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To provide education regarding the critical importance of test security for neuropsychological and psychological tests, and to establish recommendations for best practices for maintaining test security in forensic, clinical, teaching, and research settings. Previous test security guidelines were not adequately specified.Neuropsychologists practicing in a broad range of settings collaborated to develop detailed and specific guidance regarding test security to best ensure continued viability of neuropsychological and psychological tests. Implications of failing to maintain test security for both the practice of neuropsychology and for society at large were identified. Types of test data that can be safely disclosed to nonpsychologists are described.Specific procedures can be followed that will minimize risk of invalidating future use of neuropsychological and psychological measures.Clinical neuropsychologists must commit to protecting sensitive neuropsychological and psychological test information from exposure to nonpsychologists, and now have specific recommendations that will guide that endeavor.

PURPOSE Active surveillance (AS) for testicular nonseminomatous germ cell tumors (NSGCT) is widely used. Although there is no consensus for optimal treatment at relapse on surveillance, globally patients typically receive chemotherapy. We describe treatment of relapses in our non–risk-adapted NSGCT AS cohort and highlight selective use of primary retroperitoneal lymph node dissection (RPLND). METHODS From December 1980 to December 2015, 580 patients with clinical stage I NSGCT were treated with AS, and 162 subsequently relapsed. First-line treatment was based on relapse site and extent. Logistic regression was used to explore factors associated with need for multimodal therapy on AS relapse. RESULTS Median time to relapse was 7.4 months. The majority of relapses were confined to the retroperitoneum (66%). After relapse, first-line treatment was chemotherapy for 95 (58.6%) and RPLND for 62 (38.3%), and five patients (3.1%) underwent other therapy. In 103 (65.6%), only one modality of treatment was required: chemotherapy only in 58 of 95 (61%) and RPLND only in 45 of 62 (73%). Factors associated with multimodal relapse therapy were larger node size (odds ratio, 2.68; P = .045) in patients undergoing chemotherapy and elevated tumor markers (odds ratio, 6.05; P = .008) in patients undergoing RPLND. When RPLND was performed with normal markers, 82% required no further treatment. Second relapse occurred in 30 of 162 patients (18.5%). With median follow-up of 7.6 years, there were five deaths (3.1% of AS relapses, but 0.8% of whole AS cohort) from NSGCT or treatment complications. CONCLUSION The retroperitoneum is the most common site of relapse in clinical stage I NSGCT on AS. Most are cured by single-modality treatment. RPLND should be considered for relapsed patients, especially those with disease limited to the retroperitoneum and normal markers, as an option to avoid chemotherapy.

Objective: Assessment of performance validity is an essential component of neuropsychological evaluation. Performance validity indicators contained within cognitive ability measures are particularly advantageous, as they do not require additional test administration time or material, and allow for assessment of validity across multiple cognitive domains over the course of an evaluation. The present study examined the classification accuracy of the Stroop Color and Word Test (Stroop) Word, Color, and Color-Word trials in detecting invalid performance in a mixed forensic and patient sample. Method: Archival data from a mixed-diagnosis sample were analyzed, consisting of 558 (Mage=40.8; Meducation=15.3) individuals referred for neuropsychological evaluation in clinical or forensic contexts, who completed a test battery that included the Stroop and at least two performance validity tests (PVTs). Examinees were assigned to Valid or Invalid performance groups based on PVT outcomes. Results: Word and Color scores were found to have excellent classification accuracy, whereas Color-Word yielded acceptable classification accuracy. Sensitivity and specificity values are presented for a range of cutoff scores, as are positive and negative predictive values for setting-specific base rates of invalid performance. Conclusions: Performances on the Stroop Color and Word Test, particularly the Word and Color trials, can be useful in detecting invalid performance in a mixed patient and forensic sample. Clinical implications are discussed.

