The Clinical Neuropsychologist

Published by Taylor & Francis (Routledge)
Online ISSN: 1744-4144
Print ISSN: 1385-4046
There are critical issues facing the neuropsychological community, such as inadequate reimbursement for services, a lack of familiarity among public policy makers regarding the science and practice of neuropsychology, and a lack of public policy awareness among professional neuropsychologists. Advocacy for the field is the most effective way to undertake positive change. Currently, a minority of psychological professionals actively engages in an advocacy process, while the majority is not involved, or is involved periodically or passively. With weak advocacy our field risks slower development in key areas, and without strong and constant advocacy we risk losing ground previously gained. The purpose of this article, and those that follow in this special issue of The Clinical Neuropsychologist, is to: (1) convey the importance of advocacy, (2) address and dispel unfounded mental obstacles that inhibit involvement in advocating for the specialty, and (3) aid neuropsychologists in preparing to join the advocacy process. To accomplish this, we acquaint readers with the advocacy process, delineate to practitioners how they can become involved, and encourage participation in advocacy.
The main aims of this study were to develop norms for the Wisconsin Card Sorting Test in 6- to 11-year-old children in Taiwan; to explore the effect of sex, age, birth order, number of siblings, and parental education on WCST performance in 6- to 11-year-old children; and to make a comparison of WCST performance between children in Taiwan and the USA. The results of this comparison of developmental norms of school children in Taiwan and the United States may facilitate the WCST as a clinical or research instrument in combination with other test procedures to assess aspects of cognitive and neuropsychological functioning of school children.
Standardized mean score of CT, PSV, and FMS as a function of age 
Summary of demographic characteristics
Factor loadings of eight WCST scores
Hierarchical regression results
The leading aim of the present study was to examine developmental trends in performance on a computerized version of the Wisconsin Card Sorting Test (WCST) in Turkish children. Participants were 449 children aged between 8 and 11. Findings suggested that children's WCST scores improve with age, and developmental changes in executive functions follow distinct processes as assessed by different components of the WCST. The most striking improvement was noted in perseverative tendencies around age 10. This study also explored the effects of parental education on WCST performances of children, and maternal education emerged as the most important predictor.
According to Nelson's (1976) criteria, the MCST (MWCST) is a simplification of the Wisconsin Card Sorting Test (WCST). As the MCST is particularly suitable for children, the aim of this study was to establish the normative data presently lacking for that group. The MCST was administered to 1126 normal children aged 4 to 13 years. Scoring was based on all the classical parameters, according to existing criteria, plus two new ones that we propose ("categorizing efficiency" and "categorizing efficiency plus"). Strong correlation (or inverse correlation) with age is found for most parameters, including all criteria used for perseverative responses. This does not occur for "failure to maintain set," calculated according to the usual criteria. "Categorizing efficiency" and "categorizing efficiency plus" avoid the ceiling effect occurring at higher ages in the parameter categories. The MCST may be used in children 4 years of age and above. Most, but not all, of its parameters show regular improvement with age, demonstrating their validity. However, our data suggest that a participant's performance on the MCST may be based essentially on two parameters: categorizing efficiency (or categorizing efficiency plus), measuring the participant's ability to categorize, and perseverative errors (or percent perseverative errors), measuring his or her difficulty in shifting, both considered typical executive functions.
We administered the 60-item Korean version of the Boston Naming Test (K-BNT) to 2560 normally developing Korean children aged between 3 and 14 years. The children were stratified into 24 groups between the ages of 3 years, 0 months (3;0) and 14 years, 11 months (14;11) with 6-month intervals between each group. Statistical analysis did not reveal gender differences, but there were significant age differences among the groups (F = 615.340, p = .000). The lowest score (M = 14.17, SD = 4.28) was observed in the 3;0 to approximately 3;5 age-group and the highest (M = 50.64, SD = 3.70) in the 14;6 to approximately 14;11. Simple linear regression analysis revealed an R2 value of .800, indicating that the age variable explains 80% of the score variance (F = 10228.343, p = .000). Some of the 24 age groups were clustered due to lack of difference of the test scores between the neighboring groups, reducing the number of age groups to 13. This large cross-sectional study provided clinically useful norms of the BNT on Korean children and confirmed an importance of the age parameter in a neuropsychological testing.
This study assessed the ability of normal controls to simulate mild traumatic brain injury with or without the aid of general simulation strategies. An additional purpose was to evaluate the relative ability of four tests of performance motivation or malingering to discriminate among the five groups in this study. Twenty-one patients with documented mild traumatic brain injury (TBI) and 112 undergraduate students were administered the measures of symptom validity in randomized order with instructions either to perform to the best of their ability or to fake believable deficits. Students asked to malinger were either given instructions to do so with no guidance (No Strategies group or NS), a minimal level of guidance (Only Strategies group or OS) or a moderate level of guidance (Strategies and Example or SE). Students given simulation strategies (OS and SE groups) were able to match performance of the TBI group in only those instances when TBI performance was similar to the normal comparison group. When TBI performance fell considerably below the normal comparison group, naïve simulators (NS group) best approximated TBI performance. The degree of variability in the classification success of the four tests underscored the necessity of combining detection methods, as well as the need to develop new tests more resistant to attempts to feign brain injury.
