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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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2
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Darby RR, Considine C, Weinstock R, Darby WC. Forensic neurology: a distinct subspecialty at the intersection of neurology, neuroscience and law. Nat Rev Neurol 2024; 20:183-193. [PMID: 38228905 DOI: 10.1038/s41582-023-00920-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/18/2024]
Abstract
Neurological evidence is increasingly used in criminal cases to argue that a defendant is less responsible for their behaviour, is not competent to stand trial or should receive a reduced punishment for the crime. Unfortunately, neurologists are rarely involved in such cases despite having the expertise to help to inform these decisions in court. In this Perspective, we advocate for the development of 'forensic neurology', a subspecialty of neurology focused on using neurological clinical and scientific expertise to address legal questions for the criminal justice system. We review literature suggesting that the incidence of criminal behaviour is higher in people with certain neurological disorders than the general public and that undiagnosed neurological abnormalities are common in people who commit crimes. We discuss the need for forensic neurologists in criminal cases to provide an opinion on what neurological diagnoses are present, the resulting symptoms and ultimately whether the symptoms affect legal determinations such as criminal responsibility or competency.
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Affiliation(s)
- R Ryan Darby
- Department of Neurology, Division Behavioral Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Ciaran Considine
- Department of Neurology, Division Behavioral Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert Weinstock
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - William C Darby
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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3
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Janecek JK, Lang B, Butt S, Kenealy L, Heffelfinger A. Survey of evaluation policies and procedures in clinical neuropsychology postdoctoral fellowship programs. Clin Neuropsychol 2024:1-23. [PMID: 38378477 DOI: 10.1080/13854046.2024.2315731] [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: 09/07/2023] [Accepted: 12/11/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVE The objectives of this study were to examine current procedures that are used to evaluate competency development in clinical neuropsychology at the postdoctoral level and to investigate policies and procedures for the management of performance that is below expectations during the postdoctoral fellowship. METHOD Clinical neuropsychology fellowship program directors were invited via email with multiple reminders to participate in an online survey between 1/26/2023 and 3/31/2023. RESULTS Most programs administer a competency-based written evaluation of fellow performance (92%) and have a written policy for managing performance that is below expectations (86%). However, greater variability was reported regarding the use of other evaluation tools, including fellow self-assessments (46% of programs), program evaluations (57% of programs), supervisor evaluations (73% of programs), and exit interviews (82% of programs). Moreover, there was variability between programs with regard to the specific competencies that were measured and how performance that is below expectations is managed. CONCLUSIONS Competency-based evaluations and clear, written policies and procedures for management of performance that is below expectations are recommended. Such tools and policies provide clear expectations for fellowship outcomes, promote regular communication between fellows and supervisors, foster early identification of gaps in training, facilitate program quality improvement, and increase opportunities to support and intervene during the course of fellowship training.
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Affiliation(s)
- Julie K Janecek
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brittany Lang
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sakina Butt
- Child Development and Rehabilitation Center, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Laura Kenealy
- Department of Neuropsychology, Children's National Medical Center, Washington, DC, USA
| | - Amy Heffelfinger
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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4
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Wong D, Pike K, Stolwyk R, Allott K, Ponsford J, McKay A, Longley W, Bosboom P, Hodge A, Kinsella G, Mowszowski L. Delivery of Neuropsychological Interventions for Adult and Older Adult Clinical Populations: An Australian Expert Working Group Clinical Guidance Paper. Neuropsychol Rev 2023:10.1007/s11065-023-09624-0. [PMID: 38032472 DOI: 10.1007/s11065-023-09624-0] [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: 04/12/2022] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Delivery of neuropsychological interventions addressing the cognitive, psychological, and behavioural consequences of brain conditions is increasingly recognised as an important, if not essential, skill set for clinical neuropsychologists. It has the potential to add substantial value and impact to our role across clinical settings. However, there are numerous approaches to neuropsychological intervention, requiring different sets of skills, and with varying levels of supporting evidence across different diagnostic groups. This clinical guidance paper provides an overview of considerations and recommendations to help guide selection, delivery, and implementation of neuropsychological interventions for adults and older adults. We aimed to provide a useful source of information and guidance for clinicians, health service managers, policy-makers, educators, and researchers regarding the value and impact of such interventions. Considerations and recommendations were developed by an expert working group of neuropsychologists in Australia, based on relevant evidence and consensus opinion in consultation with members of a national clinical neuropsychology body. While the considerations and recommendations sit within the Australian context, many have international relevance. We include (i) principles important for neuropsychological intervention delivery (e.g. being based on biopsychosocial case formulation and person-centred goals); (ii) a description of clinical competencies important for effective intervention delivery; (iii) a summary of relevant evidence in three key cohorts: acquired brain injury, psychiatric disorders, and older adults, focusing on interventions with sound evidence for improving activity and participation outcomes; (iv) an overview of considerations for sustainable implementation of neuropsychological interventions as 'core business'; and finally, (v) a call to action.
