A commentary for neuropsychologists on CDC's guideline on the diagnosis and management of mild traumatic brain injury among children

Objective: In 2018, the Centers for Disease Control Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. This commentary summarizes the key recommendations in the CDC Pediatric mTBI Guideline most relevant for neuropsychologists and discusses research gaps and topics that should receive attention in future iterations of the Guideline.Method: We described the methods used to develop the Guideline, which included a comprehensive Systematic Review. We also distilled and presented key practice strategies reflected in Guideline.Results: To optimize care of pediatric patients with mTBI, neuropsychologists should: use validated, age-appropriate symptom scales, assess evidence-based risk factors for prolonged recovery, provide patients with instructions on return to activity customized to their symptoms, and counsel patients to return gradually to nonsports activities after a short period of rest. Future iterations of the Guideline should encompass a review and guidance on care of patients with psychiatric and psychological difficulties, as well as the potential use of imaging to assess patients with persistent symptoms. Expanded research on mTBI among girls, children age 8 and under, and effective treatments for pediatric mTBI will be beneficial to inform care practices.Conclusions: Recommendations in the CDC Pediatric mTBI Guideline highlight multiple opportunities for neuropsychologists to take action to improve the care of young patients with mTBI and to advance research in the field. Multiple resources and tools are available to support implementation of these recommendations into clinical practice.

Neuropsychology and clinical health psychology in the UK Ministry of Defence

Neuropsychological testing has been used in a wide range of applications across military settings, including the selection of personnel to engage in covert operations, battlefield assessment and rehabilitation following blast exposure, traumatic brain injury, other neurological conditions and assessment of malingering. Over recent decades, military psychologists have helped to shape the advances in assessing and remediating the psychological sequela that is associated with operationally related neurological and other physical injuries. This paper will present an overview of some of the neuropsychological and related services within the UK Armed Forces, which are provided to service personnel with traumatic brain and other physical injuries.

[Neuropsychiatry as practised in a highly specialised department of a psychiatric teaching hospital: a successful interdisciplinary approach]

BACKGROUND

Psychiatric disorders can be interpreted as a general dysregulation of the interplay between brain and behaviour. This is why, since the late 1990’s, the terms biological psychiatry and behavioural neurology have been gradually replaced by the term neuropsychiatry. Neuropsychiatry, when practiced in combination with clinical neuropsychology, have given rise to a paradigm that is not based solely on the usual classification models but is directed primarily towards diagnosis and treatment that are based on a functional-dimensional approach.

AIM

To discuss the daily practice and organisation in a specialised department for neuro-psychiatry located in a psychiatric teaching hospital.

METHOD

The interdisciplinary approach is explained and analysed on the basis of 10 case studies.

RESULTS

Most of the patients referred to the specialised department already had a long history of visits to the health care facilities where they had been treated by a variety of specialists in single disciplines. Often, however, this trajectory did not involve periodical re-evaluation and updating of the original diagnosis. If this strategy had been adopted, then a clear diagnosis with simplified treatment programme might have been devised which could have resulted in a patient’s successful reintegration into society.

CONCLUSION

It is essential that the interdisciplinary approach is adopted in specialised centres for neuropsychiatry because it can make an important contribution to individual patient care and to the spread of specialised knowledge that can benefit the entire field of psychiatry.

Slovenia: difficulties and strengths of psychiatric research in a small country

With a population of nearly 2 000 000 and an area of about 20 000 km2, Slovenia is a heterogeneous European country that extends from the Mediterranean Sea to the Alps. Slovenian political history dates back to the 6th century, when the first free principality of the ancient Slovenians was established – Caranthania – famous for its democratic institutions, legal system, popular elections of dukes and progressive legal rights for women. From the 13th century until 1918, Slovenians were ruled by the Habsburgs. After 1918, Slovenia became a part of Yugoslavia and again enjoyed a considerable degree of autonomy. But as the political and economic crisis of Yugoslavia worsened, at the plebiscite in December 1990 87% of the voting population voted in favour of sovereignty. Thus, Slovenia declared its independence on 25 June 1991, and became a member of the United Nations in May 1992. Until the Second World War the psychiatric tradition in Slovenia was German. Afterwards, the Anglo-Saxon tradition has gradually entered Slovene psychiatry.

