A survey of the perceptions and practices of faculty in clinical neuropsychology doctoral training programs: is heterogeneity the norm?

Objective: Doctoral education is a cornerstone in the training of clinical neuropsychologists. However, we know little about perceptions, practices, and needs of the faculty who oversee doctoral training in clinical neuropsychology (CN). Method: Seventy-one faculty from 45 doctoral programs providing CN training completed at least part of a survey assessing characteristics of their programs, current training practices and views, and challenges to CN doctoral training. Results: Over half of CN faculty reported having zero or only one CN colleague. CN faculty reported that the goals of CN doctoral training are research training, clinical training, and acquisition of knowledge and skills reflected in the Houston Conference Guidelines (HCG). CN faculty reported that doctoral trainees obtain more clinical hours than faculty would like and endorsed alternative clinical metrics, including competency-based ratings. CN faculty are divided about the benefits of a required two-year postdoctoral CN fellowship. Conclusions: The HCG states that specialization in CN begins at the doctoral level. CN faculty in doctoral programs are fully immersed in the early development and education of future CN researchers and practitioners. Tensions between clinical and research training in CN at the doctoral level-and student overemphasis on accruing clinical hours-might place CN at risk for failing to make research innovations necessary for our field to evolve and thrive. More CN doctoral faculty are needed to serve as mentors to students, especially for students from backgrounds that have been historically excluded and marginalized. A greater voice from CN doctoral faculty in CN governance is needed.

Factor Structure and Measurement Invariance of the Suicide Status Form-IV.

The Suicide Status Form-IV (SSF-IV) is the measure used in the Collaborative Assessment and Management of Suicidality (CAMS). The SSF-IV Core Assessment measures various domains of suicide risk. Previous studies established a two-factor solution in small, homogeneous samples; no investigations have assessed measurement invariance. The current investigation sought to replicate previous factor analyses and used measurement invariance to identify differences in the Core Assessment by race and gender. Adults (N = 731) were referred for a CAMS consultation after exhibiting risk for suicide. Confirmatory factor analyses indicated good fit for both one- and two-factor solutions while the two-factor solution is potentially redundant. Configural, metric, and scalar invariance held across race and gender. Ordinal logistic regression models indicated that neither race nor gender significantly moderated the relationship between the Core Assessment total score and clinical outcomes. Findings support a measurement invariant, one-factor solution for the SSF-IV Core Assessment.

Value-consistent rehabilitation is associated with long-term psychological flexibility and quality of life after traumatic brain injury.

Meaningful steps have been taken toward using holistic approaches in outpatient rehabilitation for traumatic brain injury (TBI) (i.e., treating the whole individual); however, research and practice continue to disproportionately focus on adapting to physical and cognitive changes. Research suggests treatment focusing on individual values may be important for psychological adjustment after TBI. The current study sought to explore individual values across multiple life domains in those with TBI as well as what values outpatient rehabilitation was helpful for, and to examine discrepancies between these factors (i.e., value-consistent rehabilitation) in relation to important long-term treatment outcomes. 215 adults with a history of TBI who had participated in outpatient rehabilitation completed online surveys assessing how consistent outpatient rehabilitation was with individual values, psychological flexibility, and quality of life. The life domains with the greatest discrepancies between individual importance and rehabilitation helpfulness were spirituality, intimate relations, and family relations. Greater value-consistent rehabilitation was associated with higher levels of psychological flexibility and quality of life beyond demographics and injury characteristics. Our findings provide further support in favour of holistic, client-centred approaches that are facilitated by neurological rehabilitation programs.

The structure of apathy symptoms.

