Forensic neuropsychological assessment.

With its firm establishment as a neuropsychology subspecialty, forensic neuropsychological assessment is integral to many criminal and civil forensic evaluations. In addition to evaluating cognitive deficits, forensic neuropsychologists can provide reliable information regarding symptom magnification, malingering, and other neurocognitive and psychological issues that may impact the outcome of a particular legal case. This article is an overview and introduction to neuropsychological assessment in the forensic mental health context. Major issues impacting the current practice of forensic neuropsychology are summarized, and several examples from case law are highlighted.

Forensic neuropsychology: History and current status.

Objective:This review provides a summary of historical details and current practice activities related to Forensic Neuropsychology (FN). Under the auspices of the American Board of Clinical Neuropsychology (ABCN), the Forensic Neuropsychology Special Interest Group (FNSIG) views the FN as a subspecialty, which has developed over time as the straightforward result of more than 20 years of numerous publications, extensive continuing education, focused research and growth of forensic practice within neuropsychology. In this article, the FNSIG core work group documents and integrates information that is the basis of efforts to consolidate practice knowledge and facilitate attainment of forensic practice competencies by clinical neuropsychologists. Method:Overview of continuing education topics at professional conferences, search results that identify relevant books and peer-reviewed publications, as well as pertinent findings across years of large-scale national survey results. Results:Relevant evidence has shown for decades that FN is prominent within Clinical Neuropsychology as practiced in the United States and Canada. A majority of U.S. neuropsychologists have received FN training and provide forensic evaluation services. FN practice time per week is considerable for many practitioners, and across survey epochs has been shown to be increasing. Conclusion:The present review leads to the conclusion that in the interest of promoting the acquisition of competence, FN practice should remain a focal point of training and continuing education. Alternate routes to attain competence are discussed, as are ongoing professional activities that undoubtedly will ensure continued growth of, and interest in, the subspecialty of FN.

Official position of the American Academy of Clinical Neuropsychology on test security.

To provide education regarding the critical importance of test security for neuropsychological and psychological tests, and to establish recommendations for best practices for maintaining test security in forensic, clinical, teaching, and research settings. Previous test security guidelines were not adequately specified. METHOD: Neuropsychologists practicing in a broad range of settings collaborated to develop detailed and specific guidance regarding test security to best ensure continued viability of neuropsychological and psychological tests. Implications of failing to maintain test security for both the practice of neuropsychology and for society at large were identified. Types of test data that can be safely disclosed to nonpsychologists are described.Specific procedures can be followed that will minimize risk of invalidating future use of neuropsychological and psychological measures.Clinical neuropsychologists must commit to protecting sensitive neuropsychological and psychological test information from exposure to nonpsychologists, and now have specific recommendations that will guide that endeavor.

Rey-Osterrieth complex figure normative data for the psychiatric population.

Objective: Appropriate normative data are crucial for competent neuropsychological assessment. Although individuals with psychiatric illness often perform more poorly than healthy adults on neuropsychological testing, data that reflect the psychiatric population are often lacking. We present a normative dataset and calculation tools for the Rey-Osterrieth Complex Figure Test (RCFT) derived from the psychiatric inpatient population. Method: A sample of 301 psychiatric inpatients completed the RCFT and the Test of Memory Malingering (TOMM) between 1999 and 2018. Participants were 59.5% male, 82.1% Caucasian, 13.3% black, and 4.6% identified as another racial demographic, largely consistent with recent Substance Abuse and Mental Health Services Administration (2018) data for inpatients in U.S. psychiatric facilities. Scores for RCFT Copy, Short-Delay Free Recall, Long-Delay Free Recall, Total Recognition, and Percent Retained were modeled via multiple regression with age and education as predictors. Base rates were computed for subscores comprising Total Recognition to aid clinical decision making. Results: Age and education served as significant individual predictors for all models except one model predicting percent retained across delay that included only age. Regression equations and regression standard errors were used to produce a score calculator using a commonly available spreadsheet software package. Healthy adult norms under-estimated performance in our sample, underscoring the importance of these normative data. Conclusions: These normative data for the RCFT represent a large cohort of psychiatric inpatients. For clinical practice and research, both the data and the tools provided are likely to be of particular usefulness among individuals with serious mental illness.