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Affiliation(s)
- Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Kerryn Pike
- School of Psychology and Public Health & John Richards Centre for Rural Ageing Research, La Trobe University, Melbourne, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Rene Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Kelly Allott
- , Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Adam McKay
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- MERRC, Rehabilitation and Mental Health Division, Epworth HealthCare, Richmond, Australia
| | - Wendy Longley
- Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, Sydney, Australia
- The Uniting War Memorial Hospital, Waverley, Sydney, Australia
| | - Pascalle Bosboom
- MindLink Psychology, West Perth, Australia
- School of Psychological Science, University of Western Australia, Crawley, Australia
| | | | - Glynda Kinsella
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Loren Mowszowski
- Faculty of Science, School of Psychology & Brain and Mind Centre, The University of Sydney, Sydney, Australia
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5
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Thompson RC, Hirst RB, Markiv Y, Pilavjian H, Murley R. The modest impact of the COVID-19 pandemic on training expectations at internship programs offering specialization in neuropsychology. Clin Neuropsychol 2023; 37:491-505. [PMID: 35614554 DOI: 10.1080/13854046.2022.2067077] [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: Given the decreased clinical training opportunities during the COVID-19 pandemic, this study aimed to provide insights into how training directors and supervising neuropsychologists from internships offering neuropsychology training adjusted expectations of competitive applicants. Method: Respondents (n = 50) from internships offering at least an "exposure" in neuropsychology completed questions about how training expectations of competitive applicants have changed because of the COVID-19 pandemic. Results: Most respondents reported decreased expectations for clinical hours and research productivity and increased expectations for telehealth experience and involvement in working with culturally diverse populations. Additionally, more than half of respondents from programs at university-affiliated and Veteran Affairs medical centers indicated reduced expectations for average number of integrated reports. Furthermore, compared to respondents at Veteran Affairs medical centers, respondents at university-affiliated medical centers stated decreased expectations for average number of paper presentations. Conclusions: The COVID-19 pandemic has motivated subtle changes in expectations of competitive neuropsychology-oriented internship applicants, specific to clinical experience, research productivity, and prioritization of certain application materials. Qualitative responses suggest that many respondents endeavored to improve applicant screening rather than lower expectations for applicants. As a result, consistent with previous recommendations, the importance of fit between trainee and training program should continue to be emphasized by prospective applicants. These findings have important implications for trainees for the next several years, as graduate students at all stages of training ultimately progress to the internship application stage.
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Affiliation(s)
- Ryan C Thompson
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Rayna B Hirst
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Yelena Markiv
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Haig Pilavjian
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Rachel Murley
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
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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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Kosmidis MH, Lettner S, Hokkanen L, Barbosa F, Persson BA, Baker G, Kasten E, Ponchel A, Mondini S, Varako N, Nikolai T, Jónsdóttir MK, Pranckeviciene A, Hessen E, Constantinou M. Core Competencies in Clinical Neuropsychology as a Training Model in Europe. Front Psychol 2022; 13:849151. [PMID: 35432061 PMCID: PMC9008746 DOI: 10.3389/fpsyg.2022.849151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
The multitude of training models and curricula for the specialty of clinical neuropsychology around the world has led to organized activities to develop a framework of core competencies to ensure sufficient expertise among entry-level professionals in the field. The Standing Committee on Clinical Neuropsychology of the European Federation of Psychologists’ Associations is currently working toward developing a specialty certification in clinical neuropsychology to establish a cross-national standard against which to measure levels of equivalency and uniformity in competence and service provision among professionals in the field. Through structured interviews with experts from 28 European countries, we explored potential areas of core competency. Specifically, questions pertained to the perceived importance of a series of foundational, functional, and other competencies, as well as current training standards and practices, and optimal standards. Our findings revealed considerable agreement (about three quarters and above) on academic and clinical training, despite varied actual training requirements currently, with fewer respondents relegating importance to training in teaching, supervision, and research (a little over half), and even fewer to skills related to management, administration, and advocacy (fewer than half). European expert clinical neuropsychologists were in agreement with previous studies (including those conducted in the United States, Australia, and other countries) regarding the importance of sound theoretical and clinical training but management, administrative, and advocacy skills were not central to their perspective of a competent specialist in clinical neuropsychology. Establishing a specialty certificate in clinical neuropsychology based on core competencies may enable mobility of clinical neuropsychologists across Europe, and, perhaps, provide an impetus for countries with limited criteria to reconsider their training requirements and harmonize their standards with others.
