Division 40 representative to APA Council of Representatives
Neuropsychologist, TIRR/Memorial Hermann, Houston, TX
Clinical Associate Professor, Dept. of Physical Medicine & Rehabilitation, University of Texas-Houston Medical School
corwin.boake@uth.tmc.edu
Cady Block, PhD
Chair, Association of Neuropsychology Students in Training (http://www.div40-anst.com/)
Clinical neuropsychology postdoctoral fellow, TIRR/Memorial Hermann and Dept. of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX
The
distinction between neuropsychological assessment performed by a clinical
neuropsychologist and brief cognitive assessment as performed by physicians is formally
recognized in the current revision of the Diagnostic and Statistical Manual of
Mental Disorders. DSM-5 states that determination of cognitive impairment, as
needed for the diagnoses of Mild and Major Neurocognitive Disorder, should be
“preferably documented by standardized neuropsychological testing” (p. 602). According to DSM-5, a key advantage of
neuropsychological assessment over other forms of cognitive testing is to
provide “quantitative assessment of all relevant domains” (p. 610), a feature
that is particularly useful for diagnosis and for detecting change.
Another area in which this distinction has been clearly made is in guidelines for management of sports concussion. A recent consensus statement (4th International Conference on Concussion in Sport, Zurich, November 2012; McCrory et al., 2013) states, “It is recognized, however, that abbreviated testing paradigms are designed for rapid concussion screening … and are not meant to replace comprehensive neuropsychological testing which should ideally be performed by trained neuropsychologists that are sensitive to subtle deficits that may exist beyond the acute episode; nor should they be used as a stand-alone tool for the ongoing management of sports concussions” (p. 90).
The distinction between neuropsychological assessment and cognitive evaluations by psychologists in other specialties is also clearly made in the documentation on user qualifications that accompany many neuropsychological tests. For example, the manual for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) states that while other professionals “may engage in some initial interpretation of performance on RBANS, the test results should ultimately be interpreted only by individuals with appropriate professional training in neuropsychological assessment for diagnostic purposes” (Randolph, 2012, p. 9). Furthermore, the manual for Advanced Clinical Solutions for WAIS-IV and WMS-IV states that, “When ACS is to be used for a neuropsychological assessment, the examiner should have appropriate training in neuropsychology and neuropsychological assessment” (Pearson, p. 8). These test qualifications make clear that administering neuropsychological tests is not equivalent to neuropsychological assessment. Specialized interpretation competencies are necessarily part of practicing neuropsychology.
These
interpretation competencies are clearly outlined in the description of the
clinical neuropsychology specialty published by the American Psychological
Association Commission for the Recognition of Specialties and Proficiencies in
Professional Psychology (CRSPPP). The CRSPPP
description (http://www.apa.org/ed/graduate/specialize/neuro.aspx) states that
core competencies in clinical neuropsychology include not only the use of
specialized neuropsychological assessment techniques, but also “the ability to
integrate neuropsychological test findings with neurologic and other medical
data, psychosocial and other behavioral data, and knowledge in the
neurosciences,” as well as “an appreciation of social, cultural and ethical
issues.”
For
comparison, the CRSPPP description of the geropsychology specialty (http://www.apa.org/ed/graduate/specialize/gero.aspx)
states that core competencies include “cognitive and functional performance
testing, integration of interdisciplinary assessments (e.g., medical,
neuropsychological, social service).” This description implies that cognitive
testing, while listed as a competency of this specialty, is distinct from
neuropsychological assessment.
Recognition
of clinical neuropsychology as a professional psychology specialty, rather than
as a proficiency, indicates that the specialty’s core competencies should be
practiced by psychologists who have undergone the education and training
required of that specialty. The large
and expanding knowledge base required of clinical neuropsychologists explains
the need for specialized postdoctoral training for two years, as outlined by
the Houston conference guidelines.
Relevant areas of knowledge include (but are not limited to)
neuropsychological assessment, psychometrics, diagnostic statistics,
neuroanatomy and neurophysiology, brain-behavior relationships, and brain
imaging.
The
distinction between neuropsychological assessment and cognitive testing is
commonly accepted and is consistent with the CRSPPP description. It follows that training of psychologists in
other specialties, which may include exposure to neuropsychology, is not
adequate preparation for practicing neuropsychological assessment. Yet this does not mean that practitioners in
other psychological specialties should amend cognitive assessment from their
scope of practice. Practitioners in
other specialties can continue to describe their assessments as cognitive
assessment or cognitive evaluation (among many possible labels)
while maintaining the existing scope of specialty practice. Cognitive
assessment is one of the tools that may be shared among psychological specialties
but it is not equivalent to neuropsychological assessment.
REFERENCES:
REFERENCES:
American
Psychiatric Association. (2013). Diagnostic and statistical manual for mental
disorders, fifth revision. Washington, DC: American Psychiatric Publishing
Houston
conference on specialty education and training in clinical neuropsychology.
(1997). http://www.div40.org/pub/Houston_conference.pdf
McCrory,
P., Meeuwisse, W.H., Aubry, M. ... (2013). Consensus statement on concussion in
sport: The 4th International Conference on Concussion in Sport,
Zurich, November 2012. Journal of Sports
Medicine, 23, 89-117. http://bjsm.bmj.com/content/47/5/250.full
Advanced
Clinical Solutions for WAIS-IV and WMS-IV, Administration and scoring manual. (2009).
San Antonio: NCS Pearson.
Randolph, C. (2012). Repeatable Battery for the Assessment of Neuropsychological
Status Update (p. 9). Bloomington, MN: NCS Pearson – PsychCorp.
