International perspectives on education, training, and practice in clinical neuropsychology: comparison across 14 countries around the world

OBJECTIVE

To review and summarize data provided by special issue authors regarding the education, training, and practice of neuropsychologists from 14 surveyed countries.

METHOD

A table was constructed to present an overview of variables of interest.

RESULTS

There is considerable diversity among surveyed countries regarding the education and training required to enter practice as a clinical neuropsychologist. Clinical neuropsychologists are typically well compensated, at least in comparison to what constitutes an average salary in each country.

CONCLUSIONS

Despite substantial variations in education and training pathways, and availability of neuropsychologists from country to country, two common areas for future development are suggested. First, identification, development, and measurement of core competencies for neuropsychological education and practice are needed that can serve as a unifying element for the world's clinical neuropsychologists. Second, greater emphasis on recognizing and addressing the need for assessment and treatment of diverse populations is needed if the world's citizens can hope to benefit from the expertise of practitioners in our field.

Commentary: the postdoctoral residency match in clinical neuropsychology

Postdoctoral recruitment in clinical neuropsychology has evolved significantly over the past two decades. Prior to 1994, there were no organized recruitment guidelines for the specialty. From 1994 to 2001, the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) facilitated a uniform notification date where member programs agreed to not make offers prior to a specified date. In 2001, APPCN partnered with National Matching Services to administer a computerized match recruitment system. Presently, not all programs participate in the match. This often results in students applying to 'match' and 'non-match' programs which can lead to significant stress on the part of applicants and program directors. This issue has recently become the focus of journal articles and public discussions. The goals of this paper were to review the history of postdoctoral recruitment in clinical neuropsychology, review the benefits of coordinated recruitment systems, review the structure and function of the computerized match, and explain why the computerized match for postdoctoral recruitment in clinical neuropsychology is beneficial for the specialty of clinical neuropsychology.

[Formula: see text]Education, training and practice of clinical neuropsychologists in the United States of America

OBJECTIVE

This invited paper is intended to give an overview regarding the education and training pathways for the practice of neuropsychology in the United States. It is also meant to describe the types of activities engaged in by neuropsychologists, a description of their work settings and the amounts/ways in which they are compensated for their work.

METHOD

The authors reviewed the literature and relied on their professional and organizational experiences to collect the necessary data.

RESULTS

The United States has well-defined pathways for one to follow to gain the experiences and knowledge necessary to practice clinical neuropsychology in a competent way. Compensation varies widely among workplace settings but overall neuropsychologists appear to be well-paid. Challenges now and in the foreseeable future include a need to develop tests that have better ecological validity and that better reflect the demographics of a changing population, and an increasing need for neuropsychologists to identify key roles as members of integrated care teams.

CONCLUSIONS

The United States has played an important role in the development of the practice and science of neuropsychology. Its continued success will, at least in part, depend on innovations in test development and application, and further demonstration of its relevance to health care and academic settings.

Reaffirming normal: the high risk of pathologizing healthy adults when interpreting the MMPI-2-RF

Monte Carlo simulations were utilized to determine the proportion of the normal population expected to have scale elevations on the MMPI-2-RF when multiple scores are interpreted. Results showed that when all 40 MMPI-2-RF scales are simultaneously considered, approximately 70% of normal adults are likely to have at least one scale elevation at or above 65 T, and as many as 20% will have five or more elevated scales. When the Restructured Clinical (RC) Scales are under consideration, 34% of normal adults have at least one elevated score. Interpretation of the Specific Problem Scales and Personality Psychopathology Five Scales--Revised also yielded higher than expected rates of significant scores, with as many as one in four normal adults possibly being miscategorized as having features of a personality disorder by the latter scales. These findings are consistent with the growing literature on rates of apparently abnormal scores in the normal population due to multiple score interpretation. Findings are discussed in relation to clinical assessment, as well as in response to recent work suggesting that the MMPI-2-RF's multiscale composition does not contribute to high rates of elevated scores.

