Practice Of Clinical Neuropsychology Research Articles

Duration of abstinence from cannabis is positively associated with verbal learning performance: A systematic review and meta-analysis.

Although there is a consensus that cannabis intoxication will have deleterious effects on a wide spectrum of cognitive skills, there is no consensus regarding the duration of time from last use necessary to ameliorate these effects. A systematic review and series of meta-analyses were undertaken to assess anticipated gains in verbal learning with longer periods of cannabis abstinence. Studies assessing verbal learning performance in abstinent regular cannabis users and nonusing control participants; studies reporting length of cannabis abstinence at the time of neuropsychological assessment; and studies implementing one of three highly comparable measures of verbal learning and memory were included in the analyses. The included tasks have demonstrated some of the most robust declines associated with cannabis use and are prevalent in the clinical practice of neuropsychology. We assessed associations between cannabis abstinence and verbal learning scores via mixed effects subgroup analyses. Twenty-three studies (k = 28; N = 1,711) met all inclusion criteria. Cannabis users abstinent for 7 days or fewer performed worse than controls on verbal learning tasks, whereas cannabis users abstinent for longer periods showed no average significant difference in verbal learning performance compared with controls. Based on available evidence, some amelioration of verbal learning limitations presumed to result from cannabis appear to resolve between 7 and 28 days of sustained abstinence. However, in the reviewed studies, years of regular use were inversely related to longer periods of abstinence and verbal learning performance, undermining a confident inference that abstinence alone has direct benefits to verbal learning and memory. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Head to Head Clinical Comparison of Two Confrontation Naming Measures in Spanish Speaking People with Epilepsy

Abstract Objective The incidence of epilepsy in Hispanic, adult Spanish-speaking people with epilepsy (PWE) residing in the United States is nearly twice that of non-Hispanic US adults. Neuropsychologists are asked to discern if test findings reveal lateralization or localization regarding known epileptiform activity. Given the high stakes nature of surgical procedures (e.g., partial temporal lobectomy), it is imperative that intervention approaches are guided by valid and reliable neuropsychological measures. Identifying these measures is especially challenging in this underserved group, where test options are limited. The purpose of the present investigation was to compare the clinical utility of two confrontation naming measures, the Pontón-Satz Modified Boston Naming Test (MBNT) and the Vocabulario Sobre Dibujos subtest from the Batería III Woodcock-Muñoz. Participants and Method Seventy-one Hispanic, primarily immigrant, Spanish-speaking PWE underwent neuropsychological assessment which included both confrontation naming measures. Seizure lateralization was agreed upon by consensus via an interdisciplinary epilepsy conference (left hemisphere [LH] = 35, right hemisphere [RH] = 36). Results Analyses used education adjusted standard scores. Independent t-tests revealed that, as expected, LH Vocabulario Sobre Dibujos scores were significantly lower than RH, t(69) = 2.0, p = 0.049. Notably, LH and RH MBNT scores did not significantly differ. ROC analyses of Vocabulario Sobre Dibujos yielded adequate classification accuracy (AUC = 0.639, p < .05; Sensitivity = 71%; Specificity = 89%); however, the MBNT was not significant (AUC = 0.594, p = .17). Conclusions Education adjusted standard scores for Vocabulario Sobre Dibujos outperformed the MBNT for detecting language impairment as well as discriminating between seizure laterality; thus, suggesting a need for further investigation and, possibly, evidence-based change in clinical neuropsychological practice with US Spanish speaking PWE.

