Clinical neuropsychology

Clinical neuropsychology is a sub-field of psychology concerned with the applied science of brain-behaviour relationships. Clinical neuropsychologists use this knowledge in the assessment, diagnosis, treatment, and or rehabilitation of patients across the lifespan with neurological, medical, neurodevelopmental and psychiatric conditions, as well as other cognitive and learning disorders.[1] The branch of neuropsychology associated with children and young people is Pediatric Neuropsychology.

Assessment is primarily by way of neuropsychological tests, but also includes patient history, qualitative observation and may draw on findings from neuroimaging and other diagnostic medical procedures. Clinical neuropsychology requires an in-depth knowledge of: neuroanatomy, neurobiology, psychopharmacology and neuropathology.

History

During the late 1800s, brain–behaviour relationships were interpreted by European physicians who observed and identified behavioural syndromes that were related with focal brain dysfunction.[2]

Assessment

Lezak lists six primary reasons neuropsychological assessments are carried out: diagnosis, patient care and its planning, treatment planning, treatment evaluation, research and forensic neuropsychology.[3] To conduct a comprehensive assessment will typically take several hours and may need to be conducted over more than a single visit. Even the use of a screening battery covering several cognitive domains may take 1.5–2 hours. At the commencement of the assessment it is important to establish a good rapport with the patient and ensure they understand the nature and aims of the assessment.[4]

Neuropsychological assessment can be carried out from two basic perspectives, depending on the purpose of assessment. These methods are normative or individual. Normative assessment, involves the comparison of the patient’s performance against a representative population. This method may be appropriate in investigation of an adult onset brain insult such as traumatic brain injury or stroke. Individual assessment may involve serial assessment, to establish whether declines beyond those which are expected to occur with normal aging, as with dementia or another neurodegenerative condition.[5]

Assessment can be further subdivided into sub-sections:

History taking

Neuropsychological assessments usually commence with a clinical interview as a means of collecting a history, which is relevant to the interpretation of any later neuropsychological tests. In addition, this interview provides qualitative information about the patient’s ability to act in a socially apt manner, organise and communicate information effectively and provide an indication as to the patient’s mood, insight and motivation.[6] It is only within the context of a patient’s history that an accurate interpretation of their test data and thus a diagnosis can be made.[7] The clinical interview should take place in a quiet area free from distractions. Important elements of a history include demographic information, description of presenting problem, medical history (including any childhood or developmental problems, psychiatric and psychological history), educational and occupational history (and if any legal history and military history.)[8]

Selection of neuropsychological tests

It is not uncommon for patients to be anxious about being tested; explaining that tests are designed so that they will challenge everyone and that no one is expected to answer all questions correctly may be helpful.[4] An important consideration of any neuropsychological assessment is a basic coverage of all major cognitive functions. The most efficient way to achieve this is the administration of a battery of tests covering: attention, visual perception and reasoning, learning and memory, verbal function, construction, concept formation, executive function, motor abilities and emotional status. Beyond this basic battery, choices of neuropsychological tests to be administered are mainly made on the basis of which cognitive functions need to be evaluated in order to fulfill the assessment objectives.[9] With advances in technology, many clinical neuropsychologists have opted to utilize online and iPad based testing measures through services such as Pearson Assessment's Q-interactive and PAR's iConnect.[10]

Report writing

Following a neuropsychological assessment it is important to complete a comprehensive report based on the assessment conducted. The report is for other clinicians, as well as the patient and their family so it is important to avoid jargon or the use of language which has different clinical and lay meanings (e.g. intellectually disabled as the correct clinical term for an IQ below 70, but offensive in lay language).[11] The report should cover background to the referral, relevant history, reasons for assessment, neuropsychologists observations of patient’s behaviour, test administered and results for cognitive domains tested, any additional findings (e.g. questionnaires for mood) and finish the report with a summary and recommendations. In the summary it is important to comment on what the profile of results indicates regarding the referral question. The recommendations section contains practical information to assist the patient and family, or improve the management of the patient’s condition.[12]

Educational requirements of different countries

The educational requirements for becoming a clinical neuropsychologist differ between countries. In some countries it may be necessary to complete a clinical psychology degree, before specialising with further studies in clinical neuropsychology. While some countries offer clinical neuropsychology courses to students who have completed 4 years of psychology studies. All clinical neuropsychologists require a postgraduate qualification, whether it be a Masters or Doctorate (Ph.D, Psy.D. or D.Psych).

