain injury litigants. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-7. [PMID: 38684109 DOI: 10.1080/23279095.2024.2348012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To investigate the ability of selective measures on the Wisconsin Card Sorting Test-64 (WCST-64) to predict noncredible neurocognitive dysfunction in a large sample of mild traumatic brain injury (mTBI) litigants. METHOD Participants included 114 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity (PVT). RESULTS Participants failing PVTs performed worse across all WCST-64 dependent variables of interest compared to participants who passed PVTs. Receiver operating curve analysis revealed that only categories completed was a significant predictors of PVT status. Multivariate logistic regression did not add to classification accuracy. CONCLUSION Consideration of noncredible executive functioning may be warranted in mild traumatic brain injury (mTBI) litigants who complete ≤ 1 category on the WCST-64.
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Colvin MK, Reesman J, Glen T. Altered Trajectories: Considering the Long-Term Impact of Educational Disruption during the COVID-19 Pandemic on Neurodevelopment and a Call to Action for Neuropsychology. Arch Clin Neuropsychol 2024; 39:305-312. [PMID: 38520379 DOI: 10.1093/arclin/acae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE The COVID-19 pandemic resulted in educational disruption of historic breadth and duration. The impact of school closures and remote learning have been evaluated in recent studies and reflect critical data for neuropsychologists who routinely assess brain development as it relates to diagnosis, recommendations, and informing public policy. METHOD Pre-pandemic and contemporaneous literature was summarized, including data on educational disruption and child and adolescent mental health challenges reported during the pandemic, and research on the impact of stress, social isolation, educational achievement, and other factors on brain development during critical developmental windows. RESULTS Studies indicate that prolonged educational disruption has resulted in attenuated learning gains, most remarkably for those already at risk for educational disparities. Studies have shown increased mental health challenges for youth during the pandemic, with higher rates of mood and eating disorders, and suicidal ideation. Given that some skills develop optimally within specific time periods, pandemic-related disruption has likely contributed to altered developmental trajectories. CONCLUSION Trajectory of neuropsychological development of children and adolescents, especially marginalized students, may be affected by effects on learning and mental health due to prolonged educational disruption and psychological stressors. Evaluation and treatment may be delayed due to backlog and increased demand. Clinical neuropsychological practice recommendations are presented with a call to action for the field in moving forward flexibly to increase access to evaluation services.
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Affiliation(s)
- Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jennifer Reesman
- Chesapeake Center for ADHD, Learning and Behavioral Health, Bethesda, MD, USA
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13
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Talbert LD, Reyes A, Beltran-Najera I, Peraza J, Santos OA. Barriers to board certification in clinical neuropsychology identified by surveyed trainees and professionals. Clin Neuropsychol 2024:1-18. [PMID: 38640404 DOI: 10.1080/13854046.2024.2343458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
Objective: Board certification (BC) in clinical neuropsychology via the American Board of Clinical Neuropsychology (ABCN) is a rigorous process demonstrating clinical competence to practice. While myths about BC have been addressed, barriers to BC have yet to be studied. The aim of this study was to identify barriers to BC among neuropsychology trainees and professionals. Method: Data were collected through pre-webinar surveys administered to 1202 participants across four webinars conducted between 2018 and 2021. The surveys, via open-ended questions, captured specific concerns about BC as well as, demographic information including self-identification with racial/ethnic and culturally diverse groups. Qualitative analyses of self-reported barriers were conducted, and themes were identified. Results: The themes identified included Preparedness (11.8%), Lack of Training and Mentoring Opportunities (5.8%), Training Flexibility (11.9%), BC Knowledge (13.4%), Overall Knowledge of neuropsychology (4.4%), Time (24.7%), Money (10.9%), Documentation (3.4%), International Issues (1.5%), and COVID-19 concerns (2.5%). Respondents that identified with a racial/ethnic diverse group were more likely to report Opportunities and International Issues, whereas White respondents more frequently identified Time and Documentation as barriers. Trainees were more likely to report Training Flexibility, Opportunities, BC Knowledge, whereas Professionals were more likely to report Preparedness and Time as barriers. Conclusions: Results from this survey demonstrate that Time, BC Knowledge, Training Flexibility, Preparedness, and Money related to the examination were the most frequently reported barriers. However, differences across groups (i.e. career stage, racial/ethnic) emerged, highlighting the need to develop initiatives that address the specific needs of different groups of neuropsychology trainees and professionals.
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Affiliation(s)
- Leah D Talbert
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Anny Reyes
- Department of Radiation Medicine and Applied Science, University of California, San Diego, San Diego, CA, USA
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14
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Shaikh KT, Bolton K, Shaikh U, Troyer AK, Rich JB, Vandermorris S. Evaluating functional abilities within the context of memory assessment: A practice survey of neuropsychologists. Clin Neuropsychol 2024; 38:557-587. [PMID: 37649186 DOI: 10.1080/13854046.2023.2249178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/12/2023] [Indexed: 09/01/2023]
Abstract
Objective: Functioning in daily life is an important consideration when differentiating between individuals with normal cognition, mild neurocognitive disorder, and major neurocognitive disorder. Despite this, there is no gold standard measurement approach for assessing functional abilities and few guidelines on how to do so. The objective of this study was to examine neuropsychologists' practices regarding the assessment of functional abilities across the spectrum of memory ability. Method: A total of 278 psychologists who routinely conduct neuropsychological assessments completed an online survey (estimated 15% response rate) querying their practices and perspectives with respect to the assessment of functional abilities. Results: Respondents identified that changes to several components of daily functioning, including activities of daily living, were important when evaluating functional abilities. Respondents reported utilizing a variety of instruments to assess functioning, with an overwhelming majority indicating the use of semi-structured interviews. Although most respondents are satisfied with existing tools, a quarter of respondents felt strongly that there was a need for more instruments of everyday functioning. Respondents further indicated that their recommendations to patients, particularly regarding compensatory strategies and follow-up with other professionals, were informed by results of their functional assessment. Conclusions: Overall, our survey results indicate that neuropsychologists perceive multiple factors of daily life to be important considerations when evaluating functioning, use a variety of techniques to assess functioning, and perceive a need for more measures of functional abilities.
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Affiliation(s)
- Komal T Shaikh
- Department of Psychology, York University, Toronto, Canada
- Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Toronto, Canada
| | - Kathryn Bolton
- Department of Psychology, York University, Toronto, Canada
- Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Toronto, Canada
- Department of Psychology, Toronto Metropolitan University
| | - Umar Shaikh
- Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Toronto, Canada
| | - Angela K Troyer
- Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Toronto, Canada
- Department of Psychology, University of Toronto, Toronto, Canada
| | - Jill B Rich
- Department of Psychology, York University, Toronto, Canada
- Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Toronto, Canada
| | - Susan Vandermorris
- Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Toronto, Canada
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15
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Varela JL, Sperling SA, Block C, O’Leary K, Hart ES, Kiselica AM. A survey of neuropsychological assessment feedback practices among neuropsychologists. Clin Neuropsychol 2024; 38:529-556. [PMID: 37438247 PMCID: PMC10784416 DOI: 10.1080/13854046.2023.2233738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Feedback on neuropsychological assessment is a critical part of clinical practice, but there are few empirical papers on neuropsychological feedback practices. We sought to fill this gap in the literature by surveying practicing neuropsychologists in the United States. Questions addressed how they provide verbal and written feedback to patients and referral sources. Survey questions also addressed billing practices and training in the provision of feedback. METHODS A survey was developed using Qualtrics XM to survey currently licensed, independently practicing clinical neuropsychologists in the United States about their feedback practices. The survey was completed by 184 individuals. RESULTS Nearly all respondents reported that they provide verbal feedback to patients, most often in-person, within three weeks following testing. Typically, verbal feedback sessions with patients last 45 min. Verbal feedback was provided to referrals by about half of our sample, typically via a brief phone call. Most participants also reported providing written feedback to both the patient and referring provider, most commonly via the written report within three weeks after testing. Regarding billing, most respondents use neuropsychological testing evaluation codes. The COVID-19 pandemic appeared to have had a limited impact on the perceived effectiveness and quality of verbal feedback sessions. Finally, respondents reported that across major stages of professional development, training in the provision of feedback gradually increased but was considered inadequate by many participants. CONCLUSIONS Results provide an empirical summary of the "state of current practice" for providing neuropsychological assessment feedback. Further experimental research is needed to develop an evidence-base for effective feedback practices.
