American Academy of Clinical Neuropsychology consensus conference statement on uniform labeling of performance test scores.

Objectives: Descriptive labels of performance test scores are a critical component of communicating outcomes of neuropsychological and psychological evaluations. Yet, no universally accepted system exists for assigning qualitative descriptors to scores in specific ranges. In addition, the definition and use of the term "impairment" lacks specificity and consensus. Consequently, test score labels and the denotation of impairment are inconsistently applied by clinicians, creating confusion among consumers of neuropsychological services, including referral sources, trainees, colleagues, and the judicial system. To reduce this confusion, experts in clinical and forensic neuropsychological and psychological assessment convened in a consensus conference at the 2018 Annual Meeting of the American Academy of Clinical Neuropsychology (AACN). The goals of the consensus conference were to recommend (1) a system of qualitative labels to describe results from performance-based tests with normal and non-normal distributions and (2) a definition of impairment and its application in individual case determinations. Results: The goals of the consensus conference were met resulting in specific recommendations for the application of uniform labels for performance tests and for the definition of impairment, which are described in this paper. In addition, included in this consensus statement is a description of the conference process and the rationales for these recommendations. Conclusions/Importance: This consensus conference is the first formal attempt by the professional neuropsychological community to make recommendations for uniform performance test score labels and to advance a consistent definition of impairment. Using uniform descriptors and terms will reduce confusion and enhance report comprehensibility by the consumers of our reports as well as our trainees and colleagues.

Assessing Adaptive Functioning in Death Penalty Cases after Hall and DSM-5.

DSM-5 and Hall v. Florida (2014) have dramatically refocused attention on the assessment of adaptive functioning in death penalty cases. In this article, we address strategies for assessing the adaptive functioning of defendants who seek exemption from capital punishment pursuant to Atkins v. Virginia (2002). In particular, we assert that evaluations of adaptive functioning should address assets as well as deficits; seek to identify credible and reliable evidence concerning the developmental period and across the lifespan; distinguish incapacity from the mere absence of adaptive behavior; adhere faithfully to test manual instructions for using standardized measures of adaptive functioning; and account for potential bias on the part of informants. We conclude with brief caveats regarding the standard error of measurement (SEM) in light of Hall, with reference to examples of ordinary life activities that directly illuminate adaptive functioning relevant to capital cases.

DSM-5: Challenging diagnostic testimony.

The Diagnostic and Statistical Manual of Mental Disorders' (DSM) 60-year evolution has not been particularly linear nor cumulative with respect to the process of its construction, its stated purpose, its framework, and inclusion of specific disorders. We consider DSM-5's stated purpose in light of the manual's explicit cautions and other complications encountered when presenting diagnoses in the course of psychological expert testimony under the applicable rules of evidence. This review considers the extent to which DSM-5 bears up under numerous criticisms when employed for forensic purposes and points out challenges that the expert should anticipate when offering diagnostic opinions underpinned by DSM-5 generally and by neurocognitive disorders in particular.

The relationship between early life stress and microstructural integrity of the corpus callosum in a non-clinical population.

BACKGROUND: Previous studies have examined the impact of early life stress (ELS) on the gross morphometry of brain regions, including the corpus callosum. However, studies have not examined the relationship between ELS and the microstructural integrity of the brain. METHODS: In the present study we evaluated this relationship in healthy non-clinical participants using diffusion tensor imaging (DTI) and self-reported history of ELS. RESULTS: Regression analyses revealed significant reductions in fractional anisotropy (FA) within the genu of the corpus callosum among those exposed to the greatest number of early life stressors, suggesting reduced microstructural integrity associated with increased ELS. These effects were most pronounced in the genu of the corpus callosum compared to the body and splenium, and were evident for females rather than males despite no differences in total ELS exposure between the sexes. In addition, a further comparison of those participants who were exposed to no ELS vs. three or more ELS events revealed lower FA in the genu of the corpus callosum among the ELS-exposed group, with trends of FA reduction in the body and the whole corpus callosum. By contrast, there were no relationships between ELS and volumetric analysis of the CC regions. The two group did not differ significantly on measures of current depression, stress or anxiety. CONCLUSION: Our results reveal that greater exposure to ELS is associated with microstructural alterations in the white matter in the absence of significant volumetric changes. Importantly, our results indicate that exposure to ELS is associated with abnormalities on DTI despite the absence of clinically significant psychiatric symptoms. Future studies are needed to determine whether specific types of ELS are more likely to impact brain structure and function.

Assigning qualitative descriptions to test scores in neuropsychology: forensic implications.

Board-certified neuropsychologists were surveyed and asked to assign a descriptive label (e.g., superior, average, normal, impaired) to 12 different standard scores (SS), from 50 to 130, of a memory test based on a brief case scenario. Surveys were returned by 49% (n = 110) of the target sample. The mean number of different classification labels assigned by participants to each of the 12 SS was 14 and ranged from 6 (for SS = 95) to 23 (for SS = 50). The mean percentages of participants who assigned the one or two most frequently used labels within each SS were 52.5% and 70.7%, respectively. Results revealed variable uniformity in assigning descriptive labels to specific standard scores, with significantly greater variability for SS in the lower half of the distribution and with applying impairment rather than normative labels. Professional and forensic implications are discussed.