Comparison of normative and validation samples on demographic and screening variables 
Coefficients for the standard regression analyses for free immediate and delayed recall 
Performance on verbal memory tests is generally associated with socio-demographic variables such as age, sex, and education level. Performance also varies between different cultural groups. The present study aimed to establish normative data for the Rappel libre/Rappel indicé à 16 items (16-item Free and Cued Recall; RL/RI-16), a French adaptation of the Free and Cued Selective Reminding Test (Buschke, 198412. Buschke, H. (1984). Cued recall in amnesia. Journal of Clinical Neuropsychology, 6, 433–440.[Taylor & Francis Online], [PubMed], [Web of Science ®]View all references; Grober, Buschke, Crystal, Bang, & Dresner, 198821. Grober, E., Buschke, H., Crystal, H., Bang, S., & Dresner, R. (1988). Screening for dementia by memory testing. Neurology, 38, 900–903.[CrossRef], [PubMed], [Web of Science ®]View all references). The sample consisted of 566 healthy French-speaking older adults (50–88 years old) from the province of Quebec, Canada. Normative data for the RL/RI-16 were derived from 80% of the total sample (normative sample) and cross-validated using the remaining participants (20%; validation sample). The effects of participants’ age, sex, and education level were assessed on different indices of memory performance. Results indicated that these variables were independently associated with performance. Normative data are presented as regression equations with standard deviations (symmetric distributions) and percentiles (asymmetric distributions).
Demographics of participants (n = 44) 
Use and frequency of concurrent therapies (n = 44) 
Test-retest reproducibility in children with unilateral cerebral palsy (n = 44) for neuropsychological measures 
Reliable change in children with unilateral cerebral palsy (n = 44) for neuropsychological measures 
The study investigated the stability of executive functioning (EF) measures in children and adolescents aged 8-17 years with unilateral cerebral palsy (CP). Here 44 participants with unilateral CP (mean age = 11 years, 11 months; Manual Abilities Classification Scale Level I = 6 and Level II = 37; Gross Motor Function Classification Scale Level I = 22 and Level II = 22) were randomized into the wait-list control group of a large randomized controlled trial. Participants had baseline testing with Wechsler Intelligence Scale for Children - Fourth Edition Short Form (WISC-IV-SF) and Delis-Kaplan Executive Function System (D-KEFS) subtests. Parents completed the Behavior Rating Inventory of Executive Functioning (BRIEF). Participants were re-assessed 20 ±2 weeks later with a shortened test battery including the D-KEFS subtests; Digit Span, Coding and Symbol Search (WISC-IV); and BRIEF. Pearson's test-retest reliabilities and Reliable change scores were calculated. Results indicated excellent to fair test-retest reliabilities (r = 0.91-0.74) for all measures except Digit Span Backwards (r = 0.62), Inhibition (r = 0.69), and Initiate (r = 0.68). Reliable change scores applying 90% confidence intervals for estimating reliable change while accounting for practice effects were provided for all measures. The data support the stability of EF measures in this population.
A modified version of the Wisconsin Card Sorting Test (mWCST) proposed by Nelson (1976) was administered to 229 healthy community-dwelling older adults, composed of 97 men and 132 women, ages 45 to 91. Investigating the impact of demographic factors such as age, education, and gender on mWCST performance, results indicated that mWCST performance was significantly affected by both age and education. Unlike the standard WCST, however, gender did not significantly influence mWCST performance. Because demographic factors appear to exert a significant influence on mWCST performance of normal older adults, demographically-corrected norms were calculated according to the procedure described by Heaton, Grant, and Matthews (1991). In addition, longitudinal analysis of mWCST performance revealed that significantly fewer nonperseverative errors were committed at retest approximately one year later. Number of categories completed and perseverative errors did not appear to demonstrate significant practice effects in this sample. Accounting for demographic influences and the inspection of practice effects on serial administration of the mWCST may improve upon its sensitivity and specificity for use in the clinical assessment of executive function in older adults.
Numerous authors have opined that forensic activities have become more prominent within clinical neuropsychology. To investigate the merits of these claims, the entire contents of Archives of Clinical Neuropsychology (ACN), Journal of Clinical and Experimental Neuropsychology (JCEN), and The Clinical Neuropsychologist (TCN) from 1990 through 2000 were reviewed and cataloged. These three journals were selected because they are the highest-ranking clinical subscription journals according to surveys of neuropsychology practitioners. Prior to rating journal content, various categories of interest were delineated and practice ratings were obtained until the two raters reached 92% agreement. Each of the raters read the journal contents and recorded content ratings for half of the journal issues under review. Results of the 8323 ratings demonstrated increases across time in the absolute numbers of articles related to forensic neuropsychology, although variable and different for each journal. Published articles that were partially or substantially forensic in nature in the three journals combined increased from 4% in 1990 to 14% in 2000. An annual peak in absolute number (n=32;16%) of forensic journal articles occurred in 1997. The most common topic of 139 articles published in ACN, JCEN, and TCN from 1990 to 2000 was malingering, which appeared in 86% of the general forensic articles. Forensic presentations at annual NAN meetings ranged from 3.9 to 11.3% (M=8%) of the convention programs, whereas within Division 40's programs at the American Psychological Association meeting, the average percentage ranged from 2.3 to 11.7% (M=6%). Results pertaining to each journal and to specific forensic topics are presented and implications of these and other results are discussed.