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Affiliation(s)
- Jacob L. Varela
- University of Missouri, Columbia, MO, 65211, USA
- Regent University, Virginia Beach, VA, 23464, USA
| | | | - Cady Block
- Emory University, Atlanta, GA, 30322, USA
| | | | - Eric S. Hart
- University of Missouri, Columbia, MO, 65211, USA
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16
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Stucky KJ, Baker LN, Rush BK, Waldron-Perrine B, Dean PM, Tlustos SJ, Barisa M. Training in Neurorehabilitation Psychology: Defining Competencies, Requisite Skill Sets, and a Proposed Developmental Pathway. Arch Phys Med Rehabil 2024; 105:604-610. [PMID: 37657530 DOI: 10.1016/j.apmr.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/18/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023]
Abstract
Psychologists have been applying neurorehabilitation models of care for many years. These practitioners come from different training backgrounds and use a variety of titles to refer to themselves despite considerable overlap in practice patterns, professional identification, and salary. Titles like 'neurorehabilitation psychologist' and 'rehabilitation neuropsychologist' are sometimes used by practitioners in the field to indicate their specialty area, but are not formally recognized by the American Psychological Association, the American Board of Professional Psychology, or by training councils in clinical neuropsychology (CN) or rehabilitation psychology (RP). Neither the CN or RP specialties alone fully address or define the competencies, skill sets, and clinical experiences required to provide high quality, comprehensive neurorehabilitation psychology services across settings. Therefore, irrespective of practice setting, we believe that both clinical neuropsychologists and rehabilitation psychologists should ideally have mastery of specific, overlapping competencies and a philosophical approach to care that we call neurorehabilitation psychology in this paper. Trainees and early career professionals who aspire to practice in this arena are often pressured to prioritize either CN or RP pathways over the other, with anxiety about perceived and real potential for falling short in their training goals. In the absence of an explicit training path or formal guidelines, these professionals emerge only after the opportunity, privilege, or frank luck of working with specific mentors or in exceptional patient care settings that lend themselves to obtaining integrated competencies in neurorehabilitation psychology. This paper reflects the efforts of 7 practitioners to preliminarily define the practice and philosophies of neurorehabilitation psychology, the skill sets and competencies deemed essential for best practice, and essential training pathway elements. We propose competencies designed to maximize the integrity of training and provide clear guideposts for professional development.
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Affiliation(s)
| | | | - Beth K Rush
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Brigid Waldron-Perrine
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
| | | | - Sarah J Tlustos
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
| | - Mark Barisa
- Psychology Department, University of North Texas, Denton, TX; Performance Neuropsychology, Frisco, TX
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17
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Sperling SA, Acheson SK, Fox-Fuller J, Colvin MK, Harder L, Cullum CM, Randolph JJ, Carter KR, Espe-Pfeifer P, Lacritz LH, Arnett PA, Gillaspy SR. Tele-Neuropsychology: From Science to Policy to Practice. Arch Clin Neuropsychol 2024; 39:227-248. [PMID: 37715508 DOI: 10.1093/arclin/acad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t). METHOD We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access. RESULTS The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology. CONCLUSIONS More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access.
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Affiliation(s)
- Scott A Sperling
- Department of Neurology, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joshua Fox-Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lana Harder
- Children's Health, Children's Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John J Randolph
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Randolph Neuropsychology Associates, PLLC, Lebanon, NH, USA
| | | | - Patricia Espe-Pfeifer
- Department of Psychiatry and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Laura H Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter A Arnett
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
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18
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Randolph JJ, Lacritz LH, Colvin MK, Espe-Pfeifer P, Carter KR, Arnett PA, Fox-Fuller J, Aduen PA, Cullum CM, Sperling SA. Integrating Lifestyle Factor Science into Neuropsychological Practice: A National Academy of Neuropsychology Education Paper. Arch Clin Neuropsychol 2024; 39:121-139. [PMID: 37873931 DOI: 10.1093/arclin/acad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE The primary aim of this paper is to review evidence and clinical implications related to lifestyle activities associated with promoting brain and cognitive health. Our review targets four key lifestyle factors: physical activity and exercise, social engagement, cognitively stimulating activity, and consuming Mediterranean-style diets. METHOD We conducted a critical review of the lifestyle factor literature in the four domains listed earlier. We contextualize this literature review by translating findings, when possible, into evidence-based recommendations to consider when providing neuropsychological services. RESULTS There is significant current evidence supporting the role of physical activity and exercise, social engagement, cognitively stimulating activity, and consuming Mediterranean-style diets on positive brain and cognitive health outcomes. While some null findings are present in all four areas reviewed, the weight of the evidence supports the notion that engaging in these activities may promote brain and cognitive functioning. CONCLUSIONS Clinical neuropsychologists can have confidence in recommending engagement in physical activity, social activity, and cognitively stimulating activity, and adhering to a Mediterranean-style diet to promote brain and cognitive health. We discuss limitations in existing lifestyle factor research and future directions to enhance the existing evidence base, including additional research with historically underrepresented groups and individuals with neurological conditions.
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Affiliation(s)
- John J Randolph
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Randolph Neuropsychology Associates, PLLC, Lebanon, NH, USA
| | - Laura H Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Patricia Espe-Pfeifer
- Department of Psychiatry & Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Peter A Arnett
- Psychology Department, The Pennsylvania State University, University Park, PA, USA
| | - Joshua Fox-Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Paula A Aduen
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Jacksonville, FL, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott A Sperling
- Center for Neurological Restoration, Department of Neurology, Cleveland Clinic, Cleveland, Ohio, USA
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19
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Woods D, Pebler P, Johnson DK, Herron T, Hall K, Blank M, Geraci K, Williams G, Chok J, Lwi S, Curran B, Schendel K, Spinelli M, Baldo J. The California Cognitive Assessment Battery (CCAB). Front Hum Neurosci 2024; 17:1305529. [PMID: 38273881 PMCID: PMC10809797 DOI: 10.3389/fnhum.2023.1305529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/28/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction We are developing the California Cognitive Assessment Battery (CCAB) to provide neuropsychological assessments to patients who lack test access due to cost, capacity, mobility, and transportation barriers. Methods The CCAB consists of 15 non-verbal and 17 verbal subtests normed for telemedical assessment. The CCAB runs on calibrated tablet computers over cellular or Wi-Fi connections either in a laboratory or in participants' homes. Spoken instructions and verbal stimuli are delivered through headphones using naturalistic text-to-speech voices. Verbal responses are scored in real time and recorded and transcribed offline using consensus automatic speech recognition which combines the transcripts from seven commercial ASR engines to produce timestamped transcripts more accurate than those of any single ASR engine. The CCAB is designed for supervised self-administration using a web-browser application, the Examiner. The Examiner permits examiners to record observations, view subtest performance in real time, initiate video chats, and correct potential error conditions (e.g., training and performance failures, etc.,) for multiple participants concurrently. Results Here we describe (1) CCAB usability with older (ages 50 to 89) participants; (2) CCAB psychometric properties based on normative data from 415 older participants; (3) Comparisons of the results of at-home vs. in-lab CCAB testing; (4) We also present preliminary analyses of the effects of COVID-19 infection on performance. Mean z-scores averaged over CCAB subtests showed impaired performance of COVID+ compared to COVID- participants after factoring out the contributions of Age, Education, and Gender (AEG). However, inter-cohort differences were no longer significant when performance was analyzed with a comprehensive model that factored out the influences of additional pre-existing demographic factors that distinguished COVID+ and COVID- cohorts (e.g., vocabulary, depression, race, etc.,). In contrast, unlike AEG scores, comprehensive scores correlated significantly with the severity of COVID infection. (5) Finally, we found that scoring models influenced the classification of individual participants with Mild Cognitive Impairment (MCI, z-scores < -1.50) where the comprehensive model accounted for more than twice as much variance as the AEG model and reduced racial bias in MCI classification. Discussion The CCAB holds the promise of providing scalable laboratory-quality neurodiagnostic assessments to underserved urban, exurban, and rural populations.
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Affiliation(s)
- David Woods
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | - Peter Pebler
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | - David K Johnson
- Department of Neurology, University of California, Davis, Davis, CA, United States
| | - Timothy Herron
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
- VA Northern California Health Care System, Martinez, CA, United States
| | - Kat Hall
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | - Mike Blank
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | - Kristi Geraci
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | | | - Jas Chok
- VA Northern California Health Care System, Martinez, CA, United States
| | - Sandy Lwi
- VA Northern California Health Care System, Martinez, CA, United States
| | - Brian Curran
- VA Northern California Health Care System, Martinez, CA, United States
| | - Krista Schendel
- VA Northern California Health Care System, Martinez, CA, United States
| | - Maria Spinelli
- VA Northern California Health Care System, Martinez, CA, United States
| | - Juliana Baldo
- VA Northern California Health Care System, Martinez, CA, United States
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20
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Robinson M, Lazar MF, Zarabba JM, Gold M. School psychologists' perceptions of the effectiveness of neuropsychological evaluation reports. APPLIED NEUROPSYCHOLOGY. CHILD 2023:1-10. [PMID: 38142047 DOI: 10.1080/21622965.2023.2292785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
Referral sources and parents value the report following a neuropsychological evaluation. Nevertheless, key stakeholders have described pediatric reports as excessive in length and jargon. Recent research indicates that it is possible to modify pediatric neuropsychological reports that result in positive outcomes for key stakeholders and clinicians. Evaluating modified pediatric neuropsychological reports for other providers is necessary. School psychologists are key stakeholders who read and interact with such reports. This study assessed school psychologists' perceptions of a modified pediatric neuropsychological report. Forty-one school psychologists were randomly assigned to read either a traditional or modified version of a pediatric report and provide feedback via survey and qualitative questions. Results revealed that school psychologists' perceptions of a traditional and modified report were not significantly different. Qualitatively, respondents noted a disconnect between recommendations and school systems. These findings suggest that pediatric neuropsychologists can create shorter and more easily understood reports that do not impact the effectiveness for school psychologists. Future research should continue to evaluate perceptions of modified pediatric neuropsychological reports for additional key stakeholders. A better understanding of the disconnect between recommendations and their feasibility in schools, as well as barriers to increased interdisciplinary collaboration, is also essential for client care.
