Neuropsychological Services Research Articles

Fetal Alcohol Spectrum Disorder and Neuropsychology: Exploring the implications of new NICE quality standards (2022) for neuropsychologists through a pilot assessment service

Recently released NICE Quality Standards for the assessment and diagnosis of Fetal Alcohol Spectrum Disorder (FASD) in children and young people emphasise neuropsychological assessment as an important part of the process. However, for many areas of England & Wales this may not be in line with current service provision. We conducted a scoping study of services within Oxfordshire to understand the current support available for children with possible FASD. In addition, we offered a pilot neuropsychology assessment service for seven children referred by a Community Paediatrician. We found that many services across Oxfordshire work with children who they suspect to have FASD, but no service offers FASD assessment or specific intervention. A trial neuropsychology service confirmed evidence for significant heterogeneity within this population, and therefore the need for careful, hypothesis driven assessment, to which neuropsychologists are well-placed to contribute.

Culturally and Linguistically Informed Neuropsychological Evaluation Protocol for Primarily Spanish-Speaking Adults

The Latina(o)/Hispanic (L/H) population represents the largest and fastest-growing ethnic group in the United States. Migration patterns have evolved and greater diversity (i.e., country of origin) is evident, highlighting the ever-changing heterogeneity of this community and the need for the field of neuropsychology to ensure equitable care for linguistically and culturally diverse communities. This paper aims to provide a flexible protocol of neuropsychological instruments appropriate for primarily Spanish-speaking adults residing in the United States. Spanish measures were selected based on availability, translations/cultural modifications, accompanying normative data sets, and clinician experience/acumen. Bilingual/bicultural providers of neuropsychological services to Spanish speakers across the training spectrum working at U.S.-based medical centers implemented a multimodal approach (i.e., literature search, clinical practice parameters, and focus groups) in the development of a multi-domain primary protocol that includes core and supplemental measures that are appropriate for individuals with varying linguistic proficiency and sociocultural demographic characteristics. A multi-domain, evidence-based, flexible neuropsychological protocol is presented. Recommendations for test selection based on sociocultural demographic factors and examples of clinical assessment practices are provided via a case illustration. Most instruments included may be applied across cultural and regional backgrounds. Provision of neuropsychological services to primarily Spanish-speaking adults presents unique challenges. Existing Spanish measures and accompanying data rarely capture the heterogeneity of L/H individuals. Although Spanish has the largest number of neurocognitive instruments, relative to other languages, robust and representative norms continue to be scarce. Future studies should prioritize collecting normative data from educationally and geographically diverse samples.

Culturally Informed Neuropsychological Evaluations in Pediatric Epilepsy: Evidence-Based Practice Considerations.

Epilepsy is one of the most common reasons for referral for a pediatric neuropsychological evaluation due its high prevalence in childhood and our well-established clinical role in tertiary care settings. Emerging evidence indicates that racial and ethnic minority populations experience increased epilepsy burden compared with White peers. Although there has been heightened recognition in our specialty regarding the dire need for culturally and linguistically responsive evaluations, the scientific evidence to support effective neuropsychological service delivery for bi/multilingual and bi/multicultural youth with epilepsy is comparatively scant and of poor quality. As a result, significant patient and clinical challenges exist, particularly in high stakes presurgical pediatric epilepsy evaluations of bi/multilingual and bi/multicultural children. Given that Spanish is the most common language spoken in the United States after English, this paper will focus on Spanish and English measures, but will provide evidence-based practice considerations that can inform practices with other non-English speaking communities. Cultural and linguistic factors that affect clinical decision-making regarding test selection, test interpretation, and feedback with families are highlighted. We offer a review of neuropsychological profiles associated with pediatric epilepsy as well as a flexible, multimodal approach for the assessment of linguistically and culturally diverse children with epilepsy based on empirical evidence and the clinical experiences of pediatric neuropsychologists from diverse backgrounds who work with children with epilepsy. Limitations to this approach are discussed, including the lack of available measures and resources for culturally and linguistically diverse pediatric populations. A case illustration highlights a culturally informed assessment approach.