In 1996 Artiola I Fortuny published a review of our book, Neuropsychological Evaluation of the Spanish Speaker (Ardila, Rosselli, & Puente, 1994), in this journal. We appreciate the time and energy taken to produce such an exhaustive review of our little volume. However, considering the extremely negative and personal nature of the review, we felt obliged to the scientific and professional community to provide reasoned information, which should help clarify the numerous misunderstandings in the review.
Demographic and injury severity measures for available analyzed data 
Summary data from random effects model collapsed across cognitive domain, presented for each epoch, including data from logarithm regression 
The meta-analytic findings of Binder et al. (1997) and Frencham et al. (2005) showed that the neuropsychological effect of mild traumatic brain injury (mTBI) was negligible in adults by 3 months post injury. Pertab et al. (2009) reported that verbal paired associates, coding tasks, and digit span yielded significant differences between mTBI and control groups. We re-analyzed data from the 25 studies used in the prior meta-analyses, correcting statistical and methodological limitations of previous efforts, and analyzed the chronicity data by discrete epochs. Three months post injury the effect size of -0.07 was not statistically different from zero and similar to that which has been found in several other meta-analyses (Belanger et al., 2005; Schretlen & Shapiro, 2003). The effect size 7 days post injury was -0.39. The effect of mTBI immediately post injury was largest on Verbal and Visual Memory domains. However, 3 months post injury all domains improved to show non-significant effect sizes. These findings indicate that mTBI has an initial small effect on neuropsychological functioning that dissipates quickly. The evidence of recovery in the present meta-analysis is consistent with previous conclusions of both Binder et al. and Frencham et al. Our findings may not apply to people with a history of multiple concussions or complicated mTBIs.
During the 1998 Division 40 presidential address by Linas Bieliauskas in San Francisco, several assertions were made contending that professional schools of psychology (PSP) had a deleterious effect on clinical neuropsychology by lowering professional standards, removing science from the curriculum, and producing mediocre clinicians. Bieliauskas reported to the author that he had based his opinion, in part, on data indicating that Boulder model graduates attained superior mean scores on the Examination for the Professional Practice in Psychology (EPPP) as compared to their Vail model counterparts. In order to determine whether significant differences existed between the two groups, a multivariate analysis of variance (MANOVA) was conducted using the 1997 EPPP scores reported by the Association of State and Provincial Psychology Boards (ASPPB, 1997). The author also provides a response to Bieliauskas' (1998) assertions.
Recently, Tremont, Hoffman, Scott, and Adams (1998) demonstrated an association between Halstead-Reitan (HRB) and Wechsler Memory Scale (WMS) performance and WAIS-R IQ scores, and recommended that premorbid intellectual estimates be utilized as general indicators of expected neuropsychological test performance. The commentary presented here demonstrates that the relationship between IQ, HRB and WMS is due to shared common factors, and argues against the use of premorbid IQ estimates, because of significant regression to the mean. "Intelligence" is redefined as the composite of neurobehavioral abilities covered in comprehensive neuropsychological assessment.
This paper updates neuropsychologists on the process of obtaining board certification in clinical neuropsychology through the American Board of Clinical Neuropsychology (ABCN), a specialty board operating under the auspices of the American Board of Professional Psychology (ABPP). At this time, the ABPP and ABCN have certified 406 clinical neuropsychologists, which makes it the largest board-certification organization in clinical neuropsychology. This article details the advantages of board certification through the ABCN and the four steps which must be passed in order to obtain board certification. These steps are: credential review, written examination, work sample, and oral examination.
Doctoral-level members of Division 40 (Clinical Neuropsychology) of the American Psychological Association and other neuropsychologists were invited to participate in a web-based survey in early 2005. Response rate was estimated to be between 28.5 and 31.3%. The range of years postdoctorate was 1-51. Demonstrating the substantial proportional change in gender taking place in the field, 7 of 10 postdoctoral residents were women. Whereas the median age of APA members has been over 50 since the early 1990s, the current median age of clinical neuropsychologists is 47 and has essentially remained unchanged since 1994, indicating substantial entrance of young psychologists into the field. Use of testing assistants remains commonplace. The "flexible battery" approach has increased in popularity and predominates, whereas endorsement of the "standardized battery" approach continues to decline. More than 90% of respondents are engaged in full-time or full-time plus part-time employment. Incomes from 2004 vary considerably by years of clinical practice, work setting, amount of forensic practice, and region of country. Job satisfaction has little relationship to income and is comparable across most variables (e.g., work setting, professional identity, amount of forensic activity), whereas income satisfaction has a stronger relationship to actual income, at least at the higher income levels. Job satisfaction of neuropsychologists in general is higher than reported for other U.S. jobs. Fewer than one in five respondents is considering changing job position and very few individuals are considering leaving neuropsychology or psychology for a different field. More than 8 of 10 respondents experienced an income increase in the last five years, whereas fewer than 1 in 10 experienced a decrease. While higher than reported by other types of psychologists, neuropsychology incomes have lagged behind inflation when compared to 1992 data. Numerous breakdowns related to income and professional activities are provided.
Age-adjusted prevalence of hypertension in Americans, ages 20–74, by sex and race=ethnicity. Data for 1999–2000 from the National Health and Nutrition Examination Survey, National Center for Health Statistics, US Centers for Disease Control and Prevention.  