Founded in 1994, The Journal of Clinical Psychology in Medical Settings (JCPMS) has paralleled the development of psychology's role in health care as well as contributing to its growth in science, services, and education in medical settings. JCPMS provides an essential, unique publishing outlet for health service psychology as represented by the recognized psychological specialties in those settings. At this point in its development, The Journal has turned its attention to generativity and contributing further to the field by helping prepare the next generation of journal manuscript reviewers and future psychological scientists. A brief developmental history of The Journal and its relationship to the evolution of health service psychology is offered followed by a description of a task-specific mentoring process for a new generation of manuscript reviewers. Building on work by other authors, a competency-based model is used to rearrange previously published guidance into categories of knowledge, skills, and attitudes required to become a competent manuscript reviewer. General competencies are described within each of those categories as well as specific behavioral anchors that a mentee must master in order to carry out a competent review.

Objective: Citation and download data pertaining to the 2009 AACN consensus statement on validity assessment indicated that the topic maintained high interest in subsequent years, during which key terminology evolved and relevant empirical research proliferated. With a general goal of providing current guidance to the clinical neuropsychology community regarding this important topic, the specific update goals were to: identify current key definitions of terms relevant to validity assessment; learn what experts believe should be reaffirmed from the original consensus paper, as well as new consensus points; and incorporate the latest recommendations regarding the use of validity testing, as well as current application of the term 'malingering.' Methods: In the spring of 2019, four of the original 2009 work group chairs and additional experts for each work group were impaneled. A total of 20 individuals shared ideas and writing drafts until reaching consensus on January 21, 2021. Results: Consensus was reached regarding affirmation of prior salient points that continue to garner clinical and scientific support, as well as creation of new points. The resulting consensus statement addresses definitions and differential diagnosis, performance and symptom validity assessment, and research design and statistical issues. Conclusions/Importance: In order to provide bases for diagnoses and interpretations, the current consensus is that all clinical and forensic evaluations must proactively address the degree to which results of neuropsychological and psychological testing are valid. There is a strong and continually-growing evidence-based literature on which practitioners can confidently base their judgments regarding the selection and interpretation of validity measures.

Objective: The current study summarizes the results of a 2020 survey that solicited information regarding backgrounds, beliefs, practices, and incomes of clinical neuropsychologists who practice in Canada. Methods: Clinical neuropsychologists who practice in Canada were invited to participate in an online survey that was available from 1/17/20 to 4/02/20. Available survey findings were obtained from 111 respondents, which reflects a response rate of 51.3% of the 216 doctoral-level Canadian neuropsychologists identified in at least one major North American or international professional organization membership list (AACN, INS, NAN, or SCN). Results: Most of the current respondents were White/Caucasian women who identified as adult providers and worked full-time in urban institutional settings. Four Canadian provinces (Alberta, British Columbia, Ontario, Quebec) accounted for more than 91% of the current respondent sample. Incomes and career satisfactions were largely encouraging, though some important variations were noted by province, work setting, and professional identity. Incomes were significantly associated with forensic practices and years of clinical experience. Most respondents made use of technician support in their practices, largely to increase productivity and patient volume. Only a small minority of respondents were board-certified and there was generally limited interest in future board certification. Conclusions: While important similarities were observed in the current Canadian sample relative to recent survey findings obtained in a U.S. sample, results also reveal a number of important differences that serve as important areas of future consideration.

