Clinical Neuropsychology Research Articles

Nöropsikoloji Alanında Yapılan Akademik Çalışmaların Son 20 Yılı Üzerine Bir Bibliyometrik Analiz

Bibliometric analysis is an analysis study that examines the developments and academic studies in a field to be examined with methods such as common word analysis, citation analysis, bibliometric matching. When bibliometric analysis is applied in a very comprehensive field such as neuropsychology, it provides a good road map for researchers to determine the areas they will work in. However, when the literature on psychology and its subfields is reviewed, it is seen that the number of bibliometric analysis studies is quite low. For this reason, this study aims to analyze the last 20 years of academic studies in the field of neuropsychology. For this purpose, in the first stage of the research, articles on "neorupsychology" were searched in the WoS database, and the fields of psychology, clinical psychology, psychiatry, neuroscience, experimental psychology, behavioral sciences, developmental psychology, pediatrics, educational psychology, neuroimaging, biological psychology, social psychology, applied psychology and psychoanalytic psychology, which were considered to be most related to the field of neuropsychology, were selected. Common word analysis and social network analysis were performed on the articles containing the related words, and concept maps were created to enable visualization. Accordingly, it was observed that words such as "schizophrenia", "psychosis", "depression" lost their influence, albeit slowly, while words such as "assessment", "performance validity", "clinical neuropsychology", "rehabilitaion" increased their influence. It can be said that current studies in the field of neuropsychology have shifted away from focusing on a specific clinical condition and towards studies that include neuropsychological assessments and rehabilitation approaches.

Clinical Neuropsychology of Bilingual Mexican American Adults: Effect of Language Proficiency and Dominance.

To assess the association between language proficiency and absolute dominance on language versus visual-perceptual formatted and executive versus delayed memory neuropsychological measures in bilingual adults. Data from 55 bilingual, conversationally fluent, neurologically intact, Mexican American, consecutive, adults tested in separate sessions in Spanish and English in a counterbalanced order were analyzed. Age, years of education, self-reported language proficiency, Woodcock-Muñoz Language Survey-Revised (WMLS-R) picture vocabulary measures of language proficiency, and dominance (absolute Spanish-English WMLS-R difference scores) were correlated with 11 measures from La Batería Neuropsicólogica en Español and its original English language tests. Self-reported and WMLS-R measures of language proficiency were significantly correlated in each language. Absolute language dominance was not significantly associated with any Spanish or English neuropsychological raw score. The WMLS-R language proficiency, but not age or years of education, was significantly correlated with language-formatted neuropsychological measures of California Verbal Learning Test delayed free recall number of words (both languages), letter fluency (both languages), delayed story memory (in English), and Stroop interference (Spanish). Linear regression models using age, years of education, and WMLS-R picture vocabulary scores as predictors were significant for all these measures excepting the last. The WMLS-R language proficiency was not significantly associated with raw scores on any visual-perceptual formatted measure. Monolingual neuropsychological test norms for language-formatted tests likely overestimate bilingual Mexican Americans' performance.

Recognition subtests of the Repeatable Battery for the Assessment of Neuropsychological Status: evidence for a cortical vs. subcortical distinction

ABSTRACT Introduction Within clinical neuropsychology, a classic diagnostic distinction is made between cortical and subcortical disorders, especially based on their memory profiles. Typically, this is based on the comparison of recall and recognition trials, where individuals with cortical conditions do not tend to benefit (i.e., score well) on recognition trials and individuals with subcortical conditions do. Although the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a widely used brief cognitive battery, there is a lack of evidence to support this measure’s utility in distinguishing between the memory profiles of these conditions. Method Thirty-six mild Alzheimer’s disease (AD), 55 Parkinson’s disease (PD), and 105 essential tremor (ET) participants (N = 196) were administered the RBANS with additional Story and Figure Recognition subtests. Group differences on recall and recognition scores (Total Correct, Hits or True Positives, False Positive Errors, and discriminability index) were examined across the three groups, while controlling for the influence of age and gender. Results As expected, individuals with AD had poorer recognition scores compared to the other clinical groups across tasks (all p-values < .05), while the ET sample largely performed comparably to the PD sample. With the exception of comparable Figure Recognition and Recall in the PD sample, all groups exhibited significantly greater recognition Hit performance compared to Recall (all p-values < .05). Conclusions The group differences in performance across RBANS recognition subtests suggest support for traditional “cortical” and “subcortical” profiles. However, all groups, including the mild AD sample, demonstrated a benefit from recognition cues compared to free recall. Overall, these findings support the inclusion of the newly developed Story and Figure Recognition subtests in future clinical practice and research endeavors.