Genetic similarities among 31 populations expressed as distances in a neighbor-joining network. Similarities based on the frequencies of 100 Alu polymorphisms. Reproduced from Watkins et al. (2003) with permission of the publisher.  
Carlo Emilio Bonferroni (1892–1960).  
Number of publications since 1970 with ''quality of life'' in their titles. Results of PubMed search on January 10, 2005.  
This address to the International Neuropsychological Society membership challenges the wisdom of several common practices in contemporary neuropsychology. It is argued that, in spite of their popularity, the development of race-specific test norms, the indiscriminate use of Bonferroni's correction for multiple comparisons, and the conduct of "quality of life" research are all conceptually problematic. These practices may have untoward sociopolitical effects as well, and neuropsychologists are urged to exercise caution before embracing them.
Demographics, measures of head injury severity, and mean score on measures of effort and ability across the two samples 
Variables influencing test scores on measures of cognitive ability and effort 
Influence of age, education, and TBI severity on measures of memory and effort, Green sample only 
Test results for both study samples on the effort measure of WMT-IR and the cognitive ability measure of Overall Test Battery Mean 
Several studies have reported that traumatic brain injury (TBI) has a smaller effect on neuropsychological test scores, in contrast to the large effect of poor effort on test performance. Consequently, many authors have concluded that effort needs to be measured routinely and that it is necessary to control for poor effort when measuring the effects of brain disease or injury on performance. Recently, however, Bowden, Shores, and Mathias (2006) have challenged these notions. They argued that the Immediate Recognition subtest of the Word Memory Test (Green & Flaro, 2003), an effort measure, is another verbal memory test rather than a measure of cognitive effort. In this study we re-examine the data from Bowden et al. (2006) and Green, Rohling, Lees-Haley, and Allen (2001) to identify differences between the two studies that might account for their contradictory conclusions. In both sets of data, reanalysis showed that effort explains approximately five times more of the variance in composite neuropsychological test scores than TBI severity. Importantly, scores on the Word Memory Test-Immediate Recognition (WMT-IR) were not correlated with measures of TBI severity, and were not found to correlate with major variables known to be measuring ability (e.g., years of education). These findings challenge the conclusions offered by Bowden and colleagues (2006).
The 2008 Diversity Summit recognized the many advantages of increasing the number of neuropsychologists from ethnically diverse backgrounds. The Summit addressed the aspiration of creating a more ethnically diverse body of neuropsychologists by increasing the recruitment of ethnic minority students to neuropsychology training programs. Challenges to successful recruitment and retention of ethnic minority students were discussion points at the Summit. This paper summarizes and expands these points and also suggests solutions to these challenges with the aim of stimulating innovative approaches to increasing the representation of ethnic minorities in neuropsychology.
Doctoral-level members of the American Academy of Clinical Neuropsychology, Division 40 (Clinical Neuropsychology) of the American Psychological Association, and the National Academy of Neuropsychology, and other neuropsychologists, were invited to participate in a web-based survey in early 2010. The sample of respondents was 56% larger than a prior related income and practice survey in 2005. The substantial proportional change in gender taking place in the field has continued, with 7 of 10 post-doctoral residents being women and, for the first time ever, more than half of the total sample of respondents being women. Whereas the median age of APA members has been over 50 since the early 1990s, the current median age of clinical neuropsychologists remains at 47 and has remained essentially unchanged since 1989, indicating substantial entrance of young psychologists into the field. The Houston Conference training model has influenced the vast majority of residency training sites, and is endorsed as compatible with prior training by two-thirds of all respondents. Testing assistant usage remains commonplace, and is much more common in institutions. The "flexible battery" approach has again increased in popularity and predominates, whereas endorsement of the "fixed/standardized battery" approach has continued to decline. The vast majority of clinical neuropsychologists work full time. Average length of time reported for evaluations increased significantly from 2005, which does not appear to be explained by changes in common referral sources or common diagnostic conditions being evaluated. The most common factors affecting evaluation length were identified, with the top three being goal of evaluation, stamina/health of examinee, and age of examinee. Pediatric specialists are more likely than others to work part time, more likely to be women, more likely to work in institutions, and report lower incomes than respondents whose professional identity is purely adult or a combination of adult and pediatric. Incomes once again vary considerably by years of clinical practice, work setting, amount of forensic practice, state, and region of country. Job satisfaction has little relationship to income and is comparable across most variables (e.g., work setting, professional identity, amount of forensic activity), whereas income satisfaction has a stronger relationship to actual income, and income satisfaction and job satisfaction are moderately correlated. Job satisfaction of neuropsychologists in general is higher than reported for other US jobs. Fewer than 5% of respondents are considering changing job position. As was true in the 2005 survey, a substantial majority of respondents reported increased incomes over the last 5 years. Actual reported income values were meaningfully higher than in 2005 across general work settings and professional identities, and were also higher for entry-level positions. Numerous breakdowns related to income and professional activities are provided.
