petit189

American Psychological Association Division 40 (Clinical Neuropsychology) Records

(Mss. 4745)

Text of document:

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January 8, 1995

PETITION FOR THE RECOGNITION OF A SPECIALTY IN PROFESSIONAL PSYCHOLOGY

THIS PETITION gives guidance to the types and amounts of information necessary for a formal decision to be reached. Petitioning organizations may use additional pages where necessary. The petitioning organization is free to provide any additional material deemed relevant.

AMERICAN PSYCHOLOGICAL ASSOCIATION
750 First Street, NE
Washington, D.C. 20002-4242
(202) 336-3500

PETITION PACKAGE

Criterion I. Distinctiveness. A specialty differs from other existing specialties in its body of specialized scientific knowledge and professional application, and provides evidence of these distinctions within each parameter of practice as described in PrincipleV.

1. Proposed title of the specialty: Clinical Neuropsychology

2. Provide a brief description of the specialty (e.g., one or two sentences that would adequately describe the specialty for the public.)

Clinical neuropsychology is a specialty that applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems. Related activities are integral to the mission and goals of the petitioning organization, the Division of Clinical Neuropsychology (40) of the American Psychological Association.

3. Identify how the following parameters differentiate the specialty from others. Describe how these parameters define professional practice in the specialty. Clinical neuropsychology has evolved as a specialized area of knowledge and practice with extensive intra- as well as interdisciplinary foundations Considered from the perspective of the sociology of the professions, the specialty is characterized by activities in a number of scientific and professional domains.These domains can be seen as having laid the foundation for the practice of clinical neuropsychology whose specialized mission encompasses roles that address psychological or behavioral manifestations of neurological, neuropathological, pathophysiological, and neurochemical changes in brain disease and the full range of aberrations

NOTE: This Petition Package was prepared by Manfred Meier, Bruce Crosson and Dan Eubanks. The directors of programs under Critrion II and III provided the documentation for their respective programs.

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in the central nervous system that may arise during development. The evolution of this mission has followed the characteristic course of scientifically-based professional role functioning, insofar as the foundations in knowledge and practice have been derived not only from the discipline of psychology, but also from the various related disciplines within the traditional professions of medicine, education and law.

Historically, three primary developmental domains appear to have provided the basis for this area of specialized knowledge and practice: basic experimental research in physiological and cognitive psychology; the development of quantitative and qualitative neuropsychological principles and procedures for clinical practice; and the syndromal analysis of the behavioral consequences of central nervous system lesions (Meier, 1992). The growth of the specialty has been influenced, as well, by the introduction of formalized procedures for accrediting educational programs and individual competencies.The developmental process, based on a considerable expansion of interdisciplinary knowledge and practices during the past half-century, appears to be following a very productive course. This is evidenced by the parallel development of participating organizations, publication of numerous books and journals, and the continued expansion of role applications beyond traditional neurological, neuropsychiatric and rehabilitation settings into the forensic, educational, and vocational arenas.

a. populations:

Adult neurological populations include cerebrovascular accidents, neoplasms, infectious and inflammatory diseases, degenerative diseases, head trauma, demyelinating disease and various forms of dementing illness. Psychiatric populations of primary interest include somatoform disorders of pseudoneurologic character; depression as a component of and/or to be differentiated from dementia; psychosis as a pseudodementing disorder and as a differential diagnostic entity to be distinguished from behavioral disturbances in selected neurological populations such as partial complex seizure disorders.

General medical and surgical populations include older individuals who may have some neuropsychological deficits associated with an early dementing illness that may complicate medical or surgical management; candidates for kidney transplant or dialysis; candidates for cardiac surgery, including transplants. and chronic pain patients with a neurological versus functional basis.

Children with learning disabilities of developmental or organic basis are referred from pediatricians, pediatric neurologists, and the schools, in addition to a marked expansion of neuropsychological evaluation and treatment of all types of pediatric neurological patients. Growing referral populations include the chemically dependent (especially polydrug users and alcoholics), AIDS dementia cases, and victims of environmental toxin exposures.

b. problems (psychological, biological, and social):

Referrals for clinical neuropsychological assessment typically include, but are not limited to, the following: differential diagnoses between psychogenic and neurogenic syndromes; differential diagnoses between two or more suspected etiologies of cerebral dysfunction; evaluation of spared and impaired functions secondary to a cerebral cortical or subcortical event; establishment of neurobehavioral baseline measures for monitoring progressive cerebral disease or recovery; comparison of pre- and postpharmacologic, surgical, or behavioral interventions; and assessment of higher cortical functions for the formulation of rehabilitation strategies.

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Intervention problems include design of procedures for utilizing available functions to compensate for an impaired functions; retraining of the impaired function to a higher level of adaptive effectiveness; and environmental (ecological) manipulations to enhance adaptive effectiveness.

It should be noted that clinical neuropsychologists function primarily on referral from health, education, and legal professionals; agencies and institutions; and in response to needs of other service systems (e.g., courts, schools, extended rehabilitation facilities and general care facilities, military installations, and chemical treatment facilities). Primary employment settings are estimated to be almost equally divided between hospital-medical centers, private practice, and a combination of (salaried) hospital or clinic-based employment, and private practice (Putnam & DeLuca, 1990, 1991).

C. procedures and technologies:

Thus, priority services include neuropsychological assessment, cognitive remediation and intervention, agency and institutional consultation, education and counseling for individuals and families, and selected psychotherapies or behavior therapies as appropriate for neurologically involved individuals. A growing armamentarium of procedures is available for neuropsychological assessment (Lezak, 1983) and for cognitive remediation and intervention (Meier, Benton & Diller, 1987). Further elaboration of procedures and technologies can be found under Criterion VI.

Differentiation of clinical neuropsychology from other psychological specialties is reflected in the distinction between generic competencies and specialized competencies as proposed by the APA Subcommittee on the Specialization (SOS) (Sales, Bricklin & Hall, 1984). Clinical neuropsychology had been evolving through an identifiable sequence of developments and was the first area of practice to provide an organized response to the SOS manual, the forerunner of this Petition Package for Specialty Recognition. Thus, a decade ago, the Division 40 TFEAC began to identify how clinical neuropsychology can be differentiated from other specialties given the SOS guidelines.

Generic applied competency requires a foundation in psychological science with a predominantly clinical emphasis, although such training may be obtained through other generic avenues if a clinical internship is included. Over the past few decades, roles of clinical counseling, and school psychologists, appeared to have converged so that there is a substantial overlap in generic applied knowledge and competency attained in related programs at the predoctoral and internship levels. Clinical neuropsychology involves the building of specialized competencies upon the generic applied knowledge and competency base obtained in a generic applied predoctoral program of a health-related nature. The generic base for clinical neuropsychology includes the structure and process of interviewing; intellectual, aptitude, interest and personality measurement; selected psychotherapy and counseling interventions; general consultation skills; and a consumer-patient education orientation, including ethics. Building upon such a generic foundation, specialized clinical neuropsychological competence includes effectiveness in comprehensive history taking; identification of neurobehavioral problems/issues to be addressed; application of a wide range of neuropsychological assessment procedures to multiple populations;test construction and validation; remedial and supportive intervention design and implementation;individual and agency consultation; and consumer education/ethics, specifically in a neuropsychological context. Such specialized competency is achieved by means of sets of skills anchored to the above parameters of practice in the settings outlined in a, b and c above. While there is overlap

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with the other health-related specialties in terms of generic applied competence, there is the elaboration, extension, and refinement of neurobehavioral applications that involve additional foundations in experimental, cognitive and physiological psychology as well as in the clinical neurosciences. Such extensions of knowledge and application are obtained by specialty track programs at the predoctoral and internship levels and/or by postdoctoral preparation in a specialized clinical neuropsychology program as exemplified under Criterion III.

4. In addition to the professional practice domains described above, describe the theoretical and scientific knowledge required for the specialty and provide references for each domain.

Competence in clinical neuropsychology requires the knowledge and skills to comprehend and integrate information in numerous areas of psychological science and the clinical neurosciences. Exemplary articles from the literature follow.At least ten (10) in each area could readily be provided.

*Selected aspects of functional neuroanatomy, neuropathology and pathophysiology.

Benton, A.L. (1991). The prefrontal region: It's early history. In: Levin, H.S., Eisenberg, H.M. and Benton, A.L. (Eds.). Frontal Lobe Function and Dysfunction. New York: Oxford.

Filskov, S.B. and Boll, T.J. (Eds.) (1986). Handbook of Clinical Neuropsychology. Vol. 2. New York Wiley. (See especially Chpaters 9, 20)

*Disorders of attention, sensory, perceptual, conceptual thinking, language, memory, and voluntary and involuntary motor and affective processes

Meier, M.J., Benton, A.L. and Diller, L. (Eds.) (1987). Neuropsychological Rehabilitation. New York: Guilford. (See especially Chapters 8, 9, 10, 11, 13, 14, 15, 16)

Margolin, D.I. (Eds.) (1992). Cognitive Neuropsychology in Clinical Practice. New York: Oxford. (See especially Chapters 2, 3, 7, 12, 13, 15) 0

*Neurological and related diseases, including their manner of presentation, course and treatment

Boll, T.J. (1986). Nontraditional and threshold conditions in neuropsychological assessment. In: Filskov, S.B. and Boll, T.J. (Eds.). Handbook of Clinical Neuropsychology. (Vol. 2). New York: Wiley.

Bornstein, R.A. and Brown, G. (Eds.) (1991). Neurobehavioral Aspects of Cerebrovascular Disease. New York: Oxford.

Many Clinical Neurology Textbooks.

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*CNS effects of systemic disorders

Tarter, R.E., Van Theil, D.H. and Edwards, K.L. (Eds.) (1988). Medical Neuropsychology: The Impact of Disease on Behavior. New York: Plenum.

Hart, R.P., Pederson, J.A., Czerwinski, A.W. and Adams, R.L. (1983). Chronic renal failure dialysis and neuropsychological function. Journal of Neuropsychology, 4,301-312.

*Child development and ontology of neuropsychological processes

Rourke, B.P. (Ed.) (1991). Neuropsychologicul Validation of Learning Disability Subtypes. New York Guilford.

Wilson, B.C. (1986). An approach to the neuropsychological assessment of the preschool child with developmental defects. In: Filskov, S.B. and Boll, T.J. Handbook of Clinical Neuropsychology (Vol. 2). New York: Wiley.

Many Developmental Psychology Textbooks.

*Expected decrements in neuropsychological processes as a function of normal aging

Scheff, S.W. (Ed.) (1984). Aging and Recovery of Function in the Central Nervous System. New York: Plenum.

Fletcher, J.M., Miner, M.E., and Ewing-Cobbs, L. (1987). Age and recovery from head injury in children: Developmental issues. In: Levin, H.S., Grafman, J. and Eisenberg, H.M. (Eds.). Neurobehavioral Recovery from Head Injury. New York: Oxford.

*Behavioral pathology and psychopharmacology

Mirsky, A.F. and Duncan, C.C. (1973). Behavioral and electrophysiological studies of absence epilepsy. In: Avioli, M., Gloor, P., Kostopoulus, G. and Naquet, R. (Eds.). Generalized Epilepsy: Neurobiological Approaches, Birkhauser, Boston.

Weinberger, D.R. Berman, K.F., and Zec, R.F. (1986). Physiological dysfunction of dorsolateral prefrontal cortex in schizophrenia.I: Regional cerebral blood flow (rCBF) evidence. Archives of General Psychiatry, 43, 114-125.