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Affiliation(s)
- Mary Robinson
- Institute of Graduate Clinical Psychology, Widener University, Chester, Pennsylvania, USA
| | - Mary F Lazar
- Institute of Graduate Clinical Psychology, Widener University, Chester, Pennsylvania, USA
| | - Jacqlyn M Zarabba
- Institute of Graduate Clinical Psychology, Widener University, Chester, Pennsylvania, USA
| | - Meghan Gold
- Institute of Graduate Clinical Psychology, Widener University, Chester, Pennsylvania, USA
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21
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Henry GK. Detection of noncredible cognitive performance with Wechsler Memory Scale-IV measures in mild traumatic brain injury litigants. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-8. [PMID: 38039520 DOI: 10.1080/23279095.2023.2287139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To investigate the operating characteristics of selective measures on the Wechsler Memory Scale-IV (WMS-IV) to predict noncredible neurocognitive dysfunction in a sample of mild traumatic brain injury (mTBI) litigants. METHOD Participants included 110 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity testing (PVT). RESULTS Participants failing two stand-alone PVTs exhibited significantly lower scores across all WMS-IV dependent variables of interest compared to participants who passed both PVTs. Participants who failed one PVT were excluded. Bivariate logistic regression revealed that all six dependent variables were significant predictors of PVT status. The best prediction model consisted of three WMS-IV variables including Logical Memory Delayed Recall (LM2), Logical Memory Recognition (LMR), and Visual Reproduction Recognition (VRR). This model demonstrated an accuracy of 90.2%, 0.89 sensitivity, 0.92 specificity, and a Receiver Operating Curve (ROC) of 0.957. CONCLUSION The current empirically-derived cutscores and logit equation for the WMS-IV may be an additional consideration in analyzing database validity and noncredible performance in mTBI personal injury litigants ages 18-69.
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22
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Dawson EL, Speelman C. Productivity measurement in psychology and neuropsychology: Existing standards and alternative suggestions. Clin Neuropsychol 2023; 37:1569-1583. [PMID: 36970878 DOI: 10.1080/13854046.2023.2192419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
Objective: The Relative Value Unit (RVU) system was initially developed to account for costs associated with clinical services and has since been applied in some settings as a metric for monitoring productivity. That practice has come under fire in the medical literature due to perceived flaws in determination of "work RVU" for different billing codes and negative impacts on healthcare rendered. This issue also affects psychologists, who bill codes associated with highly variable hourly wRVUs. This paper highlights this discrepancy and suggests alternative options for measuring productivity to better equate psychologists' time spent completing various billable clinical activities. Method: A review was performed to identify potential limitations to measuring providers' productivity based on wRVU alone. Available publications focus almost exclusively on physician productivity models. Little information was available relating to wRVU for psychology services, including neuropsychological evaluations, specifically. Conclusions: Measurement of clinician productivity using only wRVU disregards patient outcomes and under-values psychological assessment. Neuropsychologists are particularly affected. Based on the existing literature, we propose alternative approaches that capture productivity equitably among subspecialists and support provision of non-billable services that are also of high value (e.g. education and research).
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Affiliation(s)
- Erica L Dawson
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Claire Speelman
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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23
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Sunderaraman P, Dunn CB, Kamper JE, DeDios-Stern S, Azar M, Feigon M, Cooper S, Gooding A. Characteristics of and Professional Issues Experienced by Early Career Neuropsychologists in the United States - Findings from a Survey Study. Arch Clin Neuropsychol 2023; 38:1017-1034. [PMID: 36864589 DOI: 10.1093/arclin/acad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE Multiple transitions occur during the early career stage of a psychologist, perhaps to a higher extent and with more potent ramifications than subsequent career stages. However, limited information exists on the various expectations, concerns, and challenges experienced by early career psychologists (ECPs) broadly, and more specifically in clinical neuropsychology. Therefore, the Society for Clinical Neuropsychology (SCN)/Division 40's Early Career Neuropsychologist Committee developed a Needs Assessment Survey with the primary goal of identifying various training and professional development issues encountered by ECPs in clinical neuropsychology. METHOD A comprehensive survey was distributed electronically via listserv announcements and SCN communication tools (Newsletters and Neuroblasts). Data collection occurred from 29 May, 2020 to 02 August, 2020. The total sample comprised of 89 respondents (85% aged 31-40 years; 83% female; 82% Caucasian, followed by 18% Asian; 3% of Hispanic ethnicity). RESULTS Majority of the respondents graduated from APA-accredited doctoral programs and from postdoctoral programs that adhered to Houston Conference Guidelines. About 7% took >2 years to complete their residency and about 10%-15% of ECPs expressed clear dissatisfaction with at least some aspect of their residency training. Becoming board certified in neuropsychology was the highest ranked career goal for ECPs in neuropsychology (45%), whereas 72% indicated difficulty understanding billing and insurance-related issues as the most frequently encountered professional challenge. About 57% of ECPs were concerned about maintaining work/life balance. CONCLUSIONS Specific ways to aid and strengthen trainees and ECPs' professional needs are discussed with a focus on activities that can be undertaken at individual-, department-, profession-, and higher legislative-specific levels. IMPACT STATEMENT Question: Using survey data, this study aimed to characterize early career psychologists (ECPs) training history and their current work settings, identify their needs, and understand their perspectives about challenges and expectations. Findings: Results reveal that the workforce comprising of ECPs is getting increasingly diverse, and their needs are typically focused on obtaining board certification. ECPs identified areas for improvement in their training, such as increasing their knowledge of billing and insurance, and expressed concerns about maintaining work/life balance. Importance: The Minnesota 2022 Update Conference seems like a promising platform for addressing several of the needs identified by the survey and providing updated guidelines for ECPs. Next Steps: Based on the findings, general guidelines have been proposed for state and local level organizations along with call for action to higher-level legislation.
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Affiliation(s)
- Preeti Sunderaraman
- Department of Neurology & The Framingham Heart Study - Brain Aging Program, Boston University School of Medicine, Framingham, MA, USA
| | | | - Joel E Kamper
- Department of Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | | | | | | | - Shanna Cooper
- Department of Psychiatry, Brain Institute, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amanda Gooding
- Department of Psychiatry, University of California, San Diego, CA, USA
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24
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Petranovich C, Johnson A, Smith-Paine J, Tlustos SJ, Baum KT. A survey of pediatric neuropsychologists serving inpatient rehabilitation, Part II: billing, time allocation and tracking, and professional identity and perceptions. Child Neuropsychol 2023; 29:445-456. [PMID: 35834178 DOI: 10.1080/09297049.2022.2097652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Professional challenges have been documented in broad surveys of neuropsychologists. While previous surveyors have included pediatric neuropsychologists, few, if any, have specifically examined practices among those who primarily work in pediatric inpatient rehabilitation settings. Therefore, the aim of this study was to survey neuropsychologists in this setting. Thirty neuropsychologists from the U.S. and one from Canada that work in inpatient pediatric rehabilitation participated in an online survey. Most respondents (83.3%) billed for their inpatient time. Sixty-four percent indicated that payor type (private vs. public) affected services a moderate amount to a lot; this was primarily due to payor's influence on length of stay. Most providers had productivity expectations (66.7%). Among those that had productivity expectations, three-quarters used "hours billed;" 37.5% were solely or additionally tracked by relative value units (RVUs). The majority of respondents conducted some type of clinical data collection, usually for research purposes. With respect to professional identity, most respondents indicated positivity about their role. The top challenges endorsed were related to workload/ability to meet the patients' needs and billing/productivity. Issues related to billing and payor may influence aspects of pediatric inpatient rehabilitation neuropsychological care. Managing challenges related to billing and the time demands associated with providing inpatient services were top concerns for many respondents. Most sites surveyed were involved in data collection, usually for research purposes; increased data collection efforts are needed to aid with program development and evaluation and to demonstrate the added value of neuropsychological services from a patient care perspective.