A conference specific to the education and training of clinical neuropsychology was held in 1997, which led to a report published in the Archives of Clinical Neuropsychology (Hannay, J., Bieliauskas, L., Crosson, B., Hammeke, T., Hamsher, K., & Koffler, S. (1998). Proceedings of the Houston Conference on Specialty Education and Training in Clinical Neuropsychology. Archives of Clinical Neuropsychology, 13, 157-250.). The guidelines produced by this conference have been referred to as the Houston Conference (HC) guidelines. Since that time, there has been considerable discussion, and some disagreement, about whether the HC guidelines produced a positive outcome in the training of neuropsychologists. To explore this question and determine how widely the HC guidelines were implemented, a meeting was held in 2006. Present and past leaders of the American Psychological Association Division 40 (Clinical Neuropsychology), the National Academy of Neuropsychology, and the Association of Postdoctoral Programs in Clinical Neuropsychology met to discuss the possible need for an Inter-Organizational Summit on Education and Training (ISET). A decision was reached to have the ISET Steering Committee conduct a survey of clinical neuropsychologists that could address the extent to which HC guidelines were present in the specialty and whether the influence of the HC guidelines was positive. An online survey was constructed, with data gathered in 2010. The current paper presents and discusses the ISET survey results. Specific findings need to be viewed cautiously due to the relatively low response rate. However, with some direct parallels to a larger recent survey of clinical neuropsychologists, the following general conclusions appear well founded: (a) the demographics of respondents in the ISET survey are comparable with a recent larger professional practice survey and thus may reasonably represent the specialty; (b) the HC guidelines appear to have been widely adopted by training programs, in that a large proportion of younger practitioners endorsed having had HC-adherent training; and (c) HC-adherent training is associated with a higher frequency endorsement of being well prepared to engage in key professional activities subsequent to the completion of training when compared with those not having HC-adherent training. Overall, the ISET Steering Committee has concluded that the HC guidelines have been widely adopted and that trainees associate participation in HC-adherent training as advantageous. A potential revision based on unfavorable outcomes is deemed unnecessary. Nonetheless, the ISET Steering Committee recognizes that training needs change as a function of the broadening of our field and the introduction of related new technologies, which may prompt updates. The ISET Steering Committee supports the idea that periodic review and updating of training models may be is prudent.
The current study examined the over-reporting Validity Scales of the MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011) in relation to the Slick, Sherman, and Iverson (1999) criteria for the diagnosis of Malingered Neurocognitive Dysfunction in a sample of 916 consecutive non-head injury disability claimants. The classification of Malingered Neurocognitive Dysfunction was based on scores from several cognitive symptom validity tests and response bias indicators built into traditional neuropsychological tests. Higher scores on MMPI-2-RF Validity Scales, particularly the Response Bias Scale (Gervais, Ben-Porath, Wygant, & Green, 2007), were associated with probable and definite Malingered Neurocognitive Dysfunction. The MMPI-2-RF's Validity Scales classification accuracy of Malingered Neurocognitive Dysfunction improved when multiple scales were interpreted. Additionally, higher scores on MMPI-2-RF substantive scales measuring distress, internalizing dysfunction, thought dysfunction, and social avoidance were associated with probable and definite Malingered Neurocognitive Dysfunction. Implications for clinical practice and future directions are noted.
Bigler et al. (201311. Bigler, E. D., Farrer, T. J., Pertab, J. L., James, K., Petrie, J. A., & Hedges, D. W. (2013). Reaffirmed limitations of meta-analytic methods in the study of mild traumatic brain injury: A response to Rohling et al. The Clinical Neuropsychologist, 27. View all references, The Clinical Neuropsychologist) contend that weak methodology and poor quality of the studies comprising our recent meta-analysis led us to miss detecting a subgroup of mild traumatic brain injury (mTBI) characterized by persisting symptomatic complaint and positive biomarkers for neurological damage. Our computation of non-significant Q, tau2 , and I2 statistics contradicts the existence of a subgroup of mTBI with poor outcome, or variation in effect size as a function of quality of research design. Consistent with this conclusion, the largest single contributor to our meta-analysis, Dikmen, Machamer, Winn, and Temkin (1995, Neuropsychology, 9, 80) yielded an effect size, –0.02, that was smaller than our overall effect size of –0.07 despite using the most liberal definition of mTBI: loss of consciousness less than 1 hour, with no exclusion of subjects who had positive CT scans. The evidence is weak for biomarkers of mTBI, such as diffusion tensor imaging and for demonstrable neuropathology in uncomplicated mTBI. Postconcussive symptoms, and reduced neuropsychological test scores are not specific to mTBI but can result from pre-existing psychosocial and psychiatric problems, expectancy effects and diagnosis threat. Moreover, neuropsychological impairment is seen in a variety of primary psychiatric disorders, which themselves are predictive of persistent complaints following mTBI. We urge use of prospective studies with orthopedic trauma controls in future investigations of mTBI to control for these confounding factors.
Bilder, Sugar, and Helleman (2014 this issue) have criticized recent publications on performance validity test (PVT) failure in clinical samples. Bilder and colleagues appear to make an idiosyncratic interpretation of recent research and inconsistently apply principles of null hypothesis significance testing. Overall, their position seems to propose that PVTs should be held to a higher psychometric standard than conventional neuropsychological tests. Problematic aspects of these criticisms are discussed. Additional consideration is given to research aims and findings.
