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Division of Clinical Neuropsychology
Newsletter 40
American Psychological Association
Volume 16, Number 2  Summer/Fall 1998

PRESIDENT:
Linas Bielauskas, PhD
PRESIDENT-ELECT:
Cecil R. Reynolds, PhD
SECRETARY:
Ann C. Marcotte, PhD
TREASURER:
Wilfred G. Van Gorp, PhD
MEMBERS-AT-LARGE:
Kerry Hamsler, PhD
Richard Berg, PhD
C. Munro Cullum, PhD
COUNCIL REPRESENTATIVES:
Gerald Goldstein, PhD
Thomas J. Boll, PhD
Antonio Puente, PhD
COMMITTEE CHAIRS(STANDING COMMITTEES):
    FELLOWS:Stan Berent, PhD
    MEMBERSHIP:William B. Meneese, PhD
    ELECTIONS:Eileen B. Fennell, PhD
    PROGRAM:Mark Bondi, PhD
                          Glenn Smith, PhD
COMMITTEE HEADS:(AD HOC COMMITTEES/TASK FORCES):
    SCIENCE ADVISORY:Russel Bauer, PhD
    EDUCATION ADVISORY:Kerry Hamsher, PhD
    PRACTICE ADVISORY:Joseph D. Eubanks, PhD
    PUBLIC INTEREST ADVISORY:Barbara C. Wilson, PhD
    ETHICS:Bruce Becker, PhD
    MINORITY AFFAIRS:
    Duane E. Dede, PhD
    Patricia Perez-Arce, PhD
    NEWSLETTER:John DeLuca, PhD
    TRAINING PROGRAMS DATA BANK:Lloyd Cripe, PhD
    AWARDS COMMITTEE:Ida Sue Baron, PhD
    CPT CODE:Antonio Puente, PhD
    DIVISION 40 ARCHIVIST:Darlyne Nemeth, PhD
    ASHA/DIV. 40 TASK FORCE LIASON:Jill Fischer, PhD
    DIV. 40 LIASONS TO APA COMM. ON GAY, LESBIAN &
    BISEXU
On the History of Neuropsychology
An Interview with Oscar A. Parsons, Ph.D.

(Editor's Note: This is the third in our series' of interviews with eminent neuropsychologists, who have been instrumental in the development of our discipline. Dr. Parsons has a long and distinguished career as a neuropsychologist, teacher, and researcher. He has made numerous contributions to our understanding of the neuropsychology of alcoholism, among other areas. It was a particular honor to have interviewed him at the 1997 Convention of the American Psychological Association in Chicago, Illinois, where Dr. Parsons was the recipient of Division 40's 1997 Distinguished Arthur Benton Lectureship).

Ed: How did you first get interested in neuropsychology?

OAP: I had always been interested in biology, starting with a high school teacher who taught a very interesting course in biology, including dissections and the like. I also belonged to a microscope club in high school and had my own small microscope. We used to get pond water, put hay in it, and smelled up the house! Microscopy was a hobby for me in those years. Then another factor I think was that I studied fencing under an Italian fencing master, Valetino Argento. He started teaching me with his preferred right hand but he began to have trouble controlling it so he shifted to the left hand. After a while, it turned out that he had a brain tumor in the left hemisphere, of which he eventually died. That piqued my interest in the brain at that time. Then I went into the Navy in 1944 and became a hospital corpsman and then a medical lab technician, so I had a continual interest in the biological aspects of people. But I was also interested in psychological areas. After I got out of high school, my Dad had a heart attack and I had to help support the family so I could not go on to college. I went to work for a couple of years but in my spare time read omnivorously. I read Freud, Bertrand Russell, John Dewey and H.L. Mencken, among others. So at that point I had both psychological and biological interests.
    After I got out of the Navy, I got my BA from Temple University. At Temple, I majored in Science, which was for persons who were going on for graduate degrees in professions such as medicine, dentistry, psychology, and the like. I had several courses in Psychology, including Experimental and Abnormal. Dr. James Page taught Abnormal and had written a text on Abnormal with Camey Landis

Continued on page 2

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 Newsletter 40

From the Editor

    We are very pleased to present the Summer-Fall issue of Newsletter 40, which brings the Division 40 and 22 programs for the APA Convention in San Francisco. As you will see, the programs look outstanding this year, and bring together current clinical, research, and professional issues of interest to all. It looks like its going to be a spectacular meeting!
    This issue brings another installment in our series on the history of clinical neuropsychology. We are honored to have interviewed last yearis Benton Award recipient, Dr. Oscar A. Parsons. Dr. Parsons has had a major impact on our field, especially on the cognitive sequelae of alcoholism.
    We also have our regular columns on the science scene (Dr. William Barr) and Executive Committee minutes, as well as letters from the membership, and interesting news concerning the Luria Conference and other announcements.
    We hope you enjoy this issue of your Newsletter. Please keep the correspondence coming and hope to see you in San Francisco!

Joel E. Morgan, Ph.D.
Associate Editor

On the History of Neuropsychology
Continued from page 1

who, incidentally, had been influential in Dr. Arthur Benton's career, as his dissertation mentor at NY State Psychiatric Institute. - Ed.) that I found very interesting. I was originally considering going into medicine but when the time came to take the medical school aptitude test my Dad was again a semi-invalid and I figured, well, I can't see spending that much more time in getting an advanced degree. Besides, my courses in psychology had stimulated my interest in that field, so I decided to go for a Master's degree in Psychology. The clinically oriented courses steered me toward clinical psychology.
    After obtaining my MA, on the advice of Dr. Page, I applied for and was accepted at Worcester State Hospital, in Worcester, Massachusetts for a clinical internship. Worcester was the fountainhead of clinical psychology internship training, started by David Shakow, and was a very interesting and intellectually stimulating place. This was in 1948 and with a Master's Degree you could go on an internship without being in a Ph.D. program. Temple did not have a Ph.D. program in clinical psychology at that time. At Worcester I saw psychiatric patients, especially depressives, schizophrenics and organic brain syndrome patients. I also got a thorough introduction to psychodynamic psychology and projective techniques.We used the Goldstein-Scheerer tests, the Wechsler-Bellevue Scale of Intelligence, the Wechsler Memory Scale, Rorschach, Bender-Gestalt, TAT, Draw-A-Person and other tests. Schizophrenia and brain damage cases were of great interest to me. At the end of the internship, I got married to Mildred Benson who was an 0.T. at Worcester.
    The head of our Psychology Group at Worcester was Dr. Elliot Rodnick, a Clark Hull trained Ph.D. from Yale. That year, he decided to join the Faculty at Duke University and head up their training program in Clinical Psychology. I was looking for a Ph.D. program to continue my training and applied to four or five Universities. I was accepted at Duke and Western Reserve (now Case Western Reserve -Ed.). I chose Duke. It was a most fortunate choice because the Duke program required-a minor area and it was recommended that for clinical students you split the minor between cultural anthropology and

Continued on page 5
 [Page 3]

 Presidents Message

    You have now all had a chance to review thepublication of the policy statement from the Houston Conference. Though there will no doubt be continuing discussion regarding this document, I would like to make surethat misconceptions or falsehoods concerning the conference and its product not lead us astray. For that purpose, I present a number of statements and questions which I have heard expressed, along with factual responses which I trust will answer most queries and concerns.

1. Statement: The Houston Conference was organized by a small group of self-appointed individuals who wish to be in world control of Clinical Neuropsychology.

 Fact: The Houston Conference was conceived as a necessary next step following designation of Clinical Neuropsychology as a specialty by the American Psychological Association in the summer of 1996. The conference was proposed by the Clinical Neuropsychology Synarchy (CNS), an informal group which represents a forum for discussion for the major groups within Clinical Neuropsychology. The members of CNS are: the American Academy of Clinical Neuropsychology (AACN), the American Board of Clinical Neuropsychology (ABCN), the Association for Doctoral Education in Clinical Neuropsychology (ADECN), the Association of Internship Training in Clinical Neuropsychology (AITCN), the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN), the Division of Clinical Neuropsychology of the American Psychological Association (Division 40), and the National Academy of Neuropsychology (NAN)_ Each of these associations endorsed the need for this conference and appointed a delegate to serve on the planning committee for the conference. Thus, the planning committee was composed of the delegated representatives of each of these organizations. They were not self-appointed.”

2. Statement: Selection of delegates for the conference was secretive and exclusionary. Most neuropsychologists were not notified of the occurrence of the conference.

Fact: An announcement of the conference which invited applications was sent to all training programs listed in The Clinical Neuropsychologist . An announcement was also planned for publication in the APA Monitor since it was felt that this would have the widest distribution to psychologists. There
was some delay with the Monitor announcement-and it was not in the form or place that the Planning Committee had expected, once it did appear. After some initial concerns were raised about insufficient circulation of the announcement to interested clinical neuropsychologists, invitations to apply for delegate status were sent to all members of Division 40 and NAN, with sufficient time to respond. Altogether, 177 applications were received and processed.

3. Statement: The Houston Conference was not "open ” to all interested members and was thus exclusionary.

Fact: As any psychologist knows, it is not possible to have a deliberative conference with unlimited numbers of delegates. It was decided to plan the conference according to the format so successfully followed in the previous national conferences on professional psychology training at the graduate, internship, and post-doctoral levels, and the scientist-practitioner conference (see conference proceedings for references). Six breakout groups were formed in order to promote intensive small group discussion.The optimal number per working group was determined to be seven, again in keeping with group size in earlier conferences. The five financially sponsoring organizations from CNS (AACN, ABCN, APPCN, Division 40, and NAN) were invited to name one delegate, and did so based on their own internal decision-making. Thirty-seven delegates were then chosen from among the applicants to fill out the number to 42. The six members of the Planning Committee would also be delegates but were not expected to attend the breakout group sessions and could not vote in them. Planning Committee members could, however, make comments in the large plenary sessions and could vote in these sessions. Since a member of the Planning Committee was serving as parliamentarian and could not make any comments in any session or vote, the actual possible voting delegate number was to be 47. This was reduced by one to 46 for the reasons given below. The 37 delegates from among the applicants were chosen to be broadly representative of the field. Practice setting, region of the country, primary level of training interest, practice setting, gender, seniority, ethnic diversity, and subspecialization within the field were all considered in the selections. The selected delegates

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blended and covered the diverse characteristics of the total pool of applicants quite well. Six alternate delegates were also selected to be available in case any of the selected delegates was unable to attend. All but one of the selected delegates accepted the invitation to participate in the conference and one other delegate could not attend due to a last minute injury. An alternate filled one delegate position on short notice. Every breakout group mirrored the demographic characteristics on which the delegates had been selected as much as was possible. Please note: All the noted characteristics, including primary setting in independent practice, were represented among the delegates.