Australia

To become a clinical neuropsychologist in Australia requires the completion of a 3-year Australian Psychology Accreditation Council (APAC) approved undergraduate degree in psychology, a 1-year psychology honours, followed by a 2-year Masters or 3-year Doctorate of Psychology (D.Psych) in clinical neuropsychology. These courses involve coursework (lectures, tutorials, practicals etc.), supervised practice placements and the completion of a research thesis. Masters and D.Psych courses involve the same amount of coursework units, but differ in the amount of supervised placements undertaken and length of research thesis. Masters courses require a minimum of 1,000 hours (125 days) and D.Psych courses require a minimum of 1,500 hours (200 days), it is mandatory that these placements expose students to acute neurology/neurosurgery, rehabilitation, psychiatric, geriatric and paediatric populations.[13] The Australian Psychological Society does not specify a minimum word count for the research component of either degree, but this is generally around 15,000 words or more for a Masters and up to 50,000 for a Doctorate. Entry to these courses is very competitive and is generally decided on the basis of academic merit (a H1 or H2A honours mark), referee reports and an interview process. Experience with clinical populations is highly regarded and often considered essential in the selection process. Australian universities offering a D.Psych or master's degrees in clinical neuropsychology include: La Trobe University, Macquarie University, Monash University, University of Melbourne, University of Queensland and University of Western Australia.[14] Annual intake for each of these universities range from approximately 7 to 17 candidates. Depending on the university, courses may be offered as Commonwealth supported places (HECS/HELP) or full-fee courses.

Canada

To become a clinical neuropsychologist in Canada requires the completion of a 4-year honours degree in psychology and a 4-year doctoral degree in clinical neuropsychology. Often a 2-year master's degree is required before commencing the doctoral degree. The doctoral degree involves coursework and practical experience (practicum and internship). Practicum is between 600 and 1,000 hours of practical application of skills acquired in the program. At least 300 hours must be supervised, face-to-face client contact. The practicum is intended to prepare students for the internship/residency. Internships/residencies are a year long experience in which the student functions as a neuropsychologist, under supervision. Currently, there are 3 CPA-accredited Clinical Neuropsychology internships/residencies in Canada,[15] although other unaccredited ones exist. Prior to commencing the internship students must have completed all doctoral coursework, received approval for their thesis proposal (if not completed the thesis) and the 600 hours of practicum.[16] Clinical neuropsychology courses are offered at the following Canadian universities:Université de Montréal, Simon Fraser University,[17] University of Victoria, York University[18] and University of Windsor.[19]

United Kingdom

To become a clinical neuropsychologist in the UK, requires prior qualification as a clinical or educational psychologist as recognised by the Health Professions Council, followed by further postgraduate study in clinical neuropsychology. In its entirety, education to become a clinical neuropsychologist in the UK consists of the completion of a 3-year British Psychological Society accredited undergraduate degree in psychology, 3-year Doctorate in clinical (usually D.Clin.Psy.) or educational psychology (D.Ed.Psy.), followed by a 1-year Masters (MSc) or 9-month Postgraduate Diploma (PgDip) in Clinical Neuropsychology.[20] Masters programs include a research component that Postgraduate Diploma courses do not. Postgraduate courses in clinical neuropsychology are offered by: University of Bristol, University of Glasgow, University of Nottingham and University College London.[21]

United States

In order to become a clinical neuropsychologist in the US and be compliant with Houston Conference Guidelines, the completion of a 4-year undergraduate degree in psychology and a 4 to 5-year doctoral degree (Psy.D. or Ph.D.) must be completed. After the completion of the doctoral coursework, training and dissertation, students must complete a 1-year internship, followed by an additional 2 years of supervised residency. The doctoral degree, internship and residency must all be undertaken at American Psychological Association approved institutions.[22] After the completion of all training, students must apply to become licensed in their state to practice psychology. The American Board of Clinical Neuropsychology, The American Board of Professional Neuropsychology, and The American Board of Pediatric Neuropsychology all award board certification to neuropsychologists that demonstrate competency in specific areas of neuropsychology, by reviewing the neuropsychologist's training, experience, submitted case samples, and successfully completing both written and oral examinations. Although these requirements are standard according to Houston Conference Guidelines, even these guidelines have stated that the completion of all of these requirements is still aspirational, and other ways of achieving clinical neuropsychologist status are possible.

Clinical neuropsychology courses are offered at the following US universities: Adler School of Professional Psychology, Argosy University (Washington DC, Seattle, Chicago & Atlanta campuses), Ball State University,[23] Binghamton University, Brigham Young University, City University of New York, Drexel University, Florida Institute of Technology, Fielding Graduate University, Fordham University, Forest Institute, Fuller Graduate School of Psychology, Illinois School of Professional Psychology at Argosy University, Northwestern University, Nova Southeastern University, Pacific University, Palo Alto University,[24] Roosevelt University San Diego State University-University of California, San Diego (Joint Doctoral Program), Temple University, University of Arizona, University of Cincinnati, University of Connecticut, University of Florida, University of Georgia, University of Houston, University of Kentucky, University of Maryland, University of Massachusetts Amherst, University of Missouri,[25] University of Missouri-Kansas City,[26] University of South Florida, University of Texas at Austin,[27] University of Utah, University of Wisconsin, Washington State University, Washington University, Wayne State University,[28] Widener University[29] and Yeshiva University.[19]

Journals

The following represents an (incomplete) listing of significant journals in or related to the field of clinical neuropsychology.