Controversy has arisen over interpretation of performance validity tests (PVTs) when multiple PVTs are given. Some papers state that more stringent criteria are needed to judge overall performance as invalid, while others argue that concerns about the number of PVTs are overstated and that widely used criteria are appropriate. We examine theoretical models and assumptions, and analyze published data to determine the magnitude of effects implied by theory and observed in practice. Assertions advanced in the primary papers are examined for consistency with the empirical data. Existing theoretical models do not account well for the diverse empirical data, substantial empirical effects remain poorly understood, and the primary papers include assertions that are not empirically supported. The results indicate that: (a) neuropsychology lacks solid theoretical bases for estimating PVT failure rates given various combinations of PVTs, and thus needs to rely on empirical data; (b) existing empirical data fail to support the application of any uniform criteria across the broad range of scenarios involving multiple PVTs; and (c) practice should rely on empirical studies involving combinations of PVTs that have been studied together, in samples clearly appropriate to the individual case, using experimental designs germane to the questions under consideration.
Bilder, Sugar, and Hellemann (2014 this issue) contend that empirical support is lacking for use of multiple performance validity tests (PVTs) in evaluation of the individual case, differing from the conclusions of Davis and Millis (2014), and Larrabee (2014), who found no substantial increase in false positive rates using a criterion of failure of ≥ 2 PVTs and/or Symptom Validity Tests (SVTs) out of multiple tests administered. Reconsideration of data presented in Larrabee (2014) supports a criterion of ≥ 2 out of up to 7 PVTs/SVTs, as keeping false positive rates close to and in most cases below 10% in cases with bona fide neurologic, psychiatric, and developmental disorders. Strategies to minimize risk of false positive error are discussed, including (1) adjusting individual PVT cutoffs or criterion for number of PVTs failed, for examinees who have clinical histories placing them at risk for false positive identification (e.g., severe TBI, schizophrenia), (2) using the history of the individual case to rule out conditions known to result in false positive errors, (3) using normal performance in domains mimicked by PVTs to show that sufficient native ability exists for valid performance on the PVT(s) that have been failed, and (4) recognizing that as the number of PVTs/SVTs failed increases, the likelihood of valid clinical presentation decreases, with a corresponding increase in the likelihood of invalid test performance and symptom report.
Impairment in list learning and recall is prevalent in HIV-infected individuals and is strongly predictive of everyday functioning outcomes. Consistent with its predominant frontostriatal pathology, the memory profile associated with HIV infection is best characterized as a mixed encoding/retrieval profile. The Item-Specific Deficit Approach (ISDA) was developed by Wright et al. (2009) to elicit indices of Encoding, Consolidation, and Retrieval from the well-validated California Verbal Learning Test (CVLT; Delis, Kramer, Kaplan, & Ober, 1987, 2000). The current study evaluated construct validity of the ISDA for the CVLT-II in 40 persons with HIV-associated neurocognitive disorders (HIV+/HAND+), 103 HIV-infected persons without HAND (HIV+/HAND-), and 43 seronegative comparison participants (HIV-). Results provided mixed support for the construct validity of ISDA indices. HIV+/HAND+ individuals performed significantly more poorly than persons in the HIV+/HAND- and HIV- groups on ISDA Encoding, Consolidation, and Retrieval deficit indices, which demonstrated adequate classification accuracy for diagnosing HIV+/HAND+ participants and evidence of both convergent (e.g., episodic memory) and divergent (e.g., motor skills) correlations in the HIV+/HAND+ participants. However, highly intercorrelated ISDA indices and traditional CVLT-II measures showed comparable between-groups effect sizes, classification accuracy, and correlations to other memory tests, thereby raising uncertainties about the incremental value of the ISDA approach in clinical neuroAIDS research.
Descriptive Characteristics for the MDMA and Control Groups.
Mean Neuropsychological Test Scores for the MDMA and Control Groups.
While neuropsychological studies on 3,4-methylenedioxymethamphetamine (MDMA or ecstasy) users have been emerging, results have been inconsistent, possibly due to methodological issues. The current study examined the performance of 22 recreational MDMA users compared to 28 age, education, and IQ comparable normal control subjects on a comprehensive battery of neuropsychological tests. Results revealed no significant differences in cognitive functioning between the MDMA users and normal controls. However, greater use of MDMA was associated with poorer scores on several measures of nonverbal memory, and greater frequency users (> or = 50 times) evidenced significantly lower scores on 2 of 3 nonverbal memory tests compared to lesser frequency users (< 50 times). Our results suggest that a subgroup of MDMA patients, specifically heavy MDMA users, evidence declines in nonverbal (visual) memory, however, other cognitive areas appear to be spared.
In an era of rapid changes in the healthcare marketplace the specialty of clinical neuropsychology faces a substantial increase in advocacy challenges. These include maintaining both access to services and a favorable practice climate as new healthcare structures and payment models evolve. The issue of regional variability complicates an effective response to these challenges from national professional organizations. One response to the challenge of regional variability is to strengthen our national organizations' capacity to engage in coordinated and effective advocacy, and to partner with state and regional neuro/psychological associations. The Inter-Organizational Practice Committee (IOPC) was formed in 2012 to meet this need. The IOPC has developed a model of 360 Degree Advocacy that coordinates local, regional, and national resources for high-impact, efficient advocacy. This paper describes the 360 Degree Advocacy model, and walks readers through an example of the model in action, successfully responding to a threat to patient access and practice climate with a regional Medicare carrier.