4. Statement: The Houston Conference set guidelines which will disenfranchise many of those now practicing neuropsychology.

Fact: The Houston Conference recognized that the construction of an integrated training model is a progressive event. The language in the document specifically states that the espoused model is not intended to apply to neuropsychologists trained in the past or those who are currently in training. It is intended to set the standards for the future, even though most practicing Clinical Neuropsychologists meet these standards now.

5. Statement: Continuing education is not viewed by the Houston Conference as a worthwhile enterprise.

Fact: The Houston Conference document states that all specialists in Clinical Neuropsychology are expected to engage in continuing education as a way of updating knowledge and validating skills. However, the conference does clearly indicate that continuing education is not the primary vehicle for attaining specialization in Clinical Neuropsychology. There is no other similar profession which permits specialization solely by continuing education or distance learning. The conference specified that training for specialization must occur through appropriate graduate training, internship, and residency.

6. Statement: The Houston Conference was designed only for and by "academic psychologists” and disenfranchises "real psychologists, ” i.e., those involved primarily in practice.

Fact: The promotion of a distinction between "academic” and "practicing” neuropsychologists is artificial and divisive, yet it is often repeated. The Houston Conference accomplished something few other professions have been able to do - it produced an integrated training model, unanimously ratified, by an extremely diverse conference body. The conference represents an instance where delegates from many different areas and settings of neuropsychology came together and jointly spoke with one voice. This is an accomplishment of which we can be proud and which produced a truly unifying ideal - a training model which applies to all yet which also recognizes the areas of variation which exist. Those who tout a distinction between academic” and practicing” neuropsychologists do our profession a significant disservice; the Houston Conference training model stresses the unifying nature of our training backgrounds.
    Altogether, the product of the Houston Conference is a document which outlines the appropriate model of training for specialization in Clinical Neuropsychology. As we have matured and become recognized as a specialty, the development of such a model became integral to our professional identity. A profession without a model commands no respect, from anyone. The Houston Conference document reflects the result of deliberations by delegates and sponsorship from all relevant neuropsychology organizations and sets appropriate education and training standards which our patients can expect we have met. I trust you will find it as valuable and satisfying as I have and will work together to insure its implementation and continuing development.

Linas Bieliauskas, PhD

    It is with sadness that we announce the passing of Dr, Charles G. Matthews, Professor of Neuropsychology in the Department of Neurology at the University of Wisconsin School of Medicine, who died on April 19, 1998, after a lengthy illness. Dr. Matthews, 68, was a distinguished clinician, teacher, and researcher who made numerous; significant contributions to the discipline of Clinical Neuropsychology from its very inception. until his death, His diligent work helped, tci define Clinical Neuropsychology as a specialty discipline; and to bring about preeminence within APA. .Dr. Matthews' leadership is evident by hi past service as president of all the major neuropsychological. organizations, including:
American Board of Clinical Neuropsychology;
Division of Clinical Neuropsychology (40), Continued on page 8

 [Page 5]

On the History of Neuropsychology
continued from page 2

neuroanatomy. The neuroanatomy course was taught by a Professor, originally from Johns Hopkins, who taught the medical school neuroanatomy course. I mention that because I went on to take another course from him, brain modeling, which consisted of 120 hours of working on specimens of the brain, and building our own models of the brain according to the Johns Hopkins model. So that really did solidify my interest in the brain and neurological conditions.
    I spent two years in graduate school finishing up everything except my dissertation. My wife and I wanted to start a family and the research service at Worcester State wanted me to come back as a researcher and promised that I could do my dissertation there. So back we went in 1951! I worked on a schizophrenia research project studying stress and performance. I also participated in the training and supervision of the clinical psychology interns. Interestingly, Charlie Spielberger and Ray Fowler, both future Presidents of APA, came through their internships at Worcester at that time. I was a member of the working team with the Worcester Foundation for Experimental Biology, a very hot scientific group at the time. Hudson Hoagland, who had worked on potassium levels and the brain, headed the foundation. His co-leader was Gregory Pincus who helped develop the pill”, and there was Fred Elmadjian, who introduced me to his primary area of work, noradrenalin. My first papers on stress responses came out of this research project and led to my dissertation on, Status Needs and Performance under Failure.” I completed the dissertation under Dr. Rodnick and defended it in April of 1954. A month or so later, I was asked to join the Faculty at Duke. I happily accepted and we and our two young children moved back to Durham.
    My appointment at Duke was the best of all possible worlds, two-thirds in the Department Psychiatry and one-third in the Department of Psychology. I worked under Dr. Louis Cohen, a really good experienced clinical psychologist who was in charge of our clinical psychology section in the Department of Psychiatry. I was in charge of outpatient and then inpatient psychological services, so I had frequent referrals from neurology. We had three top drawer neurologists at that time, two of them had trained under Dr. Harold Wolff, an eminent neurologist in New York City, and believe it or not, was a Pavlovian oriented neurologist! I also had a lot of referrals from internists and of course from our own inpatient psychiatry ward.
    I was doing clinical evaluations then and running the assessment seminar for our clinical interns.

Ed: Were you doing neuropsychology then?

OAP: At that time, we talked about assessing for brain damage, not neuropsychology. I was on the Faculty at Duke for five years. One of the most interesting and formative experiences I had was with another neurologist, Albert Heyman, who is prominent today in dementia research. we were both consultants at the Durham VA, which is almost on the Duke campus. He proposed that we have a joint case conference with psychiatry at the VA. So we did and it was one of the best case conferences I have ever experienced. On a given patient, the neurology resident would present first, the psychiatry resident second and the clinical psychology intern would present last. This was a fascinating experience because it brought out many points of interest for our various residents and interns and demonstrated vividly the contributions from the three disciplines. At that time I also started a research program, investigating cognitive psychological effects of brain damage in multiple sclerosis patients.
    So Duke provided many opportunities for experiences with neurological and psychiatric patients. It also provided other experiences. I recall the time that I arranged to have J.B. Rhine, Duke's famous investigator of parapsychological phenomena, to talk to our Department of Psychiatry Colloquim. He gave a wonderful talk, emphasizing the tentative state of their theories and the need for careful scientific methods of study. The reaction of the audience, including me, was perhaps we had misjudged the man. Several weeks later, I happened to tune in to a radio address he was giving to a woman's group.Well, the theories were no longer tentative and scientific methods were not always appropriate to study this phenomena! He sounded like a true believer.”

Ed: What was the thing that really started you getting into neuropsychology?

[Page 6]

     Well, I was always interested in the brain and behavior, let's put it that way. My interest became much more pronounced after taking neuroanatomy and brain modeling.Then working with a neurologist deepened my interest and my research on M.S. In that research I had gotten into working with flicker fusion, attempting to correlate it with optic pallor; it did. The results formed the basis for my first grant from NINDB, plotting visual fields in brain damaged persons with flicker perimetry. This was in 1958, because I brought the grant with me to Oklahoma in 1959, and continued the work with Arthur Vega. We eventually used the technique not only to identify impaired flicker detection in brain damaged patients, but also to lateralize the lesion. It was a surprisingly good technique, but it did take a lot of time. After that I kept getting grants from NINDB and NIMH looking at various aspects of perceptual-cognitive changes in brain damaged patients for many years.
    This work was still not called 'neuropsychology'. I was working in an area of clinical psychology that dealt with assessment for brain damage, but I see that I have to retrace my steps a bit.
    Another really important event in my development in neuropsychology was the Halstead Battery. My first contact with the Battery was when Ward Halstead came to the Worcester Foundation to give a talk in 1952 or 1953. He also gave an informal talk at Wocester State Hospital on his battery - how he could identify, lateralize, and localize lesions with it. At that time we were still in the Goldstein era, you know, saying that the most important thing that brain damage does is to impair the abstract attitude.' Well, our consensus was that his presentation sounded too good to be true.
    My recollections of Halstead was that he was a very well-dressed, silver-haired, well-spoken man. I did have the impression that he was selling his battery. It turned out later that he was indeed selling a console model of the battery. The rumor was that it was $5,000, a hefty sum in those days. But he was a good scientist and thinker. He theorized about the molecular basis of memory before anyone else did.
    In 1956, at Duke, we were asked to develop a project with our colleagues in Ob-Gyn. They were going to do a follow-up of a large number of adolescents, some of whom had neonatal asphyxia at birth. We wanted to get the best tests for brain damage that we could find. Well, I had recently read Ralph Reitan's 1955 article on the validation of the Halstead Battery. Dr. Cohen and I took a train out to Indianapolis to see Ralph's set-up and data firsthand. Ralph graciously went through a lot of the things at that time, lateralization and localization and so forth. My impression was that he was doing some very impressive work in the measurement of functions impaired by brain damage. As a clinical psychologist at that time, I was disappointed in the lack of data addressing the differential diagnosis of patients with schizophrenia or severe depressions, the kinds of referrals that I was handling. Nonetheless, for our proposed project, I invited him to give a talk at our Grand Rounds in our Department. The psychiatrists and neurologists were deeply impressed, but we did not use the battery on the project because of time constraints. Later, in 1960 or 61, after I had moved to Oklahoma, I took one of Ralph's first workshops on the Battery. We obtained the battery in 1962 and have used it ever since.
    Before we got the HRB, we used many of the same tests that I mentioned using at Worcester, the Wechsler Scale of Intelligence, Wechsler Memory Scale, Goldstein-Scheerer Tests, the Rorschach Test (with Piotrowski signs), etc. We had added the MMPI based on my experience with it at Duke where I found it to be a major aid in assessment, especially where there were questions of differentiating brain damaged and functional cases.
    I should mention that in 1959, I had just been promoted to Associate Professor with tenure at Duke, when I received a call from Louis (Jolly) West, a young psychiatrist who had just assumed the Chair at the Department of Psychiatry and Behavioral Sciences at the University of Oklahoma Medical School, inviting me to visit. To put it briefly, I moved to Oklahoma as a Professor in that Department in October of 1959,
    I transferred my grant on flicker fusion perimetry to Oklahoma and was able to get my research going quickly. In 1961, I started an internship in clinical psychology and we were accredited by APA in 1962. The internship continues to this day. In 1966, with my colleagues I started a Ph.D. experimental program in biological psychology, modeled after Halstead's biological psychology program at the University of Chicago; neuropsychology was one of the tracks, Amusingly, when the program started, I was on a Fulbright Professorship at the University of Copenhagen, Denmark. I was teaching a seminar on neuropsychobgy with the clinical students, and it was the first time I had taught a course under that

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name. When I returned to the U.S. I gave the course in our biopsych program.