Centering Culture in Neuropsychological Training, Research, and Practice

During the past “long” decade, a confluence of events raised the consciousness within the discipline that neuropsychology has inadequately addressed the needs of minoritized patients. In 2010, Rivera Mindt, Byrd, Saez, and Manly (2010) challenged the discipline to improve access to competent neuropsychological services to minoritized patients by diversifying the workforce and increasing cultural competence through multicultural training, education, and research. This issue gained traction in 2014 with the projection that the United States will become a minority majority population in 2044 (Colby & Ortman, 2014). The American Academy of Clinical Neuropsychology (AACN) responded with the 2016 Relevance 2050 initiative which argued that neuropsychology must prepare itself for this demographic change, which is both a social justice and economic issue, as the discipline would become “increasingly irrelevant in the healthcare marketplace” if it were unable to provide competent neuropsychological services to its patient population (AACN, n.d.). Twin pivotal events in 2020 catalyzed the disciplines’ social consciousness at an emotional level. First, the morbidity and mortality of the COVID-19 pandemic illuminated the gravity of health disparities for Blacks, Hispanics, and Native Americans, and ingrained racist attitudes toward Asian Americans. Second, the world witnessed the inhumane murder of George Floyd, which was just one of a string of unarmed Black citizens killed by white police officers, most often with no legal repercussions. The profundity of institutional racism could no longer be ignored.

Alcy R. Torres, MD

Dr Alcy Torres is a pediatric neurologist who specializes in traumatic brain injury. Much of his clinical work takes place around the Pediatric Concussion Program at Boston Medical Center; a multidisciplinary center coordinating care between the Emergency Room, the inpatient and outpatient services but also the common referrals to Physical, Vestibular, Ocular, Speech therapies and Neuropsychology services. His aim is to provide the highest level of care to children and adolescents who have sustained a brain injury by understanding the pathophysiology of the pediatric patient through research and enhancing the health and well-being of patients, minimizing distress, and preventing longer-term difficulties.In order to achieve this goal, he has developed a Standardized Clinical Assessment and Management Plans, now adopted by the Adult Concussion Clinic at Boston University to continuously review individual patient data for areas in our practice that need improvement, thus ensuring that the Brain Injury program always provides the best, most cost-effective care for our patients. Another goal of the center is access to acute and follow-up care, to which end we began developing an open access clinic in 2013 to provide services at Boston Medical Center, our satellites and across different different specialties.

Innovations in Neuropsychology: Future Applications in Neurosurgical Patient Care

Over the last century, collaboration between clinical neuropsychologists and neurosurgeons has advanced the state of the science in both disciplines. These advances have provided the field of neuropsychology with many opportunities for innovation in the care of patients prior to, during, and following neurosurgical intervention. Beyond giving a general overview of how present-day advances in technology are being applied in the practice of neuropsychology within a neurological surgery department, this article outlines new developments that are currently unfolding. Improvements in remote platform, computer interface, "real-time" analytics, mobile devices, and immersive virtual reality have the capacity to increase the customization, precision, and accessibility of neuropsychological services. In doing so, such innovations have the potential to improve outcomes and ameliorate health care disparities.

The Evolving Need for Neuropsychology in Neurosurgical Settings: Challenges Facing Transformative Care

Clinical neuropsychology has been a valuable asset to neurologic surgery, contributing to lateralization and localization of pathologic brain tissue, identification of eloquent cortex, and evaluation of postoperative neuropsychological functioning. Moreover, neuropsychologists provide empirically driven interventions aimed at supporting preparation and/or recovery of neurosurgery patients. Nonetheless, several challenges may limit the reliability, validity, and generalizability of the assessment data obtained and reduce the usefulness of other neuropsychological services provided. Specifically, linguistic, cultural, educational, and other biases associated with demographic characteristics can lead to a narrowed view of an individual's life experiences, which must be confronted to fulfill the mission of ensuring that all patients have access to care that is appropriate to their needs. Instead of perceiving these challenges as insurmountable barriers, such issues can be viewed as opportunities to catalyze change and foster innovation for the future of neuropsychological care in neurosurgical settings. In addition to reviewing the possible mechanisms of these obstacles, the current article offers tangible solutions at both a macro level (e.g., discipline-wide transformations) and micro level (e.g., individualized patient-centric approaches). Outlined are practical techniques to potentially improve consensus and standardization of methods, advance and globalize research, expand representativeness of measures and practices to serve diverse individuals, and increase treatment adherence through engagement of patients and their families.