Characterizing cognitive function in patients with autoimmune encephalitis: an Australian prospective study

ObjectiveThis study uses the Wechsler intelligence and memory scales to characterize the cognitive function of patients with autoimmune encephalitis (AE) in the chronic stage of the disease. AE is a group of neuroinflammatory disorders, and cognitive impairment is a significant source of chronic morbidity in these patients.MethodsFifty patients with an average disease duration of 3.2 years after diagnosis were prospectively recruited from four hospitals. They underwent a comprehensive cognitive examination using the Wechsler Abbreviated Scale of Intelligence (WASI-II), Wechsler Adult Intelligence Scale (WAIS-IV) and Wechsler Memory Scale (WMS-IV). Summary statistics were computed, and single-sample and independent-samples t tests were used to compare the cohort to normative data.ResultsThe results revealed significantly reduced performances in perceptual reasoning, processing speed, and working memory among AE patients. Seropositive AE patients exhibited below-norm processing speed, while the seronegative group showed reduced working memory and processing speed. Delayed memory performance was significantly below expectations only in seronegative patients. Pattern analysis indicated that intact cognition was the most observed outcome after AE, but significant heterogeneity was observed among the impaired patients.ConclusionsThe study identified deficits in perceptual reasoning, processing speed, and working memory among chronic AE patients. Pattern analysis highlighted positive long-term cognitive outcomes for many but varied outcomes for those with ongoing difficulties. Although severely cognitively impaired patients were not included, the findings apply to AE cohorts who attend outpatient clinical neuropsychology consultations emphasizing the need for thorough cognitive assessment. The results suggest a need for further research targeting other cognitive domains, including executive functions.

Neuropsychology of Generalized Anxiety Disorder in Clinical Setting: A Systematic Evaluation.

This research paper provides a systematic review of the neuropsychology of generalized anxiety disorder (GAD), examining relevant articles' methodologies and subject matter and highlighting key findings. It suggests potential cognitive deficits in GAD patients, such as subtle attention, executive function, and working memory deficiencies. It also discusses neural correlates of GAD, particularly the hyperactivity in the amygdala and insula, and the additional impact of comorbidity with other psychiatric disorders. The paper uses the PRISMA methodology and draws data from the PsycINFO, Scopus, PubMed, and Elsevier databases. Although the reviewed research has contributed to understanding GAD's cognitive and neural mechanisms, further research is required. Additionally, the paper mentions the clinical neuropsychology of GAD, including strategies and treatments, such as cognitive behavioral therapy (CBT), mindfulness, and medication. Lastly, the review identifies the limitations of the existing research and recommends future directions to enhance the understanding of GAD's underlying cognitive and neural mechanisms. The neural underpinnings of GAD encompass heightened activity within the amygdala and insula, which are brain regions implicated in processing adverse emotional reactions. Co-occurring psychiatric disorders, such as major depressive disorder (MDD), can also impact neuropsychological functioning. Additional investigation is warranted to better understand the intricate interplay between GAD, cognitive performance, and underlying neural processes.

Training in Neurorehabilitation Psychology: Defining Competencies, Requisite Skill Sets, and a Proposed Developmental Pathway

Psychologists have been applying neurorehabilitation models of care for many years. These practitioners come from different training backgrounds and use a variety of titles to refer to themselves despite considerable overlap in practice patterns, professional identification, and salary. Titles like ‘neurorehabilitation psychologist’ and ‘rehabilitation neuropsychologist’ are sometimes used by practitioners in the field to indicate their specialty area, but are not formally recognized by the American Psychological Association, the American Board of Professional Psychology, or by training councils in clinical neuropsychology (CN) or rehabilitation psychology (RP). Neither the CN or RP specialties alone fully address or define the competencies, skill sets, and clinical experiences required to provide high quality, comprehensive neurorehabilitation psychology services across settings. Therefore, irrespective of practice setting, we believe that both clinical neuropsychologists and rehabilitation psychologists should ideally have mastery of specific, overlapping competencies and a philosophical approach to care that we call neurorehabilitation psychology in this paper. Trainees and early career professionals who aspire to practice in this arena are often pressured to prioritize either CN or RP pathways over the other, with anxiety about perceived and real potential for falling short in their training goals. In the absence of an explicit training path or formal guidelines, these professionals emerge only after the opportunity, privilege, or frank luck of working with specific mentors or in exceptional patient care settings that lend themselves to obtaining integrated competencies in neurorehabilitation psychology.This paper reflects the efforts of 7 practitioners to preliminarily define the practice and philosophies of neurorehabilitation psychology, the skill sets and competencies deemed essential for best practice, and essential training pathway elements. We propose competencies designed to maximize the integrity of training and provide clear guideposts for professional development.