Our aim was to analyze the psychometric properties of the Mini-Mental State Examination-37 using the Rasch Model (RM) in order to identify the cognitive domains that optimize detection of dementia in the Spanish population. All participants (n = 3955) were part of the NEDICES (Neurological Disorders in Central Spain) cohort study designed to detect dementia in persons aged 65 years and older. Clinical diagnosis of dementia (n = 178) was established by consensus of expert neurologists according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Results indicate that the items on the MMSE-37 have a good fit with the assumptions of the RM. None of the items on the MMSE-37 exhibits differential item functioning in relation to the groups. The items that assess orientation, attention, and language (repetition and comprehension) are those that best enable us to discriminate between the group with dementia and the group without dementia. The implications of the education and other sociodemographic characteristics of the population are discussed.
The Symptom Validity Scale (FBS), based on the 567-item form of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), has been shown to be a valid measure of symptom over-reporting. To extend its usefulness to the 370-item form, complete FBS scores (FBS) and FBS scores based on the 370-item form (FBS-S) were extracted from 707 protocols from various testing contexts. Regression analyses using the FBS-S score were developed to predict FBS scores. Results indicate that the full FBS score can be accurately prorated from the FBS-S. Calculated coefficients based on FBS-S score were slightly, but not meaningfully, better than a rationally derived proration in estimating the full FBS score.
Head injured patients show an IQ subtest pattern that can be discriminated from the profile produced by individuals who attempt to malinger intellectual decline due to head trauma. The current paper demonstrates that previously replicated methods for making this discrimination on the WAIS - R generalize to the WAIS - 3. The discriminant function equation accurately classified 83% of nonlitigating head-trauma patients with documented injuries and 72% of persons simulating intellectual impairment due to head trauma. A total of 45% of litigating mild head-trauma patients with purported intellectual decline but no documented loss of consciousness, hospitalization, or CT abnormality were classified as malingering by the discriminant function. A Vocabulary-Digit Span difference score provided 71% overall diagnostic accuracy, and may be informative when screening profiles by visual inspection or when complete WAIS - 3 results are unavailable.
The utility of the Spanish WAIS-III was investigated by examining its reliability and validity among 100 Spanish-speaking participants. Results indicated that the internal consistency of the subtests was satisfactory, but inadequate for Letter Number Sequencing. Criterion validity was adequate. Convergent and discriminant validity results were generally similar to the North American normative sample. Paired sample t-tests suggested that the WAIS-III may underestimate ability when compared to the criterion measures that were utilized to assess validity. This study provides support for the use of the Spanish WAIS-III in urban Hispanic populations, but also suggests that caution be used when administering specific subtests, due to the nature of the Latin America alphabet and potential test bias.
A retrospective study of Wisconsin Card Sorting Test (WCST) protocols was undertaken to determine the equivalence of the full WCST (Heaton, Chelune, Talley, Kay, & Curtiss, 1993) with the single-deck version of the WCST. Census-matched and demographically adjusted standardized scores for the full WCST were compared to the single deck WCST (WCST-64) with 332 clinical protocols using two methods. The comparisons were made using (1) standard scores derived from the new WCST-64 norms (Kongs, Thompson, Iverson, & Heaton, 2000) and from (2) WCST-64 percent scores standardized with the norms intended for the full WCST. The results revealed adequate correlations and accuracy scores for both census-based norms, although WCST-64 scores adjusted for demographic information were not comparable to full WCST scores. Furthermore, the number of cases in which estimated scores performed within an acceptable range of actual full-version WCST scores fell below acceptable ranges. Clinicians are encouraged to use data from the WCST-64 with caution.
The Wisconsin Card Sorting Test-64 (WCST-64) is a recently normed modification of the Wisconsin Card Sorting Test (WCST) that utilizes only one deck of cards. The present study investigated the validity of the WCST-64 in a sample of fifty-six 10- to 16-year-old children with traumatic brain injury (TBI). Standard scores for perseverative responses from the WCST-64 and from the full-length WCST shared 83% of common variance. Less than 10% of this sample had a discrepancy between the respective indexes that was greater than one standard deviation. Correlations with external criteria such as length of coma and Full Scale IQ were not significantly different between the two versions of the instrument. The findings suggest that the WCST-64 may be used interchangeably with the original WCST in older children with TBI.
The Wisconsin Cart Sorting Test (WCST) is a well-established measure of executive function. Practical and financial constraints have increased the need for abbreviated neuropsychological procedures. A number of abbreviated versions of the WCST have been introduced and cogent arguments can be made for one over another in certain situations. However, the single deck, 64-card WCST (WCST-64) is the most logical and practical short form. Psychological Assessment Resources (PAR) has recently published a new manual with comprehensive norms for the WCST-64. This paper reviews the new product, discusses the comparability of the WCST-64 and the standard version, and suggests directions for future research.
The Wisconsin Card Sorting Test-64 (WCST-64) is a recent modification of the Wisconsin Card Sorting Test (WCST) that utilizes only one deck of cards. The present study investigated the validity of the WCST-64 in a sample of 100 patients with traumatic brain injury (TBI). Mean T scores for Perseverative Responses were more than half a standard deviation lower for the WCST-64 than for the full-length version, even though the respective variables shared almost two thirds of common variance. Moreover, about a quarter of the sample had a T score discrepancy between the respective Perseverative Responses indexes that was greater than one standard deviation. The findings indicate that the WCST-64 cannot be used interchangeably with the original WCST, at least not in patients with TBI.