Teleneuropsychology during the COVID-19 pandemic in Mexico: the perspective from a middle-income country

ABSTRACT Introduction The use of teleneuropsychology (TeleNP) increased as a result of the COVID-19 pandemic; however, there have been no studies of the benefits and difficulties with this modality in middle-income countries. This study aimed to assess the current use of TeleNP in Mexico. Method Mexican neuropsychologists were invited to participate in an online survey regarding the use of TeleNP during the COVID-19 pandemic. The survey was based on issues from a literature review and consisted of 36 questions requiring yes/no, multiple choice, or ordinal answers. The survey was created using Google Forms and asked respondents to provide informed consent. A total of 107 clinical neuropsychologists completed the survey. Results 82% of participants currently use TeleNP, and most reported learning about TeleNP through personal experience, literature research, and colleagues. Brief evaluations, delivery of results, and intervention were the principal services provided, most frequently on a home-to-home basis. Almost 30% of clinicians reported not requiring informed consent for use of the modality. Consultations included children, adolescents, and adults in similar numbers; older adults were less frequent. Technological limitations were the most frequent reason for ruling out the modality with particular patients. Perceived benefits included the ability to continue consultations despite social distancing measures, lesser risk of COVID-19 infection, and the possibility of seeing patients with limited access to neuropsychological services. Reasons for not using TeleNP included a lack of standardized instruments, not feeling comfortable with the modality, and lack of technological resources and skills. Conclusions Despite the socioeconomic differences between Mexico and high-income countries, most of our findings were similar to reports from those countries. However, technological limitations were common, and smartphones were commonly used, contrary to recommendations in the literature. The future use of TeleNP in Mexico should include formal training and ethical guidelines.

The cognitive/mental health support of adults with inherited-metabolic-diseases - A review of the newly developed neuropsychology service in one tertiary metabolic centre

The cognitive/mental health support of adults with inherited-metabolic-diseases - A review of the newly developed neuropsychology service in one tertiary metabolic centre

Concurrent validity and reliability of at-home teleneuropsychological evaluations among people with and without HIV.

To determine the reliability of teleneuropsychological (TNP) compared to in-person assessments (IPA) in people with HIV (PWH) and without HIV (HIV-). Participants included 80 PWH (Mage = 58.7, SDage = 11.0) and 23 HIV- (Mage = 61.9, SDage = 16.7). Participants completed two comprehensive neuropsychological IPA before one TNP during the COVID-19 pandemic (March-December 2020). The neuropsychological tests included: Hopkins Verbal Learning Test-Revised (HVLT-R Total and Delayed Recall), Controlled Oral Word Association Test (COWAT; FAS-English or PMR-Spanish), Animal Fluency, Action (Verb) Fluency, Wechsler Adult Intelligence Scale 3rd Edition (WAIS-III) Symbol Search and Letter Number Sequencing, Stroop Color and Word Test, Paced Auditory Serial Addition Test (Channel 1), and Boston Naming Test. Total raw scores and sub-scores were used in analyses. In the total sample and by HIV status, test-retest reliability and performance-level differences were evaluated between the two consecutive IPA (i.e., IPA1 and IPA2), and mean in-person scores (IPA-M), and TNP. There were statistically significant test-retest correlations between IPA1 and IPA2 (r or ρ = .603-.883, ps < .001), and between IPA-M and TNP (r or ρ = .622-.958, ps < .001). In the total sample, significantly lower test-retest scores were found between IPA-M and TNP on the COWAT (PMR), Stroop Color and Word Test, WAIS-III Letter Number Sequencing, and HVLT-R Total Recall (ps < .05). Results were similar in PWH only. This study demonstrates reliability of TNP in PWH and HIV-. TNP assessments are a promising way to improve access to traditional neuropsychological services and maintain ongoing clinical research studies during the COVID-19 pandemic.