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*Psychophysiological principles underlying behavioral psychology

Mirsky, A.F. and Duncan, C.C. (1990). An introduction to modem techniques of clinical neuropsychology. In: Fava, G.A. and Wise, T.N. (Eds.). Research Paradigms in Psychosomatic Medicine. Karger: Basel.

Luria, A.R. (1966). Higher Cortical Functions in Man. Basic Books: New York.

*Sociocultural factors as co-determinants of behavior

Prigatano, G. (1987). Personality and psychosocial consequences after brain injury. In: Meier, J.J. Benton, A.L., and Diller, L. (Eds.). Neuropsychological Rehabilitation. New York: Guilford.

Dodrill, C.B. (1987). Psychosocial consequences of epilepsy. In: Filskov, S.D. and Boll, T.J. (Eds.). Handbook of Clinical Neuropsychology. (Vol. 2). New York: Wiley.

*Principles of personality assessment and interviewing skills

Spreen, 0. and Strauss, E. (1991). A Compendium of Neuropsychological Tests: Administration, Norms and Commentary. New York: Oxford. (See Chapters 1, 11)

*Principles of test administration and interpretation relating to both fixed and flexible neuropsychological batteries

Spreen, 0. and Strauss, E. (1991). A Compendium of Neuropsychological Tests: Administration, Norms and Commentary. New York: Oxford. (See Chapters 2, 3, 4, 5, 6, 7, 8, 9, 10)

Goodglass, H. and Kaplan, E. Assessment of cognitive deficit in the brain-injured patient. In: Guzzaniga, M.S. (Ed.), Handbook of Behavioral Neurobiology, Volume 2: Neuropsychology. New York: Plenum.

*Principles of cognitive remediation and their derivation of specific intervention strategies

Meier, M.J., Benton, A.L. and Diller, L. (Eds.) (1987). Neuropsychological Rehabilitation. New York Guilford. (SeeChapters 8, 9,10,11,12,13,14,15,16)

Seron, X., Van der Linden, M., Van der Kaa, M.A. (1978). The operant school in aphasia rehabilitation. In: Lebrun, X., Hoops, R. (Eds.). The Management of Aphasia. Amsterdam: Swets and Zeitlinger.

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It is immediately evident that the assessment role in clinical neuropsychology includes the derivation of intervention strategies and, by implication, an intervention role. Since clinical neuropsychologists are ordinarily specializing from a generic applied base, either in clinical, counseling, or school psychology, they have already acquired a foundation in assessment and intervention that is being extended by means of specialized training and supervised experience into the neurobehavioral domain, as it is broadly defined.A search for a core curriculum that will ensure the development of neuropsychological competency necessarily would include cognitive, physiological and experimental psychology; differential psychology; abnormal psychology and life-span developmental psychology. The curriculum would also include relevant areas of clinical neuroscience, including clinical neurology, behavioral neurology and specialized neurodiagnostic technologies as a basis for refinement of skills to extend competency into increasingly more specialized activities. The latter would appear to include design and validation of new neuropsychological procedures in order to extend neuropsychological applications in behavioral analysis and modification, learning disorders, psychopharmacology, psychophysiology, remedial interventions, behavior genetics, psycholinguistics, personality and psychopathology (functional and organic). Thus, clinical neuropsychology as practiced by psychologists would build upon a knowledge base that includes other disciplines as well as subdisciplines within psychology.

5. For each of the following core professional practice domains, provide a brief description of the knowledge that is required and provide published references in each area (e.g., books, chapters, articles in refereed journals, etc.)

a. assessment:

*Differential diagnosis between organic and non-organic syndromes and disorders

Reitan, R.M. (1955). Investigation of the validity of Halstead's measures of biological intelligence. Archives of Neurology and Psychiatry, 73,28-35.

Reitan, R. (1964). Psychological deficits resulting from cerebral lesions in men. In: Warren, J.M. and Akert, K. (Eds.). The Frontal Granular Cortex and Behavior. New York McGraw-Hill.

*Differential diagnosis between psychogenic and neurogenic syndromes and disorders (e.g., depression vs. dementia)

Matthews, C.G. (1981). Neuropsychology practice in a hospital setting. In: Filskov, S.B. and Boll, T.J. Handbook of Clinical Neuropsychology (Vol. 1). New York: Wiley.

McFie, J. (1975). Assessment of Organic Intellectual Impairment. London: Academic Press.

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*Differential diagnosis between two or more suspected etiologies of cerebral dysfunction (e.g., neoplasm vs. cerebral vascular accident)

Reitan, R.M. (1964). Psychological deficits resulting from cerebral lesions in men. In: Warren, J.M. and Akert, K. (Eds.). The Frontal Granular Cortex and Behavior. New York: McGraw-Hill.

Filskov, S.B., Grimm, B.H. and Lewis, J.A. Brain-behavior relationships. In: Filskov, S.B. and Boll, T.J. (Eds.). Handbook of Clinical Neuropsychology. (Vol. 1). New York: Wiley.

*Delineation of spared and impaired functions secondary to an episodic event (e.g., cerebral vascular accident, head trauma, infection)

Parker, R.S. Traumatic Brain Injury and Neuropsychological Impairment. New York: Springer-Verlag.

Bornstein, R.A. and Brown, G. (Eds.) (1991). Neurobehavioral Aspects of Cerebrovascular Disease. New York: Oxford.

*Establishment of baseline measures to monitor progressive cerebral disease or recovery processes (e.g., neoplasm, demyelinating disease, head injury)

Meier, M.J., Strauman, S., and Thompson, G. (1987). Individual differences in neuropsychological recovery. In: Meier, M.J., Benton, A .L ., and Diller, L. (Eds.). Neuropsychological Rehabilitation. New York: Guilford.

Levin, H.S., Grafman, J. and Eisenberg, H.M. (Eds.) (1987). Neurobehavioral Recovery from Head Injury. New York: Oxford. (See especially Chapter 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15)

*Comparison of pre- and post-neuropsychological functioning following pharmacologic, surgical or behavioral interventions (e.g., drug trials, tissue excision, shunts, revascularization, language or cognitive therapy)

Jones, E.G., Henderson, M. and Welch, C.A. (1988). Executive functions in unipolar depression before and after electroconvulsive therapy. International Journal of Neuroscience, 38, 287-297.

Hermann, B.P. and Wyler, A.R. (1988). Neuropsychological outcome of anterior temporal lobectomy. Journal of Epilepsy, 1, 35-45.

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*Assessment of cognitive and affective status for the formulation of rehabilitation strategies and the design of remedial interventions

Goldstein, G. and Ruthven, L. (Eds.) (1983). Rehabilitation of the Brain-Damaged Adult. New York Plenum. (See especially Chapters 5, 6, 8)

Meier, M.J., Benton, A.L. and Diller, L. (Eds.) (1987). Neuropsychological Rehabilitation. New York Guilford. (See especially Chapters 1, 2, 3, 6, 7)

The first and still fundamental practice of clinical neuropsychology is the evaluation of psychological and behavioral disturbances associated with organic central nervous system dysfunction. The clinician is required to establish a comprehensive data base of historical and current general medical and surgical, neurological, pharmacological, developmental and psychosocial factors underlying the presenting problem. Included in this data base is the entire complement of specialized neural diagnostic procedures such as neural imaging electroencephalography, and brain-mapping techniques. An assessment strategy is derived from the data base and referral issues and requires knowledge of the various neuropsychological protocols, test procedures, and inventories that are available through a rapidly expanding literature. This function includes the application of fixed batteries at their current stage of validation and the design of flexible test batteries based on an understanding of the probably primary processes that may be affected by the underlying disease process. The assessment goal is to address relevant neurobehavioral aspects of higher psychological functioning that are considered to be central to understanding the cognitive strengths and deficits of the individual.

b. intervention:

In addition to the traditional psychotherapeutic methods and competencies derived from the neuropsychologist's previous generic applied preparation, there is a growing involvement of neuropsychologists in rehabilitation settings where they are introducing and refining cognitive interventions as guided by their increasing knowledge of the cognitive and physiological basis of neurobehavioral changes in neurological and other medical diseases. Attentional and memory dysfunctions have been given primary consideration while language therapies have remained predominantly the domain of the speech therapist and speech pathologist in such settings. They also have become engaged in behavioral management of individuals with severe neuropsychological deficits. There appears to be a marked expansion of activity in neuropsychological rehabilitation so that intervention is likely to become a stronger part of the neuropsychologist's functioning in what has been historically a more assessment-oriented specialty.

The necessary knowledge for neuropsychological intervention includes theories and procedures for modifying attentional, learning and memory, problem solving, perceptual processing, and sensory motor functioning at the basic and applied levels. c. consultation: Neuropsychological consultation activities now embrace areas of medicine beyond psychiatry and neurology including medical specialties of cardiology and cardiac surgery, infectious and inflammatory diseases, toxicology, and public health. Such consultative activities require at least an introductory knowledge in those areas of medical practice.

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Similarly, consultation to educators (e.g., learning disorders) and attorneys (personal injury cases, toxic exposure cases, and selected criminal cases where competency to stand trial or be sentenced is at issue). Such consultation requires more than a lay knowledge of the statutory context in which the case is being tried. Consultation skills are transmitted largely by example from peers and mentors. They usually require advanced competence at the diplomate level (which usually requires some postdoctoral preparation.)

d. supervision:

Engagement in the supervision of trainees in clinical neuropsychology requires the above knowledge foundations and is usually obtained in training settings such as health sciences centers which is where approximately half of persons engaged in clinical neuropsychology are employed. Mentoring and supervised experience play a heavy role in preparing individuals for supervisory roles.

e. research and inquiry:

Probably more than any other specialty within psychology, clinical neuropsychologists are expected to engage in clinical research. Thus, approximately one-half of the specialist force in clinical neuropsychology is engaged in clinical research. This is evidenced by the marked expansion in the number of journals in which neuropsychological research is published and in the expansion of postdoctoral training programs.The latter exceed 50 in number, with over 30 directed by a diplomate in clinical neuropsychology (ABPP/ABCN). The research tends to be relatively specialized in accord with individual interests and opportunities within the settings at issue. Scope of clinical neuropsychological research is indeed broad and the depth of knowledge is substantial. Even a cursory review of the major journals confirms this statement. (Again, see Appendix E.)

f. consumer protection:

The establishment of the ABPP diploma in clinical neuropsychology with examinations administered by the American Board of Clinical Neuropsychology provides the context for identifying competent individuals in the interest of the consumer. Examination includes a substantial ethics component. Each major organization has an ethics committee so that there is considerable deliberation within the specialty about ethical issues.

g. professional development:

Each of the major organizations provides continuing education opportunities for professionals in the field. Many state statutes now require continuing education for maintenance of the state's license. Attendance at scientific and professional meetings is outstanding in this specialty, as evidenced by the continuing growth of program time based on attendance figures for Division 40 of APA, for example. There is also considerable interest in obtaining the ABPP/ABCN diploma in clinical neuropsychology where requests for application for the clinical neuropsychology examination exceeded that of all other specialties in the ABPP family, including clinical psychology, in 1993.

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6. Define up to a maximum of ten professional practice activities associated with the specialty area in each of the seven core professional practice domains listed below. Each activity should be operationally defined in as concrete and succinct a fashion as possible.

a. assessment

1)Assessment based on historical information, other neurodiagnostic findings, interview data, and neuropsychological test findings for the purpose of identifying the likely presence of some form of organic cerebral or subcortical disorder.

