Clinical Neuropsychology
Topic 6
Definition
 The
study of the relation between
brain function & behavior.
 Deals
with the understanding,
assessment, & treatment of behaviors
directly related to the functioning of
the brain
Neuropsychological Assessment
A
non-invasive method of describing
brain functioning based on a patient’s
performance on standardized test s
that have been shown to be accurate
and sensitive indicators of brain
behavior relationships.
Roles of Neuropsychologists
 Helps
neurologists or other
physicians to establish or rule out a
particular diagnosis
 Make predictions regarding the
prognosis for recovery
 Intervention & rehabilitation
Cont’d
 Evaluate
patients with mental
disorders to help predict the
course of illness as well as to
help tailor treatment strategies
to patient’s strengths &
weaknesses.
History of Neuropsychology
 Theories
 Edwin
of Brain functioning
Smith Surgical Papyrus – a
document thought to date between
3000 & 1700 BC, discusses
localization of function in the brain
Cont’d
 Pythagoras
– human reasoning
occurs in the brain
 Galen
( 2nd cent BC) – mind
was located in the brain
Cont’d
 19th
Cent – damage to specific cortical
areas was related to impaired function of
certain adaptive behaviors
 Franz
Gall – phrenology; certain
individual differences in intelligence &
personality could be measured by noting
the bumps & indentations of the skull.
Cont’d
 Paul
Broca (1861) – found the location of
motor speech; localization of function –
maps of the brain that located each
major function
 Pierre
Flourens & Karl Lashley – concept of
equipotetiality – although there is
certainly localization of brain function,
the cortex really functions as a whole
rather than isolated units
Cont’d
 Jackson
& Luria – functional
model; areas of the brain interact
with each other to produce a
behavior; behavior is a result of
several functions or systems of the
brain areas, rather than the result
of unitary or discrete areas.
Cont’d
 Neuropsychological Assessment
 Psychological
tests were oriented to
simple assessment of the presence &
absence of brain damage
 Ward Halstead – observed people with
brain damage in natural settings, &
identify specific characteristics of the
behavior
Cont’d
 Halstead-Reitan
Neuropsychological
Battery
 Luria-Nebraskan
Neuropsychological Battery ( 1980)
 Flexible
battery approach to
assessment
Review of the Brain Structure &
Functions
 Left Hemisphere – controls the right
side of the body; language functions;
logical inference; detail analysis
 Right hemisphere – controls the left
side of the body; visual-spatial skills,
creativity, musical activities,
perception of direction
Cont’d
 Frontal
lobes – executive functions;
emotional modulation
 Temporal lobes – linguistic
expression; reception, & analysis,
auditory processing of tones, sounds,
rhythms & meanings that are
nonlanguage in nature
Cont’d
 Parietal
lobes – tactile & kinesthetic
perception, understanding, spatial
perception, some language understanding
& processing
 Occipital lobes – visual processing,
visually mediated memory
 Cerebellum – motor coordination,
control of equilibrium & muscle tone
Cause of Brain Damage
 Trauma
 Concussions
– momentary disruptions
of brain functioning
 Contusions – severe outcome, may be
followed by coma & deliriums
 Lacerations – serious forms of damage
Cont’d
 Cerebrovascular
 Occulusions
accidents ( stroke )
– aphasia, apraxia, agnosia
 Cerebral hemorrhage – death,
paralysis, speech problems, memory &
judgment difficulties
Cont’d
 Tumors
– headaches, vision
problems, problems in judgment,
poor memory, affect problems, or
motor coordination
 Degenerative disease – severe
disturbance in many behavioral areas
i.e motor, speech, language, memory,
& judgment difficulties
Cont’d
 Nutritional
deficiences – neurological
& psychological disorders i.e.
Korsakoff’s psychosis
 Toxic disorders – brain damage,
delirium
 Chronic alcohol abuse – deficits in
memory formation, emotional
regulation, & sensory integration
Consequences & Symptoms of
Neurological Damage
 Impaired
orientation
 Impaired memory
 Impaired intellectual functions
 Impaired judgment
 Shallow & labile affect
 Loss of emotional & mental resilience
 Frontal lobe syndrome
Methods of NA
 Major
approaches
 Standard
battery approach or
Fixed battery approach
 Flexible approach or
hypothesis-testing approach
Testing Areas of Cognitive
Functioning
 Intellectual functioning – WAIS III
 Abstract Reasoning & Memory –
WAIS III, WMS
 Visual-perceptual Processing – ReyOsterrieth Complex Figure Test,
Block design of WAIS III
 Language Functioning – Luria
Nebraska
Test batteries
 The
Halstead-Reitan Battery –
category test, seashore rhythm test, finger
oscillation test, speech-sounds, trailmaking test, strength of grip test, sensoryperceptual examination, finger localization
test, fingertip-writing perception test,
tactile form recognition test, aphasia
screening test
Cont’d
 Luria-Nebraska
Battery – motor
functions, rhythm functions, tactile
functions, visual functions,
receptive speech, expressive
speech, writing functions, reading
skills, arithmetic skills, memory,
intellectual processes
Intervention & rehabilitation
 Thorough
assessment of the
patient’s strengths & weaknesses
is conducted
 Development of the rehabilitation
program given the patient’s
condition
Training
In
addition to training in
general clinical psychology, it
involves specialized training in
theoretical, empirical, and
practical aspects of the brainbehavior relationship.
Cont’d
 Education, training, and
supervision
in Clinical Neuropsychology is
available primarily at the
postdoctoral level, although
preparation begins at the doctoral
level.
Be knowledgeable
Houston Conference Guidelines
Provides an integrated model of professional
education and training in Clinical
Neuropsychology:
◦ General Knowledge Base and Skills
◦ Doctoral, Internship and Postdoctoral Training
Guidelines
◦ Continuing Education
◦ Professional and Scientific Activity
◦ Subspecialties
DEFINITION OF A CLINICAL
NEUROPSYCHOLOGIST (1989)

