Conducting assessment with individuals with physical disability, visual impairment or blindness, and hearing impairment or deafness poses significant challenges for the neuropsychologist. Although standards for psychological testing have been devised to address assessment of persons with disabilities, little research has been conducted to validate neuropsychological test accommodation and modification practices that deviate from standard test administration or to develop test parameters and interpretive guidelines specifically for persons with different physical or sensory disabilities. This paper reviews issues pertaining to neuropsychological test selection and administration, common accommodation and modification practices, test development and validation, and disability-related factors that influence interpretation of test results. Systematic research is needed to develop methodological parameters for testing and to ensure reliable and valid neuropsychological assessment practices for individuals with physical or sensory disabilities.

Nearly 25 years ago, Mirsky and colleagues proposed a multiple-component model of attention. It was proposed that attention was characterized by several distinct elements that were organized into a system. A putative neuroanatomical substrate of this model of attention was proposed. This functional anatomy was primarily based upon inferences derived from brain lesion studies. Mirsky and colleagues developed a systematic clinical evaluation of this model by applying a group of neuropsychological tests. Since the introduction of what has been commonly referred to as the "Mirsky model," significant advances have been made in our understanding of brain-behavior relationships. This article applies current neuroscientific principles to "update" our understanding of attention and the "Mirsky model." We also demonstrate how the interpretation of neuropsychological tests can be modified according to principles of large-scale brain systems and patterns of brain network functional connectivity.

To investigate the concurrent validity of the Cognitive Test for the Blind (CTB) as an intellectual assessment for the visually impaired or blind (VI/B) population. The ecological validity of the CTB was also examined. Design: Correlational analyses. Participants: Two hundred ninety-two persons with visual impairment or blindness. Main Outcome Measure: The CTB Verbal section, the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Verbal section, and the Survey of Functional Adaptive Behavior. Results: A correlation of .72 was obtained between the CTB and the WAIS-R. The correlations of the CTB Total and WAIS-R Verbal sections with overall adaptive functioning were .50 and .47, respectively. Conclusions: The CTB offers valid assessment of intellectual functioning for persons with visual impairment or blindness, as well as other useful information that may aid in the treatment planning process.

This article introduces the functional neuroanatomy of large-scale brain systems. Both the structure and functions of these brain networks are presented. All human behavior is the result of interactions within and between these brain systems. This system of brain function completely changes our understanding of how cognition and behavior are organized within the brain, replacing the traditional lesion model. Understanding behavior within the context of brain network interactions has profound implications for modifying abstract constructs such as attention, learning, and memory. These constructs also must be understood within the framework of a paradigm shift, which emphasizes ongoing interactions within a dynamically changing environment.

Attention-deficit hyperactivity disorder (ADHD) is a chronic disorder with symptoms of inattention and impulsivity that partially remit with age. A review of longitudinal studies of children and adolescents with ADHD showed that the majority will have continued cognitive and functional impairments into adulthood. The thalamus likely plays a prominent role in ADHD symptomatology, based on evidence that the thalamus generates waking-state electroencephalography (EEG) rhythms along with extensive thalamic neural circuitry connections with cortical and subcortical areas. Research demonstrates a specific abnormality in the thalamic pulvinar nucleus in ADHD populations. The thalamus can also play a role in ADHD treatment, based on solid evidence that both animals and humans can learn to self-regulate EEG oscillations. Given the underarousal and sleep disturbance commonly seen in ADHD, along with data that indicate an increased dosage of ADHD medication may improve behavioral control at a cost of lowered cognitive functioning, further investigation of the role for self-regulation through EEG training is warranted.

This article reviews the vertical organization of the brain. The cortico-basal ganglia and the cerebro-cerebellar circuitry systems are described as fundamental to cognitive and behavioral control. The basal ganglia anticipate and guide implicitly learned behaviors on the basis of experienced reward outcomes. The cerebellar-cortical network anticipates sensorimotor outcomes, allowing behaviors to be adapted across changing settings and across contexts. These vertically organized systems, operating together, represent the underpinning of cognitive control. The medial temporal lobe system, and its development, is also reviewed in order to better understand how brain systems interact for both implicit and explicit cognitive control.

Working memory (WM) impacts a gamut of cognitive abilities, but implicit WM is typically not considered in assessment or treatment, which may explain the variability of results in reviews of WM training. The role of implicit WM in adaptive behavior is reviewed. All we do is action based. Explicit WM plays a major role when we are required to "think"; that is, when we apply previously learned perception-action linkages in new ways to unique situations. Implicit WM is involved in the automation of behavior, which occurs through interaction with cortical and subcortical systems that guide sensory-motor anticipation and the prediction of reward. This article reviews evidence that implicit WM interacts with cortical-cerebellar and cortical-basal ganglia connections to form perception-action linkages. The cerebellum forms an internal model of cortical WM, corrects the content of this internal model, and then projects the improved representation back to the cortex, where it is retained for future use. The basal ganglia also form an anticipatory system, controlling cortical access to WM by allowing or restricting the information that is released based on the probability of reward. This framework is applied to the assessment and treatment of individuals with WM deficits. The ability to automate behavior can be assessed through repeated trials of existing testing instruments, such as the Trails B and Stroop tasks. Application of skill learning emphasizing automation as an end goal offers a model for the development of new types of WM training.

Brain structure and function is characterized by large-scale brain systems. However, each system has its own "small-world" organization, with sub-regions, or "hubs," that have varying degrees of specialization for certain cognitive and behavioral processes. This article describes this small-world organization, and the concepts of functional specialization and functional integration are defined and explained through practical examples. We also describe the development of large-scale brain systems and this small-world organization as a sensitive, protracted process, vulnerable to a variety of influences that generate neurodevelopmental disorders.