The State of Published Science in Clinical Neuropsychology's Lifespan Journals: A Mixed Methods Examination of Scope, Approaches, and Content.

This comment serves to discuss the major findings of a recently published crossdisciplinary investigation of the peer review process, with specific emphasis upon: (1) the contributions of neuropsychologists to our understanding of this complex phenomenon; and (b) the design and preliminary results of a recently completed investigation of the reliability of the peer review process for the Journal of Clinical and Experimental Neuropsychology.

Cohen, in a now classic paper on statistical power, reviewed articles in the 1960 issue of one psychology journal and determined that the majority of studies had less than a 5050 chance of detecting an effect that truly exists in the population, and thus of obtaining statistically significant results. Such low statistical power, Cohen concluded, was largely due to inadequate sample sizes. Subsequent reviews of research published in other experimental psychology journals found similar results. We provide a statistical power analysis of clinical neuropsychological research by reviewing a representative sample of 66 articles from the Journal of Clinical and Experimental Neuropsychology, the Journal of the International Neuropsychology Society, and Neuropsychology. The results show inadequate power, similar to that for experimental research, when Cohens criterion for effect size is used. However, the results are encouraging in also showing that the field of clinical neuropsychology deals with larger effect sizes than are usually observed in experimental psychology and that the reviewed clinical neuropsychology research does have adequate power to detect these larger effect sizes. This review also reveals a prevailing failure to heed Cohens recommendations that researchers should routinely report a priori power analyses, effect sizes and confidence intervals, and conduct fewer statistical tests.

A-66 Clinical Neuropsychology Journal Articles about Concussion from 2010-2020

The authors evaluated the impact of financial incentives on disability, symptoms, and objective findings after closed-head injury. Meta-analysis was used to review the literature. Seventeen reports, covering 18 study groups and a total of 2,353 subjects, contained data from which effect sizes could be calculated. Effect sizes were aggregated after weighting for group size. After discussion, there was 100% agreement between the authors on all calculations. A moderate overall effect size, 0.47, was found. The effect was particularly strong for mild head trauma. The data showed more abnormality and disability in patients with financial incentives despite less severe injuries. Clinical evaluation of patients after closed-head injury, particularly mild head trauma, must include consideration of the effect of financial incentives on symptoms and disability.

Traditionally, apathy has been viewed as a symptom indicating loss of interest or emotions. This paper evaluates evidence that neuropsychiatric disorders also produce a syndrome of apathy. Both the symptom and the syndrome of apathy are of conceptual interest because they signify loss of motivation. An apathy syndrome is defined as a syndrome of primary motivational loss, that is, loss of motivation not attributable to emotional distress, intellectual impairment, or diminished level of consciousness. Loss of motivation due to disturbance of intellect, emotion, or level of consciousness defines the symptom of apathy. Neuropsychiatric literature dealing with apathy is reviewed within the framework of three approaches to defining the concept of a syndrome. Clinical and investigative approaches for evaluating apathy when it occurs in association with other syndromes are described.

Objective: Women are becoming more prevalent in clinical neuropsychology, but gender bias and disparities persist across multiple professional domains. This study examined potential gender disparities in historical authorship trends across commonly read journals in clinical neuropsychology. Method: Analyses were conducted on 10,531 articles published in six clinical neuropsychology journals from 1985 to 2019. Each author was coded as either a man or a woman using the OpenGenderTracking Project database. Results: On average, women comprised 43.3% (±30.6) of the authors listed in clinical neuropsychology article bylines and were lead and/or corresponding author on 50.3% of these papers. Findings varied by journal, with Child Neuropsychology having the best representation of women across several study metrics. Women comprised an increasing proportion of authors over time and the gender gap in clinical neuropsychology is smaller than was recently reported for the broader field of psychology; nevertheless, the recent rates of women as authors lag behind the prevalence of women in clinical neuropsychology. Encouragingly, gender was not associated with the number of times an article was cited. Articles that included women in leadership roles had significantly more authors overall and specifically more women authors. Conclusions: Women are under-represented as authors in clinical neuropsychology journals, but they are becoming more common and their papers are cited just as frequently as men. Efforts to increase women as research mentors and sponsors may help to further close the publishing gender gap in clinical neuropsychology.