INTRODUCTION: Apathy is common in many neurological, psychiatric, and medical disorders and is related to a number of important clinical outcomes. Nonetheless, research on apathy is hindered by different ways of defining and measuring it, which has led to heterogeneity in research findings. METHOD: The current study aimed to investigate the factor structure of apathy symptoms using a novel item pool. We examined whether the use of this item pool has incremental validity above and beyond a widely used measure in predicting cognition and everyday functioning. Participants included 249 informants who reported on an individual with (n = 210) or without (n = 39) a neurological or psychiatric condition. RESULTS: Results showed the best fitting model of apathy symptoms was a bifactor model with apathy as a general dimension and three specific symptom factors including reduced interest and initiative, reduced emotional and verbal expression, and reduced social engagement. Incremental validity in predicting cognition was demonstrated for this more robust assessment of apathy symptoms. CONCLUSIONS: Results are most aligned with one set of proposed diagnostic criteria for apathy which differs from other criteria in that it does not distinguish between cognitive and behavioral symptoms and includes a separate social dimension. Future research could aim to replicate this model in additional clinical samples and explore the incremental validity of the newly developed Apathy Symptom Inventory (ASI) in comparison to other recently developed measures.

Serial position effects and mild cognitive impairment: a comparison of measures and scoring approaches.

INTRODUCTION: Serial position effects (SPEs) have shown promise as predictors of future cognitive decline and conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD), even when accounting for total learning and memory scores. However, conflicting results have been found in the literature, which may be at least partially related to the many ways in which SPEs are calculated. The current study aimed to address the discrepancies in the literature by examining whether one method of analyzing SPEs is more sensitive at distinguishing those with and without psychometrically defined MCI. METHOD: 86 older adult participants (57 healthy comparison, 29 MCI) completed the California Verbal Learning Test, Third Edition (CVLT3) and the Rey Auditory Verbal Learning Test (RAVLT), along with measures assessing multiple cognitive domains. Each participant completed two visits, between 3 and 9 days apart, with a different memory measure administered on each day. The standard scoring approach and the regional scoring approach to calculating SPEs were compared. RESULTS: Results showed that, when significant differences were found, SPEs were always reduced in the MCI group compared to the healthy comparison group when using regional scoring; however, results were not as consistent when using standard scoring. Further, lower primacy than recency scores were only consistently seen in the MCI group when using the RAVLT but not the CVLT3. ROC analyses showed that only regional scoring of SPEs from delayed recall of the RAVLT and the CVLT3 accurately discriminated between those with and without MCI. CONCLUSION: Regional scoring of SPEs may be more sensitive at identifying subtle cognitive decline compared to standard scoring. However, the specific measure that is used to analyze SPEs can impact the interpretation of findings.

Four year practice effects on the RBANS in a longitudinal study of older adults.

OBJECTIVE: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a widely used measure in neuropsychological assessment. Studies of practice effects on the RBANS have typically been assessed over one or two repeated assessments. The aim of the current study is to examine practice effects across four-years after baseline in a longitudinal study of cognitively healthy older adults. METHOD: 453 Participants from the Louisiana Aging Brain Study (LABrainS) completed the RBANS Form A on up to four annual assessments after baseline. Practice effects were calculated using a modified participants-replacement method where scores of returnees are compared to the baseline scores of matched participants with additional adjustment for attrition effects. RESULTS: Practice effects were observed primarily in the immediate memory, delayed memory, and total score indices. These index scores continued to increase with repeated assessments. CONCLUSIONS: These findings extend past work on the RBANS showing the susceptibility of memory measures to practice effects. Given that memory and total score indices of the RBANS have the most robust relationships with pathological cognitive decline, these findings raise concerns about the ability to recruit those at risk for decline from longitudinal studies using the same form of the RBANS for multiple years.

Logical memory, visual reproduction, and verbal paired associates are effective embedded validity indicators in patients with traumatic brain injury.