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Affiliation(s)
- Mary H. Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- *Correspondence: Mary H. Kosmidis,
| | - Sandra Lettner
- Association for Neuropsychology Austria, Bad Häring, Austria
| | - Laura Hokkanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | | | - Gus Baker
- Clinical Neuropsychology - Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Erich Kasten
- Department of Psychology, MSH University of Applied Sciences and Medical University, Hamburg, Germany
| | - Amélie Ponchel
- French Federation of Psychologists and Psychology (FFPP), French Organization of Psychologists Specialized in Neuropsychology OFPN, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Sara Mondini
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
| | - Nataliya Varako
- Psychological Methodology Department, Faculty of Psychology, Lomonosov Moscow State University, Moscow, Russia
- Research Center of Neurology, Moscow, Russia
- Psychological Institute of the Russian Academy of Education, Moscow, Russia
| | - Tomas Nikolai
- Department of Neurology, Charles University in Prague, Prague, Czechia
| | - María K. Jónsdóttir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
| | - Aiste Pranckeviciene
- Department of Health Psychology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Erik Hessen
- Department of Psychology, University of Oslo, Oslo, Norway
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Hokkanen L, Jokinen H, Rantanen K, Nybo T, Poutiainen E. Status of Clinical Neuropsychology Training in Finland. Front Psychol 2022; 13:860635. [PMID: 35310251 PMCID: PMC8927065 DOI: 10.3389/fpsyg.2022.860635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
This paper provides information on different training models within clinical neuropsychology in Finland. Systematic specialization training program began in Finland in 1983. It was first organized mainly by the Finnish Neuropsychological Society and since 1997 by the Finnish universities. At present, close to 400 clinical neuropsychologists have completed the training. The number of professionals still does not cover the needs of the country (population 5.5 million, area 338,440 km2), and geographical disparities are a constant concern. The training models in Finland have changed over the years and will continue to evolve. Specialization training can be organized by national societies or by universities. It can lead to an academic degree or a diploma. It can be linked to doctoral studies or form a parallel track. Financial model can involve student fees or be governed by ministries (such as the Ministry of Education or Ministry of Health). This paper describes and compares different strategies in education that have impact on the output of professionals. One model does not fit all, or even one country at all times. The strategies of the stakeholder ministries can change over time. The experiences from Finland can be useful for other countries that are developing their models. The estimated need of practitioners and the educational resources including the available financial models for training differ between countries. The guiding principles in specialist training should focus on the advanced competencies expected from the neuropsychologist when entering the profession.