This portion of the 2020 survey updates practice information, beliefs, and income data of clinical neuropsychologists who practice within the United States. Methods: Doctoral-level neuropsychology practitioners were invited via numerous methods, with multiple reminders, to participate in a web-based survey from January 17 through April 2, 2020. The useable U.S. sample of 1677 doctoral-level practitioners was 6.2% larger than the comparable group in the prior 2015 practice survey. Results: Whereas women practitioners predominate, which continues a steeply increasing trend across time, increases in overall ethnic/racial diversity continue at a slow pace. Median age has remained very similar over the last 30 years, reflecting a continuous influx of young practitioners. A relatively small minority of neuropsychologists work part time. The proportion of board-certified neuropsychologists continues to show meaningful increase; interest in subspecialization certification is relatively high. Reliance on technicians remains popular, especially for neuropsychologists who work in institutions or are board certified. Although implementation of new CPT codes in 2019 and related payor policies appear to have had more negative than positive effects, psychology-related annual incomes of neuropsychologists have again increased compared to prior surveys. Variables such as specific work setting, state, region, years in practice, forensic practice hours, board certification, and basis for determining income (e.g. hours billed, revenue collected, relative value units) have an impact on income. More than half of practitioners engage in forensic neuropsychology, with the number of related practice hours per week again increasing. There is very high agreement regarding the use of response validity measures in clinical practice and forensic practice. Neurologists remain the number one referral source whether working in an institution, private practice, or a combination of both, and regardless of maintaining a pediatric, adult, or lifespan practice. Career satisfaction ratings for income, job, and work-life balance remain high, with the majority of ratings regarding the future of the specialty in the positive range. Additional data summaries related to a wide range of professional and practice topics are provided. Conclusions: Updating and comparing survey information at five-year intervals continues to provide insights and perspectives regarding relative stabilities and changes in practice activities, beliefs, and incomes of U.S. clinical neuropsychologists. Such information also provides guidance regarding the future of the specialty.

Objective Within a portion of the 2020 professional practice and “salary survey,” to update key information regarding neuropsychology postdoctoral trainees. Methods Postdoctoral trainees were contacted via a variety of membership listings, including the listserv used by the program directors of the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN). Invitations sent in multiple waves to members of numerous neuropsychological organizations via e-messages and physical postcards included the request that postdoctoral trainees participate. The survey website was opened on January 17, 2020 and closed on April 2, 2020, during which time a total of 178 postdoctoral trainees in the USA and 3 in Canada participated. Results Response rate was estimated to be 56.4%, which adequately represents the target sample. The modal postdoctoral trainee is a woman whose internship was American Psychological Association (APA)-accredited and whose postdoctoral training is in an APPCN program that adheres to Houston Conference training guidelines. Extensive clinical experiences in neuropsychology in the form of externship practica and during internship were reported by the majority of trainees prior to postdoctoral training. There are few differences between APPCN and non-APPCN trainees and reported training experiences. Job satisfaction is high. Salaries appear to have increased substantially in recent years. There is universal interest in pursuing board certification. Support for the empirical foundations justifying assessment of response validity is high. Conclusions Surveys of postdoctoral trainees continue to provide valuable perspectives regarding training background, clinical experiences, practice beliefs, and incomes of individuals who will soon launch their careers in clinical neuropsychology.

This paper describes gender-related trends within clinical neuropsychology, based primarily on recurrent practice surveys within the specialty and, to a lesser extent, job-related information from medical specialties and the general U.S. labor market.Chronological and cross-sectional analyses of professional practice survey data from 2005, 2010, and 2015 relevant to gender. As is common with survey data, descriptive analysis and independent samples t-tests were conducted. Longitudinal data allowed for examination of gender trends, as well as observations of change and stability of factors associated with gender, over time.Women have become dominant in number in clinical neuropsychology, and also comprise a vast majority of practitioners entering the specialty. Gender differences are noted in professional identity, work status, work settings, types of career satisfaction, and retirement expectations. Women are more likely to identify work environment and personal/family obstacles to aspects of career satisfaction. A gender pay gap was found at all time points and is not narrowing. As is true nationally, multiple factors appear related to the gender pay gap in clinical neuropsychology.Women in neuropsychology are now dominant in number, and their presence is strongly associated with specific practice patterns, such as greater institutional employment, less involvement in forensic practice, and strong involvement in pediatric practice, which may be maintaining the sizeable gender pay gap in neuropsychology. As the proportion of women neuropsychologists continues to increase, flexible work hours, and alternative means of remuneration may be needed to offset current disproportionate family-related responsibilities.