OBJECTIVE: This study was design to evaluate the potential of the recognition trials for the Logical Memory (LM), Visual Reproduction (VR), and Verbal Paired Associates (VPA) subtests of the Wechsler Memory Scales-Fourth Edition (WMS-IV) to serve as embedded performance validity tests (PVTs). METHOD: The classification accuracy of the three WMS-IV subtests was computed against three different criterion PVTs in a sample of 103 adults with traumatic brain injury (TBI). RESULTS: The optimal cutoffs (LM ≤ 20, VR ≤ 3, VPA ≤ 36) produced good combinations of sensitivity (.33-.87) and specificity (.92-.98). An age-corrected scaled score of ≤5 on either of the free recall trials on the VPA was specific (.91-.92) and relatively sensitive (.48-.57) to psychometrically defined invalid performance. A VR I ≤ 5 or VR II ≤ 4 had comparable specificity, but lower sensitivity (.25-.42). There was no difference in failure rate as a function of TBI severity. CONCLUSIONS: In addition to LM, VR, and VPA can also function as embedded PVTs. Failing validity cutoffs on these subtests signals an increased risk of non-credible presentation and is robust to genuine neurocognitive impairment. However, they should not be used in isolation to determine the validity of an overall neurocognitive profile.

Longitudinal assessment of mental health after a flood: roles of social support, hope, recovery stressors, and prior lifetime trauma.

OBJECTIVES: Severe weather events have mental health consequences for survivors that may change over time. We assessed post-flood mental health longitudinally in three groups of mostly middle-aged and older adults who varied in current and prior severe weather experiences. METHOD: Predictors of central interest were age, perceived social support, state hope (including agency and pathways), recovery stressors, and prior lifetime trauma. Criterion variables included symptoms of depression, post-traumatic stress disorder (PTSD), and worry. RESULTS: Analyses of variance yielded significant Disaster Exposure Group x Wave interactions for depression and PTSD symptoms. Those with flooded homes and properties had elevated symptoms at Wave 1 which were reduced at Wave 2. Older age was associated with fewer symptoms of depression, PTSD, and worry. Recovery stressors and lifetime trauma predicted more PTSD symptoms. Greater agency predicted less PTSD and depression symptoms, whereas pathways predicted less worry. CONCLUSION: These data show that mental health symptoms may decrease over time for those directly impacted by severe flooding. State hope appears to contribute to better mental health after exposure to a devastating flood. Implications for understanding the dynamic relationships among risk variables and positive factors that promote post-disaster mental health in the years after a flood are considered.

Resilience as a moderator of depression and anxiety: a bidimensional approach to predictors of subjective cognition in older adults.

OBJECTIVES: Subjective cognitive complaints (SCCs) have shown to be useful predictors of objective cognitive decline in older adults. Though psychopathology symptoms (e.g. depression, anxiety) have been linked to SCCs, little is known about the influence of positive psychology factors (e.g. resilience) on these complaints. The current study aimed to determine whether resilience predicts SCCs, and whether greater resilience moderates (or lessens) the effect of negative mental health symptoms on SCCs. METHODS: Four hundred twenty-eight adults aged 60 years or older (M = 67.6, SD = 5.9) were recruited to participate in an online Qualtrics survey study. Surveys included assessed psychological resilience [University of Washington Resilience Scale 8-item short form (UWRS-8)], depression [Geriatric Depression Scale (GDS-15)], anxiety [Geriatric Anxiety Scale (GAS-30)], and SCCs [Perceived Deficits Questionnaire-Depression (PDQ-D); Barkley Deficits in Executive Functioning Scale-Short Form (BDEFS-SF)]. RESULTS: Although greater resilience was only independently associated with less complaints on BDEFS total scores, resilience moderated (i.e. reduced) the negative effects of depression and anxiety on PDQ-D retrospective memory and planning subscales as well as BDEFS-SF total scores. Resilience also moderated (i.e. reduced) the negative effect of anxiety on PDQ-D total scores. CONCLUSION: With resilience lessening the effect of depression and anxiety on SCCS, our findings suggest positive psychological factors may be useful for understanding the prevalence of complaints. Future research should seek to replicate these findings and investigate relationships between additional positive psychological factors and cognitive health in old age including the use of both objective and subjective assessments of cognition.

