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OBJECTIVE: The coronavirus 19 (COVID-19) pandemic resulted in educational disruption of historic breadth and duration. The authors describe early studies and interim standardized assessment reports to highlight effects of educational disruption and present critical questions for neuropsychologists. METHOD: A summary of pre-pandemic and interim literature was compiled, including analyses of national and local assessment data and preliminary studies on academic gains related to remote learning, educational and school services disruption, chronic absenteeism, and child and adolescent mental and physical health during 2020-2021. Ten major themes were identified in the early reports on impacts of educational disruption. RESULTS: Preliminary information indicates prolonged educational disruption has resulted in attenuated learning gains, most remarkably for those already at risk for educational disparities: students of color, students with disabilities, English learners, and students from low-income households. There have also been increased mental and physical health challenges for some youth during the pandemic. Other literature highlights challenges such as diagnosis of learning disabilities, reliance on normative data and development of academic recovery programs. CONCLUSION: The effects of prolonged educational disruption and psychological stressors on learning and mental health should be considered in the neuropsychological evaluation of children and adolescents, especially marginalized students. Normative data collected prior to the pandemic may be insufficient for interpretation of scores, and evaluation and treatment may be delayed due to backlog and increased demand. Clinical practice considerations are presented.

There is substantial empirical evidence to support the clinical value of neuropsychological evaluation and the incremental value of neuropsychological assessment, suggesting such evaluation is beneficial in the prediction and management of clinical outcomes. However, in the cost-conscious and evolving era of healthcare reform, neuropsychologists must also establish the economic value, or return on investment, of their services. There is already a modest body of literature that demonstrates the economic benefits of neuropsychological evaluation, which is reviewed in the current paper. Neuropsychologists will need to be able to communicate, and develop evidence of, economic value of their services; thus, this paper also discusses common concepts, terms, and models used in healthcare valuation studies. Finally, neuropsychologists are urged to incorporate these financial concepts in their clinical practice and research.

Current diagnostic criteria for learning disorders are insufficient because of ongoing COVID-19-related educational disruption. Diagnostic criteria for learning disorders should be modified to reduce the risk of misdiagnosis and ensure timely intervention.

Objective The National Academy of Neuropsychology (NAN), the American Academy of Clinical Neuropsychology (AACN), and the American College of Professional Neuropsychology (ACPN) collaborated to publish an update to their original position statements, confirming the organizations' opposition to third party observer (TPO). Method A review of literature addressing TPO effects, ethical standards, professional organization position statements, test publisher policies and new telemedicine developments was completed to obtain consensus on relevant issues in TPO and recording of neuropsychological evaluations. Results TPO has been shown to impact the cognitive functions most often assessed in forensic or medicolegal settings. Third party observation, whether in person, recorded or electronic, remains a potential threat to the validity and reliability of evaluation results, and violates test security guidelines, ethical principles and standards of conduct in the field. Demands for TPO in the context of medicolegal or forensic settings have become a tactic designed to limit the ability of the consulting neuropsychologist to perform assessment and provide information to the trier of fact. Conclusion The field of neuropsychology opposes the presence of TPO in the setting of medicolegal or forensic neuropsychological evaluations.

Although collaborative, and more specifically, integrated models of care have existed for years, the 2010 Patient Protection and Affordable Care Act expanded their use, and Medicare has adopted a value-based payment system that further emphasizes service provision within the collaborative health care setting. Neuropsychology as a field is well-situated to work within the integrated health care setting, which presents both opportunities and challenges for clinical neuropsychologists. This education paper details how different neuropsychology clinical practice settings fit into an integrated care framework; discusses challenges to service delivery and fiscal viability in such settings and other health care related settings; and examines future directions for the role of neuropsychology within a dynamic health care system.

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.