Clinical Neuropsychology: Status in Western Countries and Potential in Lithuania

We present an overview of the development of clinical neuropsychology, the current status of the specialty of clinical neuropsychology in Western countries, and the possibilities of developing this specialty in Lithuania. The main duties of a clinical neuropsychologist are to perform neuropsychological assessments and clinical interventions. Clinical neuropsychologists working within health care are professionals who offer services to patients across the lifespan with cognitive and behavioral/emotional symptoms related to neurological, developmental, and psychiatric disorders. Specialists of clinical neuropsychology are needed in neurology and psychiatry clinics, in centers of mental health and rehabilitation, and institutions of psychological assessment and education of children. The specialization models of clinical neuropsychology in Europe and North America are similar in their content and requirements for courses and practice. Nevertheless, specialist education in most of European countries is related to clinical training and not an academic degree, as it is in the USA and Canada. The duration of specialist education in clinical neuropsychology in Europe varies, but this education can only be started after acquiring a Master’s degree in most of the European countries. The regulation of the specialty of clinical neuropsychology in Europe also varies. In some countries, this specialty is fully legally regulated, and in some countries not regulated at all. For specialization in clinical neuropsychology, the license of a psychologist, enabling an individual to work in the health care system of the country, is required in most Western countries. Taking into consideration the Scandinavian experience, it can be expected that the planning of specialization studies in Lithuania would be easier if the licensing of psychologists would be regulated. Today, traditional specializations of psychology in Lithuania may be obtained through Master’s degree studies, i.e., a specialized Master’s diploma compensates a license and any need of further specialization. This Lithuanian tradition is not in accord with the EuroPsy politics of obtaining a diploma: a Master’s diploma is acquired within 6 years of studies, and, after these studies, specialization is continued for a few more years (participation in specialized courses, performance of supervised practice). The model of specialization in clinical neuropsychology in Lithuania should be developed in accordance with international standards of neuropsychology, which are in constant development. In Western countries, the knowledge and skills of clinical and health psychology are considered to be an important part of the specialist education in clinical neuropsychology. Therefore, two years of Master’s studies in clinical neuropsychology would not be sufficient when preparing competent clinical neuropsychologists, unless it is combined with a supervised neuropsychological practice of a defined duration. A doctoral degree is required for neuropsychological practice in the USA, but it is usually not required in Europe. In Lithuania, such a tradition for other specializations of psychology does not exist either, which suggests that a doctoral degree should not be necessary for the specialty of clinical neuropsychology as well. Nevertheless, like in Western countries, supervised clinical neuropsychological practice should be a necessary part of the specialists’ education in clinical neuropsychology.

Conducting neuropsychological assessment with transgender individuals

Objective: The purpose of this paper is to provide an overview of helpful clinical practices when working with transgender adult individuals. Method: While the number of openly transgender individuals appears to be growing with society’s increased acceptance and awareness, many neuropsychologists have had few opportunities to gain experience with this patient population. In this article, we review the existing literature as it relates to clinical neuropsychological practice. Results: We describe important terminology, ideals for creating an environment of respect, and how existing clinical guidelines for transgender individuals may apply to neuropsychology. In addition, we review the primary steps in the assessment process and provide a set of principles and recommendations for conducting neuropsychological assessments with transgender patients. Conclusions: There is a paucity of guidance in the field for working with transgender individuals. This article represents a step forward in the dialog and we look forward to future research that develops appropriate normative information, increases understanding of psychosocial factors, and better appreciates the range of hormonal influences for transgender individuals.

The worst performance rule with elderly in abnormal cognitive decline

Compared to best performances, worst performances on multi-trial psychometric tests often show stronger correlations with other g-loaded cognitive tests, which is known as the Worst Performance Rule (WPR). While worst performances may be more sensitive or specific to cognitive decline, clinical psychometric research and neuropsychological practice tends to neglect the WPR. Here, we examined the WPR-paradigm relative to abnormal cognitive decline. Specifically, we studied the WPR with binned simple reaction time task responses when rank-correlated with five different estimates of psychometric g within a memory clinic sample (n=103) of elderly diagnosed with either Mild Cognitive Impairment (MCI) (n=53) or dementia (n=50). Three of the g-estimates were composite scores constructed from 2, 6, and 28 established test scores. Results showed a consistent WPR-pattern in the whole sample for each of the five estimates (block design rs=−0.201 to −0.120; digit span rs=−0.284 to −0.112; g2 rs=−0.311 to −0.162; g6 rs=−0.314 to −0.107; g28 rs=−0.269 to −0.121). Our findings contradict classical test theory, and highlight the underused potential of the WPR when assessing cognitive dysfunction in elderly patients.

Prologue to special issue of ‘International Perspectives on Education, Training and Practice in Clinical Neuropsychology’

Prologue to special issue of ‘International Perspectives on Education, Training and Practice in Clinical Neuropsychology’

International perspectives on education, training, and practice in clinical neuropsychology: comparison across 14 countries around the world

Objective: To review and summarize data provided by special issue authors regarding the education, training, and practice of neuropsychologists from 14 surveyed countries. Method: A table was constructed to present an overview of variables of interest. Results: There is considerable diversity among surveyed countries regarding the education and training required to enter practice as a clinical neuropsychologist. Clinical neuropsychologists are typically well compensated, at least in comparison to what constitutes an average salary in each country. Conclusions: Despite substantial variations in education and training pathways, and availability of neuropsychologists from country to country, two common areas for future development are suggested. First, identification, development, and measurement of core competencies for neuropsychological education and practice are needed that can serve as a unifying element for the world’s clinical neuropsychologists. Second, greater emphasis on recognizing and addressing the need for assessment and treatment of diverse populations is needed if the world’s citizens can hope to benefit from the expertise of practitioners in our field.