A pilot examination of the validity of stylus and finger drawing on visuomotor-mediated tests on ACEmobile

ABSTRACT Introduction Cognitive assessments, such as the Addenbrooke’s Cognitive Examination (ACE-III) and Montreal Cognitive Assessment (MoCA), have been modified for administration using tablet computers. While this offers important advantages for practice, it may also threaten the test validity. The current study sought to test whether administering visuospatial and writing tests using a tablet (finger or stylus drawing), would demonstrate equivalence to traditional pencil and paper administration on ACEmobile. Method This study recruited 26 participants with Alzheimer’s disease and 23 healthy older adults. Most participants had low familiarity with using a tablet computer. Participants completed ACEmobile in its entirety, after which they repeated the infinity loops, cube, and clock drawing and sentence writing tests by drawing with a stylus and their finger onto an iPad. Performance on the drawing and writing tests using a stylus, finger, and pencil were compared. Results Statistically significant differences were observed between the finger and pencil administration on the ACEmobile, with participants performing worse on the finger drawing trials. Differences in scores were most apparent on the sentence writing task. In contrast, no statistical differences were observed between the pencil and stylus administration. Discussion The findings of this pilot study have important implications for clinical neuropsychology and demonstrate that administering ACEmobile drawing tests with finger drawing is invalid. However, due to the small sample size, a lack of counterbalancing and the narrow range of scores of the dependent variable, we are unable to confidently interpret the validity of stylus drawing. This is an important consideration for future research.

Recent Advances in Neuropsychological Test Interpretation for Clinical Practice.

Much attention in the field of clinical neuropsychology has focused on adapting to the modern healthcare environment by advancing telehealth and promoting technological innovation in assessment. Perhaps as important (but less discussed) are advances in the development and interpretation of normative neuropsychological test data. These techniques can yield improvement in diagnostic decision-making and treatment planning with little additional cost. Brooks and colleagues (Can Psychol 50: 196-209, 2009) eloquently summarized best practices in normative data creation and interpretation, providing a practical overview of norm development, measurement error, the base rates of low scores, and methods for assessing change. Since the publication of this seminal work, there have been several important advances in research on development and interpretation of normative neuropsychological test data, which may be less familiar to the practicing clinician. Specifically, we provide a review of the literature on regression-based normed scores, item response theory, multivariate base rates, summary/factor scores, cognitive intraindividual variability, and measuring change over time. For each topic, we include (1) an overview of the method, (2) a rapid review of the recent literature, (3) a relevant case example, and (4) a discussion of limitations and controversies. Our goal was to provide a primer for use of normative neuropsychological test data in neuropsychological practice.

French adult normative data for a Standard Executive Neuropsychological Test Battery.

Executive impairments are frequent and may concern a large spectrum of health conditions throughout life. Given the complexity of the executive functions, their assessment requires the administration of multiple tests. There is only one source of French-language normative data for seven traditional executive tests for adults under age 50. The aim of the present study was to establish demographically adjusted normative data of four executive tests commonly used during the neuropsychological assessment in France for adults aged 18-65. The following tools were administered to 518 community adults aged from 18 to 65: Digit Span, Trail Making Test, Color Word Interference Test, and Verbal Fluency Test. An Overall Test Battery Mean was computed. Multiple regressions were computed for normally distributed scores and percentiles were established for non-normally distributed scores. Multiple regression analyses indicated that younger age and higher education were both associated with better performance. Age did not predict the number of correct responses on the Verbal Fluency Test. Gender did not have any effect on executive performances. Regression equations to calculate Z-scores are presented. Percentiles are presented for the number of recorded errors on the Trail Making Test, Color Word Interference Test, and Verbal Fluency Test. We provide reliable and updated norms for four executive tests that are among the most used by clinical neuropsychologists in France. Our work represents a valuable addition to the limited norms currently available for the assessment of executive functions in French young and middle-aged adults.