Ed: How did you get into alcohol research?

OAP: In 1967, I was sitting at my desk in a suburb of Copenhagen when I got a call from Jolly West, our Chair, asking me to write a grant request as part of an Alcohol Center Grant request to NIMH. I went to the library of the Department of Psychology at Copenhagen University and read up on all of the relevant literature, and wrote the grant request. The Center Grant was approved and we started our research in 1968. Later, when NIAAA was created, our Center was shifted to that Institute, and I had continuous grant support from NIAAA until I retired.
    One of the reasons why research on alcoholism is attractive to a neuropsychologist is that alcohol is a legal beverage in western countries, so that drinking alcohol is not prohibited. Consequently there are new potential alcoholics being born every minute! It is a natural experiment, as it were, to see what happens to functions subserved by the brain when a toxic substance is ingested and to see whether those functions improve with sobriety. We started early enough in the neuropsychology of alcoholism to be among the forefront of people working in that field. In recent years, I have been concerned much of the time with the fact that although about 70 % or so of alcoholics will perform poorer on any given neuropsychological test, the remaining 20 to 30% do not. What factors or variables account for that? In conducting a number of studies to try to answer that question, among others, I received the 1997 Award of Distinguished Research for 1997 from the research society on Alcoholism. Incidentally, I have come to the conclusion that genetically determined individual differences in the resistance of the brain to the toxic effects of alcohol is probably the best answer. I have frequently used the example of Sir Winston Churchill who drank a pint of brandy every evening but conducted a winning war and wrote a prize winning history of England. Someone else who had drunk the same amount could develop Korsakoff's Syndrome (alcohol amnestic disorder).

Ed: What do you consider your most important work?

OAP: Well, I think that there are several contributions to neuropsychology that I consider
important, in addition to my years of teaching clinical and clinical neuropsychology to several hundred graduate students and postdocs. In the field of neuropsychology, per se, I think that the study Arthur Vega and I published in 1967 in which we replicated and extended Reitan's 1955 study, validating the Halstead Reitan Battery, is one. We were among the first to emphasize that age and education should be considered, that regional differences might occur, and that T-scores gave more information than cut-off scores. The second contribution was the Parsons and Prigatano paper, Methodological considerations in neuropsychological research”, that was published in the Journal of Consulting and Clinical Psychology in 1978. In the first issue of the Journal of Clinical Neuropsychology, now the Journal of Clinical and Experimental Neuropsychology, the editors advised reading our article before conducting and submitting studies for publication.A third contribution was a chapter entitled,Clinical Neuropsychology”, published in 1970 in Current Topics in Clinical and Community Psychology, edited by Charlie Spielberger. In that article, I reviewed the progress and current status of a new subspecialty” in clinical psychology. The chapter was one of the first ever published under the title of Clinical Neuropsychology.” In it, I predicted a glowing future for clinical neuropsychology, a prediction that certainly has been fulfilled. In the area of alcoholism, I believe that our systematic work showing that male and female alcoholics have similar patterns of cognitive deficits has been a major contribution and also, our consistent findings that the effects of alcohol abuse on cognitive functions suggest a generalized diffuse effect as opposed to localized effects.

Ed: How do you see neuropsychology today?

OAP: There is no question that clinical neuropsychology has emerged as one of the leading specialties in psychology. In fact, as Manny Meier pointed out in a recent issue of Newsletter 40, we are the only officially recognized specialty by APA. We have grown fantastically and I try to identify some of the reasons for this in my Benton Lecturer address. In terms of the future, I think the same problems that beset us are encountered by all of the health professions in the era of managed care, dwindling income, increased paper work, restricted access to patients, etc. And how are we going to support post-7

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doctoral training and clinical psychology internships? The future is only going to be as good as we make it. This means that we have to become advocates.We have to enter our State organizations and support the state and federal legislation that is being proposed to restrict some of the excesses of managed care. Over the past ten years there has been an increasing restriction of resources. The research output of medical school hospitals that have adopted managed care compared to those who have not, is strikingly reduced. This has had far reaching effects in all that we are doing. The other side of managed care, however, is that it placess a great emphasis on validation of techniques. We will be asked, How do you know this test is valid?, or, ...this treatment successful?' These are legitimate questions that should stimulate us.

Ed: A contemporary topic concerns the appropriate training of a neuropsychologist. What are your views?

OAP: I think the ideal program would be a biological/psychological model. At the undergraduate level courses in biology, especially molecular biology and genetics, with strong experimental courses in psychology, especially cognitive psychology, psychometrics, and treatment. I would like to see a continuity from undergraduate through graduate. In the clinical psychology internship, a minor or specialized clinical neuropsychology track can be taken. We have such an elective track in our internship and it works well. In postdoctoral training, medical school level neuroanatomy, neurology and neurosurgery rounds, and neuropathology experiences such as brain cuttings should be taken. Today, the many advances in the technical aspects of brain imaging and in all aspects of biological measurements of brain functions, means that our neuropsychologist trainees have to have more than a passing acquaintance with a variety of techniques. The explosion of research is impossible to keep up with today; one cannot master the field. Rather, you have to concentrate on certain areas.
    Those trained in neurosciences often elect to have clinical training after their Ph.D. - getting their clinical experiences post-doctorally. The combination of clinical training and neuroscience makes them attractive candidates for faculty positions or clinical neuropsychology practice groups. About half of the biological psychology students who worked with me have retreaded into clinical, or have gone to medical school, after earning their Ph.D.s

From the Membership

Dear Dr. DeLuca:

    Balderdash is my response to dr. Bieliauskas' President's Message in the Winter/Spring 1998 Newsletter 40. The Houston conference committee...resolutely rejected the diversity of opinion. . . .In one well-orchestrated, but rhytmless political move, the committee cut out the heart and soul of neuropsychology.
    In the academicians succeed in quelling some of the many voices that have existed in neuropsychology, the field will loose its robustness. All neuropsychologists have ties to academia. the opinions of those who work in the university setting should be heard, but not to the exclusion of the voices of those who work in settings outside of universities. Maybe some orchestration is needed, but do we have to loose the power that comes from healthy debate among professionals of varied experience?

Susan Downs Parrish, Ph.D., Scottsdale, AZ

Charles G. Mathews, Ph.D., ABPP
continued from page 4

American Psychological Association:
International Neuropsychological Society
National Academy of Neuropsychology
    Dr. Mathews earned his Ph.D. in clinical psychology at Perdue University and was continuously affiliated with the University of Wisconsin since 1962.
    Division 40, Clinical Neuropsychology, will honor Dr. Mathews with a memorial session at the annual meeting of the American Psychological Association in San Francisco, on Friday, August 14, noon to 1:00 PM, Room 220, Muscone Center.

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News from the Practice Advisory Committee ..

    Division 40 has a Practice Advisory Committee that addresses issues regarding the -professional practice of clinical neuropsychology, within the confined of the scope of the American Psychological Association. The co-chairs are Dan Eubanks, Ph.D., ABPP, and Christopher Grote, Ph.D., ABPP.
    The committee is currently working on several projects including the Medicare ruling regarding incident to” services provided in hospital settings, the use of psychometric technicians, investigation into regional differences of Medicare interpretations of Health Care Financing Administration (HCFA) rules, and White Papers” regarding professional practice of clinical neuropsychology. The committee also has an ongoing relationship with other practice divisions as well as with the Practice Directorate of the American Psychological Association.
    The committee was formed to serve the members of the Division. Suggestions from the members of the Division are welcome and will be taken into consideration. The committee will ask for assistance from the members of the committee to become active in regional issues regarding practice, such as lobbying members of congress to support legislation important to the practice of psychology when they are in their home districts.
    In an October 1996, memorandum from the Health Care Financing Administration to its regional offices, it was reiterated that there was a long-standing policy that precluded Part B Medicare payment to practitioners for all incident to” services provided in the hospital setting, even if the services are furnished incident to” those of a physician or other practitioner whose own services are paid under Part B in the hospital setting. Instead, only the hospital may bill its Medicare intermediary for the services, as a bundled” payment under Part A, and neither the practitioner nor the hospital can seek copayment from the beneficiary. The practitioner can seek payment from the hospital for technical services. However, this would typically require a contractual arrangement with the hospital and the provider. This rule applies to all practitioners; psychologists are not being singled out. The rule applies to” incident to” services for inpatients and outpatients registered through the hospital.
    This rule does not apply in a non-hospital setting. Part B payment to the psychologist may be made for services provided incident to” the psychologist's service for any covered non-hospitalized setting. A Presidential Task Force, under the leadership of Linas Bieliauskas, Ph.D., ABPP, president of Division 40 is addressing this issue. At the present time, however, the APA Director of Federal Regulatory Affairs, Amy Rabinove, ID, advises that psychologists comply with the guidelines set forth above. The regulation states that any services provided by non-Medicare-approved psychologists in a hospital setting cannot be billed directly to Medicare. For example, if a psychometrician or trainee administers a neuropsychological protocol the psychologist can only bill for her/his direct patient contact time including report writing but cannot bill for the time it took the technician to administer and score the protocol itself

    .H.R. 1415/S. 644: Patient Access to Responsible Care (PARCA)This bill was introduced by Representative Charles Norwood (R, Georgia) in the House of Representatives and by Senator Alfonse D'Amato (R, NY) and co-sponsored by over two hundred Representatives and Senators. The bill will promote accountability among managed care organizations that, they believe, put profit over care. The major provisions are:
-Managed Health Plan Accountability. Managed health care plans act as providers of care through utilization review and other cost containment techniques. They can determine if and what type and quality of care a patient receives. However, under Federal law (Employee Retirement Income Security Act of 1974 or ERISA) these HMO's often cannot be held accountable for injury to a patient caused by negligent treatment or cost containment. ERISA shields the HMO's from negligence because it preempts the state any cause of action. PARCA would remove ERISA shielding from ERISA regulated managed care plans. This will allow patients to hold managed health care plans accountable for their negligent actions.