The practice of clinical neuropsychology in Australia

Objective: This paper describes the development and practice of clinical neuropsychology in Australia. Method: Clinical Neuropsychology has shown rapid growth in Australia over the past three decades. Comprehensive and specialized training programs are producing high quality graduates who are employed in a broad range of settings or private practice. Results: Australia now has a substantial number of clinical neuropsychologists with specialist training. Whilst the majority of Australian clinical neuropsychologists still undertake assessment predominantly, there are growing opportunities for clinical neuropsychologists in rehabilitation and in a broad range of research contexts. Cultural issues relating to the assessment of Indigenous Australians and immigrants from many countries present significant challenges. Some major contributions have been made in the realms of test development and validation across various age groups. Australian clinical neuropsychologists are also contributing significantly to research in the fields of traumatic brain injury, aging and dementias, epilepsy, memory assessment, rehabilitation, substance abuse, and other psychiatric disorders. Conclusion: Expansion of roles of clinical neuropsychologists, in domains such as rehabilitation and research is seen as essential to underpin continuing growth of employment opportunities for the profession.

Development and application of neuropsychology in Hong Kong: implications of its value and future advancement

Objective: To review the development, application, and value of neuropsychology, and the standard education and training pathway for neuropsychologists or clinical neuropsychologists in Hong Kong. Method: The information provided here was gathered via a literature review of the status of neuropsychology and the validity of commonly adopted neuropsychological tests in Hong Kong. Additional details were acquired via the internet about local tertiary education curricula and the related requirements, the availability of professional associations for licensure or board certification, and relevant statistics/surveys conducted by the government. Some information about the clinical practice of neuropsychology was collected through personal communication with local clinical psychologists. Results: The development of neuropsychology in Hong Kong over the past 20 years is rapid and productive, given the increasing application of advanced neuroimaging techniques, neuropsychological tests, and opportunities for exchanging up-to-date neuropsychological knowledge and professional training through international conferences, workshops, and seminars. Given that neuropsychology services are often provided by clinical psychologists who are master’s degree graduates in clinical psychology, the relatively limited training in neuropsychological knowledge and skills and the lack of division for membership or mandatory registration as a neuropsychologist/clinical neuropsychologist may have an impact on the quality of clinical neuropsychological services and the development of this specialty. Conclusions: These findings signify a need for further improvement or refinement of educational and training pathways for neuropsychologist or clinical neuropsychologist along with the recognition of its value in clinical practice through registration of different disciplines of psychology in Hong Kong.

Clinical neuropsychology practice and training in Canada

Objective: This invited paper provides information about professional neuropsychology issues in Canada and is part of a special issue addressing international perspectives on education, training, and practice in clinical neuropsychology. Method: Information was gathered from literature searches and personal communication with other neuropsychologists in Canada. Results: Canada has a rich neuropsychological history. Neuropsychologists typically have doctoral-level education including relevant coursework and supervised practical experience. Licensure requirements vary across the 10 provinces and there are regional differences in salary. While training at the graduate and internship level mirrors that of our American colleagues, completion of a two-year postdoctoral fellowship in neuropsychology is not required to obtain employment in many settings and there are few postdoctoral training programs in this country. The majority of neuropsychologists are employed in institutional settings (e.g. hospitals, universities, rehabilitation facilities), with a growing number entering private practice or other settings. There are challenges in providing neuropsychological services to the diverse Canadian population and a need for assessment measures and normative data in multiple languages. Conclusions: Canadian neuropsychologists face important challenges in defining ourselves as distinct from other professions and other psychologists, in maintaining funding for high-quality training and research, in establishing neuropsychology-specific training and practice standards at the provincial or national level, and ensuring the clinical care that we provide is efficient and effective in meeting the needs of our patient populations and consumers, both within and outside of the publically funded health care system.