Perfectionism and Suicidal Ideation.

Background: The integrated motivational-volitional (IMV) model of suicidal behavior posits that defeat leads to suicidal ideation through increased vulnerability for feelings of entrapment. One potentially important vulnerability factor for the development of feelings of defeat is socially prescribed perfectionism. Aims: The current study investigated these relationships in a sample of 313 US adults. Method: Mediation and parallel mediation analyses were conducted to determine the relationships between defeat, entrapment, social prescribed perfectionism, negative social comparison, and rejection sensitivity. Results: Findings indicated that socially prescribed perfectionism was significantly related to defeat through both negative social comparison and rejection sensitivity even when controlling for depression symptoms. Negative social comparison and rejection sensitivity were related to entrapment through feelings of defeat. This relationship was strongest when analyzing externalized (vs. internalized) entrapment. Limitations: The findings were limited by the cross-sectional study design as well as the relatively homogeneous sample. Implications and future directions are discussed.

Longitudinal Predictors of Informant-Rated Everyday Function in Mild Cognitive Impairment.

OBJECTIVE: To examine predictors of informant-reported everyday functioning in mild cognitive impairment (MCI) and relations between everyday function and conversion to dementia. METHODS: Informants of participants (n = 2614) with mild cognitive impairment (MCI) were administered the Functional Activities Questionnaire (FAQ). Changes in dimensions of functional ability as determined by an exploratory factor analysis (EFA) were examined over 3 years and participant predictors of change were examined using multilevel modeling (MLM). RESULTS: The FAQ consisted of 3 factors, multistep, finance, and memory/orientation daily tasks. Impairment in memory/orientation tasks was significantly higher than impairment in multistep tasks. Worse functioning was associated with greater depression, worse memory, worse speed/EF, higher years of education and identifying as White. There was variability in some of these associations with different FAQ factors. Impairments in financial and memory/orientation daily tasks predicted follow-up conversion to dementia. CONCLUSIONS: Depression, speed/EF, and memory are consistently associated with domains of everyday functioning. Race, education, and age may be more variability associated with everyday functioning. Specific attention should be paid to subtle declines in the financial and memory/orientation domains as they may uniquely predict future dementia development. Depression may be a modifiable risk factor associated with functional impairment over time.

Religiosity and Social Support Predict Resilience in Older Adults After a Flood.

In this study, we examined religiosity and social support as predictors of resilience after a devastating flood. Three flood exposure groups of primarily middle-aged and older adults were compared: (1) non-flooded adults as controls, (2) once-flooded adults with structural damage to homes and property in the 2016 flood, and (3) twice-flooded adults who had relocated inland because of prior catastrophic losses in the 2005 Hurricanes Katrina and Rita and then flooded again in 2016. Resilience was assessed using the Connor-Davidson Resilience Scale (CD-RISC). Correlation analyses confirmed that older age was correlated with higher religiosity, charitable work done for others, and resilience. Regression analyses indicated that religious beliefs and coping, social support, and charitable work done for others were associated with higher levels of resilience, whereas flood damage was unrelated to resilience. Implications for current views on post-disaster adversity and resilience in later life are discussed.

Settling the Score: Can CPT-3 Embedded Validity Indicators Distinguish Between Credible and Non-Credible Responders Referred for ADHD and/or SLD?