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Affiliation(s)
- Laura Hokkanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hanna Jokinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Neuropsychology, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kati Rantanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Rehabilitation and Psychosocial Support, Tampere University Hospital, Tampere, Finland
| | - Taina Nybo
- Division of Neuropsychology, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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9
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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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Hirst RB, Thompson RC, Markiv Y, Pilavjian H, Arastu SF, Markuson SM. A Survey of Doctoral Internships Offering Clinical Neuropsychology Training: Updated Expectations for Competitive Applicants. Arch Clin Neuropsychol 2021; 37:704-721. [PMID: 34849534 DOI: 10.1093/arclin/acab081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The specialty of clinical neuropsychology has experienced significant professional growth and increasing standardization of educational and training guidelines over the past 20 years. Previous literature demonstrated the importance of routine distribution of selection criteria used by training directors and supervising neuropsychologists for competitive applicants aiming to specialize in neuropsychology during internship. This study examined supervisors' updated expectations for competitive applicants from a more diverse sample of doctoral internship programs offering neuropsychological training. These data also provide cross-sectional and longitudinal comparisons to help trainees tailor their graduate training experiences. METHOD The sample included training directors and/or supervising neuropsychologists from 80 internship programs (73.4% of submitted surveys). Spearman correlations, analyses of variance, and chi-square tests of independence were conducted for cross-sectional and longitudinal comparisons. RESULTS Clinical experience in assessment and the personal interview were consistently the two most prioritized criteria across all groups, whereas prioritization of the additional criteria was variable based on the program's characteristics. Internship programs generally preferred practica experience at university-affiliated medical centers, Veterans Affairs medical centers, and private/community-based hospitals. University-affiliated medical centers and internships offering ≥50% neuropsychology training showed similar preferences for applicants with a depth and breadth of graduate school experience in neuropsychology. Longitudinally, the applicant expectations for programs offering ≥50% neuropsychology training remained largely unchanged between 2000 and 2020. CONCLUSIONS This study updated expectations for competitive applicants from a diverse sample of neuropsychology training programs, underscored the importance of fit between trainee and program, and demonstrated consistency over time for trainees seeking neuropsychology training during internship.
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Affiliation(s)
- Rayna B Hirst
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Ryan C Thompson
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Yelena Markiv
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Haig Pilavjian
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Sana F Arastu
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Sara M Markuson
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
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11
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Baum KT, Smith-Paine J, Tlustos SJ, Johnson A, Petranovich C. Clinical and training practices: A survey of pediatric neuropsychologists serving inpatient rehabilitation. Child Neuropsychol 2021; 28:510-534. [PMID: 34724886 DOI: 10.1080/09297049.2021.1993809] [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: 10/19/2022]
Abstract
Neuropsychologists in inpatient pediatric rehabilitation settings collaborate with an interdisciplinary team to educate, evaluate, and provide intervention to patients with acquired brain injury and their families, but there are no known studies that describe or define these clinical services. Thirty-one neuropsychologists in pediatric inpatient rehabilitation settings completed an online survey. Neuropsychologists (68.2% female; 86.4% with PhD versus PsyD) from the U.S. and Canada, who represented 22 pediatric inpatient rehabilitation sites comprised the final sample. Most sites (63.6%) were embedded within medical centers, with providers dedicating 2 to 32 hours (M = 14.25, SD = 9.26) weekly to onsite inpatient rehabilitation efforts. Providers most often saw patients with traumatic brain injury and other acquired brain injuries, including stroke and brain tumor. Trainees from various levels, most commonly post-doctoral fellows, provided clinical services on inpatient units, many with some degree of independence. Clinical practices that were standard across all or most sites included targeted discharge evaluations, serial cognitive monitoring, neuropsychology consultation to rehabilitation and non-rehabilitation units, and follow-up clinics. Provision of services was influenced by multiple factors including patient diagnosis, timing of return to school, inpatient census, and payor's effect on length of stay. Findings highlight many programmatic consistencies across sites and serve as an important initial step to guiding pediatric neuropsychology providers seeking to understand the current landscape of clinical care. Future efforts are needed to establish a true clinical guideline for practice. Although preliminary, data also support establishment of neuropsychology training programs, justify administrative resources, and serve to educate recipients of neuropsychology services.