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Affiliation(s)
- Christine Petranovich
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Rehabilitation Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Abigail Johnson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Julia Smith-Paine
- Department of Developmental Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve, Cleveland, OH, USA
| | - Sarah J Tlustos
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Rehabilitation Medicine, Children's Hospital Colorado, Aurora, CO, USA
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25
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Davis JJ. Time is money: Examining the time cost and associated charges of common performance validity tests. Clin Neuropsychol 2023; 37:475-490. [PMID: 35414332 DOI: 10.1080/13854046.2022.2063190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective: This study presents data on the time cost and associated charges for common performance validity tests (PVTs). It also applies an approach from cost effectiveness research to comparison of tests that incorporates cost and classification accuracy. Method: A recent test usage survey was used to identify PVTs in common use among adult neuropsychologists. Data on test administration and scoring time were aggregated. Charges per test were calculated. A cost effectiveness approach was applied to compare pairs of tests from three studies using data on test administration time and classification accuracy operationalized as improvement in posterior probability beyond base rate. Charges per unit increase in posterior probability over base rate were calculated for base rates of invalidity ranging from 10 to 40%. Results: Ten commonly used PVTs measures showed a wide range in test administration and scoring time from 1 to 3 minutes to over 40 minutes with associated charge estimates from $4 to $284. Cost effectiveness comparisons illustrated the nuance in test selection and benefit of considering cost in relation to outcome rather than prioritizing time (i.e. cost minimization) classification accuracy alone. Conclusions: Findings extend recent research efforts to fill knowledge gaps related to the cost of neuropsychological evaluation. The cost effectiveness approach warrants further study in other samples with different neuropsychological and outcome measures.
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Affiliation(s)
- Jeremy J Davis
- Department of Neurology, Glenn Biggs Institute for Alzheimer's and Neurogenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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26
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Sweet JJ, Boone KB, Denney RL, Hebben N, Marcopulos BA, Morgan JE, Nelson NW, Westerveld M. Forensic neuropsychology: History and current status. Clin Neuropsychol 2023; 37:459-474. [PMID: 35658794 DOI: 10.1080/13854046.2022.2078740] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective:This review provides a summary of historical details and current practice activities related to Forensic Neuropsychology (FN). Under the auspices of the American Board of Clinical Neuropsychology (ABCN), the Forensic Neuropsychology Special Interest Group (FNSIG) views the FN as a subspecialty, which has developed over time as the straightforward result of more than 20 years of numerous publications, extensive continuing education, focused research and growth of forensic practice within neuropsychology. In this article, the FNSIG core work group documents and integrates information that is the basis of efforts to consolidate practice knowledge and facilitate attainment of forensic practice competencies by clinical neuropsychologists. Method:Overview of continuing education topics at professional conferences, search results that identify relevant books and peer-reviewed publications, as well as pertinent findings across years of large-scale national survey results. Results:Relevant evidence has shown for decades that FN is prominent within Clinical Neuropsychology as practiced in the United States and Canada. A majority of U.S. neuropsychologists have received FN training and provide forensic evaluation services. FN practice time per week is considerable for many practitioners, and across survey epochs has been shown to be increasing. Conclusion:The present review leads to the conclusion that in the interest of promoting the acquisition of competence, FN practice should remain a focal point of training and continuing education. Alternate routes to attain competence are discussed, as are ongoing professional activities that undoubtedly will ensure continued growth of, and interest in, the subspecialty of FN.
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Affiliation(s)
- Jerry J Sweet
- NorthShore University HealthSystem, Evanston, IL, USA
| | - Kyle Brauer Boone
- Independent Practice, Torrance, CA, USA.,Department of Psychiatry, UCLA, Los Angeles, CA, USA
| | - Robert L Denney
- Missouri Memory Center, Citizens Memorial Healthcare, Bolivar, MO, USA
| | - Nancy Hebben
- Independent Practice, Newton, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Bernice A Marcopulos
- Department of Graduate Psychology, James Madison University, Harrisonburg, VA, USA.,Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Nathaniel W Nelson
- Morrison Family College of Health, Graduate School of Professional Psychology, University of St. Thomas, Minneapolis, MN, USA
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27
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Bodin D, Beebe DW, Fuchs K, Lucas J, Marcopulos B. The American Board of Clinical Neuropsychology (ABCN) and American Academy of Clinical Neuropsychology (AACN): Recent milestones and future goals 2014-2023. Clin Neuropsychol 2023; 37:784-811. [PMID: 36931232 DOI: 10.1080/13854046.2023.2190538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Objective: The American Board of Clinical Neuropsychology (ABCN) and the American Academy of Clinical Neuropsychology (AACN) have become leading organizations in the credentialing of clinical neuropsychologists and promotion of the field, respectively. This paper updates the literature by summarizing the activities and growth of ABCN and AACN during the period 2014 through 2023. Method: Prior papers have reviewed the history of these organizations up to 2014. In this paper, the authors describe milestones that each organization has reached, provide an update reflecting improved functions and new initiatives, and describe how the organizations have responded to numerous challenges. Conclusions: The past decade has witnessed substantial societal and technological evolution, as well as wrenching events including a global pandemic and public outcry over continued racial injustice. ABCN and AACN have evolved in the face of these changes, positioning each organization well to take on future challenges.
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Affiliation(s)
- Doug Bodin
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Dean W Beebe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kathleen Fuchs
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - John Lucas
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Bernice Marcopulos
- Department of Graduate Psychology, James Madison University, Harrisonburg, VA, USA.,Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
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28
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Markey BM, Courtwright KE, Clark JL, Callahan ML. Protecting the assessor: sexual harassment in neuropsychology and related training issues. Clin Neuropsychol 2023; 37:841-859. [PMID: 36803392 DOI: 10.1080/13854046.2023.2178514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Objective: Despite a growing body of literature on sexual harassment and inappropriate patient sexual behavior towards clinicians within the broader fields of psychology and medicine, literature, guidance, and supervision frameworks specific to neuropsychology are lacking. This gap in the literature is significant, given that neuropsychology is a specialty field faced with vulnerabilities to sexual harassment, and neuropsychologists may weigh unique factors into their decision-making of whether and/or when to respond. This decision-making may be further complicated for trainees. Method: A review of the literature addressing sexual harassment by patients in neuropsychology was completed. In this paper, we summarize the relevant literature on sexual harassment within psychology and academic medicine and provide a framework for discussing sexual harassment in neuropsychology supervision. Results: Research suggests high rates of inappropriate sexual behavior and/or sexual harassment from patients towards trainees, especially amongst trainees who identify as female and/or hold marginalized identities. Trainees report inadequate training in how to deal with sexual harassment by patients and there are perceived barriers for discussing the topic in supervision. Further, most professional organizations do not have formal policies regarding how to handle incidents. Conclusions: As of this writing, guidance and/or position statements from prominent neuropsychological associations could not be found. Research and guidance specific to neuropsychology is needed to help clinicians navigate these challenging clinical situations, provide effective supervision on the topic to trainees, and normalize discussion and reporting of sexual harassment.
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Affiliation(s)
- Brittney M Markey
- VA Portland Health Care System, Portland, OR, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Kylie E Courtwright
- VA Portland Health Care System, Portland, OR, USA.,School of Graduate Psychology, Pacific University, Forest Grove, OR, USA
| | - Joshua L Clark
- VA Portland Health Care System, Portland, OR, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Megan L Callahan
- VA Portland Health Care System, Portland, OR, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
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29
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Klipfel KM, Sweet JJ, Nelson NW, Moberg PJ. Gender and ethnic/racial diversity in clinical neuropsychology: Updates from the AACN, NAN, SCN 2020 practice and "salary survey". Clin Neuropsychol 2023; 37:231-285. [PMID: 35582913 DOI: 10.1080/13854046.2022.2054360] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Examination of gender and diversity issues within clinical neuropsychology, using data from the 2020 professional practice and "salary survey." METHODS Clinical neuropsychologists in the U.S. and Canada were invited to participate in an online survey. The final sample consisted of 1677 doctoral-level practitioners. RESULTS Approximately, 60% of responding neuropsychologists are women and 53.8% of those women identify as early career psychologists (ECPs). Conversely, a majority of men in the sample are advanced career psychologists (ACPs). Both genders work predominantly in institutions, but more men than women work in private practice. ACP men produce a greater number of peer-reviewed publications and conference presentations. Across all work settings, women earn significantly less than men, and are less satisfied with their incomes. Establishing and maintaining family life is the biggest obstacle to attaining greater income and job satisfaction for both genders. Ethnic/racial minority status was identified in 12.9% of respondents, with 59.2% being ECPs. Job satisfaction and hostility in the workplace vary across ethnic/racial minority groups. Hispanic/Latino(a) and White neuropsychologists report higher incomes, but there were no statistically significant differences between any of the groups. CONCLUSIONS Income and select practice differences persist between female and male neuropsychologists. There is a slow rate of increased ethnic/racial diversity over time, which is much more apparent among early career practitioners. Trajectories and demographics suggest that the gender income gap is unlikely to be improved by the next survey iteration in 2025, whereas it is very likely that ethnic/racial diversity will continue to increase gradually.