2) Assessment based on the above information for the purpose of differentiating functional psychiatric from organic neurological disorders.

3) Assessment based on the above information for the purpose of differentiating diffuse from localized higher cortical dysfunction.

4) Assessment based on the above information for the purpose of differentiating among two or more suspected ideologies of cerebral dysfunction.

5) Assessment based upon the above information for the purpose of identifying spared and impaired functions and estimating longitudinal outcome for an episodic event.

6) Baseline assessment of spared and impaired higher cortical functions for the purpose of monitoring recovery processes.

7) Comparison of pre- and post-neuropsychological functioning following pharmacologic, surgical and behavioral interventions.

8) Assessment of cognitive and affective status for the purpose of formulating rehabilitation strategies and for the design of remedial interventions.

9) Assessment based on the above sources of information for the purpose of evaluating competence to stand trial, participate in long-term intervention such as heart and kidney transplantation, and similar treatment regimens.

b. intervention

1) Devise and implement cognitive and memory remedial or retraining paradigms for application during the recovery process in head injury, stroke and other non-progressive neurological disorders.

2) Individual and group psychotherapy for individuals with neurological disorders.

3) Counseling of individuals with learning disabilities for educational and vocational purposes.

4) Devise and implement behavioral interventions for individuals with severe psychological deficits.

C. consultation

1) Consult with attorneys regarding the neuropsychological consequences of head injuries.

2) Consultation with teachers in schools regarding the neuropsychological correlates of learning disabilities.

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3) Consultation with military regarding the cognitive requirements of particular equipment designs.

4) Consultation with public health agencies regarding the neuropsychological consequences of exposure to industrial toxins and accidents.

5) Consultation with medical specialists regarding the neuropsychological consequences of medical, neurological and psychiatric illnesses.

d. supervision

1) Supervision of graduate students,interns and postdoctoral fellows in neuropsychological assessment and intervention.

2) Supervision of allied health professionals in the performance of neuropsychological and behavioral interventions.

3) Supervision of psychometric/technical personnel in the administration and scoring of neuropsychological tests.

4) Supervision of neurological and psychiatric residents in the performance of neuropsychological screening procedures.

5) Supervision of graduate students and interns in performance of psychotherapy with neurologically involved individuals.

e. research and inquiry

1) Perform research on the efficacy of neuropsychological test procedures for the differential diagnosis of organic from non-organic disease states.

2) Perform comparable research for differentiating functional from organic disorders by means of neuropsychological tests.

3) Perform research into the cognitive processes underlying particular neuropsychological deficits.

4) Perform program evaluation studies to determine the effectiveness of service delivery in particular settings.

5) Design and evaluate in single cases the effectiveness of a cognitive intervention.

6) Perform taxonomic research for the classification of neuropsychological deficit and brain-behavior disorders.

f. consumer protection

1) Seek to meet performance criteria for becoming a diplomate of ABPP/ABCN.

2) Continually develop ethical standards for the performance of various roles of neuropsychologists as above.

3) Endeavor to publish for public distribution information regarding the activities of neuropsychologists and the costs as well as effectiveness of their services.

4) Engage in program evaluation research that evaluates in a recurring and progressive fashion the effectiveness of services and activities.

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g. professional development

1) Affiliate with scientific/professional organizations whose mission it is to advance knowledge and practice in neuropsychology.

2) Engage in continuing education activities to strengthen existing compctencies and add new competencies.

3) Attain elective office and representation on selected committees and boards.

7. For each defined professional activity, check the appropriate box indicating whether this specialty is judged to be (1) an essential activity for practice in the specialty or one that is important but not essential, and (2) and activity that is unique to the specialty or shared with one or more specialties.

Professional Practice Activities (1) Essential Important (2) Unique Shared

a. assessment

1) Assessment based on historical information, other neurodiagnostic findings, interview data, and neuropsychological test findings for the purpose of identifying the likely presence of some form of organic cerebral or subcortical disorder. X X

2) Assessment based on the above information for the purpose of differentiating functional psychiatric from organic neurological disorders.
X X

3) Assessment based on the above information for the purpose of differentiating diffuse from localized higher cortical dysfunction.
X X

4) Assessment based on the above information for the purpose of differentiating among two or more suspected ideologies of cerebral dysfunction.
X X

5) Assessment based upon the above information for the purpose of identifying spared and impaired functions and estimating longitudinal outcome for an episodic event.
X X

6) Baseline assessment of spared and impaired higher cortical functions for the purpose of monitoring recovery processes.
X X

7) Comparison of pre- and post-neuropsychological functioning following pharmacologic, surgical and behavioral interventions.
X X

8) Assessment of cognitive and affective status for the purpose of formulating rehabilitation strategies and for the design of remedial interventions.
X X

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Professional Practice Activities (1) Essential Important (2) Unique Shared

b. intervention

1)Devise and implement cognitive and memory remedial or retraining paradigms for application during the recovery process in head injury, stroke and other non-progressive neurological disorders.

2)Individual and group psychotherapy for individuals with neurological disorders.

3)Counseling of individuals with learning disabilities for educational and vocational purposes.

4)Devise and implement behavioral interventions for individuals with severe psychological deficits.

C. consultation

1)Consult with attorneys regarding the neuropsychological consequences of head injuries.

2)Consultation with teachers in schools regarding the neuropsychological correlates of learning disabilities.

3)Consultation with military regarding the cognitive requirements of particular equipment designs.

4)Consultation with public health agencies regarding the neuropsychological consequences of exposure to industrial toxins and accidents.

5) Consultation with medical specialists regarding the neuropsychological consequences of medical, neurological and psychiatric illnesses.

d. supervision

1)Supervision of graduate students, interns and postdoctoral fellows in neuropsychological assessment and intervention.

2)Supervision of allied health professionals in the performance of neuropsychological and behavioral interventions.

3)Supervision of psychometric/technical personnel in the administration and scoring of neuropsychological tests.

4)Supervision of neurological and psychiatric residents in the performance of neuropsychological screening procedures.

5)Supervision of graduate students and interns in performance of psychotherapy with neurologically involved individuals. X

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Professional Practice Activities (1) Essential Important (2) Unique Shared

e. research and inquiry

1)Perform research on the efficacy of neuropsychological test procedures for the differential diagnosis of organic from non-organic disease states.

2)Perform comparable research for differentiating functional from organic disorders by means of neuropsychological tests.

3)Perform research into the cognitive processes underlying particular neuropsychological deficits.

4)Perform program evaluation studies to determine the effectiveness of service delivery in particular settings.

5)Design and evaluate in single cases the effectiveness of a cognitive intervention.

6)Perform taxonomic research for the classification of neuropsychological deficit and brain-behavior disorders.

f. consumer protection

1)Seek to meet performance criteria for becoming a diplomate of ABPP/ABCN.

2)Continually develop ethical standards for the performance of various roles of neuropsychologists as above.

3)Endeavor to publish for public distribution information regarding the activities of neuropsychologists and the costs as well as effectiveness of their services.

4)Engage in program evaluation research that evaluates in a recurring and progressive fashion the effectiveness of services and activities.

g. professional development

1) Affiliate with scientific/professional organizations whose mission it is to advance knowledge and practice in neuropsychology.

2)Engage in continuing education activities to strengthen existing competencies and add new competencies.

3)Attain elective office and representation on selected committees and boards.

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References

Lezak, M.D. (1983). Neuropsychological Assessment (2nd Ed.). New York: Oxford.

Meier, M.J. (1992). Modem clinical neuropsychology in historical perspective. American Psychologist, 47, 550-558.

Meier, M.J., Benton, A.L. and Diller, L. (Eds.) (1987). Neuropsychological Rehabilitation. New York: Guilford.

Putnam, S.H. and DeLuca, J.W. (1990). The TCN professional practice survey: Part I: General practices of clinical neuropsychologists in primary employment and practice settings. The Clinical Neuropsychologist, 4, 199-243.

Putnam, S.H. and DeLuca, J.W. (1991). The TCN professional practice survey. Part II: An analysis of the fees of neuropsychologists by practice demographics. The Clinical Neuropsychologist, 5, 102-124.

Sales, B., Bricklin, P. and Hall, J. (1984). Manual on Specialization: Principles proposed to the Board of Professional Affairs. Washington, D.C.: American Psychological Association.

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Criterion II. Structures and Models of Education and Training in the Specialty. The specialty has a variety of structures and models to implement the education and training sequence of the specialty. The structures are stable, sufficient in number and geographically distributed, and may be found at the doctoral or postdoctoral level or both.

1. Describe the characteristics of a typical sequence of training that includes courses, research, supervision, and the evaluation of students.

The current Definition of a Clinical Neuropsychologist (The Clinical Neuropsychologist, 1989, Vol. 3, No. 1, p. 22), which is the official position of APA Division 40 (Division of Clinical Neuropsychology), states that a clinical neuropsychologist must successfully complete systematic didactic and experiential training in neuropsychology and neuroscience at a regionally accredited university” and two or more years of appropriate supervised training applying neuropsychological services in a clinical setting.”Currently, the two generally used routes for becoming a Clinical Neuropsychologist involve either: a) taking a two-year postdoctoral fellowship after completing more generic training in applied psychology (i.e. clinical, counseling, school) or b) completing a Clinical Neuropsychology track in a clinical psychology program, taking a Clinical Neuropsychology internship, and receiving one year of postdoctoral supervision in clinical neuropsychology. If a postdoctoral fellow enters a two-year fellowship from a more generic program, it is expected that the didactic component of the fellowship will cover areas of knowledge that are covered in Clinical Neuropsychology tracks at the doctoral level.

The reports of the INS-Division 40 Task Force on Education, Accreditation, and Credentialing (The Clinical Neuropsychologist, 1987, Vol. 1, No. 1, pp. 29-34) [Appendix G] detail courses, research, supervision, and evaluation guidelines at the doctoral program, internship, and postdoctoral levels. These are summarized below:

Doctoral Training Programs in Clinical Neuropsychology

Division 40 guidelines for doctoral training programs in Clinical Neuropsychology (Appendix B) list the following didactic courses, supervised experiences, and research areas to be covered.

A. Generic Psychology Core

1. Statistics and Methodology
2. Learning, Cognition, and Perception
3. Social Psychology and Personality
4. Physiological Psychology
5. Life-Span Developmental
6. History

B. Generic Clinical Core

1. Psychopathology
2. Psychometric Theory

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3. Interview and Assessment Techniques

i. Interviewing
ii. Intelligence Assessment
iii. Personality Assessment

4. Intervention Techniques

i. Counseling and Psychotherapy
ii. Behavior Therapy/Modification
iii. Consultation

5. Professional Ethics

C. Neurosciences and Basic Human and Animal Neuropsychology

1. Basic Neurosciences
2. Advanced Physiological Psychology and Pharmacology
3. Neuropsychology of Perceptual, Cognitive, and Executive Processes
4. Research Design and Research Practicum in Neuropsychology

D. Specific Clinical Neuropsychological Training

1. Clinical Neurology and Neuropathology
2. Specialized Neuropsychological Assessment Techniques
3. Specialized Neuropsychological Intervention Techniques
4. Assessment Practicum (Children and/or Adults) in University-Supervised assessment facility
5. Intervention Practicum in University-Supervised Intervention Facility
6. Clinical Neuropsychological Internship of 1800 hours preferably in noncaptive facility. (As per INS-Division 40 Task Force guidelines). Ordinarily this internship will be completed in a single year, but in exceptional circumstance may be completed in a 2-year period.

