Christopher L. Grote

Performance of Compensation Seeking and Non-Compensation Seeking Samples on the Victoria Symptom Validity Test: Cross-validation and Extension of a Standardization Study

Previous research suggests that the Victoria Symptom Validity Test (VSVT) is effective in confirming or disconfirming the validity of a patients reported cognitive impairments. We sought to cross-validate the findings of the VSVT standardization study, and to determine cut-off scores that are most efficient in discriminating our samples of compensation-seeking patients, primarily with mild traumatic brain injury (CS; n = 53), and non-compensation seeking patients with intractable seizures (NCS; n = 30). All patients in the NCS sample scored in the “valid” range on the VSVT difficult memory items, compared to only 58.5% of the CS sample. We also identified VSVT measures and cut-off scores maximally efficient in discriminating these samples. This study confirms previous research that non-compensation seeking patients do well on the VSVT, but that many compensation seeking patients perform poorly on this measure.

Has amobarbital expired? Considering the future of the Wada

Juhn Wada1 and W. James Gardner2 were among the first investigators to anesthetize the cerebral cortex, although their agents and aims differed. Gardner directly injected procaine hydrochloride (Novocain) through holes drilled into the brain, for the purpose of localizing speech in two left-handed patients scheduled for resection of brain tumors. Dr. Wada first used intracarotid amobarbital injections to treat a patient in status epilepticus, and later to direct placement of electrodes for electroconvulsive therapy in psychiatric patients. Subsequently, Dr. Wada and colleagues at the Montreal Neurologic Institute extended his technique to assessment of language and memory in epilepsy surgery patients. The intracarotid amobarbital procedure has emerged in epilepsy surgery centers around the world as the standard method to lateralize speech and memory functions and to prevent or predict the magnitude of related declines following epilepsy surgery. The continuation of this practice has recently been challenged on two fronts, however. First, some have proposed that new methodologies and technologies can replace the Wada. Second, a recent interruption in the supply of amobarbital has caused some centers to seek out novel anesthetic agents. In 2003–2004, there was a shortage of amobarbital on a worldwide basis for at least several months when the manufacturing …

Wada difference a day makes Interpretive cautions regarding same-day injections

Objective: To determine whether memory scores after second intracarotid amobarbital procedure (IAP) injections are affected by the time between the first and second injections. Methods: Sixty-two patients received their second IAP injection on the day after the first injection. Forty-three other patients received the second injection on the same day as the first injection. Both groups underwent similar IAP protocols and memory assessments, except for the timing of the second injection. Results: The second IAP memory scores in the two-day group were significantly higher (p < 0.05) than those in the one-day group. Timing of second injection was a significant correlate of second memory scores, but amobarbital dosage, first IAP memory score, and pre-IAP measures of memory and intelligence were not significant correlates. Conclusion: One-day and two-day IAP protocols do not result in similar memory scores after the second injection. Nineteen percent of a subset of patients in the one-day protocol were misclassified, in terms of IAP memory ratings, because of the deleterious effect of having both injections on the same day. It is recommended that correction scores be considered, for some patients who receive two IAP injections on one day, to approximate what the second IAP memory score would have been had the second injection occurred on a second day.

The MMPI-2 Fake Bad Scale: Concordance and Specificity of True and Estimated Scores

A number of recent studies have supported the use of the MMPI-2 Fake Bad Scale (FBS) as a measure of negative response bias, the scale at times demonstrating greater sensitivity to negative response bias than other MMPI-2 validity scales. However, clinicians may not always have access to True FBS (T-FBS) scores, such as when True-False answer sheets are unavailable or published research studies do not report FBS raw scores. Under these conditions, Larrabee (2003a) suggests a linear regression formula that provides estimated FBS (E-FBS) scores derived from weighted validity and clinical T-Scores. The present study intended to validate this regression formula of MMPI-2 E-FBS scores and demonstrate its specificity in a sample of non-litigating, clinically referred, medically intractable epilepsy patients. We predicted that the E-FBS scores would correlate highly (>.70) with the T-FBS scores, that the E-FBS would show comparable correlations with MMPI-2 validity and clinical scales relative to the T-FBS, and that the E-FBS would show an adequate ability to match T-FBS scores using a variety of previously suggested T-FBS raw score cutoffs. Overall, E-FBS scores correlated very highly with T-FBS scores (r = .78, p < .0001), though correlations were especially high for women (r = .85, p < .0001) compared to men (r = .62, p < .001). Thirty-one of 32 (96.9%) comparisons made between E-FBS/T-FBS correlates with other MMPI-2 scales were nonsignificant. When matching to T-FBS “high” and “low” scores, the E-FBS scores demonstrated the highest hit rate (92.5%) through use of Lees-Haleys (1992) revised cutoffs for men and women. These same cutoffs resulted in excellent overall specificity for both the T-FBS scores (92.5%) and E-FBS scores (90.6%). The authors conclude that the E-FBS represents an adequate estimate of T-FBS scores in the current epilepsy sample. Use of E-FBS scores may be especially useful when clinicians conduct the MMPI-2 short form, which does not include all of the 43 FBS items but does include enough items to compute each of the validity and clinical T-Scores. Future studies should examine E-FBS sensitivity in compensation-seekers with incomplete effort.