Concussion understanding and management among New England high school football coaches.

PRIMARY OBJECTIVE: To determine high school football coaches' understanding, management and sources of information of concussion at schools without a certified athletic trainer (ATC) or without one at practice. RESEARCH DESIGN: Anonymous survey of head football coaches at New England high schools. METHODS AND PROCEDURES: Surveys were mailed to 254 New England high school head football coaches. One hundred and nine (43%) surveys were returned, of which 62 respondents indicated there was no ATC either at the school or at practice. These 62 respondents were used for data analysis. MAIN OUTCOMES AND RESULTS: Coaching associations and conferences were the two most common sources of information received about concussion. Coaches were significantly more knowledgeable about concussion than a general public sample, from which data were available from a prior study. When given potential symptoms of concussion, 70-95% of coaches reported that they would consult a healthcare professional before allowing a player to return to action, consistent with most return-to-play guidelines. CONCLUSIONS: Participants demonstrated greater knowledge about concussions than the general public and most, but not all, coaches reported taking a conservative approach to concussion management. Ramifications of the results are discussed.

Investigation of biases in the general public in evaluating mild head injury using neuropsychological and CT scan results: forensic implications.

The purpose of this study was to determine how the general public considers neuropsychological (NP) vs. CT scan data in assessing the effects of a possible mild traumatic brain injury (MTBI). Ten scenarios depicting an MTBI from a motor vehicle accident were presented to community volunteer participants. Case scenarios differed with regard to diagnostic information presented (i.e., all combinations of normal, abnormal, or absent NP and CT results were provided). The number of participants ranged from 31 to 42 across the 10 cases and there were no age or educational differences among the groups. Participants rated the likelihood of symptoms being attributable to brain damage from the accident on a 7-point Likert-type scale. Scenarios with positive NP or CT results were rated as more likely to have sustained brain damage than when NP/CT results were negative. However, when NP and CT data were contradictory (i.e., one positive and the other negative), there were no differences in the ratings of the participants. Thus, members of the general public did not demonstrate any preconceived bias about the validity of NP vs. CT results in MTBI. Women were more likely than men to attribute symptoms to brain damage from the motor vehicle accident, as did participants with a history of TBI. Forensic implications are discussed.

The public's misconception about traumatic brain injury: a follow up survey.

Two prior surveys from rural Louisiana, Canada, and New York [Arch. Clin. Neuropsychol. 3 (1988) 331; Arch. Clin. Neuropsychol. 8 (1993) 461] revealed that a high portion of the population endorses misconceptions about the sequelae of traumatic brain injury (TBI). The purpose of this study was to assess the public's perceptions of head trauma in an urban setting in the Northeast region of the country and to compare those results with surveys from other geographical areas conducted 8 and 13 years ago. This study also examined the prevalence of perceptions about TBI that may be relevant to personal injury litigation with TBI plaintiffs. Data were collected at an office of the Department of Motor Vehicles from persons conducting business there. Participants (n = 179) voluntarily completed a 19-item survey covering several facets of brain injury. This sample endorsed misconceptions at a level consistent with previous studies, indicating a comparable lack of knowledge about moderate to severe TBI. With regard to mild TBI, however, our sample generally endorsed fewer misconceptions than previous samples. The public also holds perceptions of TBI that may be relevant to personal injury litigation involving TBI plaintiffs.

The Prevalence of Cigarette Smoking in an Acute Inpatient Physical Medicine and Rehabilitation Population.

The purpose of this study was to determine the prevalence of cigarette smoking among patients before and after discharge from an acute inpatient physical medicine and rehabilitation unit and to assess smokers' interest in and desire for smoking cessation. A consecutive sample of inpatients (n = 233) admitted over a 5-month period to a regional rehabilitation inpatient center for acute rehabilitation treatment was surveyed for their smoking patterns. Ten percent of patients admitted to rehabilitation were active smokers prior to their hospitalization. In spite of reporting high motivation to stop smoking, half were not interested in participating in a smoking cessation program if one were offered to them. Following discharge from inpatient rehabilitation, 54% of a small sample of patients who could be contacted had resumed smoking (all within 4 weeks of being home). Given the prevalence of smoking in this population and its adverse consequences on health and quality of life, we suggest that rehabilitation professionals actively address this health problem during the patient's hospitalization.

Neurocognitive rehabilitation guidelines for therapists.

Establishing and implementing cognitive rehabilitation (CR) plans requ i re the efforts of al I rehabilitation staff members. In addition to clear expectations about therapists' roles and responsibilities, there are other issues that need to be considered when creating CR protocols. Specifically, the patient's insight into his or her deficits is a crucial consideration when establishing a CR plan. Other factors also need to be examined, such as the role of the family, the method of establishing goals and monitoring progress, and the necessity of providing feedback to the patient. This article addresses these issues and provides guidelines for rehabilitation teams to establish CR plans.