Neuropsychological assessment, intervention, and best practices for women with non-Central nervous system cancer: A scoping review of current standards.

Objective: Existing literature has sought to characterize the broad cognitive impact of non-central nervous system cancer and its treatment, including chemotherapy, radiation, surgery, and hormonal regulation. However, despite the frequency of women that are diagnosed with breast and gynecological cancer, there is limited research on the specific cognitive experiences of women undergoing cancer treatment. Presently, the current literature lacks concise guidance for neuropsychologists to support the cognitive health of women facing cancer, despite the acknowledged impact of cancer interventions and chronic illness on cognitive outcomes. Method: Applying scoping review criteria outlined by Peters et al. (2015) and adhering to Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a comprehensive examination of literature spanning multiple databases (Google Scholar, PubMed, PsychINFO) with a focus on the cognitive impact of cancer treatment on women. Conclusions: Women are subject to unique treatment-related outcomes due to the impact of hormonal alterations, differences in metabolization of certain chemotherapies, and psychosocial risk factors. Despite the known impact of cancer intervention, chronic illness, and cancer-related sequelae on cognitive outcomes, the current literature does not parsimoniously outline best practices for neuropsychologists to promote the health of women experiencing cancer. The current paper (1) provides an overview of the cognitive implications of cancer treatment with an intentional focus on cancers that are more prevalent in women versus men, (2) addresses the characteristics of this impact for women undergoing cancer intervention(s), and (3) provides possible intervention and treatment strategies for mental health providers and neuropsychologists.

Representation of women in neuropsychology research prior to the COVID-19 pandemic.

OBJECTIVE: Prior work has demonstrated that women have been historically underrepresented across various research fields, including neuropsychology. Given these disparities, the goal of this study was to systematically evaluate the inclusion of women as participants in neuropsychology research. The current study builds upon previous research by examining articles from eight peer-reviewed neuropsychology journals published in 2019. METHOD: Empirical articles examining human samples were included in the current review if they were available in English. Eligible articles were examined to glean whether the main topic of the article was related to a gender issue, how gender was categorized, the gender distribution of the sample, whether gender was considered in analyses, whether gender was addressed in the discussion, and what age categories the study examined. RESULTS: There was a relatively even distribution of men (51.76%) and women (48.24%) in neuropsychological research studies reviewed. There were twice as many studies that included only men compared to only women (16 vs. 8 studies), and nearly twice as many studies consisted of ≥ 75% men (16.6%) compared to ≥75% of women (8.5%). Gender-focused research was limited (3%). Furthermore, gender was frequently disregarded in analyses (58%) and often not addressed in the discussion (75%). CONCLUSIONS: The current study highlights the limitations within neuropsychology related to the representation of women in research. Although it is encouraging that neuropsychological research is generally inclusive of women participants, future research should aim to more comprehensively investigate how gender may influence cognitive risk and resilience factors across different clinical presentations. Recommendations to begin addressing this challenge and to move toward more gender-equitable research are provided.

The Impact of Adverse Childhood Experiences on Symptom and Performance Validity Tests Among a Multiracial Sample Presenting for ADHD Evaluation.

OBJECTIVE: Adverse childhood experiences (ACEs) are commonly reported in individuals presenting for attention-deficit hyperactivity disorder (ADHD) evaluation. Performance validity tests (PVTs) and symptom validity tests (SVTs) are essential to ADHD evaluations in young adults, but extant research suggests that those who report ACEs may be inaccurately classified as invalid on these measures. The current study aimed to assess the degree to which ACE exposure differentiated PVT and SVT performance and ADHD symptom reporting in a multi-racial sample of adults presenting for ADHD evaluation. METHOD: This study included 170 adults referred for outpatient neuropsychological ADHD evaluation who completed the ACE Checklist and a neurocognitive battery that included multiple PVTs and SVTs. Analysis of variance was used to examine differences in PVT and SVT performance among those with high (≥4) and low (≤3) reported ACEs. RESULTS: Main effects of the ACE group were observed, such that high ACE group reporting demonstrated higher scores on SVTs assessing ADHD symptom over-reporting and infrequent psychiatric and somatic symptoms on the Minnesota Multiphasic Personality Inventory-2-Restructured Form. Conversely, no significant differences emerged in total PVT failures across ACE groups. CONCLUSIONS: Those with high ACE exposure were more likely to have higher scores on SVTs assessing over-reporting and infrequent responses. In contrast, ACE exposure did not affect PVT performance. Thus, ACE exposure should be considered specifically when evaluating SVT performance in the context of ADHD evaluations, and more work is needed to understand factors that contribute to different patterns of symptom reporting as a function of ACE exposure.