Survey of graduates of programs affiliated with the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN)

A survey addressing training experiences and current professional practices was sent to 219 persons who had completed a 2-year postdoctoral residency in clinical neuropsychology through a program that was affiliated with the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN). A total of 108 usable replies were received, yielding a response rate of 49%. More than 80% of the respondents considered completion of a 2-year postdoctoral residency to be an essential component of the training as a clinical neuropsychologist, and more than 50% indicated that their residency had yielded at least one publication in a peer-reviewed journal. They identified individual supervision as the most helpful during their postdoctoral training, and tended to remain very active in the field of clinical neuropsychology. It is concluded that APPCN-affiliated programs are largely successful in preparing residents for independent practice as clinical neuropsychologists but that there are opportunities for further didactical improvement in the area of billing and reimbursement, as well as preparation for board certification in Clinical Neuropsychology through the American Board of Professional Psychology.

A review of neuropsychological services in the United Kingdom for patients being considered for epilepsy surgery

We report a review of the current practice of neuropsychologists working within epilepsy surgery services. The aim of the review was to examine areas of diversity and consensus across current national service provision and to examine progress in service delivery since a previous survey in 1994. Sixteen centres provided information via a questionnaire on three areas of clinical practice: pre- and post-surgery neuropsychological protocols; the intracarotid sodium amytal protocol; patient and family expectations and psychological health, in addition to examining aspects of the context of clinical practice such as the role and experience of the psychologist and future service priorities. Findings of the review suggest that, whilst progress has been made towards fulfilling the recommended guidelines for services, there remain a number of areas for development in terms of the provision of a consistent nationwide service delivery approach. Cognitive assessment and the ICSA procedure remain essential components of the neuropsychology service. Assessment of psychological health and quality of life is now carried out by a growing number of centres, although these remain areas for further development. Consensus was found in terms of the need to establish centres of excellence, and to develop appropriate training for neuropsychologists in the field.

National Academy of Neuropsychology/Division 40 of the American Psychological Association practice survey of clinical neuropsychology in the United States, Part I: practitioner and practice characteristics, professional activities, and time requirements

Leaders of the National Academy of Neuropsychology and Division 40 (Clinical Neuropsychology) of the American Psychological Association determined that current information on the professional practice of clinical neuropsychology within the United States (U.S.) was needed. These two organizations co-sponsored a national survey of U.S. clinical neuropsychologists that was conducted in September 2000. The primary goal of the survey was to gather information on such topics as: practitioner and practice characteristics, economic variables (e.g., experience with major third party payors, such as Medicare and managed care), practice expenses, billing methods, experiences with Current Procedural Terminology (CPT) codes, time spent on various clinical tasks, use of assistants, and income. The adjusted return rate of 33.5% (n = 1,406) reflects the number of surveys returned with sufficient data by licensed doctoral level clinicians with membership in one or both sponsoring organizations. In this first of two articles describing the survey results, characteristics of practitioners and practices, various types of professional activities, and time requirements for clinical tasks are presented and discussed. It was noted that the proportion of women in the field is increasing rapidly. Private practice is the predominant employment setting. Findings also document that members of the two sponsoring organizations are very similar with regard to employment setting, professional characteristics, and weekly activities. That is, involvement in clinical practice and research, as well as private practice versus institutional employment, was very similar between organizations. However, across organizations, work setting (private practice vs. institution) was associated with significant and meaningful differences. Private practitioners have a more diverse set of weekly clinical activities, are less likely to use assistants, and engage in more forensic activities. Across work setting, with the exception of forensic evaluations, those using assistants invest a greater number of hours per evaluation, but bill approximately the same numbers of hours per evaluation.