Sociodemographic, cultural, linguistic, and test selection considerations for clinical neuropsychological assessment with Japanese and Japanese-American patients in the United States

Objective: Japanese-Americans are the sixth largest Asian ethnicity in the United States and represent a highly heterogeneous population. Despite representing a large and diverse group, relatively little attention has been paid to clinical best practices for working with this population in the West, particularly for Japanese speakers and issei (first-generation in the United States). This paper offers guidance for providing competent neuropsychological services to Japanese-Americans. Method: Pertinent facets of Japanese culture are presented within the context of the ECLECTIC framework (education and literacy, culture and acculturation, language, economics, communication, testing situation: comfort and motivation, intelligence conceptualization, and context of immigration; Fujii, 2018). The available literature on clinical neuropsychological tests that are translated into Japanese and normed with Japanese samples was reviewed. Results: Specific recommendations for clinicians providing neuropsychological services to Japanese-Americans are presented with an aim of maximizing test fairness by addressing the following issues: comfort with the testing situation, test biases, accessibility, and validity (American Educational Research Association et al., 2014). Additional recommendations for the use of teleneuropsychology; working with geriatric, pediatric, and multiracial populations; and providing useful recommendations and feedback from clinical assessment are provided. Measures that are appropriately translated and/or adapted for use with Japanese populations are presented by cognitive domain to assist clinicians with test selection. Conclusions: This paper provides concrete recommendations for Western neuropsychologists working with patients of Japanese descent in order to address the current gap in cultural competence among clinicians when working with this heterogeneous population.

"I Don't Think It's on Anyone's Radar": The Workforce and System Barriers to Healthcare for Indigenous Women Following a Traumatic Brain Injury Acquired through Violence in Remote Australia.

Aboriginal and Torres Strait Islander women experience high rates of traumatic brain injury (TBI) as a result of violence. While healthcare access is critical for women who have experienced a TBI as it can support pre-screening, comprehensive diagnostic assessment, and referral pathways, little is known about the barriers for Aboriginal and Torres Strait Islander women in remote areas to access healthcare. To address this gap, this study focuses on the workforce barriers in one remote region in Australia. Semi-structured interviews and focus groups were conducted with 38 professionals from various sectors including health, crisis accommodation and support, disability, family violence, and legal services. Interviews and focus groups were audiotaped and transcribed verbatim and were analysed using thematic analysis. The results highlighted various workforce barriers that affected pre-screening and diagnostic assessment including limited access to specialist neuropsychology services and stable remote primary healthcare professionals with remote expertise. There were also low levels of TBI training and knowledge among community-based professionals. The addition of pre-screening questions together with professional training on TBI may improve how remote service systems respond to women with potential TBI. Further research to understand the perspectives of Aboriginal and Torres Strait Islander women living with TBI is needed.

Incorporating Intersectionality in Neuropsychology: Moving the Discipline Forward.

Intersectionality is the interface between a person's identities in relation to social systems and institutional discrimination. The concept has generated much interest in psychology for understanding societal inequities and providing culturally informed services to minoritized patients but has yet to be incorporated in clinical neuropsychology. This omission is unfortunate as it is argued that appreciating the impact of institutional discrimination on minoritized groups can enhance our understanding of brain organization and functioning and bolster access to competent neuropsychological services to minoritized patients. The purpose of this article is to illustrate how intersectionality is germane to the discipline of clinical neuropsychology and to make recommendations for infusing it into the practice. Theories and findings in cultural neuroscience are summarized to provide a theoretical background for understanding how the environment can impact brain development and organization. The literature on disparities in education, economics, and health disparities between Whites and minoritized groups was reviewed for institutional biases that place minoritized groups at a disadvantage. These topics were selected due to their known impact on brain organization and cognition. This was followed by a similar review for access to competent neuropsychological assessments for minoritized patients. There is a confluence of institutional discriminatory processes that contribute to disparities in education attainment, economic status, health disparities, and accessibility to culturally informed neuropsychological services. Perceived discrimination has significant health and cognitive ramifications. Intersectionality is germane to appreciating brain functioning and providing competent services to minoritized patients. Recommendations were made to incorporate intersectionality in clinical neuropsychology.

Conditions required to ensure successful detection and management of mild cognitive impairment in primary care: A Delphi consultation study in China.