Parental, caregiving, and family leave during clinical neuropsychology postdoctoral training: Recommendations and guidelines from the Women in Neuropsychology (WIN) committee and Education Advisory Committee (EAC) of the Society for Clinical Neuropsychology (SCN; APA division 40).

Objective: Parental and other caregiving leave is important to postdoctoral fellows, yet there is no field-wide recommendation for leave policies among clinical neuropsychology postdoctoral training programs, which is of particular relevance given the two-year requirement for eligibility for board certification. The aims of this manuscript are to (a) discuss general guidelines and recommendations for leave policies, both informed by prior empirical evidence as well as relevant existing policy guidelines from various academic and healthcare organizations, and (b) use vignettes to provide possible solutions for potential leave scenarios. Method: A critical review of literature on family leave from public policy and political science, industrial-organizational psychology, academic medicine, and psychology was conducted and findings were synthesized. Results and Conclusions: Fellowship training programs are encouraged to adopt a competency-based model that permits flexibility in leave during training without necessarily requiring an extended end date. Programs should adopt clear policies and make this information readily available to trainees and think flexibly about training options that best meet the training needs and goals of each individual. We also encourage neuropsychologists at all levels to engage in advocacy for broader systemic supports of trainees seeking equitable family leave.

rTMS/iTBS and Cognitive Rehabilitation for Deficits Associated With TBI and PTSD: A Theoretical Framework and Review.

Rehabilitation of cognitive and psychosocial deficits resulting from traumatic brain injury (TBI) continues to be an area of concern in health care. Commonly co-occurring psychiatric disorders, such as major depressive disorder and posttraumatic stress disorder, create additional hurdles when attempting to remediate cognitive sequelae. There is increased need for procedures that will yield consistent gains indicative of recovery of function. Intermittent theta-burst stimulation (iTBS), a form of repetitive transcranial magnetic stimulation, has potential as an instrument that can be tailored to aid cognitive processes and support functional gains. The use of iTBS enables direct stimulation of desired neural systems. iTBS, performed in conjunction with behavioral interventions (e.g., cognitive rehabilitation, psychotherapy), may result in additive success in facilitating cognitive restoration and adaptation. The purpose of this theoretical review is to illustrate how the technical and physiological aspects of iTBS may enhance other forms of neurorehabilitation for individuals with TBI. Future research on combinatorial iTBS interventions has the potential to translate to other complex neuropsychiatric conditions.

Mentoring in neuropsychology: Sage advice compilation from our field.

As part of the special issue on mentoring in neuropsychology in collaboration between the Journal of Clinical and Experimental Neuropsychology (JCEN) and American Psychological Association (APA) Society for Clinical Neuropsychology (SCN; Division 40)'s Women in Neuropsychology Committee (WIN), we are excited to present a compilation of sage advice in regards to best practices in mentoring from a diverse range of well-respected clinical neuropsychologists in field. This amazing group of neuropsychologists, including: Drs. Heather G. Belanger, Erin D. Bigler, Cady Block, Mark Bondi, Greg Brown, Sandra Brown, Daryl Fujii, Robert Heilbronner, Robin C. Hilsabeck, Amy Jak, Michelle R. Madore, Luis D. Medina, Neil H. Pliskin, George Prigatano, Yakeel T. Quiroz, Lisa Jane Rapport, Maureen Schmitter-Edgecombe, Anthony Y. Stringer, Julie Suhr, Daniel Tranel, Elizabeth W. Twamley, Steven Paul Woods, and Keith Owen Yeates discuss their first-hand experiences and practical advice related to formal/informal mentoring and supervising, with a particular focus on women and underrepresented peoples.

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.

Mentoring in neuropsychology: How theory and practice can support diverse mentees.

The academic literature on mentoring is well established, with a large body of published "best practices" regarding mentoring outside of neuropsychology. Specific attention is given to the need to diversify mentors, mentoring practices, and giving voice to a new generation of academics and practitioners through the mentoring process. Still, the field of neuropsychology has much to learn and implement consistently in practice from this well-established literature base and trove of resources and best practices. Existing literature in mentoring argues for compassionate mentoring and moving away from a mentee deficit model, to a model of having clear expectations of mentors to address the needs of all their mentees (National Academies of Sciences & Medicine, 2019), but with particular attention given to women, historically marginalized racial/ethnic groups, first-generation college students, mentees with disabilities, sexual and/or gender minority individuals, and mentees with intersecting identities. Evidence-based practices and programs with a focus on culturally responsive mentoring are a new area of interest both in terms of program development based on theory and measurement of mentee-mentor outcomes. Women in Neuropsychology (WIN) is a special committee of the American Psychological Association, Society for Clinical Neuropsychology (SCN; Division 40), dedicated to facilitating success and well-being among women and gender non-binary individuals in neuropsychology (https://scn40.org/win/). This article serves as an introduction to the WIN/JCEN special issue on mentoring in neuropsychology. Articles included in this special issue are focused on this specific topic relative to the discipline of clinical neuropsychology to develop, operationalize, and highlight best practices in mentoring with attention to the need to end racist/sexist treatment of women and historically marginalized racial/ethnic individuals; develop culturally humble mentoring approaches and clinical practices; and fix the leaky pipeline limiting access to marginalized individuals to contribute to the field of research and practice.