Objective The values of a field are reflected in the science it publishes. The goal of this study was to present a historical analysis of the extent to which the field of clinical neuropsychology publishes journals with titles that address culture in the context of brain function and behavior between 2010 and 2020. Methods Titles from articles published in 13 neuropsychology journals from 2010–2020 were collected and coded with regard to culture and multicultural content. The aims of the study were to (1) determine how often cultural or multicultural topics were represented in journal titles, (2) determine if cultural or multicultural content in neuropsychology journal publication titles increased over time, and (3) to explore other neuropsychological content that was most and least likely to appear in publications pertaining to culture or multicultural issues. Results Results indicated that titles for publications in clinical neuropsychology journals with content relevant to cultural or multicultural neuropsychology represented 1.1% to 13.4% of titles across the 13 journals. The number of cultural/multicultural titles increased over time. The number of cultural/multicultural titles per journal was not significantly correlated with the journal impact factor. Normative data were addressed significantly more often in cultural/multicultural titles versus non-cultural/multicultural titles, whereas psychiatric issues were addressed significantly less often. Conclusions There are many actions that clinical neuropsychologists can take to increase the field’s attention to the effects of culture on brain function and behavior. It is vital to update our data from 2021 to the present, given the substantial increase in awareness of social justice issues that occurred since 2020.

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.

Invited Symposium 1: Traumatic Brain Injury: Highlighting the Contributions of Dr. Harvey S. Levin Ph.D., ABPP-CN, FACSM 1946 - 2022

The chapter summarizes the conceptual foundations of, and research on, emotional creativity (EC). Emotional creativity is defined as a pattern of cognitive abilities and personality traits related to originality and appropriateness in emotional experience. Emotional creativity is related to personality traits (e.g., openness to experience), positive affect, post-traumatic growth, and engagement in creative leisure activities. In applied settings, emotional creativity is related to innovative performance of employees as well as higher teaching efficacy. Meta-analysis revealed that women showed higher emotional creativity than men. Emotional creativity is also lower in older adulthood compared to younger age. Because the levels of EC are sensitive to the decline of cognitive functions in older adults, their decrease can be considered as one of the indicators of cognitive aging. Recent research in clinical neuropsychology has also revealed that older adults in the early stages of Parkinson’s disease showed decreased emotional creativity compared to healthy older adults. Several directions and research questions for future research are developed.

Research in clinical neuropsychology continues to flourish. Over the past 17 years, the field has embraced advances in structural and functional neuroimaging techniques, theoretical constructs, and statistical models in attempts to improve the quality and generalizability of its research efforts. With keen attention to methodological issues and careful consideration of broad hypotheses and underlying concepts, research in this field can continue to meet the needs of practicing clinicians and the rigorous requirements of scientific inquiry.

Research on the neuropsychological assessment of adult Hispanic Americans has used mostly elderly, poorly educated, Spanish-speaking participants, resident in the United States for more than 15 years. Studies have involved comparisons with Anglo-Americans, the effects of moderator variables (e.g., bilingualism) and test standardization and validation. Most neuropsychological studies comparing Hispanic and Anglo-Americans have methodological weaknesses, such as overly liberal Type I error rates and inappropriate statistical controls for educational differences. What intergroup discrepancies do exist are likely due to educational (quantitative and qualitative) differences, non-equivalent Spanish/English translations and/or acculturation/bilingualism related factors. Research suggests that Spanish-language neuropsychological test battery norms should be stratified by age, education (including lower grade levels), and to a limited extent gender, but there is little data to support separation by ethnicity. Acculturation/bilingualism variables can suggest when English-language tests are more appropriate to use with Hispanic Americans.