  • Aging, Neuropsychology and Cognition
  • Applied Neuropsychology
  • Archives of Clinical Neuropsychology
  • Archives of Neurology
  • Brain
  • Child Neuropsychology
  • The Clinical Neuropsychologist
  • Cognitive Neuropsychology
  • Cortex
  • Developmental Neuropsychology

See also

References

  1. ↑ National Academy of Neuropsychology. "NAN definition of a Clinical Neuropsychologist". National Academy of Neuropsychology website. Retrieved 7 December 2011.
  2. ↑ Benton, Arthur; Boller & J. Grafman(Eds.) (1988). Neuropsychology: Past, present, and future 1: 3–27. Missing or empty |title= (help)
  3. ↑ Lezak, M.D.; Howieson, D.B.; Loring, D.W. (2004). Neuropsychological Assessment (4th ed.). Oxford: Oxford University Press. pp. 5–10. ISBN 0-19-511121-4.
  4. 1 2 Clare, L. (2010). "Chpt 25: Neuropsychological Assessment". In Abou-Saleh, M. T., Katona, C. L. E. & Kumar, A. Principles and Practice of Geriatric Psychiatry (PDF) (3rd ed.). Wiley-Blackwell. p. 138. ISBN 978-0-470-74723-0.
  5. ↑ Lezak, Howieson & Loring 2004, p. 88
  6. ↑ Hebben, N.; Millberg, W. (2009). Essentials of Neuropsychological Assessment (2nd ed.). Wiley. p. 58. ISBN 978-0-470-43747-6.
  7. ↑ Hebben & Millberg 2009, p. 44
  8. ↑ Hebben & Millberg 2009, pp. 47–58
  9. ↑ Jurado, M. A. & Pueyo, R. (2012). "Doing and reporting neuropsychological assessment". International Journal of Clinical and Health Psychology 12 (1): 123–141.
  10. ↑ Pediatric Neurobehavioral Group | indianapolis - http://www.pngindianapolis.com/services.html
  11. ↑ Hebben & Millberg 2009, pp. 62
  12. ↑ Clare, L. (2010). "Chpt 25: Neuropsychological Assessment". In Abou-Saleh, M. T., Katona, C. L. E. & Kumar, A. Principles and Practice of Geriatric Psychiatry (PDF) (3rd ed.). Wiley-Blackwell. p. 139. ISBN 978-0-470-74723-0.
  13. ↑ The Australian Psychological Society. "College Course Approval Guidelines for Postgraduate Specialist Courses" (PDF). Australian Psychological Society. p. 15. Retrieved 10 March 2012.
  14. ↑ "APAC Accredited Psychology Degrees". APAC. Retrieved 1/8/11. Check date values in: |access-date= (help)
  15. ↑ http://www.cpa.ca/accreditation/cpaaccreditedprograms/
  16. ↑ Canadian Psychological Association. "Accreditation Standards and Procedures for Doctoral Programmes and Internships in Professional Psychology (5th revision)". Canadian Psychological Association. Retrieved 29 December 2011.
  17. ↑ "Clinical Neuropsychology specialty at SFU". Simon Fraser University. Retrieved 26 May 2012. |first1= missing |last1= in Authors list (help)
  18. ↑ "Course Information: Clinical Neuropsychology". York University. Retrieved 22 February 2012. |first1= missing |last1= in Authors list (help)
  19. 1 2 APA approved clinical neuropsychology programs. "APA Division of Clinical Neuropsychology". APA. Retrieved 24/8/11. Check date values in: |access-date= (help)
  20. ↑ British Psychological Society. "Qualification in Clinical Neuropsychology". BPS website. British Psychological Society. Retrieved 3 December 2011.
  21. ↑ British Psychological Society. "BPS Accredited Clinical Neuropsycholoical Courses". BPS website. British Psychological Society. Retrieved 3 December 2011.
  22. ↑ National Academy of Neuropsychology. "The Houston Conference on Specialty Education and Training in Clinical Neuropsychology" (PDF). Policy Statement. Retrieved 29 December 2011.
  23. ↑ "Psychology Specialties at Ball State University". Neuropsychology as a Cognate of Doctoral Program. Ball State University. Retrieved 6 February 2012. |first1= missing |last1= in Authors list (help)
  24. ↑ Palo Alto University. "Palo Alto Certificate in Clinical Neuropsychology". Retrieved 26 August 2012.
  25. ↑ "Neuropsychology Internships Offered". University of Missouri. Retrieved 15 December 2012.
  26. ↑ "The Clinical Neuropsychology Laboratory". University of Missouri-Kansas City. Retrieved 15 December 2012.
  27. ↑ "Clinical Psychology Handbook (Neuropsychology info pg 46)" (PDF). University of Texas at Austin. Retrieved 20 April 2013.
  28. ↑ "Clinical Psychology Program, (with speicalisation in clinical neuropsychology)". Wayne State University. Retrieved 20 April 2013.
  29. ↑ "Widener University Neuropsychological Assessment Center". Widener University. Retrieved 20 April 2013.

Further reading

External links

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