Clinical Neuropsychologist最新文献

Introduction: In February 2023, a work group began to develop a new North American organization in neuropsychology to represent and support practicum-training sites. While other training-focused organizations such as the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) and the Association of Internship Training in Clinical Neuropsychology (AITCN) have existed for many years, no organization exists to promote and support practicum level training outside of doctoral degree programs. The work group developed such an organization, subsequently named the North American Association of Practicum Sites in Neuropsychology (NAPSN), beginning with a mission statement and general purpose of the organization. Methods: The work group divided members into five task forces focused on various tasks needed to start the organization, including Mission/Vision, Administrative Structure, Membership, Financials, and Bylaws. The entire work group met monthly with additional meetings and work via email for the various task forces, which resulted in the development of a mission statement and bylaws, as well as a framework for program administration, membership requirements and financial needs. Conclusions: The group developed NAPSN primarily as a resource to support diverse practicum programs in urban, suburban, and rural areas in the US and Canada to provide optimal graduate level clinical training in neuropsychology. Didactics aimed specifically at practicum students was one need identified early in the process. NAPSN is developing a website-based resource in collaboration with other training organizations to increase the didactic offerings to practicum students. Other initiatives and collaborative efforts will be undertaken over time as circumstances warrant.

Objective: While previous survey research has focused on various training constituencies such as trainees, and postdoctoral/internship supervisors, no previous survey research has examined the needs and perspectives of practicum level supervisors and training programs. This study was designed to address this limitation. These results were used in forming the North American Association of Practicum Sites in Neuropsychology (NAPSN). Method: A 41-item survey was developed and distributed to practicum supervisors across the United States and Canada via listserv. A total of 142 supervisors completed the survey; the majority were employed at academic medical centers (62%) and located in the U.S. (93%). Most participants evaluated adults (61%), while a minority evaluated children (27%), or patients across the lifespan (12%). Results: Most respondents supervise one (44%) or two (26%) students per year and prefer advanced trainees (>90%). The majority (78%) indicated students see one case per week. The number of clinical contact hours and reports varied based on location (U.S. vs. Canada) and population (adult vs. pediatric). Supervisors found professional papers and publicly available didactics to be the most helpful resources. Commonly endorsed needs included help with policies and procedures (53%), supervising trainees from underrepresented groups (49%) and nontraditional backgrounds (44%), and access to didactics (49%). Conclusions: The survey provided insights into current practices and the needs of practicum supervisors. These findings will inform NAPSN's development of materials and policies to support trainees and supervisors and can guide other professionals in supporting their practicum trainees as they navigate training in neuropsychology.

Objective: Effective feedback is necessary for professional growth. However, guidelines and strategies for the delivery of competency-based feedback are not well-established in the field of neuropsychology. Even more complex is managing situations in which trainees require extra support; namely, developing and implementing remediation plans to help trainees to meet their benchmark competencies. Method: A critical review of the existing literature on feedback and remediation for medical and psychology trainees. Conclusion: We draw on the existing medical and psychology literature to help training directors, programs, and supervisors in clinical neuropsychology establish best practices in feedback and remediation.

Objective: The Houston Conference Policy Statement established an integrated model of training for clinical neuropsychologists and has been widely implemented. However, developments and needs related to professional competencies, cultural/linguistic diversity, and technology prompted the need to update training guidelines. In 2021, an interorganizational Planning Commission (PC), with Commissioners from 17 organizations within clinical neuropsychology, was formed to develop a process by which training guidelines would be comprehensively updated via the Minnesota 2022 Conference to Update Educational and Training Guidelines in Clinical Neuropsychology, held 12-16 September 2022.

Method: The PC met virtually from June 2021 through August 2022, and responsibilities included conference site selection, fundraising, Delegate selection, and conference goals, schedule, and policies. The PC also defined the roles and responsibilities for the conference and subsequent activities among the Delegates, Steering Committee, and Content Panels.

Conclusion: The PC set the stage for the participants of the Minnesota Conference to undertake a generational updating of training guidelines. The 25 years since the Houston Conference and the long process of completing the Minnesota guidelines underscore the need to update training guidelines with greater frequency.