Variability across subjects in free recall versus cued recall.

Memory scientists usually compare mean performance on some measure(s) (accuracy, confidence, latency) as a function of experimental condition. Some researchers have made within-subject variability in task performance a focal outcome measure (e.g., Yao et al., Journal of Clinical and Experimental Neuropsychology, 38, 227-237, 2016). Here, we explored between-subject variability in accuracy as a function of experimental conditions. This work was inspired by an incidental finding in a previous study, in which we observed greater variability in accuracy of memory performance on cued recall (CR) versus free recall (FR) of English animal/object nouns (Mah et al., Frontiers in Psychology, 14, 1146200, 2023). Here we report experiments designed to assess the reliability of that pattern and to explore its causes (e.g., differential interpretation of instructions, [un]relatedness of CR word pairs, encoding time). In Experiment 1 (N = 120 undergraduates), we replicated the CR:FR variability difference with a more representative set of English nouns. In Experiments 2A (N = 117 Prolific participants) and 2B (N = 127 undergraduates), we found that the CR:FR variability difference persisted in a forced-recall procedure. In Experiment 3 (N = 260 Prolific participants), we used meaningfully related word pairs and still found greater variability in CR than in FR performance. In Experiment 4 (N = 360 Prolific participants), we equated CR and FR study phases by having all participants study pairs and, again, observed greater variability in CR than FR. The same was true in Experiment 5 (N = 120 undergraduates), in which study time was self-paced. Comparisons of variability across subjects can yield insights into the mechanisms underlying task performance.

Salutogenic Landscape Design with Cognitive Restoration Stimuli for Stress Intervention

This study explores the potential of neighbourhood parks in reducing stress and promoting mental well-being in urban settings. Through in-depth interviews with experts in clinical psychology, neuropsychology, and landscape architecture, landscape attributes influencing psychological well-being were identified. Thematic analysis revealed the importance of human-centred design and incorporating elements that inspire enthusiasm for cognitive restoration. The study resulted in a salutogenic and cognitive landscape framework that integrating cognitive behavioural therapy (CBT) into the park design. This framework offers valuable insights and practical guidance for creating healing spaces in neighbourhood parks, catering to physical and psychological needs in urban environments.

The utility of the MMPI-3 in predicting substance use related problems in a clinical neuropsychology sample

Assessing for problematic substance use in neuropsychological assessments is crucial for differential diagnosis and attribution of symptom causes. The current investigation examines the utility of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3 in predicting such substance use in a clinical neuropsychology sample. Participants included 208 outpatient neuropsychological examinees. Correlations and risk ratios were calculated for externalizing-psychopathology-related scales and external substance use criteria. Hierarchical regressions examined the incremental prediction of criteria by MMPI-3 externalizing scales above the Substance Abuse (SUB) scale. Results indicate that MMPI-3 externalizing scales are associated with substance-use-related criteria as conceptually expected. Additionally, we report significantly increased risk of experiencing substance-use-related problems at various T score elevations on multiple externalizing scales. Finally, SUB served as the primary predictor of substance-use-related criteria. These findings support the ability of the MMPI-3 to assess for past or current substance use and negative consequences of substance use in a clinical neuropsychology setting.

Arguments for a theoretical realignment in the assessment and remediation of memory in clinical neuropsychology: Contribution of functionalism

The conception of memory as structurally and functionally different multiple systems is largely dominant in clinical neuropsychology at least in France. In addition to the focus on the structure of memory or its components, we suggest that it would be clinically more relevant for psychologists to also consider in conjunction a functional and processes-based approach to memory. Despite longstanding disagreement in the literature between these approaches, we encourage psychologists to perceive each memory conception as proposing different levels of explanation and therefore focusing on complementary questions; how is the patient's memory: efficient or impaired, relying more on a structural analysis or why it works this way, based on process identification. The present article proposes a reflection in favor of a theoretical realignment in the assessment and remediation of memory in clinical neuropsychology. It suggest that the structural and functional approaches to memory can coexist in parallel in clinical neuropsychology, advocating the freedom of the clinician to rely on one or the other approach depending on the level of explanation sought, the question asked or the therapeutic goals.