-Patient Choice of Provider. Managed health care plans would be required to offer a Point of Service plan that would allow patients

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 Newsletter 40 .

access to out-of-network providers by:
1. Allowing patients to continue current relationships with providers if the patient has to change health care plans.
2. Acting as a quality check by permitting dissatisfied patients to seek help from providers and specialists outside of the network
3. Allowing persons seeking mental health and substance abuse treatment access to providers they know because it will strengthen trust, confidentiality and hopefully, treatment success.
Provider Nondiscrimination. PARCA will prohibit managed health care plans from discriminating against providers based solely on their state licensure or certification. For example, HMO's will not be allowed to say that neuropsychological services can only be provided by psychiatrists or social workers and preclude neuropsychologists from providing these services.
    There are other provisions but these are the main points that the bill addresses. The bill, as written, may never come to the floor, but these three provisions will likely be included in some bill. Please write to your Senators and Representatives to support this bill, or at least these three provisions. If you need further information contact your State Psychology Association, The Practice Directorate at APA, or either of the co-chairs of the committee.

Dan Eubanks
Co-Chair, Practice Advisory Committee
Federal Advocacy Coordinator
Division 40
4410 Medical Drive, Suite 640
San Antonio, TX 78229
E-mail eubanksd@ix.netcom.com

Christopher Grote
Co-Chair, Practice Advisory Committee
Department of Psychology and Social Sciences Rush-Presbyterian-St. Luke's Medical Center
1653 West Congress Parkway
Chicago, IL 60612-3833
E-mail cgrote @ rush.edu

News From The APA Council

1. School Psychology was confirmed as continuing to receive recognition as a specialty in professional psychology. Psychoanalytic Psychology was also recognized as a specialty, and Geropsychology was recognized as a proficiency.
2. The Ad Hoc Task Force on Specialty and Proficiency Titles received additional funds for meetings.
3. APA is working with other groups to make the next decade The Decade of Behavior”.
4. Limited support was provided for the continuation of addressing the following issues: women in academics, ethnicity minority recruitment, retention, and training, racism, genetic issues, physical disabilities, and ethics. 5. Guidelines for the evaluation of dementia and age-related cognitive decline were adopted.
6. Pat DeLeon was emerged as the individual receiving the largest number of nominations for the Presidency. Antonio Puente, Ph.D

    Division 40, Clinical Neuropsychology, announces the fifth annual Robert A. and Phyllis Levitt Early Career Award in Neuropsychology for an APA member psychologist who isnot more than 10 years post doctoral degree and who has made a distinguished contribution to neuropsychology in research, scholarship, and/or clinical work.
    A letter of nomination and three supporting letters (at least two from nationally-known neuropsychologists familiar with the candidate's work and its impact on the field) should be included along with 5 copies of 1) a CV, 2) three supporting documents (e.g. major publications; research grants; assessment, clinical, or teaching techniques; treatment protocols) providing evidence of national-international recognition, and 3) the candidate's 400 word statement describing professional accomplishments, personal long-term goals, and future challenges and directions in the field of neuropsychology that they wish to address.
    The awardee receives a certificate and $1000 and will be invited to present a paper at APA's 1999 convention in August. The deadline is January 2, 1999. Send nominations to Ida Sue Baron, Ph.D., ABPP, Chair, Division 40 Awards Committee, 10116 Weatherwood Court, Potomac, Maryland, 20854.

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 Newsletter 40

1998 APA Convention Division 40 Program:

Friday, August 14
8-8:50 Division 40 Education Advisory Committee Meeting
Chair: Kerry des. Hamsher
San Francisco Marriott Hotel, Sierra Conference Suite G

8-9:50 Poster Session: Lifespan Clinical Neuropsychology Chairs: Christopher Randolph, Helene Yurk
Moscone Center - South Building, Exhibit Hall B

9-l0:50 Symposium: Living on the Edge”: Education, Cognitive Reserve and Dementia Risk
Chairs: Bemice A. Marcopulos and Elisabeth Koss
Moscone Center - South Building, Room 306

l0-11:50 Symposium: Asperger, Williams, and Velocardiofacial Syndromes: The NLD Connection
Chair: Byron P. Rourke
Moscone Center - South Building, Room 304

12-12:50 In Memorium: Charles G. Matthews, Ph.D.
Chair: Linas Bieliauskas
Moscone Center - South Building, Room 220

 l-1:50 Paper Session: Neuropsychology of Aging and Dementia
Chair: Glenn E. Smith
Moscone Center - South Building, Room 304

l-1:50 Paper Session: Child / Developmental Neuropsychology
Chair: Cheryl Silver
San Francisco Marriott Hotel, Yerba Buena Salon 3/4

 2-2:50 Invited Address: Stuart M. Zola Title: Memory and Emotion: Neuropsychological Findings from Human and Non-Human Primates
Chair. Kathleen Y. Haaland
Moscone Center - South Building, Room 304

3-5:50 Division 40 Executive Committee Meeting
San Francisco Marriott Hotel, Pacific Conference Suite A

Saturday, August 15
8-8:50 Division 40 Pediatric Neuropsychology Interest Group Meeting
Chair. Keith 0. Yeates
San Francisco Marriott Hotel, Golden Gate Salon Bl

8-9:50 Poster Session: Neuropsychological Assessment
Chairs: Michael Franzen, Janet Grace
Moscone Center - South Building, Exhibit Hall B

9-9:50 Conversation Hour: Houston Conference on Education and Training in Clinical Neuropsychology
Chair: H. Julia Hannay
Moscone Center - South Building, Room 308

l0-10:50 Paper Session: Division 40 Blue Ribbon Award Winners: Functional Neuroimaging Studies in Neuropsychology
Chair: Mark W. Bondi
Moscone Center - South Building, Room 308

ll-11:50 Invited Address: Eileen M. Martin Title: The Cognitive Neuropsychology of HIV-l Infection
Chair: Wilfred G. van Gorp
Moscone Center - South Building, Room 308

l-2:50 Symposium: Neurobehavioral Assessment in Neuropsychology
Chair: Jane S. Paulsen
Moscone Center - South Building, Room 308

3-4:50 Symposium: Neuropsychological Assessment of Cognitive and Functional Abilities in Severe Dementia
Chair: Guerry M. Peavy
Moscone Center - South Building, Room 308

6-7:50 Neuropsychology All Student Social Hour, Sponsored by the Division 40 Education Advisory Committee
San Francisco Marriott Hotel, Yerba Buena Salon 1

Sunday, August 16

8-8:50 Division 40 Practice Advisory Committee Meeting
Chair: Joseph D. Eubanks
San Francisco Marriott Hotel, Pacific Conference Suite A 

8-8:50 Division 40 Science Advisory Committee meeting
Chair: Russell M. Bauer
San Francisco Marriott Hotel, Pacific Conference Suite C 

9-9:50 Symposium: The National Hockey League (NHL) Neuropsychological Evaluation Program
Chair: Mark R. Love11
Moscone Center - South Building, Room 305

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 Newsletter 40

l0-1150 Symposium: Functional Brain Imaging in Neuropsychology and Rehabilitation
Chair: Linda K. Laatscb
Moscone Center - South Building, Room 305

12-12:50 Paper Session: Robert A. & Phyllis Levitt Award and Student Award
Levitt Awardee: Marlene Behrmann
Student Awardee: Brian C. Schweinsburg
Chair: Ida Sue Baron
Moscone Center - South Building, Room 274/276

2-2:50 Invited Address: Harold Goodglass
American Psychological Foundation Arthur Benton Lectureship
Title: The Changing Frontiers of Neuropsychology from 1950 to the Present Chair. Joseph D. Matarazzo
San Francisco Marriott Hotel, Yerba Buena Salon 7

3-3:50 Division 40 Presidential Address: Linas Bieliauskas
Title: Mediocrity Is No Standard: Searching for Self-Respect in Clinical Neuropsychology
Chair: Eileen B. Fennell
San Francisco Marriott Hotel, Yerba Buena Salon 7

4-4:50 Division 40 Business Meeting
San Francisco Marriott Hotel, Yerba Buena Salon 7

5-6:50 Interdivisional Collaborative Social Hour
Cosponsors: Divisions 22, 38
San Francisco Marriott Hotel, Yerba Buena Salon 7

Monday, August 17

8-9:50 Poster Session: Neuropsychology of Head Injury, Medical Disorders and Psychiatric Disorders
Chairs: Robin Hanks, Rodney Vanderploeg
Moscone Center - South Building, Exhibit Hall B

9-l0:50 Symposium: Detection of Feigned Cognitive Impairments: Current Issues and Future Approaches
Chair: Donald J. Connor
Moscone Center - South Building, Room 302

l0-11:50 Symposium: Using the WAIS-III and WMS-III Together: Implications for Clinical Practice
Chair: David S. Tulsky
Moscone Center - South Building, Room 306

12-12:50 Paper Session: Neuroimaging and Cognition in Traumatic Brain Injury
Chair: Joseph H. Ricker
Moscone Center - South Building, Room 309

l-2:50 Symposium: Forensic Neuropsychology: Assessment of Adversarial Cases
Chair: Jerry J. Sweet
Moscone Center - South Building, Room 301

3-4:50 Symposium: The MMPI-2 in the Neuropsychological Assessment of Head Injury
chair: Carlton S. Gass
Moscone Center - South Building, Room 305

Division 22 Program
1998 APA

FRIDAY, AUGUST 14

8-8:50 Symposium: A Current Perspective on Psychosocial Intervention for Adults with Multiple Sclerosis
Chair: Robert T. Fraser
Moscone Center-South Building Room 212

9-l0:50 Symposium: Treatment & Prevention of Disability in Children Through Interprofessional Alliances
Chair: Janet Farmer
Moscone Center-South Building, Room 274/276

ll-12:50 Symposium: Spirituality & Disability: Psychology Awakens to Additional Dimensions of Human Diversity
Chair: Allen Heinemann (Discussant: Susan Folkman)
Moscone Center-South Building, Room 309

l-2:50 Integrated Healthcare Mini-Convention: Psychology in Primary Care and Rehabilitation
Chair: Martin Seligman, Ph.D.
Moscone Center-South Building, Room 305

3-3:50 Integrated Healthcare Mini-Convention: Psychology and the Healing Arts
Chair: Marie DiCowden
Moscone Center-South Building, Room 305

