Controversies in Neuropsychology

Michael F. Martelli, Nathan D. Zasler
2001 NeuroRehabilitation (Reading, MA)  
We proudly introduce this special issue highlighting major controversies in the clinical practice of neuropsychology in neurorehabilitation. In order to accurately present as many controversies as possible, we necessarily deviate from the usual journal format by including more articles and allowing greater editorial license for the authors, who represent a group of talented critical thinkers who are making significant contributions in advancing the practice of this field. Notably, the last
more » ... e has witnessed phenomenal growth in neuropsychology as a scientific and applied discipline. As a brain behavior relationship specialty, clinical neuropsychology is afforded a unique opportunity for integrating recent developments in the clinical neurosciences with behavioral and medical knowledge to provide useful rehabilitation applications. However, as a young and developing field, neuropsychology is experiencing unavoidable growing pains. This "controversies" issue reflects our belief that open self-examination is a prerequisite to the growth and development of neuropsychology as a science. This perspective follows the trend set by the several authors who served to inspire this effort. Dr. Carl Dodrill, in "Myths of Neuropsycholology" [1] found that several widely held assumptions appeared to be myths under critical inspection and offered suggestions for remediation. Dr. Jerry Sweet, in "Forensic Neuropsychology: Fundamentals and Practice" [2] extended this perspective to a critical examination of the practice of neuropsychology as applied in the courts and defined a model for it's objective scientific practice that applies more generally. We followed this trend with a special issue of "Brain Injury Source" devoted to introducing controversies in neuropsychology [3] to an interdisciplinary and diverse audience interested in brain injury rehabilitation. This special "controversies" issue extends from our previous effort to address some of the more controversial issues in the clinical practice of neuropsychology. The authors were selected based on their ability to critically address these issues. Although space requirements limit full explication of remediation for all of the controversies raised, basic recommendations and guidelines are offered. Space limitations further prevented our including a Letter to the Editor and Author's reply contiguous with each paper, but we include a few and will include the rest in a future issue. Dr. Sbordone begins the issue by summarizing problems with the ability of tests designed to diagnose brain impairment to predict real-world functioning. He both defines and offers remedial guidelines for problems with ecological validity. Dr. Senior follows by providing impressive evidence from a very large database indicating that standard interpretive procedures of the MMPI are misconceived and misapplied. Alternately, he proposes a more rational hypothesis testing procedure. Dr. Gouvier's editorial article highlights widespread prevailing ignorance and failure to use base rates in standard clinical practice that result in frequent diagnostic misclassifications. His article reminds clinicians that knowing about the importance of base rates requires a correction in order to advance the practice of neuropsychology accordingly. Next, Dr. Williams reviews American Psychological Association standards to demonstrate specific common psychometric violations in clinical practice. Measurement and norming problems with commonly used tests, standards regarding differential diagnoses, validity and reliability, need for manuals, standardized administration, screening, and research versions are discussed, along with prescriptive suggestions. Drs Nicholson, Martelli and Zasler review the increasing body of evidence that pain and such associated problems as affective distress, sleep disturbance and medication use can interfere with cognitive performance and confound interpretation of neuropsychological test results. These findings seem particularly relevant in cases of posttraumatic headache. The note that further study is needed to answer the many questions raised by these findings. Dr. Green then reviews some of the reasons why clinicians and researchers arrive at discrepant results and differing conclusions by examining their theoretical and practical choices, including NeuroRehabilitation 16 (2001) 195-197
doi:10.3233/nre-2001-16401 fatcat:falergyvjnhlrh562df22w54q4