Objective: The Minnesota Conference (MNC) Guidelines for Education and Training in Clinical Neuropsychology reflect the specialty's effort to create competency-based training standards aligned with current and future needs. This article summarizes delegate perspectives on the MNC guideline revision process to inform future updates. Method: A feedback survey was distributed to all 55 delegates from June 12-22, 2025. Delegates rated their satisfaction with four aspects of the process: the in-person conference, post-conference writing process, Steering Committee communication, and the delegate role in the writing process. Open-ended feedback was collected and analyzed thematically. The authors (who are delegates) have also integrated reflections throughout the article. Results: The survey received 34 responses (62%). Satisfaction varied across the four domains queried, with the in-person conference receiving the highest satisfaction ratings (59% of respondents reported feeling "satisfied" or "very satisfied") and communication from the Steering Committee receiving the highest dissatisfaction ratings (50% of respondents reported feeling "dissatisfied" or "very dissatisfied"). In addition to several strengths, a recurring recommendation was a desire for increased transparency during the post-conference writing phase and improved communication throughout the entire process. Conclusions: The MNC revision process included years of planning and organization led by the Planning Commission and Steering Committee and was a herculean task that deserves tremendous praise. The present article highlights several strengths of the revision process, challenges regarding procedure and communication, and provides constructive feedback for future revisions. The authors believe these guidelines will advance the field and are optimistic that the recommendations provided can support future guidelines revision efforts.

Objective: This systematic review aimed to assess the neuropsychological, cognitive, and behavioral outcomes in children and adolescents with drug-resistant epilepsy undergoing resective surgery. While epilepsy surgery is often effective in achieving seizure control, post-operative outcomes across neuropsychological, cognitive and behavioral domains remain variable and require further investigation.

Method: Using advanced search terms, a systematic review of electronic databases was conducted, comprising PubMed, PsycINFO, and Scopus. Studies published from January 2010 to March 2025 were included if they involved pediatric patients (≤18 years) undergoing resective epilepsy surgery and reported pre- and/or postoperative neuropsychological, cognitive, or behavioral outcomes. Data were synthesized qualitatively due to study heterogeneity.

Results: Twenty-six studies met the inclusion criteria. Global cognition was generally stable or improved. Verbal memory declined after left temporal resections, while visuospatial and attention deficits were reported after posterior resections, although laterality of resection was not consistently specified. Executive and behavioral improvements were more common in seizure-free patients. Outcomes varied by age at surgery, epilepsy duration, seizure control, and resection extent.

Conclusions: While epilepsy surgery in pediatric populations can lead to neuropsychological, cognitive and behavioral improvements, outcomes remain heterogeneous, reflecting both variability in clinical presentation and the current state of evidence. The available evidence highlights the need to improve methodological quality and reporting standards. Well-designed prospective multicenter trials with adequate follow-up for long-term outcomes are essential to accurately assess outcomes. Establishing standardized core outcome measures across centers would facilitate higher quality evidence and support more informed decision-making for clinicians, patients, and families regarding surgical intervention and expected post-operative trajectories.

Objective: The prevalence of neuroendocrine dysfunction (NED) following mild traumatic brain injury (mTBI) remains obscure, with widely varying prevalence estimates. This study aimed to determine prevalence of NED among central hypogonadism, central hypothyroidism, and growth hormone deficiency (GHD) in active-duty military service members (SMs) receiving comprehensive TBI and psychological health care and characterize TBI burden, neurobehavioral symptom severity, and NED associations. Methods: Retrospective analysis of baseline, fasting morning serum screening labs of thyroid, gonadal, and growth hormone axes obtained from SMs attending a 4-week treatment program for TBI. NED prevalence was characterized in those who completed full tri-axis screening as well as GHD and central hypogonadism screening independently. Results: Of 1,832 TBI-screened SMs, 493 completed full neuroendocrine testing. Dual-clinician review confirmed NED in 45 (9.1%; 95% CI [6.9%, 12.0%]). Central hypogonadism (n = 33, 6.7%) was most common, followed by central hypothyroidism (n = 10, 2.0%); Screen-positive suspected GHD was 0.2% (1/493); no cases were confirmed by dynamic stimulation testing, so the true prevalence of GHD cannot be determined in this cohort. NED was associated with increased time since injury (OR = 4.15, p<.001) and fewer lifetime TBIs (OR = 0.66, p=.008), but not neurobehavioral symptoms or cognitive function. Conclusions: In the largest military TBI cohort with full NED screening to date, confirmed post-traumatic hypopituitarism prevalence was 9.1%. GHD was least common by IGF-1 (0.2%) screening, but its true prevalence remains indeterminate without systematic stimulation testing. Findings refine prevalence estimates for NED after military mTBI and emphasize the need for standardized diagnostic approaches prioritizing gonadal and thyroid axes.