E. Doctoral Dissertation

Since most doctoral Clinical Neuropsychology tracks exist in APA-approved doctoral programs, student supervision and evaluation criteria will meet APA accreditation standards.

Clinical Neuropsychology Internships

Persons entering a Clinical Neuropsychology internship are expected to have completed a designated track, specialization, or concentration in neuropsychology. The internship must devote at least 50% of its one-year full-time training experience to neuropsychology and at least 20% of the training experience to general clinical training.Supervisors are encouraged to be board-certified in clinical neuropsychology. Didactic and experiential training guidelines are as follows:

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A. Didactic Training

1. Training in Neurological Diagnosis
2. Training in Consultation to Neurological and Neurosurgical Services
3. Training in Direct Consultation to Psychiatric, Pediatric, or General Medical Services
4. Exposure to Methods and Practices of Neurological and Neurosurgical Consultation (grand rounds, bed rounds, seminars, etc.)
5. Training in Neuropsychological Techniques, Examination, Interpretation of Test Results, Report Writing
6. Training in Consultation to Patients and Referral Sources
7. Training in Methods of Intervention Specific to Clinical Neuropsychology

B. Experiential Training

1. Neuropsychological Examination and Evaluation of Patients with Actual and Suspected
2. Neurological Diseases and Disorders Neuropsychological Examination and Evaluation of Patients with Psychiatric Disorders and/or Pediatric or General Medical Patients with Neurobehavioral Disorders
3. Participation in Clinical Activities with Neurologists and Neurosurgeons (bed rounds, grand rounds, etc.)
4. Direct Consultation to Patients Involving Neuropsychological Issues
5. Consultation to Referral and Treating Professions

In general, Clinical Neuropsychology internships are APA-approved; therefore, supervision and evaluation of students will meet APA standards.General exit criteria which are used in intern evaluation are listed in the guidelines for internship training (Appendix G).

Postdoctoral Fellowships in Clinical Neuropsychology

Entry into a Clinical Neuropsychology postdoctoral program should be based upon completion of a regionally accredited Ph.D. graduate training program in one of the health service delivery areas of Psychology, or an equivalent re-specialization after obtaining a Ph.D. in another area of Psychology. Thus, postdoctoral fellows will have completed an internship program. Normally, directors are expected to be board certified. Except for individuals completing a specialty Clinical Neuropsychology track in their doctoral program and a Clinical Neuropsychology internship, the postdoctoral fellowship in Clinical Neuropsychology is expected to extend at least over a two-year period and involve at least 50% time in clinical service and at least 25% time in clinical research. Didactic and experiential training guidelines are as follows:

A. Didactic Training

1. Training in Neurological and Psychiatric Diagnosis
2. Training in Consultation to Neurological and Neurosurgical Services
3. Training in Direct Consultation to Psychiatric, Pediatric, or General Medical Services

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4. Exposure to Methods and Practices of Neurological and Neurosurgical Consultation (grand rounds, bed rounds, seminars, etc.)

5. Observation of Neurosurgical Procedures and Biomedical Tests (revascularization procedures, cerebral blood flow, Wada testing, etc.)

6. Participation in Seminars Offered to Neurology and Neurosurgery Residents (neuropharmacology, EEG, brain cutting, etc.)

7. Training in Neuropsychological Techniques, Examination, Interpretation of Test Results, Report Writing

8. Training in Consultation to Patients and Referral Sources

9. Training in Methods of Intervention Specific to Clinical Neuropsychology

10. Seminars, Readings,etc. in Neuropsychology (case conferences, journal discussion, topic-specific seminars) Didactic

11. Training in Neuroanatomy, Neuropathology, and Related Neuroscience Topics

B. Experiential Training

1. Neuropsychological Examination and Evaluation of Patients with Actual and Suspected Neurological Diseases and Disorders

2. Neuropsychological Examination and Evaluation of Patients with Psychiatric Disorders and/or Pediatric or General Medical Patients with Neurobehavioral Disorders

3. Participation in Clinical Activities with Neurologiests and Neurosurgeons (bed rounds, grand rounds, etc.)

4. Experience at a Specialty Clinic, such as a Dementia Clinic or Epilepsy Clinic which emphasizes Multidisciplinary Approaches to Diagnosis and Treatment

5. Direct Consultation to Patients Involving Neuropsychological Assessment

6. Direct Intervention with Patients, Specific to Neuropsychological Issues, and to Include Psychotherapy and/or Family Therapy where indicated

7. Research in Neuropsychology (i.e., collaboration on a research project or other scholarly academic activity, initiation of an independent research project or other scholarly academic activity, and presentation or publication of research data where appropriate)

The Association of Postdoctoral Programs in Clinical Neuropsychology is currently examining specific criteria for supervision and evaluation of postdoctoral fellows, and their standards are generally consistent with Division 40 guidelines.General exit criteria which can be used in evaluation of postdoctoral fellows are listed in the Division 40 guidelines for postdoctoral training (Appendix G).

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2. List the names of the training programs that exist in this specialty.

Appendix F is a list of doctoral, internship,and postdoctoral programs in Clinical Neuropsychology published in The Clinical Neuropsychologist, 1993, Vol. 7, No. 4, pp. 371-419. These programs profess to comply with the guidelines for doctoral, internship, and postdoctoral programs in Clinical Neuropsychology set forth by the Division 40 Task Force on Education, Accreditation, and Credentialing published in The Clinical Neuropsychologist, 1987, Vol. 1, No. 1, pp. 29-34 (Appendix G).

In general, there are now two recognized routes to becoming a Clinical Neuropsychologist. The first is to take a two-year postdoctoral fellowship in Clinical Neuropsychology after obtaining generic doctoral and internship training in some field of applied psychology (i.e., clinical, counseling, school). Such fellowships should meet Division 40 guidelines for postdoctoral training (Appendix G). The second route is to obtain doctoral education and internship training in programs meeting Division 40 guidelines for doctoral education and internship training; then, an addition year of postdoctoral training is needed. Other models have been identified but the above have become the characteristic avenues of educational preparation (See Meier, in press, in Appendix E for further discussion of these models.The program descriptions which follow under Criterion III are exemplary structures of well established programs;

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3. Select four representative doctoral and/or postdoctoral-level geographically distributed, and publicly identified programs in psychology in this specialty and provide the name, address, and telephone numbers of the directors of these programs.

Program One Doctoral _____ Postdoctoral X Both _____

Name of University, School, or institution offering program:
Medical College of Wisconsin

Name of program: Postdoctoral Program in Clinical Neuropsychology

Address: 9200 West Wisconsin Avenue, Section of Neuropsychologv

City/State/Zip: Milwaukee, WI 53226

Contact Person: Thomas Hammeke. Ph.D., ABPP

Telephone No. (414) 454-5660

Program Two Doctoral X Postdoctoral ____ Both _____

Name of University, School, or institution offering program:
Universitv of Houston

Name of program:
Clinical Psychology Program (with Clinical Neuropsychology Track)

Address: Department of Psvchologv

City/State/Zip: Houston, TX 77204

Contact Person: H. Julia Hannay, Ph.D.

Telephone No. (7 13) 743-8568

Program Three Doctoral ______ Postdoctoral X Both _____

Name of University, School, or institution offering program:
Hahnemann University

Name of program: Neuropsvchology Track

Address: 230 North Broad Street

City/State/Zip: Philadelphia, PA 19 102

Contact Person: Sandra Koffler, Ph.D.

Telephone No. (215) 762-4956

Program Four Doctoral X Postdoctoral _ Both _

Name of University, School, or institution offering program:
Universitv of Victoria

Name of program:
Clinical Psvchologv Program (with Clinical Neuropsvchology Track)

Address: Department of Psychology. P.O. Box 1700

City/State/Zip: Victoria, British Columbia. Canada V8W 3P5

Contact Person: Catherine A. Mateer, Ph.D.

Telephone No. (604) 721-8590

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4. For each of the programs listed above, designate the program administrator who will provide the information requested in Attachment A (Specifications for Education and Training in (name of specialty) Psychology”).

Program One: Thomas A. Hammeke, Ph.D., ABPP, Director of Training in Neuropsychology

Program Two: H. Julia Hannay, Ph.D., Director of Clinical Neuropsychology Track

Program Three: Sandra Koffler, Ph.D., ABPP

Program Four: Catherine A. Mateer, Ph.D., ABPP, Director of Clinical Training

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Criterion III. Doctoral Education and Training Prerequisites to Specialty Preparation. The knowledge and skills of a specialty are built upon studies in general scientific and applied knowledge in psychology.

1. Select four representative doctoral programs which are geographically distributed that provide the prerequisite preparation in this specialty.

In general, when Clinical Neuropsychology training is formally addressed at the doctoral level, it is accomplished in APA approved applied psychology programs with tracks in Clinical Neuropsychology. The route to becoming a Clinical Neuropsychologist which involves only generic training at the doctoral level and involves taking a two-year postdoctoral residency in Clinical Neuropsychology is relatively familiar. Because the route involving a Clinical Neuropsychology track in a doctoral program is less familiar, we have chosen to focus on the latter mechanism for the purposes of this application.

Program One

Name of Institution:University of Florida

Street: P.O. Box 100165, Health Science Center

City/State/Zip: Gainesville, FL 326 10-O 165

Program: Clinical Psychology

Degree(s) Offered: Ph.D.

Department: Clinical & Health Psvchologv

Administrative Personnel:
Administrative Head of Institution:

Name: John Lombardi Title: President

Chief Administrator Responsible for Instruction:

Name: Andrew Sorensen Title: Provost

Department Chair:

Name: Nathan W. Perry Telephone: 392-4551

Program Director:
Name: Cynthia D. Belar Telephone: 392-4553

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Program Two

Name of Institution:University of Victoria

Street: P.O. Box 3050

City/State/Zip: Victoria, British Columbia, Canada V8W 3P5

Program: Clinical Psychology with Specialization in Neuropsychology

Degree(s) Offered: Ph.D.

Department: Psychology

Administrative Personnel:
Administrative Head of Institution:

Name: David F. Strong, Ph.D.
Title: President

Chief Administrator Responsible for Instruction:
Name: Samuel E. Scullv, Ph.D.
Title: Vice President Academic & Provost

Department Chair:
Name: Richard May, Ph.D.
Telephone: 721-7522

Program Director:
Name: Catherine A. Mateer, Ph.D.
Telephone: 721-8590

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Program Three

Name of Institution:San Diego State University/Universitv of California, San Diego (Joint Doctoral Program in Clinical Psychology)

Street Address 1: 3427 4th Avenue, Department of Psychiatry, Universitv of California, San Diego

City/State/Zip: San Diego, CA 92103

Steet Address 2: 6363 Alvarado Court, Suite 103, San Diego State University

City/State/Zip: San Diego, CA 92120-4913

Program: Joint Doctoral Program in Clinical Psvchologv

Degree(s) Offered: Ph.D. Department: Psychiatry - UCSD

Degree(s) Offered: Ph.D. Department: Psychology - SDSU

Administrative Personnel: UCSD
Administrative Head of Institution:

Name: Richard C. Atkinson, Ph.D. Title: Chancellor

Chief Administrator Responsible for Instruction:

Name: Richard E. Attiveh, Ph.D. Title: Vice Chancellor, Office of Graduate Studies & Research

Department Chair, Department of Psychiatry:
Name: Lewis L. Judd, M.D. Telephone: (619) 534-3684

Program Director: Name: Robert K. Heaton, Ph.D. Telephone: (619) 497-6644

Administrative Personnel: SDSU
Administrative Head of Institution:

Name: Thomas B. Day, Ph.D.
Title: President

Chief Administrator Responsible for Instruction:

Name: James W. Cobble, Ph.D. Title: Dean, Graduate Division

Department Chair, Department of Psychology:

Name: Frederick Hombeck, Ph.D. Telephone: (619) 594-5909

Program Director:
Name: Richard Schulte, Ph.D. Telephone: (6 19) 594-5 135

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Program Four

Name of Institution:University of Houston

Street: 4800 Calhoun Street

City/State/Zip: Houston, TX 77204-5341

Program: Clinical Neuropsvchologv Track in Clinical Program

Degree(s) Offered: Ph.D.