CHAPTER 3 - Theoretical, Empirical and Clinical Foundations of the WAIS-IV Index Scores

Objective The military has a long history with neuropsychology and its precursors. From developing intelligence tests during World War I, to developing early capacity and personality assessments during World War II, to forward deploying for the evaluation and treatment of frequent concussive brain injuries during more recent conflicts, clinical neuropsychology has been at the forefront of military selection, healthcare and research. The objective of this special issue is to provide an overview of the latest clinical research relevant to military neuropsychology—some contributors address assessment and treatment issues that are relevant to current practice and others foretell the future of our field. Method We solicited papers from established researchers and issued a general call for papers for the special issue on military neuropsychology. Results: We received submissions from several authors, eleven of which are included in this issue. These submissions cover assessment and treatment issues, as well as healthcare utilization and return to duty issues. Two apparent themes are the importance of assessing, treating, and attending to comorbidities following traumatic brain injury (TBI) and future assessment techniques moving beyond traditional cognitive performance assessment. Conclusions The issue highlights the importance of research in clinical neuropsychology to the practice and advancement of military neuropsychology.

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessJournal DigestNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:1 Mar 2019https://doi.org/10.1176/appi.pn.2019.3a21Adolescents With Autism Appear Less Influenced By Advice of OthersiStock/phototechnoThe opinions of others can influence decision making, but a study published in PNAS reports that such social influence differs between children with autism and typically developing children.For the study, researchers from the University of Oxford invited 125 typically developing children between the ages of 6 and 14 to play a videogame in which they were required to navigate a spaceship around a series of black holes. Before each important navigation point, the children saw a video of either a child or an adult who would provide advice (which could be correct or incorrect) on how best to accomplish this task. A smaller cohort of 30 children with autism (matched by age and IQ) also performed this task under identical circumstances.Whereas adolescents aged 12 to 14 showed a bias to listen to the advice (regardless of whether the advisor was an adult or child and/or the advice given was good or bad), children under 12 did not. In contrast, the children with autism were not significantly influenced by the advice of others at any age. As a result, older children with autism performed better on the navigation task than their neurotypical peers.Though the sample size of children with autism was small, the researchers said these findings suggest that age 12 is a key period of divergence in how the brain integrates social cues.Large I, Pellicano E, Mojzisch A, Krug K. Developmental Trajectory of Social Influence Integration Into Perceptual Decisions in Children. Proc Natl Acad Sci USA.. January 28, 2019. [Epub ahead of print]Overactive Neurons May Explain Why SSRIs Don’t Always WorkSalk InstituteBy creating neurons from patient skin samples, researchers at the Salk Institute in San Diego and colleagues have discovered a possible mechanism of antidepressant resistance. Their findings, published in Molecular Psychiatry, suggest that in some patients, neurons might become too excited by the serotonin-boosting properties of antidepressants.The researchers studied a group of 803 patients with major depressive disorder who were treated for eight weeks with the selective serotonin reuptake inhibitors (SSRIs) citalopram or escitalopram. From this group, they selected three patients who achieved complete remission of their depression symptoms with the SSRIs (SSRI responders) by eight weeks and three patients who did not experience symptom improvements (SSRI nonresponders) for further analysis.The researchers isolated skin cells from these patients and used cell reprogramming techniques to convert the cells into stem cells and later mature neurons. The researchers then exposed the reprogrammed neurons to serotonin to mimic the effects of taking an antidepressant like citalopram.In the presence of serotonin, neurons derived from the SSRI nonresponders had significantly higher activity on average compared with the neurons of healthy individuals or SSRI responders, the researchers reported. Further analysis showed the hyperactivity was due to overexpression of two classes of serotonin receptors, 5-HT2A and 5-HT7. When the researchers blocked these two receptors, the neurons from nonresponders were no longer hyperactive in the presence of serotonin.Vadodaria KC, Ji Y, Skime M, et al. Serotonin-Induced Hyperactivity in SSRI-Resistant Major Depressive Disorder Patient-Derived Neurons. Mol Psychiatry.. January 30, 2019. [Epub ahead