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Affiliation(s)
- Kristen M Klipfel
- Isaac Ray Forensic Group, LLC, Chicago, IL, USA.,Michigan Avenue Neuropsychologists, Chicago, IL, USA
| | - Jerry J Sweet
- Department of Psychiatry & Behavioral Sciences, NorthShore University HealthSystem, Evanston, IL, USA
| | - Nathaniel W Nelson
- Morrison Family College of Health, University of St. Thomas, Minneapolis, MN, USA
| | - Paul J Moberg
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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30
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Del Bene VA, Gerstenecker A, Lazar RM. Formal Neuropsychological Testing: Test Batteries, Interpretation, and Added Value in Practice. Clin Geriatr Med 2023; 39:27-43. [PMID: 36404031 DOI: 10.1016/j.cger.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Neuropsychologists evaluate patients for cognitive decline and dementia, using validated psychometric tests, along with behavioral observation, record review, clinical interview, and information about psychological functioning, to evaluate brain-behavior relationships and aid in differential diagnosis and treatment planning. Also considered are premorbid functioning, education, sex, socioeconomic status, primary language, culture, and race-related health disparities when selecting tests, interpreting performance, and providing a diagnostic impression. Neuropsychologists provide diagnostic clarity, explain symptoms and likely disease course to patients and family members, and assist the family with future planning, behavioral management strategies, and ways to mitigate caregiver burden.
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Affiliation(s)
- Victor A Del Bene
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA; The Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA
| | - Adam Gerstenecker
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA; The Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA
| | - Ronald M Lazar
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA; The Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA; Department of Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA.
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31
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Chang F, Cerny BM, Tse PKY, Rauch AA, Khan H, Phillips MS, Fletcher NB, Resch ZJ, Ovsiew GP, Jennette KJ, Soble JR. Using the Grooved Pegboard Test as an Embedded Validity Indicator in a Mixed Neuropsychiatric Sample with Varying Cognitive Impairment: Cross-Validation Problems. Percept Mot Skills 2023; 130:770-789. [PMID: 36634223 DOI: 10.1177/00315125231151779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Embedded validity indicators (EVIs) derived from motor tests have received less empirical attention than those derived from tests of other neuropsychological abilities, particularly memory. Preliminary evidence suggests that the Grooved Pegboard Test (GPB) may function as an EVI, but existing studies were largely conducted using simulators and population samples without cognitive impairment. In this study we aimed to evaluate the GPB's classification accuracy as an EVI among a mixed clinical neuropsychiatric sample with and without cognitive impairment. This cross-sectional study comprised 223 patients clinically referred for neuropsychological testing. GPB raw and T-scores for both dominant and nondominant hands were examined as EVIs. A known-groups design, based on ≤1 failure on a battery of validated, independent criterion PVTs, showed that GPB performance differed significantly by validity group. Within the valid group, receiver operating characteristic curve analyses revealed that only the dominant hand raw score displayed acceptable classification accuracy for detecting invalid performance (area under curve [AUC] = .72), with an optimal cut-score of ≥106 seconds (33% sensitivity/88% specificity). All other scores had marginally lower classification accuracy (AUCs = .65-.68) for differentiating valid from invalid performers. Therefore, the GPB demonstrated limited utility as an EVI in a clinical sample containing patients with bona fide cognitive impairment.
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Affiliation(s)
- Fini Chang
- Department of Psychiatry, 12247University of Illinois College of Medicine, Chicago, Illinois, United States.,Department of Psychology, 12247University of Illinois at Chicago, Chicago, Illinois, United States
| | - Brian M Cerny
- Department of Psychiatry, 12247University of Illinois College of Medicine, Chicago, Illinois, United States.,Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, United States
| | - Phoebe Ka Yin Tse
- Department of Psychiatry, 12247University of Illinois College of Medicine, Chicago, Illinois, United States.,Department of Clinical Psychology, The Chicago School of Professional Psychology, Chicago, Illinois, United States
| | - Andrew A Rauch
- Department of Psychiatry, 12247University of Illinois College of Medicine, Chicago, Illinois, United States.,Department of Psychology, Loyola University Chicago, Chicago, Illinois, United States
| | - Humza Khan
- Department of Psychiatry, 12247University of Illinois College of Medicine, Chicago, Illinois, United States.,Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, United States
| | - Matthew S Phillips
- Department of Psychiatry, 12247University of Illinois College of Medicine, Chicago, Illinois, United States.,Department of Clinical Psychology, The Chicago School of Professional Psychology, Chicago, Illinois, United States
| | - Noah B Fletcher
- Department of Psychiatry, 12247University of Illinois College of Medicine, Chicago, Illinois, United States
| | - Zachary J Resch
- Department of Psychiatry, 12247University of Illinois College of Medicine, Chicago, Illinois, United States
| | - Gabriel P Ovsiew
- Department of Psychiatry, 12247University of Illinois College of Medicine, Chicago, Illinois, United States
| | - Kyle J Jennette
- Department of Psychiatry, 12247University of Illinois College of Medicine, Chicago, Illinois, United States
| | - Jason R Soble
- Department of Psychiatry, 12247University of Illinois College of Medicine, Chicago, Illinois, United States.,Department of Neurology, 12247University of Illinois College of Medicine, Chicago, Illinois, United States
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32
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Monette S, Bertrand JA, Perreau-Linck E, Ramos-Usuga D, Rivera D, Arango-Lasprilla JC. The profession of neuropsychologist in Canada: Findings of a national survey. Clin Neuropsychol 2023; 37:1-33. [PMID: 34791971 DOI: 10.1080/13854046.2021.2002934] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to investigate the demographic characteristics, academic training and types of professional activities of clinical neuropsychologists in Canada. 282 participants completed an online-based survey. Respondents were women for the most part and had a mean age of 43 years. They typically had doctoral-level training (85%) and about one-quarter had postdoctoral training (23%). Nearly half (47%) had a lifespan practice, over one-third (37%) had an adults-only practice, and about one-sixth (16%) had an exclusively pediatric practice. Most worked full-time (79%). Respondents were almost evenly split three ways between those who worked in the public sector, those who worked in the private sector, and those who worked in both. The most common professional activities related to assessment (95%), although clinical supervision (43%) and rehabilitation (42%) were also quite frequent, whereas research (27%) and teaching (18%) were less so. The most common reason for referral was to determine a diagnosis (79%). Pediatric neuropsychologists worked primarily with individuals with neurodevelopmental disorders and neuropsychologists working with adult populations worked primarily with individuals with emotional disorders, acquired neuropsychological disorders (traumatic brain injury, stroke/vascular), and neurocognitive disorders (dementia). At time of study, Canadian neuropsychologists seemed to enjoy a fairly balanced situation: Their level of training and the ratio of neuropsychologists per population were both high. However, these varied widely across Canada. This suggests that the profession and public interest would stand to gain from seeing training standardized to some extent nationwide.
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Affiliation(s)
- Sebastien Monette
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada.,Institut universitaire Jeunes en difficulté, CIUSSS Centre-Sud-de-l'île-de-Montréal, Montréal, Canada
| | - Josie-Anne Bertrand
- Douglas Mental Health University Institute, Montreal, Canada.,Institut universitaire de gériatrie de Montréal, Montreal, Canada
| | | | - Daniela Ramos-Usuga
- Biomedical Research Doctorate Program, University of the Basque Country, Leioa, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Diego Rivera
- Department of Health Sciences, Public University of Navarre, Pamplona, Spain
| | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,IKERBASQUE. Basque Foundation for Science, Bilbao, Spain.,Department of Cell Biology and Histology, University of the Basque Country, Leioa, Spain
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33
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Vasserman M, Virani S, MacAllister WS, Désiré N, Mish S, Fay-McClymont T, Medlin LC, Brooks BL. Parent ratings on the MEMRY questionnaire predict children's academic performance. Child Neuropsychol 2023; 29:96-114. [PMID: 35534941 DOI: 10.1080/09297049.2022.2071420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Given the high rates of learning challenges in children with medical conditions, efficient and reliable screening methods are crucial. This study examined whether parent report of daily learning and memory predicts academic achievement in youth. Parents of 213 youth (aged 6-18) with varied medical diagnoses completed the Multidimensional Everyday Memory Ratings for Youth (MEMRY), and youth completed subtests from the Wechsler Individual Achievement Test-Third Edition (WIAT-III) as part of a comprehensive assessment. All scales of the MEMRY (Learning, Daily Memory, Executive/Working Memory) correlated significantly with WIAT-III Spelling, Word Reading, and Numerical Operations, while only the MEMRY Learning subscale correlated significantly with WIAT-III Pseudoword Decoding. Regression analyses indicated that MEMRY Learning significantly predicted WIAT-III Word Reading and Spelling, while both the MEMRY Learning and MEMRY Daily Memory scales significantly predicted WIAT-III Numerical Operations. When Full Scale IQ was entered into the models first, the MEMRY Learning subscale accounted for an additional 4% of variance in WIAT-III Word Reading and 7% of variance in WIAT-III Spelling, but did not account for additional variance in WIAT-III Numerical Operations or Pseudoword Decoding. Analyses in a subset of children with broadly normal intellectual functioning demonstrated very similar results, with even higher variance in academic testing accounted for by the MEMRY. In sum, the MEMRY questionnaire may serve as an efficient screen to identify children at risk for reading, spelling, and math deficits.