Background: Technological advancements have boosted neuropsychology development. Recently, the term Digital Neuropsychology (DN) has been introduced to describe the assessment and training of cognitive functions using digital tools. However, little is known about the development and implementation of these tools, particularly in low-and middle-income countries. This study aimed to synthesize state-of-the-art DN tools in Latin America (LA).

Method: Following PRISMA guidelines, a scoping review was conducted between June and December 2024. Three electronic databases were searched: PubMed/MEDLINE, SciELO, and RedALyC. A gray literature search was also performed using Google Scholar and university thesis repositories. Studies published between 2014 and 2024 in English or Spanish were included.

Results: Of the 662 screened studies, 28 met the inclusion criteria and were fully reviewed. Brazil and Chile accounted for the highest number of studies. A likelihood ratio test indicated no significant deviation from equal distribution across countries. Cognitive assessment was the primary focus in 57.1% of studies, and serious video games were the most used technology (39.3%). Tablets (42.9%) and personal computers (32.1%) were the most frequently employed devices. No associations were found between technology and purpose, technology and device type, or country and purpose. Memory and attention were the most frequently assessed cognitive domains (32.1%).

Conclusions: The increasing body of research highlights the potential of digital technology for cognitive assessment in LA. However, the development of DN in the region faces challenges, including the need for ecological validation studies, more extensive and diverse samples, and the establishment of normative data.

Objective: Major innovations are underway in the practice of clinical neuropsychology, as they are in the neurosciences and psychology more generally. Artificial intelligence (AI) is poised to offer numerous advantages over traditional neuropsychological practices, the most important of which is to improve clinical decision-making and thereby reduce diagnostic errors. However, the emergence, rapid availability, and adoption of AI, like other technological advances, has ethical implications. The purpose of this article is to present the ethical issues of primary importance in the adoption and application of AI in clinical neuropsychology and further advance the discussion of AI, ethics, and neuropsychology. Method: Benefits and risks of AI use in clinical neuropsychology are examined in the context of general bioethical principles. Results: Some of the primary anticipated risks that may lead to harmful outcomes for patients include: (1) threats to privacy and security, (2) bias in AI models, (3) lack of professional competence, (4) limitations to informed consent, (5) inequity in access to AI, (6) overreliance on AI, and (7) lack of accountability. Conclusions: Awareness and understanding of the ethical implications of technological advances, including AI, are essential for maintaining patient welfare at the center of clinical care and for preparing clinicians to anticipate ethical challenges and avoid dilemmas or address them effectively when they are encountered. Advanced preparation enables neuropsychologists to promote the ethical and responsible use of AI, for the benefit of both practitioners and patients.

Objectives: This study investigated the validity and reliability of subtle errors and slowing in simple everyday tasks (Naturalistic Action Test [NAT]) to assess mild functional difficulties in older adults with mild cognitive impairmen (MCI). Method: Older adults (N = 111, MAge= 73.45; SD= 6.53) classified as having healthy cognition (HC) or MCI completed neuropsychological testing and two NAT tasks (breakfast and lunch) twice, separated by 4-6 wk. NATs were scored for subtle, inefficient actions (i.e., micro-errors) and the average time (in sec) to complete a task step. Results: Participants with MCI made significantly more micro-errors [F (1, 109) = 8.78, p = .004, partial η² = 0.07] and had a significantly longer average time per step [F (1, 109) = 13.98, p < .001, partial η² = 0.11] than participants with HC. Micro-errors correlated with tests of episodic memory (r = -0.237, p = .012) and executive functioning (r = -0.201, p = .035), whereas average time per step correlated only with episodic memory (r = -0.300, p = .0001). Test-retest reliability was good for average time per step (ICC = .872, p < .001) and moderate for micro-errors (ICC = .675, p < .001). Conclusions: Measures of inefficient actions and performance time in familiar everyday tasks demonstrated strong to adequate construct and concurrent validity, as well as test-retest- and inter-rater reliability, supporting their use for the quantifying mild functional difficulties. Future studies should explore this scoring approach to develop early markers of functional disability or dementia risk.