Assessment of Neurocognitive Functions, Olfaction, Taste, Mental, and Psychosocial Health in COVID-19 in Adults: Recommendations for Harmonization of Research and Implications for Clinical Practice.

OBJECTIVE: To propose a set of internationally harmonized procedures and methods for assessing neurocognitive functions, smell, taste, mental, and psychosocial health, and other factors in adults formally diagnosed with COVID-19 (confirmed as SARS-CoV-2 + WHO definition). METHODS: We formed an international and cross-disciplinary NeuroCOVID Neuropsychology Taskforce in April 2020. Seven criteria were used to guide the selection of the recommendations' methods and procedures: (i) Relevance to all COVID-19 illness stages and longitudinal study design; (ii) Standard, cross-culturally valid or widely available instruments; (iii) Coverage of both direct and indirect causes of COVID-19-associated neurological and psychiatric symptoms; (iv) Control of factors specifically pertinent to COVID-19 that may affect neuropsychological performance; (v) Flexibility of administration (telehealth, computerized, remote/online, face to face); (vi) Harmonization for facilitating international research; (vii) Ease of translation to clinical practice. RESULTS: The three proposed levels of harmonization include a screening strategy with telehealth option, a medium-size computerized assessment with an online/remote option, and a comprehensive evaluation with flexible administration. The context in which each harmonization level might be used is described. Issues of assessment timelines, guidance for home/remote assessment to support data fidelity and telehealth considerations, cross-cultural adequacy, norms, and impairment definitions are also described. CONCLUSIONS: The proposed recommendations provide rationale and methodological guidance for neuropsychological research studies and clinical assessment in adults with COVID-19. We expect that the use of the recommendations will facilitate data harmonization and global research. Research implementing the recommendations will be crucial to determine their acceptability, usability, and validity.

[Formula: see text]Survey methods for neuropsychologists: A review of typical methodological pitfalls and suggested solutions.

Objective: Survey research has enjoyed an increase in popularity, in part due to the availability of user-friendly software programs for online survey development and deployment. Neuropsychologists often use this methodology to learn about common clinical practices and attitudes in the field or to assess outcomes for patients. This paper aims to provide an overview of sound methods and common problems in survey research, along with specific recommendations for neuropsychologists wishing to conduct their own surveys or judge the quality of survey research. We also discuss some recent challenges and changes in the field of survey methodology.Method: We provide a brief literature review on survey design and methodology, as well as a review of recent studies addressing current challenges such as sampling, measurement, and response rates.Results: We suggest best practices that should be implemented when designing, administering and reporting on neuropsychological survey-based research studies. We discuss two approaches to improve survey design, Total Survey Error and the Tailored Design Method.Conclusions: In spite of the current challenges in modern survey research, with lower response rates and the proliferation of internet surveys, survey research continues to be a valuable tool in neuropsychology. We offer a list of DO's and DON'T's to guide neuropsychologists planning to conduct surveys of their field.

[Formula: see text]Survey research in neuropsychology: A systematic review.

Objective: This systematic review paper summarizes the research in neuropsychology using survey methodology, tallies key design features of published survey studies, and evaluates the degree to which the survey methods are disclosed in these publications.Method: We conducted a systematic review of neuropsychological studies that used survey methodology using PRISMA guidelines. We rated 89 surveys on the American Association for Public Opinion Research (AAPOR) required disclosure items and quality indicators.Results: Following the AAPOR guidelines for survey disclosure and quality, we found only fair to good compliance with disclosure requirements, with the average article reporting 73% of the required elements of method. Rates of disclosure of required items went up after the year 2000 but then dropped back somewhat after 2010. We also found a decrease in survey response rates over time.Conclusions: Most of the surveys published concern practice patterns and trends in the field. Response rates have gone down, as is common in other surveys. There is room for improvement in disclosure practices in survey articles in neuropsychology. We provide a rubric for evaluating disclosure of methods, to guide researchers who want to use surveys in their neuropsychological research, as well as guide consumers of survey research.

Cognitive functioning and adjudicative competence: defendants referred for neuropsychological evaluation in a psychiatric inpatient setting.