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Affiliation(s)
- Marsha Vasserman
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, AB, Canada.,Child Brain & Mental Health Program Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Shane Virani
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Kinesiology, University of Calgary
| | - William S MacAllister
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, AB, Canada.,Child Brain & Mental Health Program Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Naddley Désiré
- Department of Psychology and Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Sandra Mish
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Taryn Fay-McClymont
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, AB, Canada.,Child Brain & Mental Health Program Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - L Collins Medlin
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, AB, Canada.,Child Brain & Mental Health Program Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Psychology, University of Calgary
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34
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Robinson A, Reed C, Davis K, Divers R, Miller L, Erdodi LA, Calamia M. Settling the Score: Can CPT-3 Embedded Validity Indicators Distinguish Between Credible and Non-Credible Responders Referred for ADHD and/or SLD? J Atten Disord 2023; 27:80-88. [PMID: 36113024 DOI: 10.1177/10870547221121781] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of the present study was to further investigate the clinical utility of individual and composite indicators within the CPT-3 as embedded validity indicators (EVIs) given the discrepant findings of previous investigations. METHODS A total of 201 adults undergoing psychoeducational evaluation for ADHD and/or Specific Learning Disorder (SLD) were divided into credible (n = 159) and non-credible (n = 42) groups based on five criterion measures. RESULTS Receiver operating characteristic curves (ROC) revealed that 5/9 individual indicators and 2/4 composite indicators met minimally acceptable classification accuracy of ≥0.70 (AUC = 0.43-0.78). Individual (0.16-0.45) and composite indicators (0.23-0.35) demonstrated low sensitivity when using cutoffs that maintained specificity ≥90%. CONCLUSION Given the lack of stability across studies, further research is needed before recommending any specific cutoff be used in clinical practice with individuals seeking psychoeducational assessment.
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Affiliation(s)
| | | | | | - Ross Divers
- Louisiana State University, Baton Rouge, USA
| | - Luke Miller
- Louisiana State University, Baton Rouge, USA
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35
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Was the COVID-19 Pandemic Associated with Gender Disparities in Authorship of Manuscripts Submitted to Clinical Neuropsychology Journals? J Int Neuropsychol Soc 2023; 29:105-109. [PMID: 34879885 DOI: 10.1017/s1355617721001375] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The COVID-19 pandemic exacerbated gender disparities in some academic disciplines. This study examined the association of the pandemic with gender authorship disparities in clinical neuropsychology (CN) journals. METHOD Author bylines of 1,018 initial manuscript submissions to four major CN journals from March 15 through September 15 of both 2019 and 2020 were coded for binary gender. Additionally, authorship of 40 articles published on pandemic-related topics (COVID-19, teleneuropsychology) across nine CN journals were coded for binary gender. RESULTS Initial submissions to these four CN journals increased during the pandemic (+27.2%), with comparable increases in total number of authors coded as either women (+23.0%) or men (+25.4%). Neither the average percentage of women on manuscript bylines nor the proportion of women who were lead and/or corresponding authors differed significantly across time. Moreover, the representation of women as authors of pandemic-related articles did not differ from expected frequencies in the field. CONCLUSIONS Findings suggest that representation of women as authors of peer-reviewed manuscript submissions to some CN journals did not change during the initial months of the COVID-19 pandemic. Future studies might examine how risk and protective factors may have influenced individual differences in scientific productivity during the pandemic.
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36
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Correro AN, Hinrichs KLM, Krishnan MC, Cottingham ME, Trittschuh EH, Parmenter BA, Kang J, Stelmokas J. Neuropsychological assessment with lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals: Practice, education, and training survey. Clin Neuropsychol 2022:1-43. [PMID: 36458596 DOI: 10.1080/13854046.2022.2148379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/11/2022] [Indexed: 12/04/2022]
Abstract
Objective: We sought to describe the LGBTQ + related education, training, and clinical practice of independently licensed neuropsychologists in the United States and to identify factors that predict affirmative neuropsychological practices. We hypothesized that LGBTQ + identity, female gender, more recent training, and extent of LGBTQ + education/training would predict use of LGBTQ + practice guidelines. Method: A workgroup of clinical psychologists with experience in LGBTQ + psychology and neuropsychology developed a survey to identify personal and professional factors that predict affirmative neuropsychological testing practices. The survey was distributed through professional organizations and listservs between August and September 2021 with 118 responses meeting inclusionary criteria. Results: The majority of participants identified as heterosexual (70.3%) and cisgender (97.5%), and most (48-63%) received LGBTQ + training post-licensure. Between 19% and 32% of participants reported never completing LGBTQ + specific education. Consistent with our hypotheses, factors predicting affirmative clinical practice behaviors were LGBTQ + education/training, and personal background (sexual minority status, female/feminine gender, and years since degree). Other significant factors included prior experience with LGBTQ + patients and primary patient population (child vs. adult). Qualitative responses indicated varying values, attitudes, and knowledge regarding collection of LGBTQ + information and modification of clinical practice. Conclusions: Neuropsychologists underutilize affirming practices as evidenced by low rates of querying pronouns, knowing whether LGBTQ + health information is available at their institutions, and adjusting evaluation and feedback approaches. We provide specific training and education recommendations to increase knowledge and skills and to address beliefs about LGBTQ + health that can serve to promote affirmative neuropsychological practice.
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Affiliation(s)
- Anthony N Correro
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, Michigan Medicine, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Kate L M Hinrichs
- Mental Health Service, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Mira C Krishnan
- Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | | | - Emily H Trittschuh
- Geriatric Research Education and Clinical Center (GRECC), VA Puget Sound Healthcare System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Brett A Parmenter
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- Mental Health Service, American Lake Division, VA Puget Sound Healthcare System, Tacoma, Washington, USA
- Olympic Psychology Services, Tacoma, Washington, USA
| | - Jinkyung Kang
- Department of Internal Medicine-Geriatric and Palliative Medicine, Michigan Medicine, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Julija Stelmokas
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, Michigan Medicine, University of Michigan Health, Ann Arbor, Michigan, USA
- Mental Health Service, Brooklyn Campus, VA New York Harbor Healthcare System, Brooklyn, New York, USA
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37
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Kurniadi NE, Davis JJ. Comparison shopping: Is neuropsychological evaluation more expensive than neuroimaging? Clin Neuropsychol 2022; 36:2061-2072. [PMID: 34524072 DOI: 10.1080/13854046.2021.1976839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study empirically examined if neuropsychological evaluation (NPE) is expensive compared to other diagnostic procedures such as neuroimaging. METHOD We aggregated data on charges for NPE and common neuroimaging procedures (e.g., head CT and brain MRI) from hospitals in the U.S. Charges for five-hour NPE and eight-hour NPE were compared to charges for head CT and brain MRI, respectively. Difference scores were calculated between five-hour NPE and head CT and between eight-hour NPE and brain MRI. A charge difference of $250 or less was considered minimal. NPE and neuroimaging charges were compared across U.S. regions. RESULTS Median head CT charges were $1942 to $2699. Median brain MRI charges were $3103 to $4487. Median five-hour NPE charges were $1855 to $1977. Median eight-hour NPE charges were $2757 to $2917. Head CT and five-hour NPE charges were not significantly different. Eight-hour NPE and brain MRI charges were not significantly different. Charge differences between five-hour NPE and head CT were minimal in 32.3% of hospitals. Charge differences between eight-hour NPE and brain MRI were minimal in 21.2% of hospitals. U.S. regions were not significantly different in charges for NPE or neuroimaging. CONCLUSIONS Findings provide preliminary data on charges for NPE in relation to charges for common imaging procedures. NPE does not appear to be more expensive than neuroimaging and, in fact, appears comparable. Future research might expand the information on NPE charges to include additional settings.