A survey of neuropsychological assessment feedback practices among neuropsychologists

Objective Feedback on neuropsychological assessment is a critical part of clinical practice, but there are few empirical papers on neuropsychological feedback practices. We sought to fill this gap in the literature by surveying practicing neuropsychologists in the United States. Questions addressed how they provide verbal and written feedback to patients and referral sources. Survey questions also addressed billing practices and training in the provision of feedback. Methods A survey was developed using Qualtrics XM to survey currently licensed, independently practicing clinical neuropsychologists in the United States about their feedback practices. The survey was completed by 184 individuals. Results Nearly all respondents reported that they provide verbal feedback to patients, most often in-person, within three weeks following testing. Typically, verbal feedback sessions with patients last 45 min. Verbal feedback was provided to referrals by about half of our sample, typically via a brief phone call. Most participants also reported providing written feedback to both the patient and referring provider, most commonly via the written report within three weeks after testing. Regarding billing, most respondents use neuropsychological testing evaluation codes. The COVID-19 pandemic appeared to have had a limited impact on the perceived effectiveness and quality of verbal feedback sessions. Finally, respondents reported that across major stages of professional development, training in the provision of feedback gradually increased but was considered inadequate by many participants. Conclusions Results provide an empirical summary of the “state of current practice” for providing neuropsychological assessment feedback. Further experimental research is needed to develop an evidence-base for effective feedback practices.

What counts? A Delphi consensus-based approach to interpreting accreditation standards for Direct Client Activities in clinical psychology and clinical neuropsychology programs

ABSTRACT Objective Despite operating from the same professional accreditation standards, discrepancies in what is recorded as Direct Client Activities (DCA) in postgraduate psychology trainee logbooks have been noted across training programs in Australia. The aim of this study was to create a consensus-based list of DCA to guide the completion of trainee logbooks while undertaking practicums in clinical psychology or clinical neuropsychology. Method A modified Delphi approach was used to gather data across three rounds. Two expert panels, representing the two areas of practice endorsement (AoPEs), rated the degree to which they agreed or disagreed with a range of activities being recorded as DCA in trainee logbooks. Activities with over 80% agreement or disagreement during any round were accepted or rejected from the final list, respectively. Results Sixteen activities for clinical psychology and 30 activities for clinical neuropsychology were endorsed by the expert panels. Only nine activities across the two panels did not reach consensus over the three rounds. Conclusions This study has created a list of consensus activities within these two AoPEs which will facilitate benchmarking activities, and reduce confusion and anxiety for trainees, supervisors, and placement coordinators. Discrepancies do, however, remain across the AoPEs, warranting further clarification and definition refinement.

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

Abstract Purpose Concussions are a major public health concern and are caused by falls, motor vehicle accidents, sports-related injuries, and assaults. Concussion research increased dramatically in recent decades, with 1,015 articles about concussion listed in PubMed in 2020, up from 30 in 2000. The focus of concussion research is evolving from assessment tools towards education, biomarkers, and intervention. Little is known about the topics of concussion research in clinical neuropsychology, but this knowledge might direct research efforts in the future. Data Selection We coded the content of titles of concussion articles published in 12 clinical neuropsychological journals from 2010-2020. This project is part of a study about the cultural and multicultural content of clinical neuropsychology articles. From this larger dataset, titles that included the terms concussion, sub-concussive, mild traumatic brain injury were collected (n=317). Data Synthesis Content in titles for concussions articles were, in order, sports (29.0%), children/adolescents (23.3%), emotion and personality issues (23.0%), post-concussive symptoms (12.9%), psychiatric symptoms (12.9%), military (15.8%), sex differences (2.5%), multiple concussions (2.5%), cultural or multicultural neuropsychology (2.2%), and older adults (1.3%). Conclusions Clinical neuropsychology research is proportionately over-focused on sports concussion to the exclusion of other causes of concussion. That said, sports concussion is easier to study than other causes of concussion and thus, this work has tremendous value for the field. Concussion research would best serve public health by focusing more on sex differences, multicultural issues, and other individual difference factors that alter risk for and recovery from concussion.

Sensitivity and Specificity of the Brentano Illusion Test in the Detection of Visual Hemi-Field Deficits in Patients with Unilateral Spatial Neglect.