A professional psychologist who applies
principles of assessment and intervention based
upon the scientific study of human behavior as it
relates to normal and abnormal functioning of
the central nervous system. The Clinical
Neuropsychologist is a doctoral-level psychology
provider of diagnostic and intervention services
who has demonstrated competence in the
application of such principles for human welfare
following:
Cont’d

A. Successful completion of
systematic didactic and experiential
training in neuropsychology and
neuroscience at a regionally
accredited university.
Cont’d
 B. Two
or more years of appropriate
supervised training applying
neuropsychological services in a
clinical setting.
 C. Licensing
and certification to
provide psychological services to
the public by the laws of the state
or province in which he or she
practices.
 D. Review
by one's peers as a test of
these competencies.
*Attainment of the ABCN/ABPP
Diplomate in Clinical Neuropsychology
is the clearest evidence of competence
as a Clinical Neuropsychologist, assuring
that all of these criteria have been met.
PRELIMINARY STEP
UNDERGRADUATE TRAINING
UNDERGRADUATE FOCUS:
•Psychology coursework and/or major (esp.
abnormal, developmental, statistics).
•Biology or behavioral medicine coursework
(provides a strong foundation for graduate
neuropsychology coursework)
•Research Assistanceship and/or involvement
SELECTING A GRADUATE
PROGRAM
Graduate Schools: University or
Professional?

University programs are highly
competitive (low selection ratio).Your
application will be helped by excellent
grades, GRE scores and some previous
research experience—preferably, a
published paper, if only as a co-author.
Cont’d

Professional schools are easier to
get into, but they are very expensive.
You will have to take out enormous
student loans, or you might try to
work while studying—perhaps even
studying part-time. Also, many
professional schools offer primarily
the Psy.D. degree, reserving the
Ph.D. (if they offer it at all) for a few,
select students.
Neuropsychology Track?
Specialization in NP can begin at the
doctoral level.
Often, Clinical
Neuropsychology is
offered as a distinct track in clinical
psychology programs, designed to
follow APA Div40/Houston
Conference guidelines.
Cont’d
 Recognized
tracks make it easier to specialize
(existing, easily accessible NP faculty, research
labs, clinics, on/off campus practical sites, core
coursework curriculum…).
 No Track? That’s
OK.
 Important to be proactive
Seek out didactics, research and clinical
training opportunities in the community to be
competitive.
Predoctoral NP Specialty
Preparation

Core Coursework in NP
◦ In addition to the basic Clinical Psychology curriculum,
competitive students have completed doctoral level
coursework in:




Neuropsychology Assessment
Clinical Neuropsychology
Behavioral and Clinical neurosciences
Behavioral (Clinical) Neurology
(coursework generally includes exposure to functional neuroanatomy,
neuropathology, psychopharmacology, neuroimaging, relevant test
construction/research, neuropsychology assessment, case
conceptualization…)
Predoctoral Clinical Experience
Practical Placement



Hospital (acute inpt, rehab, outpt services)
Mental Health Clinics (LD, ADHD, TBI, CVA, MDC)
Private Practice
Goal:
◦ Exposure to a wide range of diagnoses, tests, clinical
settings, age range, conceptualization style…
◦ Experience conducting interviews, administering
comprehensive test batteries, staffing cases, writing reports
and working within a multidisciplinary treatment team.
Research

Many internship sites place a strong emphasis on
research and scholarly interest and “product” (even if
you intend to practice as a clinician).
◦ National conference attendance and association
membership
◦ Journal club participation
◦ Poster presentations
◦ Book chapters
◦ Peer reviewed publications
◦ Grants

Tendency to prefer applicants who have successfully
proposed or defended their dissertation prior to the
start of internship.
Houston Conference guidelines for
postdoctoral training
q Goal is to complete the education and training necessary for
independent practice of clinical neuropsychology (CN)
q Residency is a REQUIRED component in specialty education in
CN
q The equivalent of 2 years of full-time education and training
q Residency MUST occur on at least a half-time basis
q ENTRY criteria:
 1. Entrance SHOULD be based upon completion an APA/CPAaccredited doctoral program.
 2. Residents WILL have successfully completed an APA/CPAaccredited internship which includes SOME training in CN.