3-4:50 Symposium: Psychosocial Factors in Spinal Cord Injury Outcome Chair: Bryan Kemp
Moscone Center-South Building, Room 212

SATURDAY, AUGUST 15
8-10:50 Division 22 Board Meeting
Chair: Dennis Harper
San Francisco Marriott, Pacific Conference Suite C

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 1 l-l 1:50 Invited Address: Dennis Turk: Demonstrating the Effectiveness of Psychotherapy Services: Pain as a Prototype
Chair: David Patterson
San Francisco Marriott, Golden Gate Salon C2

12-12:50 Paper Session: Readiness to Change and Motivational Interviewing: Applications for Substance Use and Traumatic Injury
Chair: Nancy Piotrowski (Discussant is Carlo DiClementi)
Moscone Center-South Building, Room 232/234

2-2:50 Integrated Healthcare Mini-Convention: Integrated Healthcare-A New Paradigm
Chair: Ilene Serlin
Moscone Center-South Building, Room 307

3-4:50 Presidential and Fellows Addresses 
Chair: Mitchell Rosenthal
San Francisco Marriott, Nob Hill Room A/B

5-7 Social Hour and Awards Presentation: Division 22
Chair: Dawn Ehde
San Francisco Marriott, Nob Hill Room C/D

SUNDAY, August 16

8-8:50 Symposium: Feast or Famine? Psychology Training and Medicare Law
Chair: Alan Goldberg
Moscone Center-South Building, Room 270

9-10:50 Symposium: Psychospirituality and Chronic Illness-Philosophical and Data-Based Issues
Chair: Barry Nierenberg
Moscone Center-South Building, Room 252/254/256

ll-11:50 Leonard Diller Honorary Lecture, given by George Prigatano, PhD: Impaired Self-Awareness, Finger Tapping, and Rehabilitation Outcome After Brain Injury
Chair: Bruce Caplan
Moscone Center-South Building, Room 309

12-1:50 Symposium: Telehealth for Persons with Chronic Medical Conditions: Program Evaluation Developments
Chair: Robert Glueckauf
Moscone Center-South Building, Room 305

2-2:50 Symposium: When Pain is Neglected in Disability: Bum Injuries, Cerebml Palsy, and Amputations
Chair: David Patterson
Moscone Center-South Building, Room 226

3-4:50 Integrated Healthcare Mini-Convention: Town Hall
Chairs: Marie DiCowden, Ilene Serlin
Moscone Center-South Building, Room 304

5-7 Interdivisional Social Hour-Divisions 38. 40. 22

MONDAY, AUGUST 17

8-9:50 Symposium: Providing Mental Health Services to Individuals with Hearing Loss
Chair: Raymond Trybus
Moscone Center-South Building, Room 202/204/206

9-5 PM CE Workshop: Hypnosis in the Treatment of Pain Le.aders:David Patterson & Joseph Barber
Locations to be on your workshop ticket post registration
Note: You must sign up through the CE workshops to attend the workshop.

l0-l0:50 Symposium: Rehabilitation in Chronic Fatigue Syndrome: What Works and What Doesn't
Chair: Rochelle Balter
Moscone Center-South Building, Room 202/204/206

ll-12:50 Symposium: Employment Issues Affecting People with HIV
Chair: David Martin
Moscone Center-South Building, Room 302

2-2:50 Symposium: Rehabilitation Psychology: An Ethnic Minority Perspective
Chair: Paul Leung
Moscone Center-South Building, Room 252/254/256

3-3:50 Poster session: Rehabilitation Psychology: Science and Practice
Chair: Dawn Ehde
Moscone Center-South Building, Exhibit Hall B

CE CREDITS! Please remember that, at no extra cost outside of your registration fees, you can obtain Continuing Education credits for attending Division 22 events at APA. (Exception:hypnosis workshop which is through the APA CE Workshops)

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 Newsletter 40

Science Scene

On the Use of ROC Curves in Clinical Neuropsychology

William B. Barr, Ph.D., ABPP, Departments of Neurology and Psychiatry, Long Island Jewish Medical Center, The Long Island Campus for the Albert Einstein College of Medicine.

    How do we know if our tests are working? This is a question that clinical neuropsychologists might be asking themselves more frequently, given recent pressures to streamline clinical services and to reduce the length of test batteries. Many in practice today were trained in a model emphasizing the use of long test batteries with the goal of detecting clinically meaningful patterns from scores on multiple redundant measures. Now, in a rapidly changing marketplace, neuropsychologists are being asked to make the same clinical decisions in a more cost-effective” manner. This often means reducing time and the number of tests that are administered to a given patient. One is now faced with reducing the redundancy in the battery and choosing tests that are best suited for making a particular clinical decision. The question remains, how do we do this?
    Assessing the accuracy of neuropsychological tests is typically limited to the analysis of group means. For example, if patients with left hemisphere strokes are found to have a significantly lower mean scores on a given test than patients with right hemisphere strokes, that test is usually considered to be sensitive to detecting cognitive impairments associated with left hemisphere dysfunction. What is not assessed by this type of analysis, however, is what proportion of patients can be correctly classified into left and right hemisphere groups respectively by a given score on the test. Analyses of classification rates and the diagnostic accuracy of clinical test data are often overlooked in neuropsychological research.
    A growing number of investigators in neuropsychology are assessing diagnostic accuracy through the use of receiver (relative) operating characteristic (ROC) curves. ROC curves provide graphic representations of the tradeoff between true-positive and false-positive rates of classification. ROC curves were initially developed in psychological research on communication and information theory and contributed significantly to the development of modern-day cognitive psychology (Swets, 1996). These methods continue to play a prominent role in contemporary experimental research on memory and cognition. They are also used widely in research on diagnostic accuracy in radiology and in other fields of medicine. Until recently, their use in clinical psychology has been rather limited.
    ROC curves are easiest to use when making distinctions between two well-defined groups. Suppose that Test A and Test B are verbal learning measures that have been administered to patients with left or right hemisphere lesions. To compute an ROC curve, every score on each of these tests is treated as a separate cutoff score. The frequency of patients who attain scores at or below each cutoff is computed. Sensitivity and specificity values, based on these frequencies, are then calculated according to standard formulae. In this example, the sensitivity of Tests A and B would refer to the number of left hemisphere lesioned patients whose test scores are lower than the specified cutoff score. The specificity of these tests refers to the number of right hemisphere lesioned patients who obtain scores lower than the cutoff. Sensitivity and specificity values, ranging from 0 to 1, are then plotted graphically to obtain the ROC curve. A sample curve is presented in the accompanying figure.

Sample ROC curve: Verbal learning tests A and B administered to patients with left and right . . hemisphere lesioned groups.

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    One of the major benefits of the use of ROC curves is to obtain cutting scores for diagnostic classifications. When determining a cutting score, the clinician is faced with the decision of whether to emphasize the sensitivity or specificity of the measure or whether to treat these two features equally. For example, when working with high school athletes, the clinician might want to use a cutoff sensitive to the effects of concussion, so that the player can be withdrawn safely from further play. In this situation, it would obviously pay to err on the side of caution with an overly-sensitive” criterion. In contrast, a clinician working with epilepsy surgery candidates might want to emphasize the specificity of a test measure at the expense of sensitivity to reduce the number of patients that may be misclassified” by a relatively non-specific cutting score. In the first situation, determining the most appropriate cutoff score will involve choosing an arbitrary level of sensitivity (e.g., 90%) and finding the largest specificity value that exceeds this criterion. In the second situation, the cutoff value will be based on an arbitrary level of specificity.
    When sensitivity and specificity are given equal emphasis, there are at least two other ways to determine cutting scores. The first is rather basic, and depends on the score with the highest combined sensitivity and specificity values. For example, if a score of 15 correct on Test A classifies left and right hemisphere lesioned patients into their respective groups with a sensitivity of 93% and a specificity of 82%, the combined value would be 175. If this combined value was higher than any other single combined value, 15 would be considered to be the most accurate cutting score.
    The second method for determining a cutoff score requires a computation of the area under the curve. The area under an ROC curve is considered to be the single most useful index of diagnostic accuracy (Swets, 1996). The area represents the overall rate of correct classifications across the test's entire range of scores. The value, represented as proportion of the area in the unit square, ranges from SO (chance classification) to 1.0 (perfect classification). Computation of area values can be computed with extensive calculations. Use of a computer program developed for this purpose is recommended. Once the area under the ROC curve has been calculated, the most sensitive cutting score will be the score associated with the largest amount of area under the curve.
    Determining whether one test possesses more diagnostic accuracy than another can be accomplished by performing statistical comparisons of areas under ROC curves (Metz & Kronman, 1980). In our pictorial example, the area under the ROC curve for Test A is .896 (SE = .013) and the area under the curve for Test B is .792 (SE = .019). Statistical comparison indicates that the area associated with Test A is significantly larger (P c .00l). One can thus safely say that Test A is more accurate in classifying patients with left and right hemisphere lesions than Test B.
    ROC curve analysis was recently introduced to clinical neuropsychology through the work of Andreas Monsch and colleagues at the University of California at San Diego (Monsch et al., 1991). These investigators conducted a study of various verbal fluency measures and their ability to distinguish between normal controls and patients with early Alzheimer's Disease. Their analyses revealed that category fluency tasks (e.g., animals, supermarket items, etc.) provided greater discrimination between these groups than letter fluency tasks (letters F, A, & S). Results indicated that the animal naming task, in particular, provided the highest degree of diagnostic accuracy. With an animal naming cutting score of 14 or less, Alzheimer's Disease patients and normal controls were classified with 92.1% sensitivity and 94.3% specificity. ROC curve analysis has been used to assess diagnostic accuracy in a number of other neuropsychological studies of early dementia (Drebing et al., 1994; Engelhart, Eisenstein, & Meininger, 1994; Sliwinski et al., 1997).
    Hermann and colleagues (1995) employed ROC curves to assess classification of patients with left or right temporal lobe seizure onset using the Warrington Recognition Memory Test (Warrington, 1984). The results indicated limited diagnostic accuracy preoperatively with improved classification post-operatively. In a study in our laboratory, modest levels of classification of left and right temporal lobe onset cases was obtained with Logical Memory Subtest II and a difference between Verbal and Visual Index scores from the Wechsler Memory Scale -Revised (Barr, 1997; Wechsler, 1987). All other scores from this test provided relatively limited classification of patients from a preoperative sample. More recently, Loring and colleagues have used ROC curve analysis in a study

