Improving the Quality of Neuropsychological Assessment Practice: The Development of a Self-Assessment Audit Tool.

OBJECTIVE: Strict competency frameworks exist for training in, and provision of, clinical neuropsychological assessment practice. However, as in all disciplines, daily clinical practice may drift from the gold standard practice without routine monitoring and audit. A simple-to-use, but thorough and evidence-based audit tool has been developed to facilitate the tracking, maintenance, and discussion of best practice over time. METHOD: A literature search and liaison with experienced neuropsychology colleagues did not unearth any pre-existing audit standards. Therefore, 39 new standards were generated, which were guided by best practice literature and clinical neuropsychology colleague discussions, to form the proposed self-assessment audit tool. Due to the diverse nature of services, both core and supplementary standards are proposed to enable the audit to be tailored to suit individual services' needs. RESULTS: During its development, the tool has so far been trialed in two U.K. National Health Service clinical services in different localities, on three occasions, with a total patient population of N = 78 in order to refine the standards and to generate practice recommendations. CONCLUSIONS: This audit tool is presented for services to self-assess their neuropsychological assessment practice. The authors plan to take this work forward with the British Psychological Society's Division of Neuropsychology as a policy document for self-assessment and peer review. Other potential developments include contributing to clinical neuropsychology training tools and refining audit standards for use more widely, such as in pediatric services, or internationally with diverse populations.

Effects of intrinsic and extrinsic motivation on attention and memory.

It is well recognised that motivational factors can influence neuropsychological performance. The aim of this study was to explore individual differences in intrinsic motivation and reward-seeking and the effect of these on attentional and mnemonic processes, in the presence or absence of financial incentives. Forty participants (18-35years) completed two testing sessions where the Attentional Network Test (ANT) and the Newcastle Spatial Memory Test (NSMT) were administered. After a baseline assessment, participants were re-tested after randomisation to a non-motivated (control) group or to a motivated group, where payment was contingent upon performance. Performance in the motivated group was significantly improved compared to the control group on the NSMT (condition by session; F(1,33)=4.52, p=0.041) and the ANT, with participants increasing performance to cued presentations within the alerting network (F(1,36)=5.48, p=0.025) and being less distracted by incongruent stimuli in the executive control network (F(1,36)=6.74, p=0.014). There were significant negative correlations between the 'Interest/ Enjoyment' Intrinsic Motivation Inventory subscale and both NSMT between-search errors and ANT(alerting). In the motivated group, those who had higher self-reported internal motivation were less susceptible to- or affected by- the external motivation of financial incentive. The effects of motivational factors should not be overlooked when interpreting absolute levels of performance in neuropsychological processes.