Department: Psychology

Administrative Personnel:
Administrative Head of Institution:

Name: James H. Pickering Title: President

Chief Administrator Responsible for Instruction:

Name: Henry Trueba Title: Provost & Sr. Vice President of Academic Affairs

Department Chair:

Name: Marco Mariotto Telephone: (7 13) 743-8503

Program Director: Clinical

Name: John P. Vincent Telephone: (713) 743-8619

Clinical Neuropsychology Track Director:

Name: H. Julia Hannav, Ph.D. Telephone: (7 13) 743-8568 2.

For each of the 4 programs listed above, designate the program administrator who will provide the information requested in Attachment B (Doctoral Education and Training Prerequisites to (name of specialty) Psychology”).

Program One: Cynthia D. Belar, Ph.D., ABPP, Director of Clinical Training

Program Two: Catherine A. Mateer, Ph.D., ABPP, Director of Clinical Training

Program Three: Robert K. Heaton, Ph.D., ABPP, Co-Director of Clinical Training

Program Four: H. Julia Hannay, Ph.D., Director of Clinical Neuropsychology Track

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Criterion IV. Advanced Scientific and Theoretical Preparation. In addition to the scientific and professional foundations described above, a specialty requires advanced, specialty-specific scientific knowledge.

1. List the requirements for the advanced scientific core in the following areas, as appropriate. This refers to the specialty specific scientific knowledge that builds upon the basic common and scientific core.

a. biological bases of behavior:
b. cognitive-affective bases of behavior:
C. social bases of behavior:
d. individual bases of behavior:
e. other:

Division 40 guidelines for doctoral training programs in Clinical Neuropsychology (Appendix G) list the following areas to be covered.Superscripted letters cross-reference these areas to the areas mentioned in the application.

A. Generic Psychology Core

1. Statistics and Methodology
2. Learning, Cognition and Perception
3. Social Psychology and Personality
4. Physiological Psychology
5. Life-Span Developmental
6. History

B. Generic Clinical Core

1. Psychopathology
2. Psychometric Theory
3. Interview and Assessment Techniques
i. Interviewing
ii. Intelligence Assessment
iii. Personality Assessment
4. Intervention Techniques
i. Counseling and Psychotherapy
ii. Behavior Therapy/Modification
iii. Consultation
5. Professional Ethics

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C. Neurosciences and Basic Human and Animal Neuropsychology
1. Basic Neurosciences'
2. Advanced Physiological Psychology and Pharmacology
3. Neuropsychology of Perceptual, Cognitive, and Executive Processes
4. Research Design and Research Practicum in Neuropsychology”

D. Specific Clinical Neuropsychological Training
1. Clinical Neurology and Neuropathology”
2. Specialized Neuropsychological Assessment Techniqueshd
3. Specialized Neuropsychological Intervention Techniques”
4. Assessment Practicum (Children and/or Adults) in University-Supervised assessment facility
5. Intervention Practicum in University-Supervised Intervention Facility
6. Clinical Neuropsychological Internship of 1800 hours preferable in noncaptive facility. (As per INS-Div. 40 Task Force guidelines). Ordinarily this internship will be completed in a single year, but in exceptional circumstance may be completed in a 2-year period.

E. Doctoral Dissertation

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Criterion V. Advanced Preparation in the Parameters of Practice. A specialty requires the advanced didactic and experiential preparation that provides the basis for services with respect to the essential parameters of practice. The parameters to be considered include: a) populations,b) psychological, biological, and social problems, and c) procedures and technologies. These parameters should be described in the context of the range of settings or organizational arrangements in which practice occurs.

1. Describe the advanced didactic and experiential preparation for specialty practice in each of the following parameters of practice: ::

a. populations:
b. problems (psychological, biological, and social):
c. procedures and technologies:

Clinical neuropsychology is a practice and research specialty of psychology that deals with the relationship between the brain and behavior. Domains of knowledge considered fundamental to clinical neuropsychology includes the basic neurosciences, neuropathology, psychological theory, psychopathology, and psychometrics, among others.

Educational programs are usually based in universities, medical schools, or hospitals. The degree program is usually offered through a clinical psychology program with a special emphasis on neuropsychological training. The following article presents a list of training programs that the respective program directors believe to be in compliance with the guidelines published by Division 40.

Cripe, L.I. (1993). Listing of training programs in clinical neuropsychology -1993. The Clinical Neuropsychologist, 7, 371-419.

Recently the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) was formed to assist institutions in developing advanced postdoctoral education and training in clinical neuropsychology and to establish residence program standards for the training of students who wish to specialize in clinical neuropsychology. These programs emphasize supervised clinical and research training on a variety of patient populations -- developmental, neurological and psychiatric.Students are involved in rigorous programs of neuropsychological assessment and treatment. A description of the APPCN and a list of its founding members may be found in:

Hammeke, T.A. (1993). The association of postdoctoral programs in clinical neuropsychology (APPCN). The Clinical Neuropsychologist, 7, 197-204.

In clinical settings, neuropsychologists assess, diagnose, and provide treatment to individuals who have been born with neurological abnormalities or who have sustained central nervous system injury, or illness.Such maladies include genetic abnormalities, congenital problems, traumatic brain injury, stroke, tumors, exposure to toxic substances, metabolic diseases, and degenerative diseases of the brain. Clinical neuropsychologists also assess, diagnose, and treat children and adults with psychiatric illnesses. Treatment may include direct intervention and program development, as well as consultation with other professionals and family members.

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Individuals who have had neurological injuries or illnesses or children who are not doing well at home, in society, or in the classroom are often referred to a neuropsychologist in order to determine if their problematic behaviors are the result of the injury, illness, an attentional deficit hyperactive disorder, a learning disability, an emotional disability, or some other biopsychosocial factor.

In the neuropsychologist's attempt to make such determinations the clinician uses a set of constructs and tools believed to be valid and reliable. These constructs are:

1) The brain, a very complex biological system, is the organ” of behavior.

2) The brain is genetically determined but shaped by environmental factors.

3) Behavior, what an organism can do to effect change in its environment, is also genetically and environmentally determined.

4) Neural functioning can be measured and predicted, thereby meeting the criteria for scientific investigation.

5) Behavior is predictable and measurable, thereby also meeting criteria for scientific investigation.

6) There are meaningful correlates between neurological functions and behavior.

7) There are cause and effect relationships between brain and behavior.

8) There are valid and reliable measurement devices that may be used to define and understand neural functioning.

9) There are valid and reliable measurement devices that may be used to define and understand behavior.

10) Both neurological and behavioral systems are dynamic, change unequally over time, and are subject to manipulation.

There are a number of recognized and valid approaches to clinical neuropsychological assessment ranging from standardized batteries of test to a flexible battery approach in the assessment of neuropsychological functions. Interpretation of data generated by these tests transcends the actuarial basis of interpretation through interpretation is clearly anchored to the scientific and practice literature supporting test applications.

In analyzing the results of testing it must be kept in mind that a clinical judgment regarding an individual complements statistical interpretation in an important and crucial manner. The clinical judgment, however, must be based upon a sound knowledge of the facts and theories about cognitive science and neuropsychology as well as upon an appreciation for any emotional or psychogenic factors that can alter the patient's level of neurocognitive functioning at the time of assessment.

The results of these analyses are then used to assist with diagnosis, treatment, and rehabilitation, vocational and/or educational planning, such as determining whether a person is in need of a neurocognitive rehabilitation program, or disability assistance, or qualifies for special education.

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Important domains of neuropsychological functioning the neuropsychologist examines include the following:

1) Arousal and Attention Functions

a. awake and alert
b. focus and maintain
C. Resist distracters
d. hemiattention
e. sustain
1. simple
2. complex (concentration)
f. span of attention
g . divide attention

2) Executive Functions
a. plan
b. initiate
C. program
d. sequence
e. verify
f. alter

3) Sensory-Laterality-Motor Functions

4) Visuospatial Functions
a. primary visuoperceptual
b. secondary visuospatial
C. construction
d. organization

5) Language and Related Functions
a. speech
b. receptive language
C. expressive language
d. lexicon
e. verbal fluency
    1. semantic
    2. ortholexic
    3 . discoursive

6) Learning and Memory Functions
a. memory retrieval
    1. verbal
    2. visual
b. acquisition of novel information
    1. verbal lists
    2. verbal logical
    3. isual

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4. visual-verbal
5. procedural

7) Organizational, Problem Solving and Judgmental Functions

a. using inherent structure
    1. verbal
    2. visual
b. using explicit structure
    1. verbal
    2. visual
C. problem solving
    1. verbal
    2. visual
d. judgment
    1. verbal
    2. visual

8) Emotional

a. personality
b. anxiety
C. affect
d. reality orientation

9) Academic Achievement

a. reading
    1. spelling
    2. vocabulary
    3. comprehension
    4. rate
b. writing
    1. spelling
    2. syntax
    3. fluency
    4. content
C. mathematics
    1. operations
    2. applications
    3. metric
d. knowledge
    1. science
    2. social studies
    3. humanities

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A partial list of assessment procedures and tests which have been determined to be useful in assisting the neuropsychologist with diagnosis and treatment planning include:

A Laterality Examination
A Sensory-Perceptual Examination
Aural Comprehension
Beck Depression Inventory
Benton Visual Retention Test
Boston Diagnostic Aphasia Test
Boston Naming Test
Buschke Selective Reminding Test
California Verbal Learning Test
California Verbal Learning Test-Children
Child Behavior Checklist
Child Anxiety Scale
Children's Depression Inventory
Children's Auditory Verbal Learning Test
Cognitive Estimation Test
Collateral Interview with family and significant others
Conner's Teacher's Rating Scale
Conner's Parent's Rating Scale
Controlled Auditory Word Association Test (COWAT)
Diagnostic Interview
Figural Fluency Test
Grooved Pegboard
Halstead-Reitan Neuropsychological Assessment Battery
Hooper Visual Organization Test
Jastak Wide Range Achievement Test-Revised
Mattis Dementia Rating Scale
MLA, token test
MLA, visual naming
MLA, controlled word fluency test
MMPI
Multilingual Aphasia Test (MLA), sentence repetition
Paced Auditory Serial Addition Task
Plan of Search

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Porteus Maze Test
Raven's Progressive Matrices
Reading Comprehension
Record Review
Rey Auditory Verbal Learning Test
Rey-Osterrieth Complex Figure Test
Rey-Taylor Complex Figure Test
Rule Governed Drawing
Sequencing Span Tests
Spelling
State-Trait Anxiety Inventory
Strength of Grip
Stroop Test
Teachers' Report Form
Trail Making Test
Verbal Primary Memory Test with Interference
Visual Cancellation Test
Warrington Recognition Test
Wechsler Intelligence Scale for Children-III
Wechsler Memory Scale-Revised
Wechsler Adult Intelligence Scale-Revised
Wechsler Preschool and Primary Scale of Intelligence-Revised
Wide Range Assessment of Memory and Learning
Wisconsin Card Sorting Test
Woodcock-Johnson-Revised, Tests of Achievement
Woodcock-Johnson-Revised, Tests of Cognitive Abilities
Youth Self Report

For reviews of the tests and further information about other tests, please refer to:

Lezak, M.D. (1983). Neuropsychological Assessment, Second Ed., New York: Oxford University Press.