Associative reinstatement memory measures hippocampal function in Parkinson's Disease

In Parkinson's Disease (PD), hippocampal atrophy is associated with rapid cognitive decline. Hippocampal function is typically assessed using memory tests but current clinical tools (e.g., free recall) also rely on executive functions or use material that is not optimally engaging hippocampal memory networks. Because of the ubiquity of executive dysfunction in PD, our ability to detect true memory deficits is suboptimal. Our previous behavioural and neuroimaging work in other populations suggests that an experimental memory task – Associative Reinstatement Memory (ARM) – may prove useful in investigating hippocampal function in PD. In this study, we investigated whether ARM is compromised in PD and we assessed its convergent and divergent validity by comparing it to standardized measures of memory and of attention and executive functioning in PD, respectively. Using fMRI, we also investigated whether performance in PD relates to degree of hippocampal engagement. Fifteen participants with PD and 13 age-matched healthy controls completed neuropsychological testing as well as an ARM fMRI recognition paradigm in which they were instructed to identify word pairs comprised of two studied words (intact or rearranged pairs) and those containing at least one new word (new or half new pairs). ARM is measured by the differences in hit rates between intact and rearranged pairs. Behaviourally, ARM was poorer in PD relative to controls and was correlated with verbal memory measures, but not with attention or executive functioning in the PD group. Hippocampal activation associated with ARM was reduced in PD relative to controls and covaried with ARM scores in both groups. To conclude, ARM is a sensitive measure of hippocampal memory function that is unaffected by attention or executive dysfunction in PD. Our study highlights the benefit of integrating cognitive neuroscience frameworks and novel experimental tasks to improve the practice of clinical neuropsychology in PD.

Clinical neuropsychology in Israel: history, training, practice and future challenges

Objective: This is an invited paper for a special issue on international perspectives on training and practice in clinical neuropsychology. We provide a review of the status of clinical neuropsychology in Israel, including the history of neuropsychological, educational, and accreditation requirements to become a clinical neuropsychologist and to practice clinical neuropsychology. Method: The information is based primarily on the personal knowledge of the authors who have been practicing clinical neuropsychology for over three decades and hold various administrative and academic positions in this field. Second, we conducted three ad hoc surveys among clinical and rehabilitation psychologists; heads of academic programs for rehabilitation and neuropsychology; and heads of accredited service providers. Third, we present a literature review of publications by clinical neuropsychologists in Israel. Results: Most of the clinical neuropsychologists are graduates of either rehabilitation or clinical training programs. The vast majority of neuropsychologists are affiliated with rehabilitation psychology. The training programs (2–3 years of graduate school) provide solid therapeutic and diagnostic skills to the students. Seventy-five percent of the participants in this survey are employed at least part-time by public or state-funded institutions. Israeli neuropsychologists are heavily involved in case management, including vocational counseling, and rehabilitation psychotherapy. Conclusions and future goals: Although clinical neuropsychologists in Israel are well educated and valued by all health professionals, there are still several challenges that must be addressed in order to further advance the field and the profession. These included the need for Hebrew-language standardized and normalized neuropsychological tests and the application of evidence-based interventions in neuropsychological rehabilitation.

Neuropsychological Assessment of Hippocampal Integrity

ABSTRACTFinding methods to describe subcortical processes assisting cognition is an important concern for clinical neuropsychological practice. In this study, we reviewed the literature concerning the relationship between a neuropsychological instrument and the underlying neural substructure. We examined evidence indicating that one of the oldest neuropsychological tests still in use, the Rey Auditory Verbal Learning Test (RAVLT), includes reliable indicators of hippocampal integrity. We reviewed studies investigating the neural structures underlying seven tasks generated by the RAVLT, from the perspective of whether the performance of these tasks is dependent on the hippocampus. We found support for our hypothesis in five cases: learning capacity, proactive interference, immediate recall, delayed recall, and delayed recognition. No support for our hypothesis was found with regard to short-term memory and retroactive interference. The RAVLT appears to be a reliable tool for assessing the integrity of the hippocampus and for the early detection of dysfunction. There is a need for such assessments, due to the crucial role of the hippocampus in cognition, for instance, in terms of predicting future outcomes.