[Page 16]

 of accuracy of object versus drawing stimuli in memory testing during the Wad a procedure (Loring et al., 1997).
    ROC curves are used most effectively in situations when diagnostic classifications can be made reliably through the use of an independent measur e (Mossma n & Somoza, 1992). In ROC curve studies of dementia ,the gold standard ” classification curves have been based on the results of clinical diagnoses established by independent raters. In the case of temporal lobe epilepsy, EEG results typically provide the standard for group classification. It becomes more problematic to use ROC analyses with samples such as mild traumatic brain injury patients where it can be difficult to ascertain a diagnosis independent of the measure to be studied. In these situations, brain imaging findings or scores from other neuropsychological tests can be used to provide independent classification of subjects.
    One of the major criticisms of ROC curves analysis is that it places neuropsychological testing in a relatively artificial context. In most clinical situations, one must make a diagnosis of one of a wide range of clinical disorders. Rarely is a clinician faced with a situation where he or she is asked to make a distinction between two well-defined groups. Also, these analyses typically treat a single test in isolation, and not in the natural context of a comprehensive test battery. One of the goals of future research will be to examine how ROC curves can be used to study the performance of selected test batteries or subsets of tests grouped together in making diagnostic classifications among two or more clinical groups.
    With their limitations in mind, ROC curves can provide a valuable tool for the clinician who is attempting to learn how well a given test works with a particular population. ROC curves can provide objective information on how two tests compare to each other and how these tests compare to other forms of diagnostic classification. In a health-care environment now emphasizing efficiency and outcome, neuropsychologists should become increasingly aware of techniques such as ROC curves and other measures of diagnostic accuracy for making empirically informed decisions regarding the quality and efficacy of our tests.

References

Barr W.B. (1997). Receiver Operating Characteristic (ROC) Curve Analysis of Wechsler Memory Scale - Revised Scores in Epilepsy Surger y Candidates . Psvchological Assessment, 9, 171- 176.

Drebing, C.E. ,Van Gorp, W.G., Stuck, A.E., Mitrushina, M . & Beck, J. (1994). Early detection of cognitive decline in higher cognitivel y functioning older adults: Sensitivity and specificity of a neuropsychological screening battery . Neuropsychology, 8, 31-37.

Engelhart . C., Eisenstein , N. & Meininger, J. (1994). Psychometric properties of the Neurobehavioral Cognitive Status Exam. The Clinical Neuropsychologist, 8,405415.

Hermann , BP., Connell , B., Barr, W.B., Wyler, A.R. (1995). The utility of the Warrington Recognition Memory Test for temporal lobe epilepsy: Pre- and postoperative results. Journal of Epilepsy, 8, 139- 145.

Loring , D.W., Hermann , BP., Perrine, K., Plenger, PM., Lee, G.P., & Meador , K.J. (1997). Effect of Wad a memory stimulus type in discriminating lateralized temporal lobe impairment. Epilepsia, 38, 2 19-224.

Metz, C.F. & Kronman, H.B. (1980). Statistical significance tests for binomial ROC curves. Journal of Mathematical Psychology, 22, 218-243.

Monsch, A.U., Bondi, M.W., Butters, N., Salmon, D.P., Katzman , R. & Thal, L.J. (1992). Comparisons of verbal fluency tasks in the detection of dementia of the Alzheimer 's type. Archives of Neurology, 49, 1253-1258.

Mossman , D. & Somoza, E. (1992). ROC curves, test accuracy, and the description of diagnostic tests. Journal of Neuropsychiatry , 4, 95-98.

Sliwinski, M., Buschke, H., Stewart, W.F., Masur, D., & Lipton, R.B. (1997). The effect of dementia risk factors on comparative and diagnostic selective reminding norms. Journal of the International Neuropsychological Society, 3, 3 17-326.

Swets, J.A. (1996). Signal Detection Theory and ROC Analysis in Psvchology and Diagnostics; Collected Papers . Mahwah, NJ: Lawrence Erlbaum Associates.

Warrington, E.K. (1984) . Recognition Memory Test. Berkshire, U.K.: NFER-Nelson.

Wechsler, D. (1987). Wechsler Memory Scale Revised -Psychological  Corporation . Revised. New York:

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 Newsletter 40

CONFERENCE REVIEW
David E. Tupper and Antonio E, Puente
First International Luria Memorial Conference

    The First International Luria Memorial making a pilgrimage to discuss the life, legacy; and Conference (I Mezhdunarodnaya Konferentsiya Pamyati A.R. Lurii) was held in Moscow, Russia, from September 24-26, 1997. Although a number of other conferences dedicated to Alexander Romanovich Luria's memory have been held locally in various countries since his death in 1977 (e.g., the Bremen conference, June 27A28, 1992; Jantzen, Lomscher, M,traux, & Stadler, 1994), this was the first major international conference organized by Luria's own students, colleagues and friends, and dedicated to his memory.
    The conference, which took place at Moscow State University, was sponsored by the Psychology Department of Moscow State University and a number of Russian scientific organizations (Russian Foundation for Basic Research, Russian Humanities Foundation, Soros Foundation, Beaufour-Ipsen International, and Lek Pharmaceutical and Clinical Company). It was the first conference to commemorate the 95th anniversary of Luria's birth (born in 1902) and the 20th anniversary of his death, and represented the first major international meeting backed by and held at Luria's supporting institution. Financial support was also provided by Division 40 of the American Psychological Association and the National Academy of Neuropsychology.
    The recent glasnost or openness in the former Soviet Union, among many other changes, has allowed a much greater communication between Russian psychologists and other psychologists around the world. Because of this, the conference was a very unique occurrence.
    The Luria conference was a world-class event which included well-known psychologists and neuroscience professionals from around the world, much like other international psychological meetings. In fact, several hundred people attended conference, representing 19 countries and 60 cities, including 23 Russian cities. Participants arrived from a number of continents including North and South America, Africa, Europe, and Asia, all ongoing research and practice stemming from the work of Alexander Luria. As noted by the conference Program Committee chairperson Eugenia D.Homskaya, one of Luria's longest and closest collaborators, Luria is a psychologist of international merit. He was well known during his life and now, in the 20 years following his death, his works continue to be very popular. The publications of A.R. Luria influenced to a great extent different branches of psychology (especially neuropsychology) all over the world”. This conference was truly a great tribute to this man and, in some ways, even 20 years later, it served as a formal international funeral and requiem which could not be held previously.
    Conference co-presidents included VP Zinchenko and Karl H. Pribram. Eugenia D. Homskaya acted as chairperson of the International Program Committee, and Janna M. Glozman was chair of the Local Organizing Committee. The program itself was very full, including one day of preconference scientific excursions to several major Moscow research, clinical, and rehabilitation centers, one day which included an opening ceremony and a comprehensive plenary session with greetings from worldwide psychological organizations, invited presentations about Luria's influence on scientific psychology, and a rather unique mid-day visit to Luria's grave. The final two days consisted of chaired thematic concurrent sessions running morning, afternoon, and evening, with a fascinating closing ceremony at the end which included not only comments by Luria's disciples” (as they identify themselves) and a former patient about his life, but an audiotape recording of Luria himself discussing his role and activities as a psychologist. An additional specially arranged highlight of the conference was a video-the bridge” satellite videoconference between a number of conference participants in Moscow (in a distinctive and contemporary international electronics center”) and presenters in New York,

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 who included Jason Brown, Jerome Bruner, Anne-Lise Christensen, Elkhonon Goldberg, and Oliver Sacks. The video-bridge was a truly exceptional experience, as the technology clearly functioned to integrate European and North American psychological science in discussions of Luria's broad-ranging influence. Much has changed and some has remained the same in Russian psychology in the past few years. It was apparent in conference discussions that many of Luria's ideas are applied in much the same fashion as they were in Luria's day. However, a large number of presentations dramatically demonstrated ongoing advancement in psychological research since Luria's time, such as use of quantitative methodology, statistical analyses, and relationships to MRI and other imaging techniques. Alternative Russian neuropsychological conceptualizations to Luria's were also discussed, such as the work of a number of professionals at the V.M. Bekhterev Psychoneurological Research Institute in St. Petersburg, who have utilized a Russian WAIS and other methods in a more psychometric and modular” approach.Many of the themes covered in the conference were, of course, concerned with neuropsychology, the area in which Luria worked for most of his life, and for which he is best known. Such topics included the neuropsychological study of cognition, methods of neuropsychological assessment, neurorehabilitation, developmental neuropsychology, interhemispheric activity, aphasia and neurolinguistics, the elderly, individual differences, and neuropsychology in psychiatry and psychosomatics. A number of additional, more broad, psychological topics, sometimes concerned with Luria's romantic science” side, were also reviewed. Michael Cole presented on Luria'sresolution” to the crisis in psychological thinking, Vladimir Zinchenko discussed Luria as psychology's Beethoven, Andrey V. Brushlinsky was concerned with the problem of activity in psychology, E.D. Homskaya and Lubov S. Tsvetkova spoke about development of Luria's ideas in modern Russian psychology and neuropsychology, and Karl Pribram offered a talk about conscious experience, as examples.
    An almost "who's who” of psychology around the world attended the conference. North America Newsletter 40 18 was represented not only by Pribram, Cole and the video-bridge” presenters, but also with attendance by Harold Goodglass, James Wertsch, Joseph Tonkonogy (formerly of St. Petersburg), J.P. Das (Canada), the authors, and others. Well-known international psychologists and colleagues of Luria included Luciano Mecacci from Italy, Bo ydar Kaczmarek from Poland, Paul Sch"nle from Germany, Kolbein Lyng from Norway, and numerous others, as well as eminent psychologists and neuropsychologists from Russia including J.M. Glozman, T.V. Akhutina, E.N. Sokolov, Ya.A. Meerson, L.I. Vasserman, N.K. Korsakova, and others. As conference participants, we will take away a very large number of fond and wonderful memories from our visit to Moscow. These include professional happenings such as being introduced to Gita Vygodskaya, Lev Vygotsky's psychologist daughter; seeing and participating in a memorial service” at Luria's grave-including being served vodka on the bus ride back to the meeting (apparently a Russian tradition; or possibly just an excuse to drink) by Vasili Davydov, Director of the Institute of General and Educational Psychology of the Russian Academy of Education; listening to personal reminiscences and stories about Luria (with multiple toasts”) by Jim Wertsch, Michael Cole, Karl Pribram, Vladimir Zinchenko, and others; hearing the Luria audiotape; being awed by the displayed collection of Luria's writings (in many languages) in the Moscow State University Psychology Department library; and of course meeting a large number of new international colleagues.
    Contemporary visitors to Moscow are also certainly astonished by some of the cultural and daily life changes visible in the city. The Luria conference, in fact, was held only several weeks after Moscow's 850th birthday celebration, and many wonderful European-style changes were apparent in the city; it was reasonably clean, Muscovites were friendly and helpful, roads were repaired, a new "mall” was being completed outside Red Square, and the city in general was much more open (although with many more bright lights and billboards). Personal remembrances include visits to the Pushkin and Tretiakov museums, negotiating