Ten-year follow-up survey of clinical neuropsychologists: part II. Private practice and economics

Analyses of a 10-year follow-up survey of clinical neuropsychologists demonstrated significant changes in employment settings away from institutions, placing a clear majority of the field in private practice settings in 1999 (Sweet, Moberg, & Suchy, 2000). The present paper compares characteristics of practices and beliefs of clinical neuropsychologists who work in institutions versus private practice, using data from 1989, 1994, and 1999. Previous survey data had not been analyzed along the dimension of work setting. Among the significant findings are differences in age, referral sources, hours per week engaged in specific professional activities (clinical, neuropsychological, forensic, supervisory, research, teaching), ages of patients, type and frequency of data gathered in assessments, hours spent per evaluation, use of an assistant to gather data, and journal subscriptions. Economic changes within the last 5 years have had a differential impact for the two groups in terms of yearly income and hourly reimbursement. However, approximately half of the neuropsychologists in both groups have increased hours performing clinical work, hours performing administrative duties, and patient load to compensate for economic changes in the last 5 years. Decreases in clinical research and teaching activities are apparent in both groups, but in different amounts.

The quantified process approach: an emerging methodology to neuropsychological assessment

An important development in the field of neuropsychological assessment is the quantification of the process by which individuals solve common neuropsychological tasks. The present article outlines the history leading to this development, the Quantified Process Approach, and suggests that this line of applied research bridges the gap between the clinical and statistical approaches to neuropsychological assessment. It is argued that the enterprise of quantifying the process approach proceeds via three major methodologies: (1) the "Satellite" Testing Paradigm: an approach by which new tasks are developed to complement existing tests so as to clarify a given test performance; (2) the Composition Paradigm: an approach by which data on a given test that have been largely overlooked are compiled and subsequently analyzed, resulting in new indices that are believed to reflect underlying constructs accounting for test performance; and (3) the Decomposition Paradigm: an approach which investigates the relationship between test items of a given measure according to underlying facets, resulting in the development of new subscores. The article illustrates each of the above paradigms, offers a critique of this new field according to prevailing professional standards for psychological measures, and provides suggestions for future research.

In response to the 1998 APA Division 40 Presidential Address: so where's the beef?

During the 1998 Division 40 presidential address by Linas Bieliauskas in San Francisco, several assertions were made contending that professional schools of psychology (PSP) had a deleterious effect on clinical neuropsychology by lowering professional standards, removing science from the curriculum, and producing mediocre clinicians. Bieliauskas reported to the author that he had based his opinion, in part, on data indicating that Boulder model graduates attained superior mean scores on the Examination for the Professional Practice in Psychology (EPPP) as compared to their Vail model counterparts. In order to determine whether significant differences existed between the two groups, a multivariate analysis of variance (MANOVA) was conducted using the 1997 EPPP scores reported by the Association of State and Provincial Psychology Boards (ASPPB, 1997). The author also provides a response to Bieliauskas' (1998) assertions.

[The system of psychoprophylactic measures and psychiatric care in the Strategic Missile Forces]

Since 1992 psychiatric morbidity, hospitalisation and discharge rates among the SRF personnel show a tendency to increase, reaching accordingly 7.7/1000, 7.3/1000 and 2.7/1000. The existing psychoprophylaxis programme includes primary medical and psychoexamination of young recruits, medical check-ups for servicemen going on duty and on guard, sociometric and psychological studies of the servicemen interpersonal relations with the aim of correction thereof and medical control of those who return to the troops after leaves or temporary assignments. The SRF's medical service closely coordinates its actions with the Ministry of Health's appropriate setups, commanding officers and personnel instructors.

Establishing clinical neuropsychology in Germany: scientific, professional, political, and legal issues

German psychologists may have been first to establish a university curriculum in psychology with the expressed purpose to provide--after its successful completion--a certificate of professional qualification. This "Diplom-Prüfungsordnung" (Diploma Examination Regulation) was accepted nationwide in 1941. However, it took over fifty more years before some progress toward the political and legal acceptance of autonomous clinical activities of psychologists was made. Legislation to secure these advances is still pending. In this context the efforts to establish the profession of clinical neuropsychology are described and discussed within the historical development of professional psychology in Germany with special emphasis on the problems of compromises within the force fields of science and professional politics. Finally, the postgraduate training as well as the certification and accreditation procedures developed by the Gesellschaft für Neuropsychologie, the Society of German-speaking neuropsychologists, are presented.