Spreen, O., and Strauss, E. (1991). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. New York: Oxford University Press.

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Some clinical neuropsychologists employ technicians whose clinical duties are limited to the administration and scoring of neuropsychology is a recognized standard of practice; however, there are many clinical neuropsychologists who do not use them, and this is also acceptable. In either case, the clinical neuropsychologist is responsible for the assessment. The following article presents the current guidelines for the education and training of technicians and other nondoctoral personnel:

Report on the Division 40 task force on education, accreditation and credentialing: Recommendations for the education and training of nondoctoral personnel in clinical neuropsychology (1991). The Clinical Neuropsychologist, 5, 20-23.

The use of computers and computer programs is a relatively new development for clinical neuropsychology, and there are many significant issues yet to be resolved regarding the clinical use of such technology. Computers and programs are used for assessment and rehabilitation by some clinical neuropsychologists. For information regarding Division 40's position on the use of assessment programs, please refer to:

Division 40: Task force report on computer-assisted neuropsychological evaluation (1987). The Clinical Neuropsychologist, 2, 161- 184.

For information regarding Division 40's position on the use of computer-assisted rehabilitation programs, please refer to:

Matthews, C.G., Harley, J.P. & Malec, J.F. (1991). Guidelines for computer-assisted neuropsychological rehabilitation and cognitive remediation. The Clinical Neuropsychologist, 5, 3- 19.

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Criterion VI. Public Need for Specialty Practice. The services of the specialty are responsive to identifiable public needs and attend to human diversity.

1. Describe what procedures this petitioning organization and/or other associations associated with this speciality utilize to demonstrate identifiable public needs.

That a need for psychological services, including neuropsychological services, exists in our society is obvious. The problem is identifying, as precisely as possible, what the need is, or more appropriately, what the needs are. This is a multidimensional problem because many factors must be assessed in making this determination. These factors include the scientific and clinical expertise of neuropsychologists, the individuals who require neuropsychological services, and the publics knowledge abut the utility of neuropsychological services, including funders of those services, both public and private.

In clinical settings, neuropsychologists assess, diagnose, and provide treatment to individuals who have been born with neurological abnormalities or who have sustained central nervous system injury or illness. Such maladies include genetic abnormalities, congenital problems, traumatic brain injury, stroke, tumors, exposure to toxic substances,, metabolic diseases, and degenerative diseases of the brain. While most of the patients neuropsychologists work with have a primary neurological diagnosis, they are also asked to assess and make differential diagnoses of children and adults with suspected psychiatric illnesses in order to rule out neuropsychological problems.

Examples of the utility of neuropsychological services in total patient management: .

Diagnosis of progressive dementing diseases, including differential diagnosis of psychiatric illness .

Identification of subtle acquired neurocognitive dysfunction undermining adaptive and prosocial functioning .

Identification of subtle developmental neurocognitive dysfunction impeding academic and social functioning .

Incorporation of neuropsychological findings in treatment plans to increase the probability that specific treatment modalities can be efficacious .

Identification of medication side-effects that may attenuate cognitive functioning .
Use of neuropsychological data in refining educational plans for children .

Use of neuropsychological data in remediating vocational problems in adults .

Identification of community-based programs for remediation and rehabilitation of neurocognitive dysfunction

Referrals are usually made by physicians, psychologists, schools, and lawyers.

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2. Describe how practitioners in the specialty attend to public need and to issues of human diversity (research reports, needs assessment, market surveys, etc., are examples of some types of appropriate documentation.) Evidence that the specialty is monitoring developments and has moved to meet identified emergent needs is also appropriate.

Neuropsychology has a broad range of clinical applications and experimental support. Division 40 of the American Psychological Association is one of the largest and most rapidly growing divisions (Shapiro, & Wiggins, 1994). One way of defining the need for clinical neuropsychologists is to see where they are employed. Clinical neuropsychologists work in a variety of settings, both public and private, including independent practice, hospitals, and rehabilitation centers. The following paper presents an overview of the professional practice of clinical neuropsychology.

Putnam, S.H. & DeLuca, J.W. (1990). The TCN professional practice survey: Part I: General practices of neuropsychologists in primary employment and private practice settings. The Clinical Neuropsvchologist, 4, 199-244.

Another way of assessing the need is to demonstrate the integration of neuropsychological services into domains not necessarily thought of as psychological.” Epilepsy research and treatment is one field in which clinical neuropsychologists, through their training and practice, have made significant impacts. (c.f. Psychology and the Public Forum, American Psychologist, 1992).

An additional method of assessing the need for neuropsychological services is to examine diagnostic systems and payment schedules. The DSM-IV has diagnostic codes that are neuropsychological in intent and content. Similarly, there are ICD-10 codes for neuropsychological syndromes. The CTP-4 codes, codes upon which reimbursements are made, includes a code which is specifically neuropsychological.

Division 40, Clinical Neuropsychology, of the American Psychological Association has several committees that address special needs. These include committees on ethics, minority affairs, and international relations. A database of providers of neuropsychological services in languages other than English is being developed. A national network of neuropsychologists are working on tests and norms to insure valid and reliable assessment of Spanish-speaking individuals. Neuropsychologists are instrumental in offering services to individuals with alternate lifestyles. This is best exemplified by the contribution of neuropsychologists in the study of and treatment provided to individuals infected with Human Immunosuppressant Virus.

3. Describe how the recognition of this specialty will increase the availability and quality of services without reducing access to needed services.

Continuing assessments concerning the need for services must remain a priority in clinical research.These projected studies will not only provide data regarding the estimated need for the amount and level of services expected to be funded under current and proposed health-care policies, but also will serve to direct the development and implementation of public and private policy designed to meet public demands for psychological services. These demands would include the need for services to under- or non-served populations, such as the chronically mentally ill, rural populations, and impoverished individuals with no source of funding. These data can then be used to develop effective marketing and lobbying campaigns designed to educate the public and legislators about what neuropsychologists do. Such campaigns will help broaden

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the understanding by these groups regarding the real needs of the users of neuropsychological services.

Another issue of concern is the need for outcome measures which demonstrate that neuropsychological services have efficacy and incremental utility over other providers of similar services. Services that are neuropsychological in nature are offered not only by neuropsychologists, but also by physicians, speech and language pathologists, occupational therapists, rehabilitation counselors, and special education teachers (Murstein, & Fontaine 1993). Assessment services are offered by various nonpsychologists who have access to instruments used in psychological and neuropsychological evaluations. Companies have developed and marketed computer assessment and interpretive programs that are psychological or neuropsychological in intent and content, which are available to nonpsychologists. Federal and state mandates have given schools an increased role in the assessment and treatment of children and adolescents with developmental and acquired neuropsychological difficulties. Most of these assessments are made by nondoctoral level school psychologists. All of these other service providers have the potential to impact on the need for clinical neuropsychologists.

There are published reports about the efficacy of psychological treatment, including neuropsychology (Lipsey, & Wilson, 1993), books on the value of neuropsychological evaluation and treatment (Lehr, 1990), and several journals that support the need and value of neuropsychological intervention, e.g., The Journal of Head Trauma Rehabilitation.

References

Lehr, Ellen (Ed). (1990). Psychological Management of Traumatic Brain Injuries in Children and Adults, Rockville, Maryland: Aspen Publishers.

Lipsey, M.W. & Wilson, D.B. (1994). The efficacy of psychological, educational, and behavioral treatment: Confirmation from meta-analysis. The American Psychologist, 48, 1181-1209.

Murstein, B.I. & Fontaine, P.A. (1993). The public's knowledge and other mental health providers. The American Psychologist, 48, 839-845.

Shapiro, A.E. & Wiggins, J.G. (1994). A Psy D degree for every practitioner: Truth in labeling. The American Psychologist, 49,207-210.

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VII. Administrative Organizations. The proposed specialty is represented by one or more organizations that provide systems and structures which make a significant contribution to the organized development of the specialty.

1. Name and address of the Administrative Organization making the petition

Name: Division of Clinical Neuronsvchologv American Psychological Association Title:

Address: 750 First Street N.E.

City/State/Zip: Washington, D.C. 20002-4242

Phone: (202) 336-5500
FAX: (206) 223-3557 (Current Div. 40 President - Carl Dodrill, Ph.D.) Fax: 223-4409

2. Contact person:

Name: Manfred J. Meier, Ph.D. Title: Chair, Division 40 Planning Committee

Address: 1201 Yale Place. #1307

City/State/Zip: Minneapolis, MN 55403

Phone: (612) 341-0006 FAX:

3. Signatures of officials submitting the petition:

Manfred J. Meier, Ph.D.
Chair, Division 40 Planning Committee (title) & Past President, Division 40 c& Lg& 1 l/1/94 (d a t e)

(name) Carl Dodrill, Ph.D.
President, Division 40(title) 1 l/1/94 (date) Past President, Division 40

(name) Robert Heaton, Ph.D. (title) (date)1 l/1/94

4. Year this organization founded? 1980

5. Is this organization incorporated?Yes _ No X In what state? If so, please provide a copy of charter and articles of incorporation.

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6. Please enclose the bylaws for this petitioning organization, if any.
See Appendix A.

7. Please provide the following information for all officials in the organization, including the Executive Officer or responsible administrative staff person.

7a.
Name: Carl Dodrill, Ph.D.

Title: President, Division 40

APA membership status: Fellow 40

Address: Harborview Medical Center, Neuropsychology Laboratory, Epilepsy Center, ZA-50

City/State/Zip: Seattle, WA 98 104

Phone: (206) 223-3557

FAX: (206) 223-4409

7b.
Name: Robert Heaton, Ph.D.

Title: Past President, Division 40

APA membership status: Fellow 40

Address: University of California-San Diego, Department of Psvchiatrv Gifford Clinic, 3427 4th Avenue

City/State/Zip: San Diego. CA 92103

Phone: (619) 497-6644

FAX: (619) 497-6686

7c.
Name: Manfred J. Meier, Ph.D.

Title: Chair, Planning Committee

APA membership status: Fellow 38, 40

Address: 1201 Yale Place, #1307

City/State/Zip: Minneapolis, MN 55403

Phone: (612) 341-0006

FAX: (612) 626-4102

8. Describe the purpose and objectives of the administrative organization.

See Division 40 Planning Document - Appendix B

9. Outline the structure and functions of the single administrative organization (frequency of meetings, number of meetings per year, membership size, functions performed, how decisions are made, types of committees, dues structure, publications, etc. Provide samples of newsletters, journals, and other publications, etc.