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 Newsletter 40

with "scalpers” for tickets to the Bolshoi theater and a night on the town, a Russian pizza restaurant, souvenir shopping, seeing snowflakes in September, searching for warm clothes due to lower than expected temperatures (there was no heat flowing in the Moscow State University dorm rooms!), and many enjoyable times and discussions with our Russian student interpreters.
    The First International Luria Memorial Conference, as intended by its organizers, was a huge success. A Russian-language volume with the conference proceedings will be published in the near future, further adding to the importance and recognition of Luria's international accomplishments in his own country. Unfortunately, this first Luria conference may represent one of the last major international and personal tributes to Alexander Romanovich Luria, as many of his closest colleagues and collaborators are elderly and may not survive until a centennial Luria conference. Nevertheless, it was a first-class effort to memorialize and pay tribute to one of the pre-eminent influences on psychology and neuropsychology around the world.

Reference
    Jantzen, W., Lompscher, J., M,traux, A., & Stadler, M. (Eds.), (1994). Die neuronalen Verstrickungen des Bewuatseins A Zur Aktualit,,t von A.R. Lurijas Neuropsychologie (Fortschritte der Psychologie, Band 6). Munster: Lit Verlag.

(Left to Right) Antonio Puente, Harold Goodglass, and Bo ydar Kaczmarek at Luria's grave.

(Left to Right) Janna M. Glozman, Gita Vygodskaya, and David Tupper between sessions.

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 Newsletter 40

DIVISION 40 EXECUTIVE COMMITTEE MEETING MINUTES

February 4, 1998, Hawaiian Hilton Village, Honolulu, Hawaii

Present: Adams, Baron, Becker, Berent, Berg, Bieliauskas, Boll, Bondi, Cripe, Cullum, Dede, DeLuca, Edwards for Wilson, Fennell, Goldstein, Hamsher, Mapou, Marcotte, Nemeth, Reynolds, Smith, Van Gorp.

Absent Eubanks, Fischer, Herfkens, Meneese, Perez-Arce Puente, Shear, Wilson.

1. The meeting was called to order by Dr. Bieliauskas at 1:06 pm.

2. Minutes of the Executive Committee (EC) meeting held on August 15, 1997 were reviewed and approved with no revisions.

3. Treasurer's Report: Dr. Van Gorp presented the Treasurer's Report for the fiscal year 1997. As of December 31, 1997, Division 40 had total assets of $180,167.31. Expenses for 1997 totaled $57,255.56, with a surplus of $1,704.44 for the budget year. The Secretary's office ended the year with an override of $5,977.57, which was supervised by Drs. Van Gorp and Bieliauskas. Dr. Marcotte noted that the total expenditure of the override was about $2,000 higher than had been anticipated at the August EC meeting. The extra expense was encountered when APA changed dates for the 1998 elections, prompting the Call for Nominations to be mailed in December, 1997, under the 1997 fiscal year rather than February, 1998, in the 1998 fiscal year.

Dr. Van Gorp raised the concern that two elected Division 40 officers, namely the President-Elect and Past-President, do not have budgets and therefore no monies to help defray the cost of travel to attend required EC meetings.A motion was made to create budgets for both of these elected officers; the motion was approved. Dr. Van Gorp will work with Dr. Nemeth to outline the Division Policy and Procedures Manual policy on travel for elected EC members. Dr. Van Gorp also raised the issue that the four Advisory Committees have not utilized much of the funds allocated for their efforts since the Committees were created. A discussion ensued, and it was the majority opinion that the four Advisory Committee budgets should be reviewed. The Chairs of the Science, Education, Practice, and Public Interest Advisory Committees will submit new budgets to Dr. Van Gorp, which will be discussed at the August, 1998 EC meeting.

4. Council Representatives' Report: Drs. Goldstein and Boll made the following report. Division 40 was successful in its attempt to earn a fourth seat in the Council of Representatives effective January, 1999. It was one of the Divisions that earned a wildcard” seat in the reapportionment which adds 48 seats to Council. In the August, 1997, meeting, Council recognized 20 Clinical Health Psychology” as a new specialty area. This has triggered off concerns by some members of APA about the use of the term Clinical” in newly recognized specialties. A moratorium has been instituted on the use of this term by CRSSP. There is concern that when Clinical Neuropsychology goes up for renewal as a specialty that the term Clinical” may be stripped from the title. EC members expressed significant concern about this, and resolved to fight any such efforts in the future. To this end, the EC has advised our Council Representatives to not support a proposed Task Force which would be empowered with $50,000 to investigate the use of the term "ClinicaI”. Drs. Boll and Goldstein also reported that Division 12 is changing its name from the Division of Clinical Psychology to the Society of Clinical Psychology: A Division of APA. This is being done in part to allow the Division to speak as a entity independent of APA.

Dr. Abels and committee have prepared a brochure, What Practitioners Need to Know About Working with Older Adults”. In addition, guidelines have been drafted by APA for the evaluation of dementia and age-related cognitive decline. Dr. Bieliauskas received a draft of the guidelines for comments, and circulated it among EC members for comment. He has written a letter summarizing concerns on behalf of the Division. Concerns have further been expressed that this document may lead to the development of a proficiency in geriatric assessment by the National College.

5. Newsletter: Dr. DeLuca reported that the Winter/Spring edition of the Newsletter was sent to members in early February. The report of the Houston Conference is included in the Newsletter for members to review. The Newsletter totaled over 20 pages, and included pictures from the Houston Conference. Dr. DeLuca encouraged Committee Chairs to submit columns for the Newsletter, noting to date only the Science Advisory Committee has done such. He also suggested the Division 40 Representatives to the APA Council consider a writing a regular column. Deadline for submissions to the next Newsletter is May 1, 1998.

6. Membership: Dr. Marcotte presented the following report for Dr. Meneese who was unable to attend the meeting. The names of 275 applicants were presented to the EC for membership in Division 40 (66 Members, 3 Associate Members, 209 Student Affiliates).The EC voted to accept all of the applicants. As of January, 1998, Division 40 membership totaled 4,221. The newly elected members bring Division membership to 4,290 (excluding student affiliates). There are now 425 student affiliates. Dr. Meneese also compiled information on minority membership in Division 40. According to APA records, the Race/Ethnicity totals are as follows (excluding White and Not specified totals): American Indian, 25; Asian, 56,; Black, 37; Hispanic, 98; Other, 12. Dr. Meneese had also been asked to inquire how Primary Division” designations are made by APA; Sarah Jordan at APA Division Services reported that APA no longer categorizes division membership in such a manner.

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 7. Nominations: Dr. Fennell reported that the Nominations Committee will meet during INS to developed the slate for the upcoming Division 40 elections. Positions to be filled in 1998 include: President-elect, one Member-at-Large, and three Council Representatives (up from the two rotating off due to the gained seat in the wildcard” apportionment balloting in the Fall of 1997). The Call for Nominations resulted in several members obtaining the required 43 nominations to have their names placed on the ballot. According to the Division Bylaws, each position must have two names appearing on the ballot; the Nominations Committee will ensure that sufficient names appear on the final ballot. Ballots will be mailed directly to members from APA around April 15, 1998. Division 40 will again this year request that all nominees prepare statements, which will be mailed to all voting Division 40 members prior to the election.

A discussion then ensued about the Call for Nominations, and the use of the nomination ballot . Dr. Marcotte, who coordinates the Call, noted that this year, over 50 members did not use the official ballot in nominating members for elected office. All of these submissions did, however, include the name of the person submitting the ballot. This required verification of membership status before the ballot could be declared valid. It was motioned and approved that all future nominations for Division officers must be made using the official Call for Nominations ballot mailed from the Division 40 Secretary's office. No faxes, e-mail submissions, or submissions sent by mail on any other form will be accepted. These instructions will also appear on the Call.
 

8. Fellows: Dr. Berent announced that the Fellows Committee received 25 inquiries this year from members about applying for Fellow status. Nine members completed applications by the deadline. The Fellows Committee is currently reviewing these application,and will forward the names of members recommended for Fellow status to APA by February 15, 1998.

9. Program: Drs. Bondi and Smith presented the following Program Committee report. This year, 191 submissions were received for the 1998 Division 40 Program at the APA Annual Convention, and the acceptance rate was 75%. Sessions have been scheduled for August 14 - 17, 1998, with the Division's Award session (Levitt and Student), Benton Lectureship, Presidential Address, Annual Business Meeting and Social Hour scheduled for Sunday, August 16. The program also includes three poster sessions, 10 symposia, and 5 paper sessions. Invited addresses will be delivered by Stuart M. Zola and Eileen M. Martin. Dr. Julia Hannay will lead an invited conversation hour on the Houston Conference on Education and Training in Clinical Neuropsychology.This year's student award goes to Brian C. Schweinburg, a graduate student in the UCSD/SDSU joint doctoral program, who's mentor and co-author is Dr. Igor Grant.

10. Ethics: Dr. Becker reported that the committee will be informally meeting during the INS meetings.

11. Science Advisory: Dr. Bauer was unable to attend the meeting but prepared the following report presented by Dr. Marcotte. The Science Advisory Committee has decided to present two new student research awards beginning at the 1999 APA Convention. One will be for excellence in clinical neuropsychological research, for a submission that applies methods and concepts of neuropsychology to the study of clinical phenomenon. The second will be for research in the area of cognitive neuroscience, for a submission in which the primary emphasis is to elucidate a neurocognitive ability or mechanism in a nonclinical setting. The Science Advisory Committee also attempted to organize a symposium at the APA Convention on functional neuroimaging. but had difficulty luring neuroimaging researchers to attend the convention. The Committee will attempt again next year to coordinate sponsoring a symposium with a science emphasis with the Program Committee.

