The American Medical Association Current Procedural Panel developed a new billing code making behavioral health screening a reimbursable healthcare service. The use of computerized testing as a means for cognitive screening and brief cognitive testing is increasing at a rapid rate. The purpose of this education paper is to provide information to clinicians, healthcare administrators, and policy developers about the purpose, strengths, and limitations of cognitive screening tests versus comprehensive neuropsychological evaluations. Screening tests are generally brief and narrow in scope, they can be administered during a routine clinical visit, and they can be helpful for identifying individuals in need of more comprehensive assessment. Some screening tests can also be helpful for monitoring treatment outcomes. Comprehensive neuropsychological assessments are multidimensional in nature and used for purposes such as identifying primary and secondary diagnoses, determining the nature and severity of a person's cognitive difficulties, determining functional limitations, and planning treatment and rehabilitation. Cognitive screening tests are expected to play an increasingly important role in identifying individuals with cognitive impairment and in determining which individuals should be referred for further neuropsychological assessment. However, limitations of existing cognitive screening tests are present and cognitive screening tests should not be used as a replacement for comprehensive neuropsychological testing.
Several studies reveal the prevalence of negative response bias (NRB) in civil forensic settings, but little NRB base rate information is available for criminal forensic neuropsychological settings. We reviewed the published literature on neuropsychological NRB in the civil setting. We then present data from 105 criminal defendants serially referred for neuropsychological assessment to determine the prevalence of NRB. The rate of NRB using one positive indicator was 89.5%. The rate was 70.5% when using two or more positive indicators and 53.3% for three or more indicators. Based on the Slick, Sherman, and Iverson (1999) classification for malingered neurocognitive dysfunction (MND), 19% were Valid, 26.7% were Possible MND, 32.4% were Probable MND, and 21.9% were Definite MND. The combined rate of probable and definite MND was 54.3%. Results suggest rates of neuropsychological NRB and malingering in criminal forensic settings are higher than in civil forensic settings.
The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized neuropsychological test battery commonly used to assess cognitive functioning after a concussion. It is recommended that application of ImPACT utilizes a baseline administration so athletes have an individualized baseline with which to compare post-injury results should they sustain a concussion. It has been suggested that athletes may provide suboptimal effort, called "sandbagging," in order to return to their baseline cognitive scores, and thus to play, more quickly. This research examines ImPACT baseline scores when high school athletes were asked to attempt to "sandbag," and compares those scores with scores obtained when they were asked to give their "best effort." Fifty-four high school student athlete volunteers participated in the study. In contrast to previous research that just looked at the cut-score invalidity indicators built into ImPACT, this research developed a regression equation to predict sandbagging. A logistic regression equation developed with four variables that demonstrated the largest effect size between "best effort" and "sandbagged" baselines showed a 99.7% classification accuracy for the "best effort" and "sandbag" groups.
In our increasingly mobile society, psychologists may be presented with greater opportunities to practice in jurisdictions outside of their licensure. Interjurisdictional practice has been particularly common under circumstances of litigation involving the services of psychological experts. Psychologists practicing elsewhere must abide by local licensing laws, which are not readily accessible. We sought clarification by surveying regulatory boards of the United States, Canada, and U.S. territories. Most jurisdictions allow interjurisdictional practice but with a variety of restrictions. A sizable minority of jurisdictions forbids such practice entirely. Disciplinary action for noncompliance may range from injunction to incarceration. Mobility programs and preventive measures can minimize risk.
The Edinburgh Handedness Inventory (EHI) is the most widely used handedness inventory. The EHI has some weaknesses: it has been suggested it is outdated; the instructions are frequently misunderstood by participants; and the response format produces skewed responses in those who avoid extreme responding. This study introduces the Fazio Laterality Inventory (FLI) as an alternative that addresses these limitations. In an initial development study, the 12-item instrument showed acceptable internal reliability (Cronbach's alpha =.921), and a one-component solution explained 55.5% of the variance. After removal of two items, a validation study revealed the instrument again had good internal reliability (Cronbach's alpha =.943) with a one-component solution explaining 65.8% of the variance. The FLI did not correlate as strongly as expected with the EHI, likely due to its lack of an "Oldfield Admonition" as well as the finer scaling of the response format. Additional analyses of the FLI as a whole and each item are offered. A scoring procedure and cutoffs for utilizing the FLI in clinical and research settings are suggested.
This article reviews the application of clinical neuropsychology to criminal court proceedings, a complex, underserved, yet growing area of neuropsychological practice. The authors write from the perspective that the audience is primarily neurorehabilitation clinicians with limited experience in criminal matters. Discussions on the theoretical differences between clinical and forensic work, the forensic evaluation process with conceptual model, historical and current perspectives on criminal competencies and responsibility, prediction of dangerousness, and professional and ethical issues often encountered in criminal neuropsychology are provided.
Research suggests there is a link between trauma and violence, although the nature of the relationship is rather equivocal. This study explored this relationship by examining self-reported trauma as a predictor of self-reported violence in 93 jail inmates. Ninety-six percent of the sample reported experiencing a traumatic event, and 67% reported having been violent during the year preceding incarceration. Inmates reporting trauma were more than twice as likely to report having been violent than nonviolent. Stepwise multiple regression analyses suggested traumatic events, as a combined model, significantly contributed to violence perpetration. In addition, witnessing serious violence predicted perpetration of violence. Implications and limitations of the present study are discussed.
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