Advances in structural and functional neuroimaging have resulted in significant clinical utility, especially in geriatric neuropsychiatry. However, in the absence of clinical correlation with cognitive, behavioral, and emotional impairment and functional disability, neuroimaging evidence is not sufficient for diagnosis of neurodegenerative conditions. This is especially true in the medicolegal environment. This chapter summarizes recent developments in neuroimaging for the most common geriatric neuropsychiatric conditions, including Alzheimer’s disease, vascular dementia, and frontotemporal dementia, and describes limitations in applying those findings to single-subject clinical formulations in the forensic arena. Applications of neuroimaging in the medicolegal geriatric setting are explored.

Purpose To determine the association between health literacy and outcomes of care (seizure control and quality of life) in individuals with epilepsy followed at a level four epilepsy center. Methods We conducted a face-to-face interview of patients seen at the Comprehensive Epilepsy Program of the University of Florida HSC/Jacksonville. We obtained demographic and clinical data, administered the Quality of Life in Epilepsy-10 inventory, and performed the Liverpool Seizure Severity Scale. We asked three screening questions taken from the Short Test of Functional Literacy in Adults. Using each health literacy question as the target variable we determined the predictor variables that were associated with responses to these questions and performed multiple linear regression to determine those that retained their significance. Results One hundred and forty adult patients with epilepsy comprised the study population. On univariate analysis, patients who did poorly on questions for health literacy that included "difficulty reading hospital materials" and "difficulty filling out medical forms" had lower scores on the QOLIE-10 and lower annual household incomes. This significance was maintained on multivariate analysis. Those who had problems learning about their medical condition due to difficulties understanding written information had poorer scores on the QOLIE-10, increased seizure frequency, and lower educational levels on univariate analysis. However, on multivariate analysis, only poorer scores on quality of life were independently significant. Conclusion Patients with epilepsy who have limited health literacy do not necessarily have poorer seizure control but have lower quality of life scores.

Objective The goal of the work described here was to determine whether seizure severity is associated with quality of life and if this association exists independent of seizure frequency. Methods We administered a survey questionnaire to patients followed at the Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville. Results The study population comprised 142 subjects. On univariate analysis, increased seizure severity (as measured with the revised Liverpool Seizure Severity Scale, LSSS) and seizure frequency were significantly associated with poorer Quality of Life in Epilepsy-10 (QOLIE-10) scores. Most items on the LSSS were significantly associated with QOLIE-10 scores, as well as the various scales of the QOLIE-10. Likewise, all QOLIE-10 scales were significantly associated with overall LSSS scores. The correlation between seizure severity and frequency was insignificant. On multiple linear regression, both seizure severity and frequency were independently associated with QOLIE-10 scores. Conclusion Seizure severity is associated with quality of life and this association exists independent of seizure frequency.

Summary Purpose To determine those variables associated with utilization of healthcare resources in epilepsy patients. Methods We interviewed 256 epilepsy patients. Target variables included the number of clinic visits, ER visits and in-patient admissions over the past year and AEDs currently being used. Predictor variables were age, race/ethnicity, marital status, education, income, insurance, seizure frequency and QOLIE-10 results. We used univariate analysis to determine those factors associated with the target variables and multivariate analysis to ascertain those independently significant. Results On univariate analysis, higher seizure frequency and poorer QOLIE-10 scores were associated with the number of clinic visits, ER visits and in-patient admissions. Increased seizure frequency and male gender were associated with higher use of AEDs. Using ordinal logistic regression, QOLIE-10 scores was the only variable associated with the number of clinic visits. Both seizure frequency and QOLIE-10 scores were independently associated with the number of in-patient admissions while seizure frequency and male gender remained independently associated with AED use. Using binary logistic regression, QOLIE-10 scores and seizure frequency were independently associated with the number of ER visits. Conclusion Seizure frequency and quality of life are major factors associated with utilization of healthcare resources in epilepsy patients.

OBJECTIVE To establish the validity of the Orientation Log (O-Log) by comparison with the Galveston Orientation and Amnesia Test (GOAT). DESIGN Correlation of daily measures of orientation. SETTING Acute rehabilitation hospital. SUBJECTS Sixty-eight inpatients receiving rehabilitation following traumatic brain injury (TBI). PRIMARY MEASURES The O-Log and GOAT. RESULTS There was a significant correlation between the GOAT and O-Log (r = .901, P