Division 40 of the American Psychological Association meets annually in conjunction with the general meeting of the APA. As with other APA divisions, Division 40 has a Program Committee that receives submissions for platform paper presentations, poster presentation,

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symposia, invited lecturers, and conversation hours with selected individuals. The abstracts for accepted submissions are published in the Clinical NeurqxychoZogist (edited by Rourke & Adams). There are now over 3,000 members of Division 40, many of whom attend the annual meeting.

There are a number of standing committees and an Executive Committee made up of the current and immediate past president, treasurer, secretary, and various committee chair persons. The Executive Committee meets twice yearly, once during the APA meetings and again during the winter, usually during the winter meeting of the International Neuropsychological Society. Executive Committee decisions are made by voice vote. Major policy decisions are reached after consultation with the membership, usually by means of a survey conducted through the Division 40 newsletter, which is published two to four times annually.

In addition to the Program Committee, other standing committees include Membership, Elections, Professional Affairs, Scientific Affairs, and Education. Ad hoc committees include Planning and a Task Force on Education, Accreditation and Credentialing. Under consideration is the possibility of a revision in the structure of the Division to conform more precisely with the changed structure of APA. Liaison persons have already been identified for working with each directorate of APA (science, practice, education, and public interest) and for working toward the addition of the Planning Committee to standing status. The Task Force on Education, Accreditation and Credentialing has added significantly to the productivity of Division 40 through the development of guidelines for predoctoral, internship, and postdoctoral education, and computer-assisted testing and intervention. The Task Force has also helped guide the development of the first new credentialing board to be added to the family of specialties within the American Board of Professional Psychology. The later has now expanded, beginning with clinical neuropsychology, to include board examinations for advanced competency in forensic psychology, family psychology, health psychology, behavioral psychology, and psychoanalysis. There are modest dues to cover costs of a newsletter, a copy of which is included in Appendix C.

10. What was your annual budget for the previous three fiscalyears?Please attach a copy of annual reports and tax returns (if available) for the last three years.

Annual fiscal reports will be submitted as Appendix D. Robert Firnhaber-White, Ph.D., is the current treasurer as well as newsletter editor, and will be providing related documents as soon as possible, if they do not arrive by the time this petition is submitted to APA.

11. List other organizations that are associated with or that have as a major focus this psychological specialty. Please provide letters from these other organizations supporting your petition.

Other organizations involved in clinical neuropsychology include the International Neuropsychological Society, the National Academy of Neuropsychology, and the American Board of Clinical Neuropsychology, a member board of the American Board of Professional Psychology (ABPP). Letters of support will be provided by these organizations after they have had an opportunity to review this petition package.

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12. Present a rationale for your organization as nationally representative and responsible for dominant views and practices of your specialty area.

The Division of Clinical Neuropsychology was established by a steering committee comprised of leading clinical neuropsychologists from the United States and Canada who were members of the governing board of the International Neuropsychological Society (either past or current at that time). Since the INS was both an international and interdisciplinary organization, it encouraged North American neuropsychologists to establish mechanisms, within the discipline of psychology and for North America, for sharing information and developing standards for education, accreditation and credentialing. Division 40 quickly became the primary organization in North America for generating new knowledge and for establishing educational and practice standards. The latter have emphasized competency evaluation by means of examinations developed by the American Board of Clinical Neuropsychology, a board established by a group of Division 40 fellows. See Meier (In Press), a copy of which is attached in Appendix E.

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Criterion VIII. Effectiveness. Petitions demonstrate the effectiveness of the services provided by its specialist practitioners.

PLEASE NOTE: If the same article illustrates more than one of these items, it may be referenced under each applicable category.

1. Provide at least five psychological manuscripts published in refereed journals (or equivalent) that demonstrate the efficacy of the specialty's services for dealing with the types of clients or populations (including groups with a diverse range of characteristics and human endeavors) usually served by this specialty.

References on the efficacy of neuropsychological services for dealing with types of clients or populations.

Bondi, M.W., Monsch, A.U., Butters, N., Salmon, D.P., & Paulsen, J.S. (1993). Utility of a modified version of the Wisconsin Card Sorting Test in the detection of dementia of the Alzheimer's type. The Clinical Neuropsychologist, 7 161-170.

Hanlon, R., Clontz, B., & Milton, T. (1993). Management of severe behavioral dyscontrol following subarachnoid hemorrhage. Neuropsychological Rehabilitation, 3 63-76.

Lewington, P.J. (1993). Counseling survivors of traumatic brain injury. Canadian Journal of Counseling, 27,274288.

Prigatano, G.P.,Klonoff, P.S., O'Brien, K.P., Altman, I.M. et al. (1994). Productivity after neuropsychologically oriented milieu rehabilitation. The Journal of Head Trauma Rehabilitation, 9, 91- 102.

Ryan, T.V., Sautter, S.W., Capps, C.F., Meneese, W., et al. (1992). Utilizing neuropsychological measures to predict vocational outcome in a head trauma population. Brain Injury, 6, 175- 182.

2. Provide at least five psychological manuscripts published in refereed journals (or equivalent) that demonstrate the efficacy of the specialty's services for dealing with the types of psychological, biological, and social problems usually confronted and addressed by this specialty.

References on neuropsychological services dealing with psychological, biological, and social problems.

Baker, D.B. (1994). Parenting stress and ADHA; A comparison of mothers and fathers. Journal of Emotional & Behavioral Disorders, 2, 46-50.

Heaton, R.K., Velin, R.A., McCutchan, J.A., Gulvich, S.J. et al. (1994). Neuropsychological impairment in human immunodeficiency virus-infection: Implications for employment. Psychosomatic Medicine, 56, 8- 17.

Lang, R.A. (1993). Neuropsychological deficits in sexual offenders: Implications for treatment. Paraphilias, Sexual & Martial Therapy, Special Issue, 8, 181-200.

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Mapou, R.L. & Law, W.A. (1994). Neurobehavioral aspects of HIV disease and AIDS: An Update. Professional Psychology: Research and Practice, 25, 132-140.

Parsons, Oscar A. (1994). Determinants of cognitive deficits in alcoholism: The search continues. The Clinical Neuropsychologist, 8 39-58.

3. Provide at least five psychological manuscripts published in refereed journals (or equivalent) that demonstrate the efficacy of the specialty's procedures and technologies when compared with services rendered by other specialties or practice modalities.

References of efficacy of nemopsychological services when compared to services provided by other specialties or practice modalities.

Baryza, M.J. & Haley, S.M. (1994). Use of the Children's Orientation and Amnesia Test at hospital discharge for children with neurological and non-neurological traumatic injuries. Brain Injury, 8 167- 173.

Benton, Al L., Van Grop, W.G., Stuck, A.E., Mitrushina, M. & Beck, J. (1994). Early detection of cognitive decline in higher cognitive functioning older adults: Sensitivity and specificity of a neuropsychological screening battery: Neuropsychology, 8, 3 l-38.

Mitrushina, M., Abra, J., & Blumfield, A. (1994). The Neurobehavioral Cognitive Status Examination as a screen tool for organicity in psychiatric patients. Hospital and Community Psychiatry, 151, 252-256.

Ruff, R.M., Wylie, T., & Tennabt, W. (1993). Malingering and malingering-like aspects of mild closed head injury. Journal of Head Trauma Rehabilitation, 8, 60-73.

4. Provide at least five psychological manuscripts published in refereed journals (or equivalent) that demonstrate the efficacy of the specialty's services for dealing with the types of settings or organizational arrangements where this specialty is practiced.

References on the efficacy of neuropsychological services for dealing with the types of settings or organizational arrangements where neuropsychology is practiced.

Bemier, J.C. & Siegel, D.H. (1994). Attention-deficit hyperactivity disorder: A family and ecological systems perspective. Families in Society, 75, 142- 152.

Carr, J.S. & Marshall, M. (1993). Innovation in long-stay care for people with dementias. Reviews in Clinical gerontology, 3, 157-167.

Kay, T. (1993). Neuropsychological treatment of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8 74-85.

Putnam, S.H. & DeLuca, J.W. (1990). The TCN professional practice survey: Part 1: General practices of neuropsychologists in primary employment and private practice settings. The Clinical Neuropsychologist, 4 199-243.

Weinstein, C.S., Seidman, L.J., Ahern, G. & McClure, K. (1994). Integration of neuropsychological and behavioral neurological assessment in psychiatry: A case example involving brain injury and polypharmacy. Interpersonal and Biological Processes, 57,62-76.

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Criterion IX. Quality Improvement. A specialty promotes ongoing investigations and procedures to develop further the quality and utility of its knowledge, skills, and services.

1. Provide a description of the types of investigations that are designed to evaluate and increase the usefulness of the skills and services in this specialty. Estimate the number of researchers conducting these types of studies, the scope of their efforts, and how your organization and/or other organizations associated with the specialty will act to foster these developments. It also is appropriate to provide evidence of current efforts in these areas.

Most of the research related to the evaluation of services and usefulness of this specialty has addressed primarily issues of reliability and construct validity relative to the use of neuropsychological tests in addressing the types of problems identified in Meier (In Press -- see Appendix E). The specialty is cognizant of the need for program evaluation studies to measure the impact (favorable or unfavorable) of neuropsychological services in particular settings. Comprehensive program evaluation studies have not been done, but his is not unusual in the psychological specialties, including the traditional specialties, since our techniques are logically subject to methodologies that emphasize criterion-referenced validation research, including the efficacy of particular techniques in addressing specific diagnostic and intervention issues. The Division 40 Planning Committee has recognized the need for broader program evaluation research, and is encouraging members of Division 40 to take the initiative for such research. This is a major item on Division 40's agenda for the next decade. Division 40 hopes, therefore to conduct model research that will be of use to the other psychological specialties as well.

Characteristic validation research is quite extensive, judging by the proliferation of journals in clinical neuropsychology and the numerous criterion-referenced predictive studies and construct validation studies appearing in the neuropsychological literature. Meier (In Press, see Appendix E) has listed journals that are edited by a neuropsychologist, a list that is not all-inclusive since many other journals that are edited by someone of another profession publish neuropsychological studies done by psychologists.

The sheer volume of the publications that have arisen from these journals is reflected, as well, in a list of twenty books in the above publication (Meier, In Press, see Appendix E) and attests to the breadth and depth of the existing knowledge for specialized practice in clinical neuropsychology.

2. Describe how the specialty seeks ways to improve the quality and usefulness of its practitioners' services beyond its original determinations of effectiveness.

The specialty seeks to improve the quality and usefulness of its practitioners' services by conducting numerous conferences and workshops. Many of these are offered under the auspices of Division 40, but many also appear by means of structured presentations and conferences under the auspices of the International Neuropsychological Society and the National Academy of Neuropsychology. Individuals may request recognition for their continuing education offerings through the APA Continuing Education Committee, so that there is an elaborate network of resources engaged in the expansion of competence and of the knowledge base for practice of any neuropsychologist seeking to expand her/his knowledge and skills. The assessment of competence in educationally qualified practitioners has become the primary goal of the American Board of Clinical Neuropsychology within the structure of ABPP. The diploma in clinical neuropsychology has now been granted to approximately 250 individuals by means of peer review examinations conducted by ABCN, with full counsel and guidance from other specialty examining boards within ABPP. The history of recognition of ABCN in this credentialing

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context and of the expansion of ABPP into other specialized areas of practice is also summarized in Meier (In Press), a copy of which is enclosed in Appendix E.