OBJECTIVE: The purpose of the present study was to further investigate the clinical utility of individual and composite indicators within the CPT-3 as embedded validity indicators (EVIs) given the discrepant findings of previous investigations. METHODS: A total of 201 adults undergoing psychoeducational evaluation for ADHD and/or Specific Learning Disorder (SLD) were divided into credible (n = 159) and non-credible (n = 42) groups based on five criterion measures. RESULTS: Receiver operating characteristic curves (ROC) revealed that 5/9 individual indicators and 2/4 composite indicators met minimally acceptable classification accuracy of ≥0.70 (AUC = 0.43-0.78). Individual (0.16-0.45) and composite indicators (0.23-0.35) demonstrated low sensitivity when using cutoffs that maintained specificity ≥90%. CONCLUSION: Given the lack of stability across studies, further research is needed before recommending any specific cutoff be used in clinical practice with individuals seeking psychoeducational assessment.

Factor structure of the anxiety sensitivity index-3 in a sample of older adults.

Anxiety sensitivity is a transdiagnostic risk factor for internalizing psychopathology in children and adults. Several factor analytic studies have examined the factor structure of anxiety sensitivity in children, adolescents, and adults. However, to date, no studies have specifically examined the factor structure of the Anxiety Sensitivity Index-3 in older adults. The purpose of the current study was to compare the fit of a correlated three-factor, higher-order, and bifactor model of the Anxiety Sensitivity Index-3 (ASI-3) in a sample of older adults. Participants were 856 older adults aged 60-94 recruited through Qualtrics Panels. Confirmatory factor analyses demonstrated good model fit for the bifactor model and the higher-order model and adequate fit for the correlated three-factor model. These results suggests that the ASI-3 is a valid tool assessing anxiety sensitivity in older adults. Limitations and future directions are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00736-9.

Mentorship in clinical neuropsychology: Survey of current practices, cultural responsiveness, and untapped potential.

INTRODUCTION: Neuropsychology trainees have identified mentorship as an important factor in their training. Limited past work has been conducted on mentorship within neuropsychology, and there is a need to better understand the experiences and perspectives of neuropsychology mentors. METHOD: Self-identified mentors in clinical neuropsychology completed a survey about their mentorship practices, including culturally responsive mentorship, as well as perceived barriers and challenges to providing effective mentorship. Themes were derived using qualitative analyses for free response questions, and descriptive statistics were calculated for quantitative variables. RESULTS: Mentors identified assessment, professionalism, and ethics as top priorities in mentorship, which may reflect the overlap within neuropsychology of assessment supervision and mentoring. Reported best practices included being self-aware and engaging in a personalized approach to mentorship relationships that varies depending upon the needs of the mentee. A majority reported that their training program is not diverse and they themselves do not mentor trainees from diverse backgrounds which provides a clear area for targeted efforts to recruit and retain diversity in the discipline. Mentors described practices related to discussing diversity-related differences with their trainees including self-disclosure, creating a safe space for conversations, and tailoring discussions to the individual trainee. They reported an interest in more training on how to engage in culturally competent mentorship. Two barriers to providing effective mentorship identified most by mentors were time constraints and a lack of training. CONCLUSIONS: These results highlight a variety of perspectives and approaches to mentorship, which may be beneficial for mentors to consider as they reflect on their mentorship practices and/or for trainees as part of their professional development toward becoming future mentors themselves. These results also highlight the need for a greater emphasis on mentorship training within neuropsychology, including training in culturally responsive mentorship practices.

Examining patterns of executive functioning across dimensions of psychopathology.

BACKGROUND AND OBJECTIVES: The current study examined relationships between psychopathology and individual domains of executive functioning (EF) amongst adults. While previous studies have examined these relationships using diagnostic groups, we compared factor structures of both dimensional psychopathology and EF and used an approach to better isolate EF-specific task variance within each domain. METHODS: This study analyzed the data of 722 individuals between the ages of 18-59 years, who took part in the Nathan Kline Institute (NKI)-Rockland project. Confirmatory factor analyses were used to derive a three-factor model of EF (i.e., inhibition, shifting, and fluency) proposed by Karr et al. (2019) with scores primarily from the Delis-Kaplan Executive Function System (D-KEFS), as well as a three-factor model of psychopathology (i.e., internalizing, externalizing, and thought disorder symptoms) from the Adult Self-Report (ASR) and Peter's et al. Delusions Inventory (PDI). These models were compared using structural equation modeling. RESULTS: Results demonstrated an adequate fit for both model structures and indicated that internalizing and externalizing psychopathology had positive and negative relationships with different factors of EF, while thought disorder traits were not related to EF. LIMITATIONS: This study examines pathological traits within a non-clinical sample that excluded individuals with severe mental illness. Additionally, analyses were limited by the availability of certain variables, and potential shared method variance within factors. CONCLUSIONS: Patterns of associations with EF were unique to all three aspects of dimensional psychopathology. When examined together, different dimensions of psychopathology were related to both better and worse EF performance.