This study examined the factor structure and contrasted-group validity of the Wisconsin Card Sorting Test-64 (WCST-64) in a stroke sample (n = 112). Confirmatory factor analyses were used to compare five different models suggested by prior factor analyses. The results indicated that the WCST-64 was best represented by a three-dimensional model comprising response inflexibility (factor 1), ineffective hypothesis-testing strategy (factor 2), and set maintenance (factor 3). A significant overall multivariate effect for group (F = 2.87, df = 18,495.46, p <.001) was found in a multivariate analysis of covariance with WCST scores as dependent variables and four different groups (three stroke subgroups with different levels of cognitive function and a normal control group) as independent variable, after controlling for gender. The results of discriminant analysis supported the use of the WCST-64 in stroke patients with cognitive impairment.
The Wisconsin Card Sorting Test (WCST: Heaton, Chelune, Talley, Kay, & Curtiss, 1993) is among the most commonly administered measures of executive function. Recently, a short form of the test was developed (WCST-64: Kongs, Thompson, Iverson, & Heaton, 2000), and it affords psychometric properties commensurate with the full version of the test. Yet, similar to other measures of executive function, relatively little is known concerning the effects of repeated administration on the WCST-64. Towards this end, 53 men (age M = 32.38) were administered the WCST-64 twice over 12 months, and scores on several indices improved significantly during this interval. Suggestions concerning the use of these measures in longitudinal research designs and clinical follow-up examinations are offered, and reliable change indices concerning these measures are included.
Individuals aged 85 years and above (i.e., the oldest old) represent the fastest growing segment of the US population and are at increased risk of developing dementia. This represents an important challenge for the clinical neuropsychologist, as the extant normative data on neuropsychological measures remain relatively limited for this age group. Therefore the aim of the present study was to characterize the performance effects of age and education in a large, well-characterized sample of women between the ages of 85 and 95 years on the California Verbal Learning Test-II (CVLT-II) Short Form (Delis, Kramer, Kaplan, & Ober, 2000), verbal fluency tasks, and the WAIS-III Digit Span Test (Wechsler, 1997 ). In order to minimize the likelihood that women with an incipient neurodegenerative process were included in the final normative sample, we applied regression-based change scores to identify and exclude women who evidenced a statistically significant decline on a global cognitive screening measure over a 20-year interval. The results of our analysis indicate varying influence of age and education on these measures and we provide tables with descriptive statistics stratified by both age and education. Findings from the present normative study are discussed within the context of "robust" longitudinal normative data.
Description of SCL-90-R subscales 
Participant and normative sample characteristics at Time 1 and Time 2 and correlations 
Reliable change in SCL-90-R index scores from Time 1 to Time 2 
The current study examined the 3-year longitudinal course of psychopathology reported by 53 definite MS patients, then assessed for clinical elevations. Across SCL-90-R scales, only 9-21% of patients' scores changed. Intercorrelations among Time 1 and Time 2 were significant (p < .01). Clinical elevations on the scales ranged from 26% (anxiety) to 52% (somatization). Consistent with studies of depression, results demonstrated that other types of psychopathology are very stable over time. Because a relatively high percentage of patients displayed clinical elevations across the scales over time, this study suggests that the stability of psychopathology in MS patients is of clinical concern.
This study sought to determine the classification agreement between the standard and abbreviated forms of the Portland Digit Recognition Test (PDRT), a well-established symptom validity test. PDRTs (N=200: 100 traumatic brain injury, 100 chronic pain) were randomly selected from case manager and attorney referrals for psychological assessment. Only three cases were misclassified and agreement was as high as 99.5%. This study demonstrated that when using the abbreviated PDRT there is little risk of false negative errors.
Normative data for the Kaplan version of the Stroop Test are presented for 153 healthy, cognitively intact older adults aged 50-89 years. Increasing age was associated with decreased performance on all three subtests (Stroop A, Stroop B, and Stroop C), while years of education was only associated with Stroop B performance. Hence the normative data were stratified by age into three groups (50-64, 65-74, 75-89). Completion times for the first half of each trial (half-time scores) were found to have good split-half reliability and correlated highly with the original full administration scores. Means and standard deviations for the half-time administration are also presented for this sample. The current study provides more comprehensive normative data for older adults than previously available, as well as normative information for half-time scores that may have future clinical utility as an alternative, abbreviated version of the Kaplan Stroop Test.
The present study compared the efficacy of the abbreviated and the full scale PDRT in simulated malingerers and effortful controls. A total of 80 undergraduates were randomly assigned to normal effort, naïve simulators, informed simulators, and simulators with information and warning about malingering detection groups. Comparison shows abbreviated forms are superior to the full scale PDRT at detecting malingerers. The conservative abbreviated form detected 80% of the Naïve and Informed malingerers and 35% of the Warned. Warned Simulators were overall better at avoiding detection than Naïve or Informed Simulators.
Top-cited authors
Scott R Millis
  • Wayne State University
Glenn Larrabee
  • Glenn J. Larrabee, Ph.D., P.A.
Jerry J Sweet
  • NorthShore University HealthSystem
Ryan W Schroeder
  • University of Kansas
Laurence Binder
  • Oregon Health and Science University