Definition of clinical neuropsychology Neuropsychology is the study and application of brain-behavior relationships. “Clinical neuropsychology is a specialty that applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal Scope of clinical neuropsychology Clinical neuropsychology involves the application of brain- behavior relationships in the assessment and treatment of a wide variety of neurologic, medical, developmental, and psychiatric disorders. Clinical neuropsychologists are trained to conduct research and to engage in clinical practice, and they are employed in a wide variety of settings that draw on these areas of expertise. Clinical neuropsychologists are employed as professors in colleges and universities and as clinicians and researchers in medical centers and hospitals, rehabilitation facilities, community mental health agencies, schools, and private practice. Neuropsychologists often work with multidisciplinary teams. For example, they may consult and collaborate with primary care physicians, nurse practitioners, social workers, neurologists, psychiatrists, and teachers to provide useful information about assessment, diagnosis, and treatment planning for a wide variety of disorders. Clinical neuropsychologists work with children and adults of all ages. Some clinical neuropsychologists specialize in a particular age group, such as geriatric or pediatric populations; others have a broader practice base and conduct assessments with Activities of clinical neuropsychologists The most common clinical activity of neuropsychologists is to conduct assessments of persons with a neurologic, psychiatric, developmental, or medical disorder to (1) assist in diagnosis, (2) determine strengths and weaknesses in cognitive, emotional, and psychosocial functions, (3) assist in treatment planning, and/ or (4) to track the progression (i.e., improvement or decline) in cognitive and emotional functions over time and/or in response to intervention. Usually the goals of an assessment are multifaceted; the referral source may want information about diagnosis as well as recommendations for treatment. For example, a clinical neuropsychologist might be asked if memory problems in a 65-year-old patient are due to normal aging or a mild neurocognitive disorder due to Alzheimer’s disease and, based on the diagnostic decision, to recommend treatment for memory problems and to maximize function. Results of the evaluation will also be useful to track change over time. The same patient can be reassessed at an appropriate interval to determine if cognitive abilities are stable or changing. At repeat testing, treatment recommendations can be updated and modified to fit the patient’s most current situation. Another example of an assessment with multiple goals would be a The neuropsychological evaluation Neuropsychologists obtain information with a variety of methods and tools and from a number of sources. A major goal in neuropsychological assessment is to determine if there is converging evidence for a deficit or strength across different sources of data. For the older adult, the neuropsychologist would conduct a detailed clinical interview with the patient and a close family member or acquaintance (e.g., spouse or adult child), administer tests to the patient to assess cognitive and emotional functions, have the family member complete some Localization versus equipotentiality of brain function To best understand the unique training of clinical neuropsychologists and how they can be useful consultants, it is helpful to be familiar with the history of neuropsychology. The origins of the field date back to early work on understanding brain function (as reviewed in Stirling, 2002). At the end of the 19th century, there was debate about how the brain functioned. Some believed that particular brain functions (e.g., speech
and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain- behavior relationships and the application of such knowledge to human problems” (American Psychological Association, 2016). persons from a variety of age groups. Neuropsychologists also are trained to work with persons from diverse backgrounds with regard to language, culture, ethnicity, and sexual orientation, to name a few important individual difference factors (Fujii, 2018). Additionally, the types of disorders that clinical neuropsychologists assess and treat are wide-ranging. Neuropsychologists work with persons with all types of major or mild neurocognitive disorders, such as disorders due to Alzheimer’s disease, traumatic brain injury, HIV infection, vascular neurocognitive disorder, or another medical condition (e.g., multiple sclerosis); with psychiatric disorders, such as depressive disorders, anxiety disorders, and bipolar and related disorders; with neurodevelopmental disorders, such as attention- deficit/ hyperactivity disorder (ADHD), autism spectrum disorder, or specific learning disorder; and persons with medical disorders, such as cardiovascular disease or diabetes. These are just a few examples. Often, cases that are referred to neuropsychologists are complex and may involve comorbidities between two or more of the disorders listed above. referral of a 6-year-old child who is having significant difficulty learning early reading skills in 1st grade and who seems sad and withdrawn. The teacher and parents might want diagnostic information (e.g., whether the child has a specific learning disorder and/or a depressive disorder), as well as recommendations to help the child learn essential reading skills and treat any potential emotional problems. Again, findings from the evaluation can be used to track progress over time because results can serve as a baseline against which to compare future test scores. Neuropsychologist have long been involved in rehabilitation of patients who have suffered neurological or psychiatric disorders that affect cognition (Gómez-Gastiasoro et al., 2019). Rehabilitation efforts focus not only on cognitive skills but on social, emotional, and functional capabilities. Persons with traumatic brain injury, dementia, schizophrenia, multiple sclerosis, and stroke have been the focus of rehabilitation programs. Goals of rehabilitation include restoration of function, compensation of impairment, and optimization of residual function. questionnaires, review medical records, and carefully observe the patient’s behavior and affect during their interactions. For the elementary school child, similar procedures would be used and would also include a careful review of school records (e.g., report cards), an interview and questionnaires for the teacher and/or guidance counselor, and detailed input from one or both parents or legal guardians. Neuropsychological evaluation procedures are detailed further in Chapter 3.
BRIEF HISTORY OF CLINICAL NEUROPSYCHOLOGY
production) could be localized to a particular region of the brain (e.g., the frontal lobes of the brain). Others insisted that all brain tissue was equipotential and could not be differentiated on the basis of function. Those in favor of equipotentiality asserted that all brain tissue participated equally in behavioral tasks, whereas localizationist hypothesized that some regions of the brain were specialized to participate in particular behavioral
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