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Published in Rudi Coetzer, The Notebook of a New Clinical Neuropsychologist, 2017
To perform a responsible job one needs the right tools. This is no different for a scientist-practitioner. The tool for eliciting and structuring patients’ stories through the process of the clinical interview is the glue that holds everything together. It is not a particularly difficult algorithm, or recipe, to learn. Provided we accept its imperfections, and that it requires practice. The bedside assessment in clinical neuropsychology shares several similarities with the same process used in behavioural neurology and neuropsychiatry. No wonder the universal language of applied clinical neuroscience is composed of a few ‘dialects’, by profession, but with the main version of the language remaining the common thread through all these disciplines. In this world of the hospital the rule of membership is simple: no language proficiency – no citizenship. Learning the skills underpinning clinical assessment has many benefits for testing hypotheses and developing diagnostic formulations, but one is often overlooked. It is that this is also the structure, although much more compressed and focused on the ‘highlights’ of a specific case, of the basic process of presenting during ward rounds, writing case reports or engaging in case-based academic teaching. Let’s now take a slight detour to have a closer look at the broad approach of how to perform and structure assessments. Remember that the case vignettes in the remainder of this book will follow the same structure.
Application of the neuropsychological evaluation in vocational planning after brain injury
Published in Robert T. Fraser, David C. Clemmons, Traumatic Brain Injury Rehabilitation, 2017
The focus of the present discussion will be those aspects of neuropsychology that deal with assessment and treatment based upon brain-behavior relationships. The term clinical in clinical neuropsychology underscores the reality that human function exists within a biopsychosocial context (see Engel6 and Paris7 for an explication of the biopsychosocial model). That is, one cannot understand human behavior unless its related biological underpinnings, psychological processes, and social or interpersonal levels of analysis are considered.
Problems Assessing Executive Dysfunction in Neurobehavioural Disability
Published in Tom M. McMillan, Rodger Ll. Wood, Neurobehavioural Disability and Social Handicap following Traumatic Brain Injury, 2017
It has long been known that a disturbance of executive functions can exist in the absence of any measurable impairment on standardised tests of cognitive ability. For example, Newcombe and Artioli Fortuny (1979), Lezak (1983), and Shallice and Burgess (1991b) all noted that patients with executive dysfunction can perform equally well as healthy controls on traditional neuropsychological tests. As recently as 2006, Wood and Liossi noted that tests traditionally used in neuropsychological assessment have been inconsistent in their ability to identify executive dysfunction, yet much of clinical neuropsychology has continued to use these traditional measures. The main concern has been that tests that purport to measure specific cognitive functions using composite scores do not have a predictable relationship to cognitive impairment in everyday life (Lezak, 1995). Ponsford, Sloan and Snow (1995) also noted that it is frequently difficult to predict how results on psychometric tests reflect an individual’s daily life and roles in society. When placed in situations in which they should be able to function (based on measured cognitive ability), many fail to adapt skills to the task at hand; make errors they do not detect; fail to adjust behaviour as the situation changes; lack the ability to anticipate or plan ahead; respond badly to negative feedback; and fail to execute tasks properly, not because they don’t know what to do but because they cannot sequence the actions necessary to achieve a goal.
Performance and Symptom Validity in Outpatient Pediatric Neuropsychological Evaluations
Published in Developmental Neuropsychology, 2023
Lauren M. Berrill, Quinton Quagliano, Timothy Boyce, Jacobus Donders
Evaluation of the validity of an examinee’s test results is considered the standard of care within the field of clinical neuropsychology (Bush et al., 2005; Heilbronner et al., 2009). There have been notable attempts to develop empirically-based criteria (Bianchini, Greve, & Glynn, 2005; Sherman, Slick, & Iverson, 2020; Slick, Sherman, & Iverson, 1999) to help clinicians interpret the meaning of invalid test findings. Historically, this has been thought of primarily as a concern most often associated with adults (DeRight & Carone, 2015). However, recent findings have suggested that validity assessment is also necessary for pediatric practice (Emhoff, Lynch, & McCaffrey, 2018; Kirkwood, 2015; MacAllister & Vasserman, 2015; Tonks, Whitfield, Williams, Slater, & Frampton, 2018). Clearly, failure on even one performance validity test suppresses scores on other cognitive tests with children (Donders & Gardner, 2020; Green & Flaro, 2019; Kirk, Baker, Kirk, & MacAllister, 2020). According to the American Academy of Clinical Neuropsychology (AACN) 2021 consensus statement on validity assessment, “the pediatric empirical literature on validity assessment and malingering has now grown large enough to support a recommendation that practitioners should use [validity tests] routinely in neuropsychological evaluations of school-aged children and adolescents” (Sweet et al., 2021, p. 21).
Feasibility and user-experience of virtual reality in neuropsychological assessment following stroke
Published in Neuropsychological Rehabilitation, 2022
Lauriane A. Spreij, Johanna M.A. Visser-Meily, Jacqueline Sibbel, Isabel K. Gosselt, Tanja C.W. Nijboer
Ecologically valid assessment has evolved as an area of focus within clinical neuropsychology (Chaytor & Schmitter-Edgecombe, 2003). Several standardized tests have been developed with an improved ecological validity, such as the Test of Everyday Attention (TEA; Robertson et al., 1996), the Rivermead Behavioural Memory Test (RBMT; Wilson et al., 1985), and the Behavioural Assessment of the Dysexecutive Syndrome (BADS; Wilson et al., 1996). However, even if most researchers agree that these tests seem similar to everyday tasks, participants remain well aware of the laboratory setting. For this reason, ecologically valid tests have been developed that are conducted in the real-world, such as the Multiple Errands Test (Shallice & Burgess, 1991) or the Executive Secretarial Task (Lamberts et al., 2010). A limitation, however, is the lack of a standardized and controlled setting, which results in an inconsistent degree of distractions within and between assessments.
Technology meets tradition: a hybrid model for implementing digital tools in neuropsychology
Published in International Review of Psychiatry, 2021
Neuropsychology is a relatively small area of mental health, yet the results from neuropsychological evaluations communicate impactful and even life-changing insights. Board-certified neuropsychologists typically have 2–5 years of neuropsychology-focussed practica, a year-long clinical internship with a focus in neuropsychology, and a 2-year postdoctoral fellowship in clinical neuropsychology. It is important to recognize and acknowledge that only a very small portion of these years of training is focussed on how to administer and score tests; rather, training in neuropsychology is learning to synthesize quantitative and qualitative data and provide patients with invaluable information about their cognitive, emotional, and psychiatric functioning. By not effectively using this potentially transient period wherein many clinicians are utilizing digital tools in evaluations for the first time, neuropsychologists may miss valuable opportunities to question what it means to be a neuropsychologist and how to adapt to the current era without becoming technologically irrelevant.