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Affiliation(s)
| | - Jeremy J Davis
- University of Texas Health Science Center at San Antonio, San Antonio, TX.,Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, San Antonio, TX
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Driskell LD, Del Bene VA, Sperling SA. What makes for a competitive fellowship candidate? A survey of clinical neuropsychology postdoctoral training directors. Clin Neuropsychol 2022; 36:2041-2060. [PMID: 34429020 DOI: 10.1080/13854046.2021.1967451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To obtain objective data about the factors that clinical neuropsychology postdoctoral training directors (TDs) look for and prioritize in their review and selection of fellowship candidates. We identified 167 TDs who were overseeing postdoctoral training programs that provided training consistent with the Houston Conference Guidelines. We invited all TDs to complete an anonymous online survey that assessed their expectations as they relate to the selection of fellowship candidates. Eighty-eight TDs completed the survey in full. We used descriptive statistics to analyze the data and investigate potential between-group differences in TDs' responses across patient populations, training settings, and APPCN member program status. TDs ranked the intensity of candidates' neuropsychology education and training experiences, their fellowship interviews, and letters of recommendation as most important. Increasing the representation of under-represented minorities and other factors were ranked lower. Minimum benchmarks related to candidates' scholarly productivity, dissertation progress, and the time they spent engaged in clinical neuropsychology activities during internship were revealed. There were relatively few differences in TDs' responses when compared across patient populations, training settings, or APPCN member program status. Students may increase their competitiveness for clinical neuropsychology fellowships by obtaining intensive education and training experiences in the specialty, which includes clinical training and coursework, and by producing scholarly work. Students may also benefit from improving their interviewing skills, completing an internship with at least 40% of time spent in neuropsychological activities, and at minimum by having their dissertation data collected before their fellowship interviews.
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Affiliation(s)
- Lucas D Driskell
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Victor A Del Bene
- Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Scott A Sperling
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Bradstreet LE, Ludwig N, Koterba C, Zabel TA, Wilson CS. Supporting the Transition to Adulthood for Youth With Spina Bifida: A Call for Neuropsychology-Informed Interventions. Top Spinal Cord Inj Rehabil 2022; 28:59-62. [PMID: 36017124 DOI: 10.46292/sci21-00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lauren E Bradstreet
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Natasha Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine Koterba
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - T Andrew Zabel
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Camille S Wilson
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
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Lasprilla JCA, Rodríguez-Irizarry W, Oliveras-Rentas RE, Ramos-Usuga D, Gonzalez I, Perez PK, Romero-García I. Hispanic neuropsychologists in the United States: What do we know about them and how can the field address their needs? NeuroRehabilitation 2022; 51:101-121. [DOI: 10.3233/nre-210333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Despite numerous calls throughout the years for an increase in ethnic, cultural, and racial diversity within the field of psychology, it remains an elusive reality for Hispanic neuropsychology practitioners in the United States (U.S.). OBJECTIVE: 1. Determine the background and current work situation of Hispanic clinical neuropsychologists in the U.S. (e.g., professional training, assessment and diagnostic procedures used, rehabilitation techniques employed, populations targeted, teaching responsibilities, and research activities), and 2. Examine issues related to perceived discrimination in the field of neuropsychology and what this means for our profession. METHODS: The sample consisted of 107 Hispanic neuropsychologists residing among the 50 United States, District of Columbia, and Puerto Rico who took a survey of professional practices and experiences in clinical neuropsychology. RESULTS: Our findings confirm that Hispanic neuropsychologists in the U.S. are culturally diverse, present with varied levels of bilingualism, have been faced with discrimination during training and in their workplace, and compare favorably with non-Hispanic neuropsychologists in terms of education and clinical training. CONCLUSIONS: Transforming neuropsychology into a diverse and inclusive field requires intentional, strategic, and systematic interventions in education, academia, training, professional organizations and in research.
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Affiliation(s)
| | - Walter Rodríguez-Irizarry
- Inter American University of Puerto Rico, San Germán Campus, San Germán, Puerto Rico
- Ponce Health Sciences University, Ponce, Puerto Rico
| | | | - Daniela Ramos-Usuga
- Biomedical Research Doctorate Program, University of the Basque Country, Leioa, Spain
| | - Isabel Gonzalez
- Baptist Health South Florida, Miami, FL, USA
- Insight Neurocognitive & Behavioral Center, Miami, FL, USA
| | - Paula Karina Perez
- University of Miami, Miller School of Medicine, Mailman Center for Child Development, Miami, FL, USA
| | - Ivonne Romero-García
- Inter American University of Puerto Rico, San Germán Campus, San Germán, Puerto Rico
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Sullivan KL, Gallagher MW, Bucks RS, Weinborn M, Woods SP. Factor Structure of the Memory for Intentions Test (MIsT): A Conceptual Replication in Older Adults and People with HIV Disease. J Clin Exp Neuropsychol 2022; 44:281-292. [PMID: 35930244 PMCID: PMC9474617 DOI: 10.1080/13803395.2022.2107183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The Memory for Intentions Test (MIsT) is a clinical measure of prospective memory that has strong evidence for convergent, discriminative, and ecological validity. This study uses a conceptual replication design to evaluate the latent structure of the MIsT in two parallel samples who commonly experience prospective memory deficits: older adults and people living with HIV disease. PARTICIPANTS AND METHODS Study participants included 303 people with HIV disease (ages 18-67) and 267 community-dwelling older adults (ages 50-91). Confirmatory factor analyses of the MIsT were conducted separately in each sample. We evaluated a one-factor model, as well as three two-factor models with the MIsT items loading onto each factor based on cue type, delay interval, or response modality. RESULTS The one-factor model provided the best (and most parsimonious) fit to the data in both study samples. All two-factor models also demonstrated good fit statistics, although correlations between the two factors in each model were high and none of the two-factor models provided a significantly better fit than the one-factor model. CONCLUSIONS Results of this conceptual replication study provide support for a robust factor structure of the MIsT across older adults and people with HIV disease. A total score for the MIsT provides the most parsimonious solution, although available evidence and theory also support the potential use of subscales (e.g., cue type). Future studies of the MIsT would be useful to determine its psychometrics in different clinical populations and across demographic factors (e.g., race/ethnicity).
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Affiliation(s)
- Kelli L Sullivan
- Department of Psychology, University of Houston, Houston, Texas, USA.,Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, USA
| | | | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Michael Weinborn
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, Texas, USA.,School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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Madore MR, Byrd D. Optimizing mentoring relationships with persons from historically marginalized communities through the use of difficult dialogues. J Clin Exp Neuropsychol 2022; 44:441-449. [PMID: 35924945 DOI: 10.1080/13803395.2022.2108770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Neuropsychology has struggled to recruit and retain trainees and early career professionals from historically marginalized communities (HMC). One of the primary strategies for retaining these individuals, and ensuring their success, is quality mentorship. Effective mentorship for trainees from HMC requires responsive attention to the unique training experiences that emerge from societal forces, such as structural racism and classism. Although not often discussed with mentors, trainees from these groups experience discrimination at substantial rates, which contributes to dissatisfaction, stress, and ultimately elevated attrition. One strategy to reduce attrition involves developing relational mentorship dynamics to encourage explicit conversations about instances of discrimination during training. However, a barrier to nurturing these types of dynamics is the difference in power and privilege across multiple axes in the dyad. Infusing techniques from the Difficult Dialogues framework offers mentors of HMC trainees a tangible route to reducing the impact of differential power, enhancing relational dynamics, and increasing the likelihood of retention in neuropsychology. The objectives of this manuscript are to elucidate the necessity of understanding one's power and privilege in the mentorship dyad by understanding barriers experienced by persons from HMC. This manuscript also outlines specific strategies through the lens of the Difficult Dialogues framework to ameliorate the negative impact of unaddressed differentials of power and privilege in the mentoring of training experiences in clinical neuropsychology. Finally, through the use of anonymized case examples, the manuscript offers effective strategies for responsive, professional development of trainees from HMC to facilitate supportive neuropsychological training experiences.