Stroke survivors with right-brain damage (RBD) often present with attentional deficits such as left unilateral spatial neglect. Some patients also present with contralesional visual hemi-field deficits. A late detection of visual hemi-field deficits (VHFD) contributes to hampering neurorehabilitation and functional outcome of patients with neglect. The Brentano Illusion Test (BRIT) may be used for an early detection of VHFD during the neuropsychological assessment. In the present study, we determined the sensitivity and specificity of the BRIT for screening VHFD in patients with neglect. Sixty-four consecutive RBD patients were examined. Forty-five presented with neglect. Of these, 23 presented with VHFD (hemianopia or quadrantanopia) as detected by the Humphrey automated static visual field testing (reference standard). Consecutive patients also included 19 participants without neglect, who did not have any VHFD. The sensitivity and specificity of the BRIT for neglect patients were 78.3% (95% CI: 61.4-95.1) and 90.9 (95% CI: 78.9-100.0), respectively. Positive predictive value (PPV) was 89.6% (95% CI: 76.4-100.0); negative predictive value (NPV) 80.7% (95% CI: 65.2-96.2). No false positives in the group without neglect were identified. We conclude that the BRIT is an effective tool for clinical neuropsychologists to screen for possible VHFD in neglect patients during the neuropsychological assessment, allowing the refinement of the clinical picture in the neuropsychological report. An early detection of VHFD also allows referring the patient to standard diagnostics for a formal visual field examination, right from the first neuropsychological assessment.

Awake craniotomy does not lead to increased psychological complaints.

Patients with brain tumours are increasingly treated by using the awake craniotomy technique. Some patients may experience anxiety when subjected to brain surgery while being fully conscious. However, there has been only limited research into the extent to which such surgeries actually result in anxiety or other psychological complaints. Previous research suggests that undergoing awake craniotomy surgery does not lead to psychological complaints, and that post-traumatic stress disorders (PTSD) are uncommon following this type of surgery. It must be noted, however, that many of these studies used small random samples. In the current study, 62 adult patients completed questionnaires to identify the degree to which they experienced anxiety, depressive and post-traumatic stress complaints following awake craniotomy using an awake-awake-awake procedure. All patients were cognitively monitored and received coaching by a clinical neuropsychologist during the surgery. In our sample, 21% of the patients reported pre-operative anxiety. Four weeks after surgery, 19% of the patients reported such complaints, and 24% of the patients reported anxiety complaints after 3months. Depressive complaints were present in 17% (pre-operative), 15% (4weeks post-operative) and 24% (3months post-operative) of the patients. Although there were some intra-individual changes (improvement or deterioration) in the psychological complaints over time, on group-level postoperative levels of psychological complaints were not increased relative to the preoperative level of complaints. The severity of post-operative PTSD-related complaints were rarely suggestive of a PTSD. Moreover, these complaints were seldom attributed to the surgery itself, but appeared to be more related to the discovery of the tumour and the postoperative neuropathological diagnosis. The results of the present study do not indicate that undergoing awake craniotomy is associated with increased psychological complaints. Nevertheless, psychological complaints may well exist as a result of other factors. Consequently, monitoring the patient's mental wellbeing and offering psychological support where necessary remain important.

Screening for Dementia in Audiology Clinics – Advantages, Pitfalls, and Recommendations

Screening for Dementia in Audiology Clinics – Advantages, Pitfalls, and Recommendations

Parental, caregiving, and family leave during clinical neuropsychology postdoctoral training: Recommendations and guidelines from the Women in Neuropsychology (WIN) committee and Education Advisory Committee (EAC) of the Society for Clinical Neuropsychology (SCN; APA division 40)

Objective: Parental and other caregiving leave is important to postdoctoral fellows, yet there is no field-wide recommendation for leave policies among clinical neuropsychology postdoctoral training programs, which is of particular relevance given the two-year requirement for eligibility for board certification. The aims of this manuscript are to (a) discuss general guidelines and recommendations for leave policies, both informed by prior empirical evidence as well as relevant existing policy guidelines from various academic and healthcare organizations, and (b) use vignettes to provide possible solutions for potential leave scenarios. Method: A critical review of literature on family leave from public policy and political science, industrial-organizational psychology, academic medicine, and psychology was conducted and findings were synthesized. Results and Conclusions: Fellowship training programs are encouraged to adopt a competency-based model that permits flexibility in leave during training without necessarily requiring an extended end date. Programs should adopt clear policies and make this information readily available to trainees and think flexibly about training options that best meet the training needs and goals of each individual. We also encourage neuropsychologists at all levels to engage in advocacy for broader systemic supports of trainees seeking equitable family leave.