Archival Description of Clinical Neuropsychology

Populations:

Adult neurological populations include cerebrovascular accidents, neoplasms, infectious and inflammatory diseases, degenerative diseases, head trauma, demyelinating disease and various forms of dementing illness. Psychiatric populations of primary interest include somatoform disorders of pseudoneurologic character; depression as a component of an/or to be differentiated from dementia; psychosis as a pseudodementing disorder and as a differential diagnostic entity to be distinguished from behavioral disturbances in selected neurological populations such as partial complex seizure disorders.

General medical and surgical populations include older individuals who may have some neuropsychological deficits associated with an early dementing illness that may complicate medical or surgical management; candidates for kidney transplant or dialysis; candidates for cardiac surgery, including transplants; and chronic pain patients with a neurological versus functional basis.

Children with learning disabilities of developmental or organic basis are referred from pediatricians, pediatric neurologists, and the schools, in addition to a marked expansion of neuropsychological evaluation and treatment of all types of pediatric neurological patients. Growing referral populations include the chemically dependent (especially polydrug users and alcoholics), AIDS dementia cases, and victims of environmental toxin exposures.

Problems:

Referrals for clinical neuropsychological assessment typically include, but are not limited to, the following: differential diagnoses between psychogenic and neurogenic syndromes; differential diagnoses between two or more suspected etiologies of cerebral dysfunction; evaluation of spared and impaired functions secondary to a cerebral cortical or subcortical event; establishment of neurobehavioral baseline measures for monitoring progressive cerebral disease or recovery; comparison of pre- and postpharmacologic, surgical, or behavioral interventions; and assessment of higher cortical functions for the formulation of rehabilitation strategies.

Intervention problems include design of procedures for utilizing available functions to compensate for impaired functions; retraining of the impaired function to a higher level of adaptive effectiveness; and environmental (ecological) manipulation to enhance adaptive effectiveness.

Clinical neuropsychologists function primarily on referral from health, education, and legal professionals; agencies and institutions; and in response to heeds of other service systems (e.g., courts, schools, extended rehabilitation facilities and general care facilities, military installations, and chemical treatment facilities). Primary employment settings are estimated to be almost equally divided between hospital-medical centers, private practice, and a combination of (salaried) hospital or clinic-based employment, and private practice.

Procedures:

Clinical neuropsychological services include neuropsychological assessment, cognitive remediation and intervention, agency and institutional consultation, education and counseling for individuals and families, and selected psychotherapies or behavior therapies as appropriate for neurologically involved individuals.

Differentiation of clinical neuropsychology from other psychological specialties is reflected in the distinction between generic competencies and specialized competencies. Generic applied competency requires a foundation in psychological science with a predominantly clinical emphasis, although such training may be obtained through other generic avenues if a clinical internship is included. Over the past few decades, roles of clinical, counseling, and school psychologists have converged so that there is a substantial overlap in generic applied knowledge and competency attained in related programs at the predoctoral and internship levels. Clinical neuropsychology involves the building of specialized competencies upon the generic applied knowledge and competency base obtained in a generic applied predoctoral program of a health-related nature. The generic base for clinical neuropsychology includes the structure and process of interviewing; intellectual, aptitude, interest and personality measurement; selected psychotherapy and counseling interventions; general consultation skills; and a consumer-patient education orientation, including ethics. Building upon such a generic foundation, specialized clinical neuropsychological competence includes effectiveness in comprehensive history taking; identification of neurobehavioral problems/issues to be addressed; application of a wide range of neuropsychological assessment procedures to multiple populations; test construction and validation; remedial and supportive intervention design and implementation; individual and agency consultation; and consumer education/ethics, specifically in a neuropsychological context. Such specialized competency is achieved by means of sets of skills anchored to the above parameters of practice in the settings outlined in a,b, and c above. While there is overlap with the other health-related specialties in terms of generic applied competence, there is the elaboration , extension, and refinement of neurobehavioral applications that involve additional foundations in experimental, cognitive, and physiological psychology as well as in the clinical neurosciences. Such extensions of knowledge and application are obtained by specialty track programs at the predoctoral and internship levels and/or by postdoctoral preparation in a specialized clinical neuropsychology program.