ObjectiveDetection and management of mild cognitive impairment (MCI) in primary care has been recognized internationally as one of the strategies that can be employed to delay the development of dementia. However, little is known about what role primary care should play. This study aimed to develop a checklist of conditions necessary for successfully detecting and managing mild cognitive impairment in primary care in China.MethodsThis study employed the Delphi method to establish expert consensus on the conditions required for successfully detecting and managing MCI in primary care in China. Twenty-four experts who specialized in general practice, public health, neuropsychology, or community health service management rated the importance of pre-defined conditions (44 items measuring providers' preparedness, patient engagement, and system support in line with the Chronic Care Model). The degree of consensus among the experts was measured using four indicators: median ≥ 4, mean ≥3.5, Co-efficient of Variance < 0.25, and retention in the checklist required ≥ 80% agreement with a rating of important or essential. The checklist and descriptions of the conditions were revised according to the experts' feedback and then sent out for repeated consultations along with a summary of the results of the previous round of consultations. Consensus was achieved after the second round of consultations, which was completed by 22 of the experts.ResultsThe experts endorsed a checklist of 47 conditions required for successful detection and management of MCI in primary care in China. These conditions were categorized into four domains: prepared general practitioners (17 items), engaged patients (15 items), organizational efforts (11 items), and environmental support (4 items).ConclusionsSuccessful detection and management of MCI in primary care in China requires a dedicated and competent workforce of general practitioners, as well as the engagement of patients and family caregivers. Adequate support from healthcare organizations, health system arrangements, and the broader society is needed to enable effective interactions between general practitioners and patients and efficient delivery of the services required to detect and manage MCI.

A-164 Processing Speed Differences between Attention-Deficit Hyperactivity Disorder Groups with and without Co-Morbid Anxiety Diagnoses

Abstract Objective: Existing literature has identified deficits in processing speed abilities in those diagnosed with attention deficit-hyperactivity disorder (ADHD) relative to normative data (Kramer et al., 2020; Woods et al., 2002). Furthermore, research has explored the relationship between severe anxiety symptoms and processing speed in numerous populations (Petkus et al., 2005; Vissicchio et al., 2019). As such, anxiety has been demonstrated to further negatively impact processing speed in conditions in which processing speed deficits are classically observed, such as multiple sclerosis (Vissicchio et al., 2019). The current study looks to examine whether there are significant differences in PSI between a group with both ADHD and an anxiety disorder and a group with no co-morbid anxiety disorders. Method: This study uses archival data from a neuropsychology service in a private practice clinic in the Midwest. 112 adult participants were examined in this study. Processing speed was examined using the Processing Speed composite score (PSI) from the Weschler Adult Intelligence Scale-Fourth Edition (WAIS-IV). Co-morbid anxiety disorders were assessed based on the presence of a diagnosed anxiety disorder according to patient records. Results: An independent samples t-test was employed to examine differences in PSI between the group with co-morbid anxiety disorders and ADHD and the group without an anxiety disorder diagnosis. There was no significant difference in PSI between the groups (t = -1.655, p = .10). Conclusion: Overall, there was no significant difference in PSI between groups with co-morbid ADHD and anxiety and one with ADHD alone. Implications and limitations of the current study will be discussed.

A-213 Patient Barriers to Accessing Hospital-Based Neuropsychological Services

Objective: Annually, thousands of youths are admitted to pediatric intensive care units (PICUs) and are at increased risk for long-lasting neurocognitive and psychiatric sequelae, referred to as Post Intensive Care Syndrome (PICS). Research shows that youth with PICS strongly benefit from neuropsychological follow-up services; however, high proportions of referred patients (i.e., 25-33% at our hospital) do not attend follow-up appointments. The current study aims to better understand the barriers that hinder families’ abilities to access follow-up services.Method: Participants included guardians of children ages 0-18 years (N = 149) referred for follow-up neuropsychological assessment and did not attend the appointment. Data was collected via individual 10-minute structured telephone interviews focusing on treatment barriers chosen from prior research on social determinants of health. Participants identified the extent to which various barriers impacted appointment attendance.Results: Data collection is currently underway. Preliminary results demonstrate time limitations/scheduling difficulties and challenges related to the COVID-19 pandemic as the most frequent barriers to accessing treatment with 60% endorsement rates each. Relatedly, 50% reported difficulty taking time off from work. Several endorsed confusion surrounding the purpose of the appointment (40%), financial concerns (30%), family stress/mental health (30%), limited childcare (20%), transportation (10%), housing difficulties (10%), and language barriers (20%).Conclusion: Current findings highlight challenges that contribute to inequities in families’ access to care. These challenges represent important targets for interventions aimed at minimizing health care disparities. Such interventions hold promise for mitigating the extent to which PICS-related difficulties negatively impact youth’s social, psychological, and academic functioning following inpatient hospitalization.