A scoping review of stereotype threat for BIPOC: Cognitive effects and intervention strategies for the field of neuropsychology.

OBJECTIVE: Abundant evidence documents stereotype threat's (ST) detrimental effect on test performance across identities and contexts (i.e., eliciting underperformance). Review of the literature shows varied aspects of both stereotyped identities and cognition are inconsistently explored across studies. Only a portion of the literature focuses on ST's impact on Black, Indigenous, and People of Color (BIPOC). It is important to understand and learn to mitigate ST, particularly for historically marginalized and systemically oppressed BIPOC patients. Relevance exists for neuropsychologists, who engage in activities (i.e., assessments) that may activate ST, and should be aware of additional factors impacting testing results and clinical decision making. METHOD: Using scoping review criteria (Peters et al., 2015) and Preferred Reporting Item for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we reviewed literature across multiple databases (Google Scholar, PubMed, PsychINFO) on ST and cognition with a focus on BIPOC. RESULTS: The current literature suggests that race-based ST may be implicated in underperformance for executive functioning and separately working memory. There is limited research on the effects of ST for memory, language, attention, and visuospatial skills. CONCLUSION: Research on ST requires additional attention to establish interventions to mitigate negative effects in practice. These results provide 1) an overview of the cognitive implications of ST, 2) address the scope of this impact for BIPOC, and 3) provide possible intervention and training strategies for neuropsychologists and other clinicians to work to mitigate the effects of ST on BIPOC.

Cognition and Other Predictors of Functional Disability Among Veterans With Mild Traumatic Brain Injury and Posttraumatic Stress Disorder.

BACKGROUND: Limitations in everyday functioning are frequently reported by veterans with a history of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD). Multiple factors are associated with functional disability among veterans, including depression, poor social support, cognition, and substance use. However, the degree to which these factors, particularly cognitive capacities, contribute to functional limitations remains unclear. METHODS: We evaluated performance on tests of processing speed, executive functioning, attention, and memory as predictors of functioning on the World Health Organization Disability Assessment Scale (WHODAS) 2.0 in 288 veterans. Participants were placed in one of the following groups: PTSD-only, mTBI-only, mTBI + PTSD, and neither PTSD nor mTBI (deployed control group). Cognitive test performances were evaluated as predictors of WHODAS 2.0 functional ratings in regression models that included demographic variables and a range of mood, behavioral health, and postconcussive symptom ratings. RESULTS: Multiple cognitive test performances predicted WHODAS 2.0 scores in the deployed control group, but they generally did not predict functioning in the clinical groups when accounting for demographics, mood, behavioral health, and postconcussive symptoms. CONCLUSIONS: In veterans with mTBI and/or PTSD, cognitive test performances are less associated with everyday functioning than mood and postconcussive symptoms.

Can mentor organizations impact mentor outcomes? Assessing organizational norms on mentor intent to stay and willingness to "go the extra mile".

The current study explores how organizational norms within mentoring organizations predict mentor outcomes over and above individual mentor characteristics. Specifically, this study examines whether mean levels (as an indicator of organizational norms) of mentors' perceptions of their relationship quality with mentees' families predict mentor satisfaction, mentor intent to stay and mentor extra-role prosocial behavior over and above individual mentor perception of their relationship quality with mentees' families. Multilevel modeling was used to assess 204 mentors nested within 37 mentoring organizations. The current study found that mentor organization averages of perceived relationship quality with mentees' families positively predicted mentor extra-role prosocial behavior over and above the individual mentor perceptions of relationship quality with mentees' families. Additionally, organizational averages negatively predicted mentor intent to stay, while individual mentor perceptions positively predicted mentor intent to stay. Results have implications for mentoring organizations to create organizational norms that reduce burnout, increase continuity of mentor relationships, and help mentors go above and beyond on behalf of their mentees and mentoring organization.