Neuropsychologist

Definition

A clinical psychologist is a licensed or certified professional who holds a doctoral degree in psychology and works in the area of prevention and treatment of emotional and mental disorders. A neuropsychologist is typically a clinical psychologist with additional training and experience in neuropsychology, an area of psychology that focuses on brain-behavior relationships.

Description

Neuropsychologists are licensed professionals within the field of psychology. Most have a doctorate (PhD) in psychology with additional years of post-doctoral training in clinical neuropsychology. The graduate education and training for neuropsychologists emphasizes brain anatomy , brain function, and brain injury or disease. The neuropsychologist also learns how to administer and interpret certain types of standardized tests that can detect effects of brain dysfunction. Neuropsychologists may receive certification from the American Board of Clinical Neuropsychology (ABCN), the member board of the American Board of Professional Psychology (ABPP) that administers the competency exam in the specialty of clinical neuropsychology.

Neuropsychologists are not medical doctors; they are consultants who work closely with physicians, teachers, and other professionals to assess an individual's brain functioning. With the aid of standardized tests, neuropsychologists help to diagnose and assess patients with a variety of medical conditions that impact intellectual, cognitive, or behavioral functioning. They may also provide psychotherapy or other therapeutic interventions.

Neuropsychologists usually work in private practice or in institutional settings such as hospitals or clinics. Most neuropsychologists are in clinical practice; that is, their primary responsibilities include evaluation and treatment of patients. A neuropsychologist's practice may include pediatric neuropsychology, a specialty that concerns the relationship between learning and behavior and a child's brain, and forensic neuropsychology, an area that deals with determination of disability for legal purposes. In addition to seeing patients, neuropsychologists may also engage in professional activities such as teaching, research, and administration.

Reasons for referral

Neuropsychological evaluation is generally warranted for patients who show signs of problems with memory or thinking. Such problems may manifest as changes in language, learning, organization, perception, coordination, or personality. These symptoms can be due to a variety of medical, neurological, psychological, or genetic causes. Examples of conditions that may prompt a referral to a neuropsychologist include stroke , brain trauma, dementia (such as Alzheimer's disease ), seizures , psychiatric illness, toxic exposures (such as to lead), or an illness that increases the chance of brain injury (such as diabetes or alcoholism).

Neuropsychological evaluation

The purpose of a neuropsychological evaluation is to provide useful information about an individual's brain functioning. Such information may help a physician, teacher, or other professional:

• make or confirm a diagnosis
• find problems with brain functioning
• determine individual thinking skill strengths and weaknesses
• guide treatment decisions such as rehabilitation, special education, vocational counseling, or other services
• track changes in brain functioning over time

Neuropsychological evaluation can reveal abnormalities or even subtle difference in brain functioning that may not be detected by other means. For example, testing can help determine if a person's mild memory changes represent the normal aging process or if they signify a neurological disorder such as Alzheimer's disease.

During the evaluation, a neuropsychologist may take a medical history, review medical records, and administer and interpret a series of standardized tests. Though the time required to conduct a neuropsychological exam varies, the exam can last six to eight hours and may span the course of several visits. The standardized tests used in a neuropsychological assessment involve answering questions ("paper and pencil" or computerized tests) or performing hands-on activities at a table. The goal of testing is to evaluate how well the brain functions when it performs certain tasks. A trained examiner, also called a technician, may give or score the tests. Testing does not include x rays, electrodes, needles, or other invasive procedures. Tests used may examine one or more of the following areas:

• general intellect
• attention, memory, and learning
• reasoning and problem-solving
• planning and organization
• visual-spatial skills (perception)
• language
• sensory skills
• motor functions
• academic skills
• emotions
• behavior
• personality

Neuropsychologists tailor their services to the patient's needs and the reason for referral. For example, in a child who is having difficulty reading, the neuropsychologist will try to determine if this difficulty is related to a problem with attention, language, auditory processing, or another cause.

The neuropsychologist's conclusions about an individual's brain functioning may complement findings from brain imaging studies such as a computerized topography (CT) scan or magnetic resonance imaging (MRI) , or the results of blood tests. Depending on the circumstances, a neuropsychologist may treat the patient with interventions such as cognitive rehabilitation, behavior management, or psychotherapy. A neuropsychologist may also recommend referrals to other health care specialists, including neurologists, psychiatrists, psychologists, social workers , nurses, special education teachers, therapists, or vocational counselors.

Resources

BOOKS

Stringer, A. Y., and E. L. Cooley. Pathways to Prominence: Reflections of Twentieth Century Neuropsychologists. Philadelphia: Psychology Press, 2001.

Joseph, R. Neuropsychiatry, Neuropsychology, and Clinical Neuroscience: Emotion, Evolution, Cognition, Language, Memory, Brain Damage, and Abnormal Development. Baltimore: Lippincott, Williams & Wilkins, 1996.

PERIODICALS

Division 40, American Psychological Association. "Definition of a Clinical Neuropsychologist." The Clinical Neuropsychologist 3 (1989): 22.

Sweet, J. J., E. A. Peck, C. Abromowitz, and S. Etzweiler. "National Academy of Neuropsychology/Division 40 of the American Psychological Association Practice Survey of Clinical Neuropsychology in the United States, Part I: Practitioner and Practice Characteristics, Professional Activities, and Time Requirements." The Clinical Neuropsychologist 16 (2002): 109–127.

Therapeutics and Technology Subcommittee of the American Academy of Neurology. "Assessment: Neuropsychological Testing of Adults. Considerations for Neurologists." Neurology 47 (1996): 592–599.

WEBSITES

National Academy of Neuropsychology (NAN). Neuropsychological Evaluation Brochure. 2001 (April 27, 2004). <http://www.nanonline.org/paio/PaioResHandout.shtm>.

National Academy of Neuropsychology (NAN). Neuropsychological Evaluation Information Sheet. 2001 (April 27, 2004). <http://www.nanonline.org/paio/PaioResHandout.shtm>.

National Academy of Neuropsychology (NAN). Pediatric Neuropsychological Evaluation Information Sheet: For Parents. 2001 (April 27, 2004). <http://www.nanonline.org/paio/PaioResHandout.shtm>.

National Academy of Neuropsychology (NAN). Pediatric Neuropsychological Evaluation Information Sheet: For Physicians. 2001 (April 27, 2004). <http://www.nanonline.org/paio/PaioResHandout.shtm>.

Public Interest Advisory Committee, Division 40 (Clinical Neuropsychology), American Psychological Association. Pediatric Neuropsychology Brochure. 2000 (April 27, 2004). <http://www.nanonline.org/paio/PaioResHandout.shtm>.

Public Interest Advisory Committee, Division 40 (Clinical Neuropsychology), American Psychological Association. Clinical Neuropsychology Brochure. 2000 (April 27, 2004). <http://www.nanonline.org/paio/PaioResHandout.shtm>.

ORGANIZATIONS

National Academy of Neuropsychology. 2121 South Oneida Street, Suite 550, Denver, CO 80224-2594. (303) 691-3694. [email protected]. <http://www.NANonline.org>.

American Psychological Association, Division 40—Clinical Neuropsychology Homepage. 750 First Street NE, Washington, DC 20002-4242. (202) 336-6013; Fax: (202) 218-3599. [email protected]. <http://www.div40.org>.

Dawn Cardeiro, MS, CGC