A survey of pediatric neuropsychologists serving inpatient rehabilitation, Part II: billing, time allocation and tracking, and professional identity and perceptions

ABSTRACT Professional challenges have been documented in broad surveys of neuropsychologists. While previous surveyors have included pediatric neuropsychologists, few, if any, have specifically examined practices among those who primarily work in pediatric inpatient rehabilitation settings. Therefore, the aim of this study was to survey neuropsychologists in this setting. Thirty neuropsychologists from the U.S. and one from Canada that work in inpatient pediatric rehabilitation participated in an online survey. Most respondents (83.3%) billed for their inpatient time. Sixty-four percent indicated that payor type (private vs. public) affected services a moderate amount to a lot; this was primarily due to payor’s influence on length of stay. Most providers had productivity expectations (66.7%). Among those that had productivity expectations, three-quarters used “hours billed;” 37.5% were solely or additionally tracked by relative value units (RVUs). The majority of respondents conducted some type of clinical data collection, usually for research purposes. With respect to professional identity, most respondents indicated positivity about their role. The top challenges endorsed were related to workload/ability to meet the patients’ needs and billing/productivity. Issues related to billing and payor may influence aspects of pediatric inpatient rehabilitation neuropsychological care. Managing challenges related to billing and the time demands associated with providing inpatient services were top concerns for many respondents. Most sites surveyed were involved in data collection, usually for research purposes; increased data collection efforts are needed to aid with program development and evaluation and to demonstrate the added value of neuropsychological services from a patient care perspective.

Movement disorders in COVID-19 times: impact on care in movement disorders and Parkinson disease.

The purpose of this review is to outline the impact of the COVID-19 pandemic on movement disorder holistic care, particularly in the care of people with Parkinson disease (PWP). As the pandemic unfolds, a flurry of literature was published regarding the impact of COVID-19 on people with Parkinson disease including the direct impact of infection, availability of ambulatory care, loss of community-based team care, and acceptability of telemedicine. COVID-19 has impacted the care of PWP in numerous ways. Recognizing infection in PWP poses challenges. Specific long-term complications, including emerging reports of long COVID syndrome is a growing concern. Caregivers and PWP have also been impacted by COVID-19 social isolation restrictions, with radical changes to the structure of social networks and support systems globally. In a matter of weeks, the global community saw an incredible uptake in telemedicine, which brought benefits and pitfalls. As PWP adapted to virtual platforms and the changing architecture of care delivery, the pandemic amplified many preexisting inequities amongst populations and countries, exposing a new 'digital divide'.

“The journey of a thousand miles begins with one step”: An Asian American perspective on mentoring in neuropsychology

ABSTRACT Objective The Asian Neuropsychological Association (ANA) is a recently established cultural identity-based organization with the mission to ensure accessibility and provision of culturally sensitive neuropsychological services for individuals of Asian descent. One of ANA’s programmatic goals has been to foster a pipeline of neuropsychologists through mentoring and networking. In this paper, we aim to understand the historical context as well as unique considerations that are relevant for mentoring in the Asian American community. Methods A search of the existing literature in psychology and allied fields such as counseling and sociology was conducted to identify and formulate suggestions for mentoring culturally diverse communities, with a specific focus on Asian Americans. Firsthand narrative descriptions of effective examples of mentoring experiences in the context of shared values are discussed. Findings and Implications This paper reviews the historical context and establishes an initial contextual foundation for increasing knowledge about best practices that can be used to establish effective mentoring relationships for Asian Americans. Six key considerations were identified: model minority myth, acculturation and enculturation, ethno-racial status and gender, the context of communication, quantity and quality of mentorship, and unique values specific to the Asian American community. Our findings identify the value of cultural identity-based organizations in creating communities that can support the professional development of future neuropsychologists at various career stages. Overall, findings have implications for maintaining the relevance of the field of neuropsychology in adequately serving an increasingly culturally diverse national and international population.

Supporting the Transition to Adulthood for Youth With Spina Bifida: A Call for Neuropsychology-Informed Interventions.

Supporting the Transition to Adulthood for Youth With Spina Bifida: A Call for Neuropsychology-Informed Interventions.