A Survey of Neuropsychologists' Practices and Perspectives Regarding the Assessment of Judgment Ability

Abstract

Judgment is an important aspect of cognitive and real-world functioning that is commonly assessed during neuropsychological evaluations. This study utilized a brief, online survey to examine neuropsychologists' practices and perspectives regarding available judgment instruments. Participants (n=290, 17% response rate) were randomly selected members of the International Neuropsychological Society and the National Academy of Neuropsychology. Respondents rankordered the following issues that should be incorporated into assessments of judgment (from most to least important): safety, ability to perform activities of daily living, and problem solving/ decision making about medical, financial, social/ethical, and legal matters. A majority of respondents reported that they "often" or "always" assessed judgment when evaluating patients with traumatic brain injury (89%), dementia (87%), and psychiatric disorders (70%). Surprisingly, the top-ranked instruments were not tests of judgment per se, and included the WAIS-III Comprehension, Wisconsin Card Sorting Test, and WAIS-III Similarities. Further, 61% of respondents were slightly confident, and only 23% were very confident, in their ability to assess a patient's judgment skills with their current tests. The overwhelming majority (87%) of respondents perceived a need for improved measures. Overall results indicate use of varied techniques by neuropsychologists to evaluate judgment and suggest the need for additional tests of this cognitive domain.

Neuroimaging Training Among Neuropsychologists: A Survey of the State of Current Training and Recommendations for Trainees

“…In the recent “salary survey” of neuropsychologists that had a large response rate (56%; Sweet, Meyer, Nelson, & Moberg, 2011), the proportion of their respondents mostly endorsed having a Ph.D. (82.5%), were female (52.8%), white (89.9%), and board certified by ABPP (35.1%), not unlike the survey respondents in this study (i.e., 87.3% Ph.D., 51.5% female, 94.9% white, and board certified 41.8%), one difference being that the 74.0% respondents in the salary survey obtained their degree in the field of clinical psychology in contrast to just 51.9% in our study. As previously mentioned, the relatively modest response rate in this study is at least comparable to the number of respondents in a previously published survey which also did not offer direct compensation to its respondents (Rabin et al, 2008). …”

“…237 respondents completed the survey, representing a 15.3% response rate. While modest, this survey’s response rate is comparable to the proportion of respondents in a previously published survey of neuropsychological practices and perspectives regarding the assessment of judgment ability (17%; Rabin, Borgos, & Saykin, 2008) which also did not offer direct compensation to its respondents.…”

Neurocognitive Variability in High-Functioning Individuals: Implications for the Practice of Clinical Neuropsychology

“…A neuropsychological test baftery consisting of the Rey Complex Figure Test, Digit Span, Judgment of Line Orientation, Finger Tapping Test, California Verbal Learning Test-II, and the Wechsler Abbreviated Scale of Intelligence (Vocabulary and Block Design subtests) was used to index each participant's level of cognitive functioning. These tests were chosen on the basis that they are some of the neuropsychological tests most commonly employed by clinicians (Rabin, Borgos, & Saykin, 2008). It is noted that a measure of executive functioning (i.e., Wisconsin Card Sorting Test) was administered, but an administration error was found following the collection of the data.…”

Remaking Responsibility Complexity and scattered causes in human agency

“…Applebaum lists four criteria for determining competence: ability to communicate a choice (which itself ought to remain stable over time); demonstrated understanding of the relevant information; appreciation of the situation and its consequences; and capacity to reason about treatment options [52]. Assays of patient competence along these dimensions are available, but an "overwhelming majority" of physicians find these tools inadequate [53]. Although a life-and-death situation like this one calls for a high standard of competence, if the patient can pass muster in all four areas, her right to autonomy ought to prevail over the possible objections of her physicians.…”