Trainee perceptions of multicultural climate and supervision in neuropsychology.

INTRODUCTION: Mentor relationships are important in developing and supporting professional self-efficacy among psychology trainees. Additionally, the rapid diversification of the United States calls for the preparation of clinical neuropsychology trainees to work within a multicultural context. The present study aimed to assess neuropsychology trainees' perceptions of multicultural climate and supervision and if these perceptions differ based on trainee demographics. We also sought to identify aversive experiences of trainees, program strengths or weaknesses, and how programs support trainees. METHOD: Participants were 310 neuropsychology trainees (Mean age = 30.27, SD = 5.67) from clinical psychology graduate (n = 136), pre-doctoral internship (n = 38), and post-doctoral (n = 71) programs across the United States and Canada who completed a survey assessing perceptions to multicultural climate and supervision. 64.5% self-identified as women, 60.3% as heterosexual, and 46.1% as non-Hispanic White. 34.5% of trainees reported at least one American Disabilities Act (ADA) recognized disability. RESULTS: Though satisfied with general supervision, trainees reported overall dissatisfaction with multicultural supervision. Satisfaction with multicultural supervision did not differ by demographics. Trainees also reported various aversive experiences with supervisors, clients, and research participants that negatively impacted their training. These experiences were at times due to an aspect of the trainee's multicultural identity, with Black and Hispanic trainees being more likely to report an aversive experience. Trainees reported ways in which they felt unsupported by their programs. CONCLUSIONS: Important areas of growth for programs are discussed. Issues raised by neuropsychology trainees overlap to some degree with the experiences of trainees in other fields. Recommendations of approaches that have been successfully adopted in other fields to improve trainee satisfaction are provided. Early identification of needs that go above and beyond clinical training will allow programs to respond promptly, improve trainee satisfaction, and potentially improve the retention of trainees from diverse backgrounds.

Examining heterogeneity in depression symptoms and associations with cognition and everyday function in MCI.

INTRODUCTION: Although there is some evidence that different symptoms of depression have differential effects on cognition in older adults, these relationships remain understudied in older adults with mild cognitive impairment (MCI). METHOD: Older adults (>50 years old) were classified as having MCI by Alzheimer's Disease Research Centers (ADRCs). Exploratory factor analyses and factor mixture modeling were used to determine depression symptom classes. Classes were then compared across different domains of cognition (i.e., memory, attention, language, and executive function) and informant-rated everyday function. RESULTS: Analyses revealed six, distinct symptom classes (i.e., somatic symptoms, severely depressed, anhedonic symptoms, cognitive symptoms, minimally depressed, and low life satisfaction symptoms). Classes significantly varied on all measures of cognition and everyday function. In particular, the anhedonic class often showed the most substantial decline (on par with the severely depressed class), while the low life satisfaction class often showed the least (on par with the minimally depressed class). CONCLUSIONS: To our knowledge, this is the first study to examine the relationship between depression symptom profiles and cognitive and everyday function in those with MCI. Our findings show that depression symptoms greatly differ in their associations with cognitive and everyday function. It may be beneficial for clinicians to specifically note if patients with MCI are reporting anhedonic and somatic symptoms of depression specifically.