A Direct Comparison of Real-World and Virtual Navigation Performance in Chronic Stroke Patients

An increasing number of studies have presented evidence that various patient groups with acquired brain injury suffer from navigation problems in daily life. This skill is, however, scarcely addressed in current clinical neuropsychological practice and suitable diagnostic instruments are lacking. Real-world navigation tests are limited by geographical location and associated with practical constraints. It was, therefore, investigated whether virtual navigation might serve as a useful alternative. To investigate the convergent validity of virtual navigation testing, performance on the Virtual Tubingen test was compared to that on an analogous real-world navigation test in 68 chronic stroke patients. The same eight subtasks, addressing route and survey knowledge aspects, were assessed in both tests. In addition, navigation performance of stroke patients was compared to that of 44 healthy controls. A correlation analysis showed moderate overlap (r = .535) between composite scores of overall real-world and virtual navigation performance in stroke patients. Route knowledge composite scores correlated somewhat stronger (r = .523) than survey knowledge composite scores (r = .442). When comparing group performances, patients obtained lower scores than controls on seven subtasks. Whereas the real-world test was found to be easier than its virtual counterpart, no significant interaction-effects were found between group and environment. Given moderate overlap of the total scores between the two navigation tests, we conclude that virtual testing of navigation ability is a valid alternative to navigation tests that rely on real-world route exposure.

Stable measures of number sense accuracy in math learning disability: Is it time to proceed from basic science to clinical application?

Math learning disability (MLD) or developmental dyscalculia is a highly prevalent and persistent difficulty in learning arithmetic that may be explained by different cognitive mechanisms. The accuracy of the number sense has been implicated by some evidence as a core deficit in MLD. However, research on this topic has been mainly conducted in demographically selected samples, using arbitrary cut-off scores to characterize MLD. The clinical relevance of the association between number sense and MLD remains to be investigated. In this study, we aimed at assessing the stability of a number sense accuracy measure (w) across five experimental sessions, in two clinically defined cases of MLD. Stable measures of number sense accuracy estimate are required to clinically characterize subtypes of MLD and to make theoretical inferences regarding the underlying cognitive mechanisms. G. A. was a 10-year-old boy with MLD in the context of dyslexia and phonological processing impairment and his performance remained steadily in the typical scores range. The performance of H. V., a 9-year-old girl with MLD associated with number sense inaccuracy, remained consistently impaired across measurements, with a nonsignificant tendency to worsen. Qualitatively, H. V.'s performance was also characterized by greater variability across sessions. Concomitant clinical observations suggested that H. V.'s difficulties could be aggravated by developing symptoms of mathematics anxiety. Results in these two cases are in line with the hypotheses that at least two reliable patterns of cognitive impairment may underlie math learning difficulties in MLD, one related to number sense inaccuracy and the other to phonological processing impairment. Additionally, it indicates the need for more translational research in order to examine the usefulness and validity of theoretical advances in numerical cognition to the clinical neuropsychological practice with MLD.

Assessment of response bias in neurocognitive evaluations.

In clinical neuropsychological practice, assessment of response validity (e.g., effort, over-reporting, under-reporting) is an essential component of the assessment process. By contrast, other health care professionals, including those in neurorehabilitation settings, often omit assessment of this topic from their evaluations or only rely on subjective impressions. To provide the first comprehensive review of response validity assessment in the neurorehabilitation literature, including why the topic is often avoided, what methods are commonly used, and how to decrease false positives. A literature review and documentation of personal experience and perspectives was used to review this topic. There is a well-established literature on the necessity and utility of assessing response validity, particularly in patients who have external incentives to embellish their presentation or to under-report symptoms. There are many reasons why non-neuropsychologists typically avoid assessment of this topic. This poses a significant problem, particularly when patients exaggerate or malinger, because it can lead to misdiagnosis and it risks increasing the cost of healthcare by performing unnecessary tests and treatments, unfair distribution of disability/compensation resources, and a reduced access to these and other health resources by patients who genuinely need them. There is a significant need for non-neuropsychologists to develop and incorporate symptom and performance validity assessments in clinical evaluations, including those in neurorehabilitation settings.

Perception of Ethical Misconduct by Neuropsychology Professionals in Latin America

To date, extremely limited research has focused on the ethical aspects of clinical neuropsychology practice in Latin America. The current study aimed to identify the frequency of perceived ethical misconduct in a sample of 465 self-identified neuropsychology professionals from Latin America in order to better guide policies for training and begin to establish standards for practitioners in the region. Frequencies of neuropsychologists who knew another professional engaging in ethical misconduct ranged from 1.1% to 60.4% in the areas of research, clinical care, training, and professional relationships. The most frequently reported perceived misconduct was in the domain of professional training and expertise, with nearly two thirds of participants knowing other professionals who do not possess adequate training to be working as neuropsychologists. The least frequently reported perceived misconduct was in the domain of professional relationships. Nearly one third of participants indicated that they had never received formal training in professional ethics.

