Psy 507 NEUROPSYCHOLOGY
History and Assessment Approaches
Fall, 2009
Neuropsychology
- Study of Brain-behavior Relationships
History of Neuropsychology
- Egyptians
– 3500 B.C.
- Packaged viscera with mummies, tossed brain!
- First description of aphasia
- Alcmaeon
of Croton (500 BC)
- Hippocrates
- Galen
– physician to gladiators (129-~210 A.D.)
- Learned from deficits associated with different
wounds
- Gall
(1758-1828)
- Broca
(1824-1880)
- Wernicke
(1848-1904)
- “Neuropsychology”
- term first used in German physiology text by Unzer in 1771, translated
into English in 1851
- 1929
– Karl Lashley, then president of APA, calls for discipline combining
neurology and psychology
- 1954
– Arthur Benton at University of Iowa supervises first dissertations in
clinical neuropsychology
- Neuropsychology
journals established
- 1963 – Neuropsychologia
- 1964 – Cortex
- International
Neuropsychological Society
- Established in late 1960s, with only 175 members in
1970. Early meetings attended by only 70-75 people, held in conjunction
with APA. Today there are approximately 3200 members with about 1300
attending the North American annual meeting (a second conference is held
outside North America each year)
- National
Academy of Neuropsychology
- APA
Division 40: clinical neuropsychology
- Established
in late 1970s
A Clinical Neuropsychologist is:
·
a professional
psychologist who applies principles of assessment and intervention based upon
the scientific study of human behavior as it relates to normal and abnormal
functioning of the central nervous system.
·
a doctoral-level
psychology provider of diagnostic and intervention services who has
demonstrated competence in the application of such principles for human welfare
following:
o successful completion of systematic
didactic and experiential training in neuropsychology and neuroscience at a
regionally accredited university;
o two or more years of appropriate
supervised training applying neuropsychological services in a clinical setting;
o licensing and certification to provide
psychological services to the public by the laws of the state or province in
which he or she practices;
o review by one’s peers as a test of
these competencies.
- Attainment
of ABCN/ABPP Diploma in Clinical Neuropsychology is the clearest evidence
of competence as a Clinical Neuropsychologist, assuring that all of these
criteria have been met.
Diplomate
- What
is it?
- ABPP/ABCN
- American
Board of Professional Psychology (ABPP)
- American
Board of Clinical Neuropsychology (ABCN)
- ABCN
is part of ABPP
- ABPP/ABCN
·
Application
- required training, letters of recommendations, licensure
·
Multiple choice
examination - given 3
times a year (at 3 major meetings: international neuropsychological society,
national academy of neuropsychology, American psychological association)
·
Multiple choice
exam on:
o Neuropsychological assessment
b) Clinical neuropsychology
c) Basic and clinical neurosciences
d) Behavioral neurology
e) General clinical psychology
·
Submission of 2
work samples - reviewed by panel
·
Oral
examination
o Ethics
o Work samples
o Fact-finding case
American Board of Professional
Neuropsychology (ABPN)
Employment Settings for
Neuropsychologists
·
Private practice
only (34%)
- 29%
have secondary private practice
·
University
hospital/medical center (23%)
·
Non-university
hospital/medical center (13%)
·
Government
agency/facility (9%)
·
Independent
rehabilitation center (8%)
·
Group practice
(5%)
·
Other generic
setting (4%)
·
Community mental
health center (2%)
·
School system (2%)
Who Receives Neuropsychological
Services?
- Recent
Survey Data from Rabin, L.A., Barr, W. B., & Burton, L. A. (2005).
Assessment practices of clinical neuropsychologists in the United States
and Canada: A survey of INS, NAN, and APA Division 40 members.
Archives of Clinical Neuropsychology, 20, 33-65.
- Clients
o Adults ages 40-65 (29%)
o Young adults ages 19-39 – (24%)
o Older adults ages >65 (20%)
- Adolescents ages 12-18 (13%)
o Children ages<12 (15%)
o Infants (not reported in survey)
- Settings
[36% worked in more than one setting]
- 62% Private or group practice
- 34% Medical hospitals
- 17% Rehabilitation facilities
- 15% Other (schools, correctional facilities,
university research centers, nursing homes)
- 7% Psychiatric hospital
- 5% VA medical center
- 4% College/university counseling center
- 3% Community mental health center
- 1% Business/industry
- Assessment
Referral Questions
·
Determination of
diagnosis (71%)
·
Rehabilitation and
treatment planning (48%)
·
Forensic
determination (32%)
- For the plaintiff
- For the defense
- Malingering
·
Educational
planning (30%)
·
Assess capacity to
work (28%)
·
Establish baseline
of function for subsequent testing (24%)
·
Assess capacity
for independent living – (20%)
·
Pre- and
post-medical intervention (10%)
·
Other – 4%
·
Localization of
lesion (3%)
o Neuropsychological Assessment (42%)
o Psychotherapy – 19%
o Research and teaching (17%)
o Rehabilitation and/or cognitive
rehabilitation (8%)
- Education
of Survey Respondents (N=747)
- Ph.D. (87%)
- Psy.D. (9%)
- Ed.D. (3%)
- Degree
Area of Survey Respondents (N=747)
- Clinical psychology (62%)
- Clinical neuropsychology (11%)
- School psychology (5%)
- Counseling psychology (11%)
- Neuroscience (2%)
Approaches to Neuropsychological
Assessment
Luria-Nebraska Neuropsychological
Battery (Golden, Purisch, & Hammeke, 1985)
- Utilizes
test procedures developed by A.R. Luria, a Russian neuropsychologist
- Composed
of clinical, summary, localization, and factor scales
- Much
information derived from individual items
- Takes
approximately 90 minutes to administer
Halstead-Reitan Battery
- Set
of 5 tests yielding 7 scores and an “impairment index” which is based on
the number of scores that exceed cutoff for impairment:
- Category
test
- Tactual
performance test
- Rhythm
test
- Halstead-Reitan
Battery
- Speech
sounds perception test
- Finger
tapping test
- Also
may include trail-making test, aphasia screening test, sensory
examination, grip strength, WAIS, MMPI.
- Administration
time runs from 6 to 8 hours
Flexible Battery Approach
- Hypotheses
tested in a systematic fashion
- Patient-specific
hypotheses developed concerning location, quality, and extent of brain
impairment
- Hypotheses
generated based upon referral question, medical records, and interview
- Flexible
Battery Approach
- Specific
tests then administered to help determine the degree of impairment or
preservation of various cognitive functions
- After
identifying a deficit by a screening test, further testing may be
performed to better delineate the impairment
- Also
consider the “process” by which the patient approaches the tasks
- Flexible
Battery Approach
- Testing
never based on a single score, but rather the pattern of test performance
as a whole
- Much
more flexible than rigid battery approach
- Time
varies with patient performance - generally about 6 hours of testing
- Cognitive
Areas Assessed
- Gross Cognitive Functioning
- Achievement
- Intelligence
- Attention/Concentration
- Executive Functions
- Language
- Perceptual/Organizational
- Memory
- Motor
- Personality
- Effort/Motivation