12. Education Advisory: Dr. Hamsher reported that the Education Advisory Committee will be meeting on February 5, 1998, to discuss future plans.

13. Practice Advisory: Dr. Mapou reported for Dr. Eubanks. The issue of the bundling of technicians' services to a neuropsychologist (the incident to” issue) is currently being reviewed by APA attorneys. The Committee has been has not been able to go forward with any position or white” papers due to APA's moratorium on guidelines.

In his written report to the EC, Dr. Eubanks sought input for future activities to be pursued by the Practice Advisory Committee. Numerous EC members expressed significant concerns that this important committee has not been more active in light of the gravity of managed care and incident to” issues that threaten the practices of many Division 40 members. This led to a discussion of the Incident to” Task Force, which was created in August, 1997, and chaired by Dr. Eubanks.

14. Task Force on Incident To” Issues: Dr. Bieliauskas reviewed the incident t o" issue as it relates to the use of technicians in neuropsychological practice. Presently, many neuropsychologists employ technicians and bill for their services as incident to” their own services. The CPT codes developed for neuropsychological procedures, however, did not include the possible use of technicians in practice. This practice is much akin to the use of radiology technicians by radiologists; radiology CPT codes, however, clearly delineate the role of technicians in procedures. In hospital settings, particularly those that receive federal monies, institutions have been accused of double dipping” for these bundled services as the services of these support staff members is assumed under the federal monies. This applies to both inpatient and outpatient hospital-based services. In some instances, institutions have had to pay back large sums of money to the government for such alleged practices. A new threat is that

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 Medicare has recently begun auditing institutions for billing compliance; it is possible that not only the institution but individual providers may be held liable for any cases of non-compliance.

Drs. Bieliauskas and Berent shared with the group that the neuropsychology practice at the University of Michigan has been so audited by Medicare, and that the billing for services provided in part by a technician has been found in non-compliance and that monies must be returned. Dr. Bieliauskas noted that this threatens the very existence of neuropsycholgical practice in many hospital settings, and has profound implications for our field. Furthermore, third-party payers frequently follow Medicare/HCFA practice.

Given the severity of the situation, and the need for immediate action, Dr. Bieliauskas has changed this Task Force to a Presidental Task Force; he will appoint a co-chair to work with Dr. Eubanks in these efforts and will himself be integrally involved in overseeing the Task Force's work. The Task Force was further advised to coordinate its efforts with the American Academy of Neuropsychology which is also actively engaged in addressing this issue. The Task Force also needs to work actively with APA's Practice Directorate in vigorously dealing with this problem. EC members also suggested that enlisting the support of State Psychological Associations would be advantageous, and recommended that the Practice Advisory Committee pursue enlisting a neuropsychologist in each state to liaison with State Psychological Associations on these practice issues. It was also recommended that a Division 40 member should attend the upcoming APA State Leadership Conference which focuses on promoting advocacy skills in psychologists.

15. Public Interest Advisory: Dr. Edwards reported for Dr. Wilson. EC voting members received copies of documents the Public Interest Advisory Committee members have prepared pertaining to neuropsychological practice to help enhance the public's understanding of our profession. The drafts that had been circulated underwent editorial review by Dr. Charles Matthews just prior to the EC meeting, who had many concerns about their current state. New drafts have been prepared, and will be sent to EC voting members and Committee Chairs in the next few weeks for review. Precisely how these documents will be used remains unresolved; while the documents must receive approval from the EC to have the Division's name attached to them, any formal” endorsement by the Division will have to undergo APA review.

16. Division 40 Web Page: Dr. Cripe presented information on how frequently the Division's web page has been visited since its inception in August, 1997. To date, there have been 27,536 hits to www.div40.org. Dr. Cripe noted that there is space on the web page for announcements to be posted. A subcommittee comprised of Drs. Cripe, Cullum and Marcotte has been appointed to develop policies about announcements to be posted. A motion was made and approved to provide Dr. Cripe with a budget to maintain the web page. Dr. Cripe will work with Dr. Van Gorp to develop such a budget, to be reviewed at the August EC meeting.

17. Program Listings: Dr. Cripe announced that the Training Program data base has been updated. The listing currently is comprised of 39 doctoral programs, 49 predoctoral internships and 72 postdoctoral programs in clinical neuropsychology. A discussion ensued as to whether the new listing should be published as in the past in The Clinical Neuropsvchology m or just be electronically posted on the Internet. After debate, it was decided that the 1998 listing should be published in TCN and listed on the Division 40 web page.

18. CPT Code Task Force: Dr. Puente could not attend the meeting, but provided a written report. Dr. Puente noted that new CPT codes are in place for psychotherapy services. The issue of documentation will become increasingly important as practices begin to be audited, particularly in hospitals and nursing homes; documentation guidelines are currently being drafted. The limitations of current neuropsychology CPT codes was also reviewed in light of the incident to” issues outlined above. Dr. Puente also reported that the World Health Organization teamed up with 3-M to develop the International Classification of Disease - 10th Edition, and several psychologists were involved.

19. Minority Affairs: Dr. Dede reported that committee members have been appointed to the Minority Affairs Committee, which will hold meetings on February 4 and 7, 1998. Committee members were selected for representation of all geographic areas. The committee's first agenda items are to improving recruitment and retention of minority students interested in clinical neuropsychology and issues pertaining to the assessment of minorities.

20. Awards Committee: Dr. Baron reported that her committee received three applications for the Levitt Award, and are currently reviewing the applications. She expressed concern over the small number of applicants for this award, and encourages all clinical neuropsychologists who have served as mentors to neuropsychologists less than 10 years postdoctoral fellowship to actively encourage their former students to apply for this award. The committee will also be selecting the recipient of the Benton Lectureship in the next few weeks. The committee will forward the names of the Levitt and Benton award recipients to APF. The Committee will also work with APF on selection of the two student scholarships, the H&aen and Meier Scholarships.

21. ASHA/Division 40 Task Force: Dr. Marcotte reported for Dr. Fischer. This committee has not met since February, 1997; they will be meeting on February 5.1998, and Dr. Fischer will update the EC on activities in August, 1998.

22. Interdivisional Health Care Committee: Dr. Marcotte attended the mid-winter meeting of the Interdivisional Healthcare Committee (IHC) held January 26, 1998 in Ft. Lauderdale, FL. Dr. Fennell, the other Division 40 Newsletter 40

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 representative, was unable to attend the meeting. The IHC developed bylaws for the group. Efforts were also devoted to developing a strategic plan to advocate for greater presence of psychologists working in healthcare within APA, particularly on important APA Committees. The group decided to unite efforts in endorsing candidates put forth by IHC member Divisions for appointment to APA Committees. To this end, Dr. Nate Perry (Division 38) will coordinate a campaign to promote IHC candidates; Division IHC representatives sent Dr. Perry the CVs of members being nominated to APA Committees as well as a letter outlining the candidate's qualifications for the post. Should any of the IHC backed candidates make the final slate, lobbying efforts will be coordinated to ensure APA Council Representatives receive information about the candidates prior to Council elections. The IHC also delineated another important task for the group to address is the development of CPT codes for the delivery of psychological/behavioral medicine services in healthcare settings.

23. Bylaws/Policy and Procedures Manual: Dr. Nemeth circulated the second draft of the Policy and Procedures manual for review, noting some information remains to be added. She will be working with various EC members to complete this project, which will be presented for final approval at the August EC meeting.

24. Division 40 Archivist: Dr. Nemeth was appointed by Dr. Bieliauskas as the Division 40 Archivist. Dr. Nemeth reported that Louisiana State University Libraries have agreed to serve as the official archival repository for Division 40. Mr. Glenn McMullen will be our collection's curator/liaison. Details will be announced in the future as to how materials can be stored in the archives.

25. Division 40 Representative to the APA Committee on Gay, Lesbian and Bisexual Concerns: Dr. Mapou reported to the EC that membership on this committee is not limited to gay, lesbian or bisexual members, but to any APA member interested in and/or possessing expertise in these areas. Division 44 is drafting Professional Practice Guidelines for psychotherapy with these populations. APF has announced the Placek Grant, developed to fund research advancing the public's understanding of gay men and lesbians. Grants could be used to fund research in clinical neuropsychology on sexual orientation and cognition.

26. Division 40 Representative to the APA Committee on Women: Dr. Marcotte reported for Dr. Shear. The Committee has had no activity since Dr. Shear joined as our divisional representative.

27. Report from the Supply and Demand Conference: Division 40 was represented at the Conference held in November, 1997, by Dr. Kenneth Adams. The Conference was to address issues of supply and demand for entry into graduate study in psychology, internships, postdoctoral fellowships and beyond. Most of the conference, however, focussed on the internship issue. Last year, 500+ students were not able to obtain an intern position. Some discussion was also pursued as to whether licenses should be issued at the end of graduate study, as in medicine. The conference attendees were unable to complete the work; a steering committee has been appointed to continue efforts. One issue that was not thoroughly discussed was the influx of Psy.D. programs and their many graduates, and how these factors may be complicating the supply and demand situation. Dr. Adams recommended that Division 40 request information from APA as to how many Psy.D.s have been granted from for-profit programs; the issue was turned over to the Education Advisory Committee for exploration.

28. Houston Conference: The Report from the Houston Conference was distributed to all EC members for review prior to the meeting. A motion was made that the Report be endorsed by the EC; the motion was unanimously passed. The Report of the Houston Conference is available for Division members to review in the Newsletter; it is also posted on the NAN web page. The Report is to be published in The Archives of Clinical Neuropsvchologv in February in Volume 13. No. 2.

29. The EC met subsequent to the closing of the general meeting in executive session. Lydia Artiola was appointed to chair the International Affairs Committee.

30. There being no other business, the meeting was adjourned at 4:05pm.

Respectfully Submitted,
Ann C. Marcotte, Ph.D.
Secretary, Division 40

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 Newsletter 40

Newsletter 40 is the official publication of Division 40. The Editor is John DcLuca, and the Associate Editor is Joel Morgan. Dr. DeLuca's address is Neuropsychology and Neuroscience Laboratory,
Kessler Institute for Rehabilitation,
1199 Pleasant Valley Way,
West Orange, NJ 07052.
Dr. Morgan's address is
Neuropsychology Service,
VA Medical Center,
385 Tremont Ave.,
East Orange, NJ 07019.
Division 40's Website is: www. div40. org.
Webmaster is Dr. Lloyd Cripe.

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