Visuospatial Learning in Traumatic Brain Injury: An Examination of Impairments using the Computerised Austin Maze Task

An important aspect of cognitive functioning that is often impaired following traumatic brain injury (TBI) is visuospatial learning and memory. The Austin Maze task is a measure of visuospatial learning that has a long history in both clinical neuropsychological practice and research, particularly in individuals with TBI. The aim of this study was to evaluate visuospatial learning deficits following TBI using a new computerised version of the Austin Maze task. Twenty-eight individuals with moderate-to-severe TBI were compared to 28 healthy controls on this task, together with alternative neuropsychological measures, including the WAIS-III Digit Symbol and Digit Span subtests, the Trail Making Test, WMS-III Logical Memory, and Rey Osterrieth Complex Figure Test. The results demonstrated that TBI individuals performed significantly more poorly on the Austin Maze task than control participants. The Austin Maze task also demonstrated good convergent and divergent validity with the alternative neuropsychological measures. Thus, the computerised version of the Austin Maze appears to be a sensitive measure that can detect visuospatial learning impairments in individuals with moderate-to-severe TBI. The new computerised version of the task offers much promise in that it is more accessible and easier to administer than the conventional form of the test.

Trends in the neuropsychological assessment of ethnic/racial minorities: a survey of clinical neuropsychologists in the United States and Canada.

Despite the importance of diversity variables to the clinical practice of neuropsychology, little is known about neuropsychologists' multicultural assessment practices and perspectives. The current study was the first to survey issues related to neuropsychologists' assessment of minority populations, proficiency in languages other than English, approaches to interpreting the cognitive scores of minorities, and perceived challenges associated with assessing ethnic/racial minority patients. We also surveyed respondents with regard to their own demographic backgrounds, as neuropsychologists who identify as ethnic/racial minorities are reportedly underrepresented in the field. Respondents were 512 (26% usable response rate; 54% female) doctorate-level psychologists affiliated with the International Neuropsychology Society or the National Academy of Neuropsychology who resided in the United States or Canada. Overall, results suggest that lack of appropriate norms, tests, and referral sources are perceived as the greatest challenges associated with assessment of ethnic/racial minorities, that multicultural training is not occurring for some practitioners, and that some are conducting assessments in foreign languages despite limited proficiency. In addition, ethnic/racial minorities appear to be grossly underrepresented in the field of neuropsychology. Findings are discussed in relation to the need for appropriate education and training of neuropsychologists in multicultural issues and the provision of more valid assessments for ethnic/racial minority individuals.

Intraindividual neuropsychological test variability in healthy individuals with high average intelligence and educational attainment

Knowledge of patterns of neuropsychological performance among normal, healthy individuals is integral to the practice of clinical neuropsychology, because clinicians may not always account for intraindividual variability (IIV) before coming to diagnostic conclusions. The IIV was assessed among a sample of 46 healthy individuals with high average intelligence and educational attainment, utilizing a battery of neuropsychological tests, including the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) and Wechsler Memory Scale, Fourth Edition (WMS-IV). The data indicated substantial variability in neurocognitive abilities. All participants were found to demonstrate scores considered impaired by at least 2 standard deviations (SDs). Despite adjusting for outliers, no participant produced a “normal” testing profile with an intraindividual maximum discrepancy (MD) of less than 1 SD in either direction. When WAIS-IV Full Scale IQ (FSIQ) was considered, participants generally demonstrated cognitive test scores ranging from 2 SDs less than to 1.5 SDs greater than their FSIQ. Furthermore, after demographic corrections, the majority (59%) of participants demonstrated at least 1 impaired cognitive test score, as defined by being 1 to 1.5 SDs below the mean. Overall, results substantiate the need for clinicians to consider FSIQ and educational attainment in interpretation of neuropsychological testing results, given the relevant commonality of “abnormal” test scores within this population. This may ultimately reduce the likelihood of making false-positive conclusions of impairment when educational attainment and intelligence are high, thus improving diagnostic accuracy.