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Affiliation(s)
| | | | - Sarah J Tlustos
- Children's Hospital Colorado, Aurora, CO, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
| | - Abigail Johnson
- Department of Physical Medicine and Rehabilitation, University of Michigan Medicine, Ann Arbor, MI, USA
| | - Christine Petranovich
- Children's Hospital Colorado, Aurora, CO, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
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Franzen S, Papma JM, van den Berg E, Nielsen TR. Cross-cultural neuropsychological assessment in the European Union: a Delphi expert study. Arch Clin Neuropsychol 2021; 36:815-830. [PMID: 33043958 PMCID: PMC8292927 DOI: 10.1093/arclin/acaa083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/06/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The increasing ethnic diversity in the European Union (EU) calls for adaptations to neuropsychological assessment practices. The aims of this study were to examine the current state of cross-cultural neuropsychological assessment in EU-15 countries and to provide recommendations for researchers and policy makers. METHOD Twelve experts from nine EU-15 countries participated in a Delphi consensus study involving two sequential rounds of web-based questionnaires and an in-person consensus meeting. The experts individually rated Delphi topics on the basis of importance (scale 1-10). The degree of consensus was determined by assessing first and third quartiles (Q1 and Q3) and medians. RESULTS Consensus outcomes showed the following priorities: (a) the development of tests (median importance rating 10, Q1-Q3: 9-10), (b) the collection of normative data (median importance rating 9, Q1-Q3: 8-10), and (c) more training, awareness, and knowledge regarding cross-cultural assessment among neuropsychologists in the EU (median importance rating 9, Q1-Q3: 8-10). Whereas memory tests were often available, tests measuring social cognition (median 9, Q1-Q3: 8-10) and language (median 9, Q1-Q3: 7-10) are particularly lacking. Recommendations were made regarding essential skills and knowledge necessary for cross-cultural neuropsychological assessment. CONCLUSIONS This study in a small group of experts suggests that the development and availability of cross-cultural tests and normative data should be prioritized, as well as the development and implementation of training initiatives. Furthermore, EU guidelines could be established for working with interpreters during neuropsychological assessment. Before implementing these recommendations, follow-up studies are recommended that include more minority neuropsychologists and community stakeholders.
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Affiliation(s)
- Sanne Franzen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M Papma
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
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Riello M, Rusconi E, Treccani B. The Role of Brief Global Cognitive Tests and Neuropsychological Expertise in the Detection and Differential Diagnosis of Dementia. Front Aging Neurosci 2021; 13:648310. [PMID: 34177551 PMCID: PMC8222681 DOI: 10.3389/fnagi.2021.648310] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Dementia is a global public health problem and its impact is bound to increase in the next decades, with a rapidly aging world population. Dementia is by no means an obligatory outcome of aging, although its incidence increases exponentially in old age, and its onset may be insidious. In the absence of unequivocal biomarkers, the accuracy of cognitive profiling plays a fundamental role in the diagnosis of this condition. In this Perspective article, we highlight the utility of brief global cognitive tests in the diagnostic process, from the initial detection stage for which they are designed, through the differential diagnosis of dementia. We also argue that neuropsychological training and expertise are critical in order for the information gathered from these omnibus cognitive tests to be used in an efficient and effective way, and thus, ultimately, for them to fulfill their potential.
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Affiliation(s)
- Marianna Riello
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Elena Rusconi
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Barbara Treccani
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
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14
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Heffelfinger AK, Janecek JK, Johnson A, Miller LE, Nelson A, Pulsipher DT. Competency-based assessment in clinical neuropsychology at the post-doctoral level: Stages, milestones, and benchmarks as proposed by an APPCN work group. Clin Neuropsychol 2020; 36:1209-1225. [PMID: 33138689 DOI: 10.1080/13854046.2020.1829070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In recent years, there has been considerable progress in developing competencies in Clinical Neuropsychology. The field also needs to work towards consistency in competency-based assessment of the development of each competency to ensure competent, independent practice. The purpose of this manuscript is to a) document the relevant literature, b) describe the process applied by an Association of Post-Doctoral Programs in Clinical Neuropsychology (APPCN) workgroup on Competency-Based Assessment, and c) propose a framework and assessment tool for competency-based assessment at the post-doctoral training level. Methods: The work group conducted a literature review of competency-based assessment in Clinical Neuropsychology and related fields, considered various constructs for assessment, delineated a framework that can be flexible for program-specific goals, and created a tool for assessment. The workgroup then asked for review of the framework and assessment tool by APPCN Board of Directors, the APPCN Executive Committee, and Program Directors from APPCN and non-APPCN programs. Revisions were made following this review. Conclusions: This manuscript and proposed assessment tool invite constructive feedback within the community for ongoing evolution of the process and the tool. The proposed assessment tool is intended to be implemented flexibly within post-doctoral programs to respect their specific training goals while simultaneously providing underlying consistency in the method of assessing a recently proposed set of competencies within Clinical Neuropsychology. Creation of competency-based assessment tools across all training levels within Clinical Neuropsychology that facilitate continuity and hierarchical development is a long-term goal.