3. Describe how the research and practice literature are regularly reviewed for developments which are relevant to the specialty's skills and services, and how this information is publicly disseminated.

4. Describe how the specialty promotes and participates in the process of accreditation in order to enhance the quality of specialty education and training.

The research and practice literatures are regularly reviewed for developments which are relevant to the specialty skills and services by the Task Force on Education, Accreditation and Credentialing (TFEAC) of Division 40 and, in the future, by the Planning Committee of Division 40. Liaison activities, in cooperation with the International Neuropsychological Society, ABCN/ABPP, and the National Academy of Neuropsychology, enhance Division 40's efforts to identify this literature and to disseminate relevant information to the public. The primary mechanisms for information dissemination are the Division 40 newsletter, the NAN newsletter, and the Clinical Neuropsychologist (which publishes reports from the Division 40 Task Force on Education, Accreditation and Credentialing), in addition to the many journals and books relating to Clinical Neuropsychology. Therefore, there is an extensive network of publications for sharing developments in this specialty with clinical neuropsychologists, other psychologists, other professions and the public. The journal, Neuropsychology Review, in addition to selected APA journals, publishes broad review articles that summarize the state of our knowledge and practice in particular applications.The Division 40 TFEAC has been the most vital group in pursuit of this goal.

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Criterion X. Standards for Specialty Service Delivery.Specialty practitioners conform their professional activities, not only to the profession'sgeneral practice standards and ethical principles but also to appropriate specialty standards.

1. Describe how the specialty's practitioners assure effective and ongoing communication to members of the discipline and the public as to the specialty's practices, practice enhancements, and/or new applications.

Communication regarding practices, practice enhancements, and/or new applications happens through several mechanisms. Some of these include:

1) Division 40 publishes a Newsletter twice a year which often contains information useful to practitioners, such as a recent statement on Current Procedural Terminology (CPT) codes. Activities of standing and ad hoc committees (e.g. Ethics Committee, Professional Affairs Committee) are also covered.

2) Division 40 sponsors a scientific and professional program at the Annual Meeting of the American Psychological Association (APA). This program includes scientific papers and posters, invited speakers on current advances in the field, and special sessions on professional practice.In addition to the invited speakers and scientific presentations, discussion hours were held at the 1994 APA Meeting on topics like neuropsychological assessment with Hispanic populations, managed care, ethics in Clinical Neuropsychology, process versus battery approaches to assessment, and problems in Clinical Neuropsychology. A schedule for the 1994 program is included in Appendix C.

3) Division 40 has maintained a close relationship with The Clinical Neuropsychologist, a journal in the field oriented toward the practitioner. Various statements relevant to the practice of Clinical Neuropsychology have been published in this journal, as noted above. The Clinical Neuropsychologist publishes the abstracts from Division 40's scientific program at APA.

4) The Division 40 Professional Affairs Committee has developed a brochure to communicate about the practice of Clinical Neuropsychology to other professionals and patients (Appendix L).

5) In addition to Division 40, two other prominent organizations have programs at meetings which include scientific and practice aspects. The International Neuropsychological Society has North American meetings in the winter and European meetings in the summer of every year. Programs include workshops which usually have topics of both clinical and scientific interest and scientific papers and posters. The National Academy of Neuropsychology has a meeting in the fall of each year which covers practice and scientific aspects in its program with emphasis upon continuing education workshops for practitioners.

2. How does your specialty encourage the development of standards of practice?

Considered as a whole, the various developments outlined in this petition characterize a specialty in relatively rapid evolution. An underlying value on the part of the specialty toward achieving excellence in clinical practice has been a primary propelling force in the development of the specialty to its current developmental status. Most of these converging developments have been described elsewhere in the petition but warrant additional comment in the context of this particular question:

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1) The establishment of an INS/Division 40 Task Force on education, accreditation and credentialing in the 1970s led to the development and subsequent divisional endorsement of guidelines for pre-doctoral, internship, and postdoctoral education and training activities for the specialty. The work of that Task Force also produced guidelines for computer-assisted neuropsychological assessment, responsible and effective use of subdoctoral personnel in neuropsychological application, and continuing education. Those guidelines have influenced educators of applied personnel in neuropsychology and, thereby, helped prepare programs in the field for future accreditation review following recognition of the specialty and the incorporation of related educational programs into the acccreditation process within APA and elsewhere where appropriate.

2) Formation of the Association of Postdoctororal Programs in Clinical Neuropsychology was a natural outgrowth of the work of the Division 4O/INS Task Force. APPCN has developed self-study forms and site visit evaluation forms for future accreditation purposes. These procedures have been piloted among these programs which now exceed 50 in number, with over 35 directed by a ABPP/ABCN diplomate in clinical neuropsychology. A comparable group is being formed for developing similar procedures for pre-doctoral and internship programs. A representative of APPCN is seated on the Interorganizational Council for Postdoctoral Programs in Professional Psychology, an organization consisting of representatives from APA, ABPP, the National Register, AASPB, CPA. This interorganizational council will assure that the reliability, relevance, and effectiveness of future accreditation procedures for neuropsychological education and training programs at all levels.

3) The development of a relationship between ABCN and ABPP yielded an increasingly more refined credentialing procedure for identifying knowledgeable and competent clinical neuropsychologists.ABCN has been working under the aegis of ABPP and in collaboration with the Professional Examination Service (PES) to develop objective written as well as multiple oral examination procedures. These procedures are monitored by ABPP and progressively refined by means of rigorous procedural reviews and studies to determine the reliability and the validity of the examination.

4) The Joint Committee on Standards for Educational and Psychological Testing is currently engaged in its work toward producing a revision of the 1985 standards. The Joint Committee deliberating upon the inclusion of standards for neuropsychological testing/assessment in the forthcoming revision.The articulation of those standards is expected to be achieve with the assistance of a panel of experts in clinical neuropsychology. This panel has been named and approved by the Joint Committee to assist in the development of practice standards for neuropsychological testing/assessment. Manfred Meier chairs that panel which is already engaged in this effort.

5) The research results being presented at meetings of Division 40, INS and NAN is designed to increase the standard of application in neuropsychology. In addition, there are groups within these organizations, such as the NAN Research Consortium, that are attempting to identify the empirical basis for changes in practice as they are warranted by the results.

6) It has been proposed that an interorganizational mechanism be established for increasing the effectiveness of collaborative efforts among organizations and individuals for pursuing excellence in education, research, and practice. This group would be known as the Clinical Neuropsychology Synarchy. It would be modeled upon cooperative interorganizational efforts such as the Interorganizational Council (above) and the Psychology Executive's Roundtable. The latter models are themselves relatively recent

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in origin but they exemplify a trend toward interorganizational cooperation toward the establishment of practice standards.

The clinical neuropsychological community has been providing leadership in these interorganizational contexts so that clinical neuropsychology is becoming recognized as a major contributor to the setting and the continued refinement of practice standards. Such standards are expected to become focused in terms of achieving the necessary competence for effective practice based upon an organized program of educational preparation and supervised applied activities within the framework of programs that have met specific accreditation criteria.

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Criterion XI. Provider Identification and Evaluation. A specialty recognizes the public benefits of developing sound methods for permitting individual practitioners to secure an evaluation of their knowledge and skill and to be identified as meeting the qualifications for competent practice in the specialty.

1. Describe how and by whom the specialty identifies those who are qualified to practice in the specialty.

Identification of persons qualified to practice Clinical Neuropsychology occurs at two levels:

1) The Definition of a Clinical Neuropsychologist published in The clinical Neuropsychologist 1989, Vol. 3, No. 1, p. 22 (Appendix I) sets forth guidelines for use of the title Clinical Neuropsychologist.” According to this definition, a Clinical Neuropsychologist is a doctoral level psychologist who a) has completed systematic didactic and experiential training in neuropsychology at a regionally accredited university,b) has to or more years of supervised training in Clinical Neuropsychology, c) is licensed or certified in the state or province in which she/he practices, and d) has submitted to review by peers as a test of these competencies. This definition has been widely accepted among practitioners, but there are currently no enforcement mechanisms to prevent use of the title by someone who is not qualified. Thus, compliance is largely voluntary.

It should also be noted that the Division 40 Task Force on Education, Accreditation, and Credentialing in its Guidelines for Continuing Education in Clinical Neuropsychology published in The Clinical Neuropsychologist, 1988, Vol. 2, No. 1, pp. 25-29 (Appendix M) has clearly stated that continuing education is not a method for development of basic competence in the clinical practice of neuropsychology. ” Thus, the mere acquisition of continuing education credits does not qualify one to use the title of Clinical Neuropsychologist.

2) The American Board of Clinical Neuropsychology (ABCN) offers a Diploma in Clinical Neuropsychology under the auspices of the American Board of Professional Psychology. In order to obtain diplomate statue, a candidate must a) pass a credentials review regarding training in applied psychology and Clinical Neuropsychology, b) submit and pass the review of a work sample in Clinical Neuropsychology, c) pass a written examination in Clinical Neuropsychology, and d) pass an oral examination administered by an ABCN examining committee. Although diplomas such as the ABPP or ABCN have been seen as representing an elite group in the past, ABPP is currently making an effort to change them to a criterion for entry level practice within specialties, similar to the boarding system for medical specialties. This process, if successful, will probably take several years. ABPP has reorganized into a federation of specialty boards to enhance the effectiveness of this system.

In general, Clinical Neuropsychology has not yet been recognized as a specialty at the level of state psychology boards. However, in Louisiana, Clinical Neuropsychology has been recognized as a specialty in which one must be qualified to practice.A copy of the relevant rule for the Louisiana State Board of Examiners of Psychologists is attached (Appendix N).

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2. Describe how and by whom the specialty assesses the actual knowledge and skills of individuals who wish to be identified as practitioners in this specialty.

Assessment of the knowledge and skills of individuals wishing to practice Clinical Neuropsychology is carried out at two levels:

1) The first is at the training level. As noted in response to previous questions in this application, there are currently two characteristic routes to becoming a Clinical Neuropsychologist. The first involves obtaining generic training in applied psychology and taking a 2-year postdoctoral fellowship in Clinical Neuropsychology, and the second involves obtaining training in Clinical Neuropsychology at the doctoral level (usually in a specialty Clinical Neuropsychology track of a Clinical Psychology program), taking an internship which meets Division 40 standards, and obtaining an additional year of training at the postdoctoral level. At each level, the Clinical Neuropsychologists responsible for training must assess whether the knowledge and skills of the candidate will be adequate to practice at the next level of training or practice.Ultimately, then, the postdoctoral supervisors must decide whether a trainee's knowledge and skills are adequate to practice Clinical Neuropsychology.

With respect to quality control and postdoctoral programs, it should be noted that the field is moving toward development of accreditation procedures with the establishment of the Interorganizational Council on the Accreditation of Postdoctoral Programs in Professional Psychology. For Clinical Neuropsychology, the Association of Postdoctoral Programs in Clinical Neuropsychology is working on these issues (see Appendix 0 from The Clinical Neuropsychologist, 1993, Vol. 7, No. 2, pp. 197-204). Thus, training in Clinical Neuropsychology at the postdoctoral level should continue to move toward uniform standards of quality control.

2) The American Board of Clinical Neuropsychology (ABCN) examines candidates for diplomate status, which is issued under the auspices of ABPP. As noted in response to the prev