OBJECTIVE: A paucity of peer-reviewed research exists regarding the relation between cognitive functioning and adjudicative competence, despite increasing awareness of cognitive deficits associated with serious mental illness. This retrospective study sought to add to and expand upon existing research by considering performance validity and court determinations of competence, when available. METHOD: We compared demographic and cognitive variables of a group of defendants with presumed valid testing admitted to an inpatient psychiatric facility for evaluation of adjudicative competence and referred for neuropsychological evaluation (n = 45) and compared individuals determined by the evaluator and/or the court to be competent (n = 30) and incompetent (n = 15). RESULTS: Defendants who were incompetent were more likely to be diagnosed with a cognitive disorder, with a medium effect size. There was a difference in tests of immediate and delayed memory as measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), with medium to large effects, and high delayed memory scores were helpful in ruling out incompetence (Negative predictive power = 85.71%). CONCLUSIONS: These results provide support for the relationship between cognitive functioning and trial competence, particularly at high and low levels of performance.

Clinical decision making in response to performance validity test failure in a psychiatric setting.

This study examined the clinical utility of a performance validity test (PVT) for screening consecutive referrals (N = 436) to a neuropsychology service at a state psychiatric hospital treating both civilly committed and forensic patients. We created a contingency table with Test of Memory Malingering (TOMM) pass/fail (355/81) and secondary gain present/absent (181/255) to examine pass rates associated with patient demographic, clinical and forensic status characteristics. Of the 81 failed PVTs, 48 had secondary gain defined as active criminal legal charges; 33 failed PVTs with no secondary gain. These individuals tended to be older, female, Caucasian, and civilly committed compared with the group with secondary gain who failed. From estimations of TOMM False Positive Rate and True Positive Rate we estimated base rates of neurocognitive malingering for our clinical population using the Test Validation Summary (TVS; Frederick & Bowden, 2009 ). Although PVT failure is clearly more common in a group with secondary gain (31%), there were a number of false positives (11%). Clinical ratings of patients without gain who failed suggested cognitive deficits, behavioral issues, and inattention. Low scores on PVTs in the absence of secondary gain provide useful information on test engagement and can inform clinical decisions about testing.

A comparison of normative data for the Trail Making Test from several countries: equivalence of norms and considerations for interpretation.

The Trail Making Test may not be equivalent across cultures, i.e., differences in the scores across different cultures may not reveal real differences in the ability of the subjects on the construct being measured. In order to assess this hypothesis, normative samples from ten different countries were compared. Age decade subgroups across samples were ranked based on mean time taken to complete each part of the task. Large Z scores differences were found between these samples when comparing the first with the second, and the last in the rank. These differences were significant even when age and education were comparable across samples. Following Van de Vijver & Tanzer (1997), several possible sources of bias were identified. Incomparability of samples and administration differences were the most likely factors accounting for differences. Because of the lack of validity studies in the countries considered, no firm conclusions could be obtained regarding construct bias. Although the TMT may be measuring visual scanning, psychomotor speed and mental flexibility, normative data from different countries and cultures are not equivalent which might lead to serious diagnostic errors.

Group treatment approaches to address cognitive deficits.

Psychiatric rehabilitation services are primarily delivered using group modalities. Recent evidence points to the deleterious effects of poor cognitive functioning on group involvement, skill development and functional outcomes. This paper reviews the impact of individual cognitive deficits on group functioning, discusses the rationale for using a cognitive framework for group development, and presents multiple examples of group programming with compensatory and remediation techniques to improve group functioning. Examples include modifying groups to address cognitive limitations, as well as developing groups targeting specific cognitive functions. The groups described are suitable for persons with serious and persistent mental illness across hospital and community treatment settings.

The relationship between neuropsychological test performance, social functioning, and instrumental activities of daily living in a sample of rural older adults.

This study examined the relationship between neuropsychological functioning, activities of daily living, and social interaction in a biracial sample of 133 rural community-dwelling participants with fewer than 10 years of education, who were tested twice over 4 years as part of a normative study. Neuropsychological tests predicted self-reported IADL and social functioning at Time 1 after accounting for age, education, health, depression, and gender. Physical health and the Initiation and Perseveration subscale of the Mattis Dementia Rating Scale best predicted instrumental activities of daily living. Social functioning was best predicted by gender and delayed memory recall from the Fuld Object Memory Evaluation. Functional independence and social activities declined slightly over time for all participants, but those whose neuropsychological test scores declined significantly at Time 2 reported less independence and fewer social activities at Time 1 than those participants whose cognition remained stable. Ecological and concurrent validity of self-report measures of functional status and neuropsychological testing in predicting cognitive decline are discussed.