Deficits in Delayed Memory Following Cerebral Malaria: A Case Study

Cerebral malaria is a common disease, but there have not been any reports or investigations of long-term neurological or neuropsychological outcome. We present a case in which severe deficits in delayed memory and naming ability are observed 10 years after the patient contracted cerebral malaria. Neuropsychological testing and medical imaging are both consistent with temporal lobe/hippocampal dysfunction, which corroborates earlier animal research that cerebral malaria is particularly likely to lead to interrupted blood circulation in this area.

COURTING THE CLINICIAN Responses to Perceived Unethical Practices in Clinical Neuropsychology: Ethical and Legal Considerations

Neuropsychologists often review the work of colleagues who have performed a neuropsychological evaluation. At times, these reviews may cause one to believe that a colleague acted in an unethical manner. However, it is often unclear whether the situation warrants contacting the colleague or filing a complaint. This article provides examples of potential unethical practices in neuropsychology, and then reviews the relevant ethical principles and legal precedents concerning the obligations and possible risks of reporting perceived unethical practices of a colleague. The paper concludes with a series of recommendations and options as to when and how one should proceed in such situations.

A panel interview on the ethical practice of neuropsychology

Neuropsychologists who have considerable experience reflecting, presenting, publishing, and advising on ethical matters are a rich resource for clinicians who have ethics questions. Consultation with such colleagues can be an important part of the ethical decision-making process. The purpose of the present article is to provide the opinions and perspectives of three neuropsychologists who, based on their experience and scholarly activities, served as panelists regarding ethical matters. Although the advice and opinions of colleagues are not a substitute for familiarity with relevant ethical requirements, guidelines, and professional literature, they offer valuable information that enhances the ethical decision-making process.

Disclosure of neuropsychological test data: Official position of Division 40 (Clinical Neuropsychology) of the American Psychological Association, Association of Postdoctoral Programs in Clinical Neuropsychology, and American Academy of Clinical Neuropsychology

Disclosure of Neuropsychological Test Data: Official Position of Division 40 (Clinical Neuropsychology) of the American Psychological Association, Association of Postdoctoral Programs in Clinical Neuropsychology, and American Academy of Clinical Neuropsychology Deborah K. Attix a , Jacobus Donders b , Doug Johnson-Greene c , Christopher L. Grote d , Josette G. Harris e & Russell M. Bauer f a Divisions of Medical Psychology and Neurology, Duke University Medical Center, Durham, NC, USA b Psychology Service, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA c Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA d Departments of Behavioral Sciences and Neurological Sciences, Rush University Medical Center, Chicago, IL, USA e Deparment of Psychiatry, University of Colorado School of Medicine, Denver, CO, USA f Department of Clinical Psychology, University of Florida, Gainesville, FL, USA

International perspectives on education, training, and practice in clinical neuropsychology: comparison across 14 countries around the world

Abstract Objective: To review and summarize data provided by special issue authors regarding the education, training, and practice of neuropsychologists from 14 surveyed countries. Method: A table was constructed to present an overview of variables of interest. Results: There is considerable diversity among surveyed countries regarding the education and training required to enter practice as a clinical neuropsychologist. Clinical neuropsychologists are typically well compensated, at least in comparison to what constitutes an average salary in each country. Conclusions: Despite substantial variations in education and training pathways, and availability of neuropsychologists from country to country, two common areas for future development are suggested. First, identification, development, and measurement of core competencies for neuropsychological education and practice are needed that can serve as a unifying element for the world’s clinical neuropsychologists. Second, greater emphasis on recognizing and addressing the need for assessment and treatment of diverse populations is needed if the world’s citizens can hope to benefit from the expertise of practitioners in our field.

Education, training and practice of clinical neuropsychologists in the United States of America

Abstract Objective: This invited paper is intended to give an overview regarding the education and training pathways for the practice of neuropsychology in the United States. It is also meant to describe the types of activities engaged in by neuropsychologists, a description of their work settings and the amounts/ways in which they are compensated for their work. Method: The authors reviewed the literature and relied on their professional and organizational experiences to collect the necessary data. Results: The United States has well-defined pathways for one to follow to gain the experiences and knowledge necessary to practice clinical neuropsychology in a competent way. Compensation varies widely among workplace settings but overall neuropsychologists appear to be well-paid. Challenges now and in the foreseeable future include a need to develop tests that have better ecological validity and that better reflect the demographics of a changing population, and an increasing need for neuropsychologists to identify key roles as members of integrated care teams. Conclusions: The United States has played an important role in the development of the practice and science of neuropsychology. Its continued success will, at least in part, depend on innovations in test development and application, and further demonstration of its relevance to health care and academic settings.