of print]SSRIs Best Option for Pediatric Anxiety, Meta-Analysis FindsiStock/asiseeitSelective serotonin reuptake inhibitors (SSRIs) may be the most effective treatment for patients with pediatric anxiety disorders, suggests a meta-analysis in the Journal of Clinical Psychiatry.Researchers from the University of Cincinnati and Yale University compiled data from 22 randomized, controlled trials, including 2,623 participants. These trials included evaluations of established medications such as SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and benzodiazepines; there were also studies of other agents including the alpha-2 agonist guanfacine and serotonin 1A receptor agonist buspirone.Among the tested medications, SSRIs, SNRIs, and buspirone were all superior to placebo in achieving treatment response (at least a 50 percent reduction in symptoms), with SSRIs having the strongest effect. SSRIs were also most effective when considering overall reduction in anxiety symptoms, regardless of the response rate.The analysis also found that SNRIs had the lowest rate of treatment discontinuation due to adverse side effects, while guanfacine had the highest rate. However, there were no significant differences between the medications in relation to treatment discontinuation for any reason.“These findings confirm recommendations from the American Academy of Child and Adolescent Psychiatry and others regarding SSRIs as first-line pharmacotherapy for pediatric anxiety disorders,” the authors wrote.Dobson ET, Bloch MH, Strawn JR. Efficacy and Tolerability of Pharmacotherapy for Pediatric Anxiety Disorders: A Network Meta-Analysis. J Clin Psychiatry. 2019; 80(1):17r12064.Physical Problems May Link Concussion, DepressioniStock/fredrockoA history of football-related concussions is more likely to lead to depression in former NFL players who also have physical problems such as body pain, headaches, and dizziness, according to a study conducted by researchers at the Vanderbilt Sports Concussion Center and colleagues.The investigators assessed data from 43 retired NFL players who had received comprehensive neuropsychological exams as part of a large neurological study. The exams included the Beck Depression Inventory II (BDI-II) to screen for depression and the Patient Health Questionnaire-15 (PHQ-15) to screen for somatic symptoms.Twenty-nine of the 43 former players reported minimal depressive symptoms, nine reported symptoms of mild depression (BDI-II score of 14 to 19), three reported symptoms of moderate depression (BDI-II score of 20 to 28), and two reported symptoms of severe depression (BDI-II score of 29 to 63).There was no connection between concussion history and depressive symptoms in the players whose PHQ-15 scores were below the study average of 5.35. In contrast, former players with PHQ-15 scores at or above the average exhibited more severe depression symptoms if they had more concussions. The researchers calculated that the presence of somatic symptoms contributed about twice as much to an individual’s depression as the concussions.“If a retired athlete reports an extensive history of SRC [sport-related concussion] and somatic or depressive symptomatology, referral to a sports psychiatrist or clinical neuropsychologist is recommended for further assessment … and to differentiate depressive symptoms as purely somatic, psychiatric, or mixed,” the authors wrote.This study was published in the Journal of Neuropsychiatry and Clinical Neurosciences.Brett BL, Mummareddy N, Kuhn AW, et al. The Relationship Between Prior Concussions and Depression Is Modified by Somatic Symptomatology in Retired NFL Athletes. J Neuropsychiatry Clin Neurosci. 2019; 31(1): 17-24.Yeast Infection Impairs Memory in MiceiStock/Dr_MicrobeA study published in Nature Communications reports that the infectious yeast Candida albicans can cross the blood-brain barrier and impair memory in mice. This suggests that fungal infections may be a risk factor for dementia.Researchers at Baylor College of Medicine and colleagues injected mice with low levels of Candida. The injected mice showed no physical problems or stress and cleared out the infectious yeast in about 10 days. However, during this time, mice infected with Candida did show worse working memory compared with control mice as measured by maze tests. Once the infection cleared, the mice performed better.The researchers observed that the yeast entered the brain and induced cerebritis (the formation of small inflammatory lesions). The researchers termed these lesions fungal-induced glial granulomas, or FIGGs. The FIGGs contained numerous inflammatory molecules, including amyloid beta fragments, which were involved in helping clear the yeast from the brain.Although the memory problems were transient in this study, the authors suggested that repeated low-grade fungal infections and resulting cerebritis over many years might contribute to lasting cognitive defects. ■Wu Y, Du S, Johnson JL, et al. Microglia and Amyloid Precursor Protein Coordinate Control of Transient Candida Cerebritis With Memory Deficits? Nat Commun. 2019;10(1): 58. ISSUES NewArchived