A Panel Interview on the Ethical Practice of Neuropsychology

Neuropsychologists who have considerable experience reflecting, presenting, publishing, and advising on ethical matters are a rich resource for clinicians who have ethics questions. Consultation with such colleagues can be an important part of the ethical decision-making process. The purpose of the present article is to provide the opinions and perspectives of three neuropsychologists who, based on their experience and scholarly activities, served as panelists regarding ethical matters. Although the advice and opinions of colleagues are not a substitute for familiarity with relevant ethical requirements, guidelines, and professional literature, they offer valuable information that enhances the ethical decision-making process.

The MMPI-2 Fake Bad Scale: Concordance and Specificity of True and Estimated Scores

A number of recent studies have supported the use of the MMPI-2 Fake Bad Scale (FBS) as a measure of negative response bias, the scale at times demonstrating greater sensitivity to negative response bias than other MMPI-2 validity scales. However, clinicians may not always have access to True FBS (T-FBS) scores, such as when True-False answer sheets are unavailable or published research studies do not report FBS raw scores. Under these conditions, Larrabee (2003a) suggests a linear regression formula that provides estimated FBS (E-FBS) scores derived from weighted validity and clinical T-Scores. The present study intended to validate this regression formula of MMPI-2 E-FBS scores and demonstrate its specificity in a sample of non-litigating, clinically referred, medically intractable epilepsy patients. We predicted that the E-FBS scores would correlate highly (>.70) with the T-FBS scores, that the E-FBS would show comparable correlations with MMPI-2 validity and clinical scales relative to the T-FBS, and that the E-FBS would show an adequate ability to match T-FBS scores using a variety of previously suggested T-FBS raw score cutoffs. Overall, E-FBS scores correlated very highly with T-FBS scores (r = .78, p < .0001), though correlations were especially high for women (r = .85, p < .0001) compared to men (r = .62, p < .001). Thirty-one of 32 (96.9%) comparisons made between E-FBS/T-FBS correlates with other MMPI-2 scales were nonsignificant. When matching to T-FBS "high" and "low" scores, the E-FBS scores demonstrated the highest hit rate (92.5%) through use of Lees-Haley's (1992) revised cutoffs for men and women. These same cutoffs resulted in excellent overall specificity for both the T-FBS scores (92.5%) and E-FBS scores (90.6%). The authors conclude that the E-FBS represents an adequate estimate of T-FBS scores in the current epilepsy sample. Use of E-FBS scores may be especially useful when clinicians conduct the MMPI-2 short form, which does not include all of the 43 FBS items but does include enough items to compute each of the validity and clinical T-Scores. Future studies should examine E-FBS sensitivity in compensation-seekers with incomplete effort.

Performance of compensation seeking and non-compensation seeking samples on the Victoria symptom validity test: cross-validation and extension of a standardization study

Previous research suggests that the Victoria Symptom Validity Test (VSVT) is effective in confirming or disconfirming the validity of a patient's reported cognitive impairments. We sought to cross-validate the findings of the VSVT standardization study, and to determine cut-off scores that are most efficient in discriminating our samples of compensation-seeking patients, primarily with mild traumatic brain injury (CS; n = 53), and non-compensation seeking patients with intractable seizures (NCS; n = 30). All patients in the NCS sample scored in the "valid" range on the VSVT difficult memory items, compared to only 58.5% of the CS sample. We also identified VSVT measures and cut-off scores maximally efficient in discriminating these samples. This study confirms previous research that non-compensation seeking patients do well on the VSVT, but that many compensation seeking patients perform poorly on this measure.

Responses to perceived unethical practices in clinical neuropsychology: ethical and legal considerations

Neuropsychologists often review the work of colleagues who have performed a neuropsychological evaluation. At times, these reviews may cause one to believe that a colleague acted in an unethical manner. However, it is often unclear whether the situation warrants contacting the colleague or filing a complaint. This article provides examples of potential unethical practices in neuropsychology, and then reviews the relevant ethical principles and legal precedents concerning the obligations and possible risks of reporting perceived unethical practices of a colleague. The paper concludes with a series of recommendations and options as to when and how one should proceed in such situations.

Wada difference a day makes: interpretive cautions regarding same-day injections

OBJECTIVE

To determine whether memory scores after second intracarotid amobarbital procedure (IAP) injections are affected by the time between the first and second injections.