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Affiliation(s)
- Michelle R Madore
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System Sierra Pacific Mental Illness Research Education Clinical Centers (MIRECC), Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - Desiree Byrd
- Department of Psychology, Queens College and The Graduate Center of City University of New York, New York, NY, USA
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Pugh E, Robinson A, Montgomery V, Calamia M. Trainee perceptions of multicultural climate and supervision in neuropsychology. J Clin Exp Neuropsychol 2022; 44:386-397. [PMID: 35906733 DOI: 10.1080/13803395.2022.2107185] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Mentor relationships are important in developing and supporting professional self-efficacy among psychology trainees. Additionally, the rapid diversification of the United States calls for the preparation of clinical neuropsychology trainees to work within a multicultural context. The present study aimed to assess neuropsychology trainees' perceptions of multicultural climate and supervision and if these perceptions differ based on trainee demographics. We also sought to identify aversive experiences of trainees, program strengths or weaknesses, and how programs support trainees. METHOD Participants were 310 neuropsychology trainees (Mean age = 30.27, SD = 5.67) from clinical psychology graduate (n = 136), pre-doctoral internship (n = 38), and post-doctoral (n = 71) programs across the United States and Canada who completed a survey assessing perceptions to multicultural climate and supervision. 64.5% self-identified as women, 60.3% as heterosexual, and 46.1% as non-Hispanic White. 34.5% of trainees reported at least one American Disabilities Act (ADA) recognized disability. RESULTS Though satisfied with general supervision, trainees reported overall dissatisfaction with multicultural supervision. Satisfaction with multicultural supervision did not differ by demographics. Trainees also reported various aversive experiences with supervisors, clients, and research participants that negatively impacted their training. These experiences were at times due to an aspect of the trainee's multicultural identity, with Black and Hispanic trainees being more likely to report an aversive experience. Trainees reported ways in which they felt unsupported by their programs. CONCLUSIONS Important areas of growth for programs are discussed. Issues raised by neuropsychology trainees overlap to some degree with the experiences of trainees in other fields. Recommendations of approaches that have been successfully adopted in other fields to improve trainee satisfaction are provided. Early identification of needs that go above and beyond clinical training will allow programs to respond promptly, improve trainee satisfaction, and potentially improve the retention of trainees from diverse backgrounds.
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Affiliation(s)
- Erika Pugh
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Anthony Robinson
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Valencia Montgomery
- Riverview Health Physicians Neuropsychology, Riverview Health, Noblesville, IN, USA.,Society for Black Neuropsychology, Weehawken, NJ
| | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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What are the predictors of TOMM failure in clinical TBI populations? A retrospective analysis. J Int Neuropsychol Soc 2022; 29:336-345. [PMID: 35811454 DOI: 10.1017/s1355617722000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To determine base rates of invalid performance on the Test of Memory Malingering (TOMM) in patients with traumatic brain injury (TBI) undertaking rehabilitation who were referred for clinical assessment, and the factors contributing to TOMM failure. METHODS Retrospective file review of consecutive TBI referrals for neuropsychological assessment over seven years. TOMM failure was conventionally defined as performance <45/50 on Trial 2 or Retention Trial. Demographic, injury, financial compensation, occupational, and medical variables were collected. RESULTS Four hundred and ninety one TBI cases (Median age = 40 years [IQR = 26-52], 79% male, 82% severe TBI) were identified. Overall, 48 cases (9.78%) failed the TOMM. Logistic regression analyses revealed that use of an interpreter during the assessment (adjusted odds ratio [aOR] = 8.25, 95%CI = 3.96-17.18), outpatient setting (aOR = 4.80, 95%CI = 1.87-12.31) and post-injury psychological distress (aOR = 2.77, 95%CI = 1.35-5.70) were significant multivariate predictors of TOMM failure. The TOMM failure rate for interpreter cases was 49% (21/43) in the outpatient setting vs. 7% (2/30) in the inpatient setting. By comparison, 9% (21/230) of non-interpreter outpatient cases failed the TOMM vs. 2% (4/188) of inpatient cases. CONCLUSIONS TOMM failure very rarely occurs in clinical assessment of TBI patients in the inpatient rehabilitation setting. It is more common in the outpatient setting, particularly in non-English-speaking people requiring an interpreter. The findings reinforce the importance of routinely administering stand-alone performance validity tests in assessments of clinical TBI populations, particularly in outpatient settings, to ensure that neuropsychological test results can be interpreted with a high degree of confidence.
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Neal TM, Line EN. Income, Demographics, and Life Experiences of Clinical-Forensic Psychologists in the United States. Front Psychol 2022; 13:910672. [PMID: 35874388 PMCID: PMC9302360 DOI: 10.3389/fpsyg.2022.910672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
We provide aggregate data about income, demographics, and life experiences of women and men practicing clinical-forensic psychology primarily in the United States (N = 376). We examine how these variables relate to one another, as well as how gender demographics of the field have changed over time. The average hourly rate charged by psychologists for forensic work, aggregated across all types of referral questions, regions, and employment settings is $280.23 (US Dollars; SD = $108.12; median and mode = $250). Total median annual income is = $125,000 - $149,999 and mode is = $100,000 - $124,999. Men’s annual income (median = $175,000 - $199,000) is significantly higher than women’s (median = $100,000 - $124,999) even while controlling for years of experience and number of hours worked per week. Women forensic psychologists earn $0.83 for every $1.00 men make. Having a Ph.D. is disproportionately associated with men and PsyD with women; however, the difference is not significant once controlling for years of experience. Employment type related to pay, such that people in private practice make significantly more than those who work in institutions (e.g., prisons, hospitals) or universities. Year of highest degree associated with employment type, such that people in practice longer are more likely to be in private practice. Although we expected caretaking responsibilities and children would relate to gender and pay, no differences emerged in this sample. Women are more likely than men to have completed a formal postdoctoral fellowship in forensic psychology, even when controlling for year of highest degree. Regarding the gender composition of the field over time, we calculated the Index of Dissimilarity for each five year increment spanning 1965-2019. Before the late 1990s, proportionally more men entered the field; after the late 1990s, proportionally more women entered. We discuss the promising and less promising implications of these findings for gender equity and work-life management in forensic psychology, as well as how professionals in the field and students might make use of these data.
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Affiliation(s)
- Tess M.S. Neal
- New College of Interdisciplinary Arts and Sciences, Arizona State University, Phoenix, AZ, United States
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- *Correspondence: Tess M.S. Neal,
| | - Emily N. Line
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL, United States
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Calamia M, Kaseda ET, Price JS, De Vito A, Silver CH, Cherry J, VanLandingham H, Khan H, Sparks PJ, Ellison RL. Mentorship in clinical neuropsychology: Survey of current practices, cultural responsiveness, and untapped potential. J Clin Exp Neuropsychol 2022; 44:366-385. [DOI: 10.1080/13803395.2022.2128068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Erin T. Kaseda
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Jenessa S. Price
- Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alyssa De Vito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Cheryl H. Silver
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jared Cherry
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | | | - Humza Khan
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - P. Johnelle Sparks
- Department of Demography, University of Texas at San Antonio, San Antonio, TX, USA
| | - Rachael L. Ellison
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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Rehman SS, Irani F, Cheung AM, Tan A, Madore MR, Sunderaraman P. “The journey of a thousand miles begins with one step”: An Asian American perspective on mentoring in neuropsychology. J Clin Exp Neuropsychol 2022; 44:409-419. [DOI: 10.1080/13803395.2022.2108769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sonia S. Rehman
- Fielding Graduate University, Department of Psychology, CA, USA
| | - Farzin Irani
- AAA Neuropsychology, Independent Practice, Malvern, PA, USA
| | - Angeles M. Cheung
- Independent Practice, New York, NY, USA
- Rehabilitation and Human Performance at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander Tan
- Children’s Hospital of Orange County, Department of Psychology, CA, USA
| | - Michelle R. Madore
- VA Palo Alto Health Care System Sierra Pacific Mental Illness Research Education Clinical Center, CA, USA
- Stanford School of Medicine, Department of Psychiatry and Behavioral Sciences, CA, USA
| | - Preeti Sunderaraman
- Boston University School of Medicine, Department of Neurology, MA, USA
- The Framingham Heart Study - Brain Aging Program, Framingham, MA, USA
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Chao D, Badwan M, Briceño EM. ADDRESSING diversity, equity, inclusion and belonging (DEIB) in mentorship relationships. J Clin Exp Neuropsychol 2022; 44:420-440. [PMID: 36239021 DOI: 10.1080/13803395.2022.2112151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The growing racial, ethnic, and cultural diversity within the United States underscores the importance of neuropsychologists developing cultural competence to improve patient care and support increased practitioner diversity. APA has recognized the importance of expanding the field's diversity, equity, inclusion, and belonging (DEIB) efforts to promote the retention of historically underrepresented practitioners and culturally competent practices. Supervisors and mentors are particularly well suited and ethically required to support DEIB-related professional development in their trainees. However, current literature suggests that a lack of time and perceived lack of competence in initiating and facilitating these conversations remain barriers to DEIB efforts. This paper aims to increase a supervisor's/mentor's self-efficacy in facilitating these efforts. We offer adapted theoretical models of cultural competence and provide a "tool kit" of experiential activities adapted for neuropsychologists that can be utilized to support the initiation, maintenance, and quality of DEIB-focused discussions within these relationships.
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Affiliation(s)
- Dominique Chao
- Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Emily M Briceño
- Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
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Van Patten R. Introduction to the Special Issue - Neuropsychology from a distance: Psychometric properties and clinical utility of remote neurocognitive tests. J Clin Exp Neuropsychol 2022; 43:767-773. [PMID: 35133240 DOI: 10.1080/13803395.2021.2021645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ryan Van Patten
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown, University, Providence, RI, USA.,Providence VA Medical Center, Providence, RI, USA
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50
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OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1103-1117. [DOI: 10.1093/arclin/acac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/18/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
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