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Affiliation(s)
- Amy K Heffelfinger
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Julie K Janecek
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abigail Johnson
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Liv E Miller
- Department of Behavioral Medicine and Psychiatry, University of West Virginia School of Medicine, Morgantown, WV, USA
| | - Amelia Nelson
- Rockefeller Neuroscience Institute, Department of Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dalin T Pulsipher
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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15
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Guidotti Breting LM, Towns SJ, Butts AM, Brett BL, Leaffer EB, Whiteside DM. 2020 COVID-19 American Academy of Clinical Neuropsychology (AACN) Student Affairs Committee survey of neuropsychology trainees. Clin Neuropsychol 2020; 34:1284-1313. [PMID: 32842877 DOI: 10.1080/13854046.2020.1809712] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective: To conduct an online survey in order to understand neuropsychology trainees' perspectives during the COVID-19 pandemic and identify pertinent concerns, training gaps, and recommendations.Method: A total of 874 neuropsychology trainees (81% female) completed the 69-item survey. Of the included trainees, 48% were doctoral students, 17% were interns, and 35% were postdoctoral residents (50% of resident respondents were in their first year).Results: The majority of neuropsychology trainees reported some impact of the pandemic on their professional and/or personal life. Overall, the impact did not differ by training level, geographic location, or demographic factors. Trainees' primary professional concerns included uncertainty about the impact of the pandemic on their professional future, loss of clinical hours, and desire for increased and ongoing communication from their leadership. A notable percentage of trainees reported increased personal mental health symptoms (i.e. anxiety/depression; 74%/54%), as well as a number of other personal stressors. Despite the transition to telehealth (mostly interviews/feedback sessions), few trainees have prior training or experience in providing neuropsychological services via phone or video platform. A limited proportion of trainees (approximately 10%) were still seeing patients face-to-face for neuropsychological evaluations during the COVID-19 pandemic as of 14 April 2020.Conclusions: The COVID-19 pandemic is impacting neuropsychological training and the well-being of trainees. This survey highlights the importance of communication with trainees during uncertain times. Based on the survey results, recommendations were developed to assist neuropsychology organizations in developing initiatives to support trainees during the current pandemic and in the future.
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Affiliation(s)
| | - Stephanie J Towns
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Alissa M Butts
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Benjamin L Brett
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Emily B Leaffer
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Douglas M Whiteside
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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16
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Gauthier B, Dupont C, Gosselin N, de Guise E. Neuropsychology supervision: A survey of practices in Quebec and a cross-cultural comparison. Clin Neuropsychol 2020; 35:1232-1257. [DOI: 10.1080/13854046.2020.1732467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Bruno Gauthier
- Department of Psychology, University of Montreal, Montreal, Canada
| | - Caroline Dupont
- Department of Psychology, University of Montreal, Montreal, Canada
| | | | - Elaine de Guise
- Department of Psychology, University of Montreal, Montreal, Canada
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17
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Abbate C, Trimarchi PD, Inglese S, Tomasini E, Bagarolo R, Giunco F, Cesari M. Signs and symptoms method in neuropsychology: A preliminary investigation of a standardized clinical interview for assessment of cognitive decline in dementia. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:282-296. [PMID: 31269816 DOI: 10.1080/23279095.2019.1630626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Psychologists usually perform a preliminary assessment of the person's cognitive status through a brief interview conducted before the formal testing. However, this exam has not yet been standardized with ad hoc recommendations in psychology literature. In this work, a standard observational NeuroPsychological Examination (NPE) designed for psychologists was proposed, and its clinical effectiveness evaluated. The NPE was administered to patients referred to a neuropsychological service in a memory clinic over a 2-year period. The NPEs of the patients with Alzheimer dementia (AD), vascular dementia (VaD), and healthy controls (HC) were retrospectively retrieved. Comparisons among the three groups were conducted. Abnormalities/signs identified during the NPE in the AD and VaD groups are more numerous compared to those reported in the HC group. About 80% of HCs show none or only one abnormal sign. Vice versa, 87.5% of both AD and VaD patients show three or more abnormalities. Accordingly, the NPE has 0.88 (95%CI = 0.81-0.95) sensitivity and 0.95 (95%CI = 0.88-1.02) specificity for detecting cognitive decline when a cut-point of three or more signs is applied. Some significant differences also emerge on the number of pathological signs between AD and VaD patients. NPE is a promising tool with demonstrated diagnostic utility in dementia patients.
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Affiliation(s)
- Carlo Abbate
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Silvia Inglese
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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