METHODS

Sixty-two patients received their second IAP injection on the day after the first injection. Forty-three other patients received the second injection on the same day as the first injection. Both groups underwent similar IAP protocols and memory assessments, except for the timing of the second injection.

RESULTS

The second IAP memory scores in the two-day group were significantly higher (p < 0.05) than those in the one-day group. Timing of second injection was a significant correlate of second memory scores, but amobarbital dosage, first IAP memory score, and pre-IAP measures of memory and intelligence were not significant correlates.

CONCLUSION

One-day and two-day IAP protocols do not result in similar memory scores after the second injection. Nineteen percent of a subset of patients in the one-day protocol were misclassified, in terms of IAP memory ratings, because of the deleterious effect of having both injections on the same day. It is recommended that correction scores be considered, for some patients who receive two IAP injections on one day, to approximate what the second IAP memory score would have been had the second injection occurred on a second day.

Language outcome following multiple subpial transection for Landau-Kleffner syndrome

Landau-Kleffner syndrome is an acquired epileptic aphasia occurring in normal children who lose previously acquired speech and language abilities. Although some children recover some of these abilities, many children with Landau-Kleffner syndrome have significant language impairments that persist. Multiple subpial transection is a surgical technique that has been proposed as an appropriate treatment for Landau-Kleffner syndrome in that it is designed to eliminate the capacity of cortical tissue to generate seizures or subclinical epileptiform activity, while preserving the cortical functions subserved by that tissue. We report on the speech and language outcome of 14 children who underwent multiple subpial transection for treatment of Landau-Kleffner syndrome. Eleven children demonstrated significant postoperative improvement on measures of receptive or expressive vocabulary. Results indicate that early diagnosis and treatment optimize outcome, and that gains in language function are most likely to be seen years, rather than months, after surgery. Since an appropriate control group was not available, and that the best predictor of postoperative improvements in language function was that of length of time since surgery, these data might best be used as a benchmark against other Landau-Kleffner syndrome outcome studies. We conclude that multiple subpial transection may be useful in allowing for a restoration of speech and language abilities in children diagnosed with Landau-Kleffner syndrome.

Deficits in delayed memory following cerebral malaria: a case study

Cerebral malaria is a common disease, but there have not been any reports or investigations of long-term neurological or neuropsychological outcome. We present a case in which severe deficits in delayed memory and naming ability are observed 10 years after the patient contracted cerebral malaria. Neuropsychological testing and medical imaging are both consistent with temporal lobe/hippocampal dysfunction, which corroborates earlier animal research that cerebral malaria is particularly likely to lead to interrupted blood circulation in this area.

Significance of unilateral ear extinction on the dichotic listening test

The association between unilateral ear extinction on the dichotic listening test and the lateralization of epileptogenic foci was examined in a sample of 49 seizure patients undergoing preoperative evaluation for epilepsy surgery. Results from patients who were left hemisphere dominant for speech indicated that right ear impairment was always predictive of a unilateral left hemisphere focus, but left ear extinction was associated with unilateral lesions of either hemisphere. In this patient sample, dichotic listening performance reflected an interaction of both lateralized foci and hemispheric preference of language processing. Implications concerning clinical use of the dichotic listening test are discussed.

Cognitive outcome after cardiac operations. Relationship to intraoperative computerized electroencephalographic data

Cardiopulmonary bypass frequently causes new postoperative neuropsychologic deficits. To assess whether these deficits could be predicted or limited, we monitored 29 patients receiving bypass intraoperatively with an on-line computerized electroencephalograph. We hypothesized that the 15 patients whose cerebral perfusion pressure was adjusted on the basis of this electroencephalographic data would have fewer postoperative deficits than the 14 patients whose pressure was monitored on the basis of systemic pressure. The results showed that new postoperative cognitive deficits in both groups were less prevalent than in previous studies, but there was not a significant difference in outcomes between the two groups. The intraoperative electroencephalographic records correlated with surgical, but not neuropsychologic, outcome. It is concluded that careful attention to intraoperative cerebral perfusion pressure may decrease the prevalence of postoperative neuropsychologic complications, but that the use of a computerized electroencephalograph does not necessarily contribute to an improved outcome.