Objectives: Descriptive labels of performance test scores are a critical component of communicating outcomes of neuropsychological and psychological evaluations. Yet, no universally accepted system exists for assigning qualitative descriptors to scores in specific ranges. In addition, the definition and use of the term "impairment" lacks specificity and consensus. Consequently, test score labels and the denotation of impairment are inconsistently applied by clinicians, creating confusion among consumers of neuropsychological services, including referral sources, trainees, colleagues, and the judicial system. To reduce this confusion, experts in clinical and forensic neuropsychological and psychological assessment convened in a consensus conference at the 2018 Annual Meeting of the American Academy of Clinical Neuropsychology (AACN). The goals of the consensus conference were to recommend (1) a system of qualitative labels to describe results from performance-based tests with normal and non-normal distributions and (2) a definition of impairment and its application in individual case determinations. Results: The goals of the consensus conference were met resulting in specific recommendations for the application of uniform labels for performance tests and for the definition of impairment, which are described in this paper. In addition, included in this consensus statement is a description of the conference process and the rationales for these recommendations. Conclusions/Importance: This consensus conference is the first formal attempt by the professional neuropsychological community to make recommendations for uniform performance test score labels and to advance a consistent definition of impairment. Using uniform descriptors and terms will reduce confusion and enhance report comprehensibility by the consumers of our reports as well as our trainees and colleagues.

Neuropsychological tests undergo periodic revision intended to improve psychometric properties, normative data, relevance of stimuli, and ease of administration. In addition, new tests are developed to evaluate psychological and neuropsychological constructs, often purporting to improve evaluation effectiveness. However, there is limited professional guidance to neuropsychologists concerning the decision to adopt a revised version of a test and/or replace an older test with a new test purporting to measure the same or overlapping constructs. This paper describes ethical and professional issues related to the selection and use of older versus newer psychological and neuropsychological tests, with the goal of promoting appropriate test selection and evidence-based decision making.Ethical and professional issues were reviewed and considered.The availability of a newer version of a test does not necessarily render obsolete prior versions of the test for purposes that are empirically supported, nor should continued empirically supported use of a prior version of a test be considered unethical practice. Until a revised or new test has published evidence of improved ability to help clinicians to make diagnostic determinations, facilitate treatment, and/or assess change over time, the choice to delay adoption of revised or new tests may be viewed as reasonable and appropriate. Recommendations are offered to facilitate decisions about the adoption of revised and new tests. Ultimately, it is the responsibility of individual neuropsychologists to determine which tests best meet their patients' needs, and to be able to support their decisions with empirical evidence and sound clinical judgment.

Context Symptom cluster research expands cancer investigations beyond a focus on individual symptoms in isolation. Objectives We conducted a prospective longitudinal study of sleep, fatigue, depression, anxiety, and perceived cognitive impairment in patients with breast cancer undergoing chemotherapy. Methods Patient-reported outcome measures were administered prior to chemotherapy, at Cycle 4 Day 1, and six months after initiating chemotherapy. Participants were divided into four groups and assigned a symptom cluster index (SCI) score based on the number/severity of symptoms reported at enrollment. Results Participants ( N = 80) were mostly women (97.5%) with Stage II (69.0%) breast cancer, 29–71 years of age. Scores on all measures were moderately-highly correlated across all time points. There were time effects for all symptoms, except sleep quality (nonsignificant trend), with most symptoms worsening during chemotherapy, although anxiety improved. There were no significant group × time interactions; all four SCI groups showed a similar trajectory of symptoms over time. Worse performance status and quality of life were associated with higher SCI score over time. Conclusion With the exception of anxiety, the coherence of the symptom cluster was supported by similar patterns of severity and change over time in these symptoms (trend for sleep quality). Participants with higher SCI scores prior to chemotherapy continued to experience greater symptom burden during and after chemotherapy. Early assessment and intervention addressing this symptom cluster (vs. individual symptoms) may have a greater impact on patient performance status and quality of life for patients with higher SCIs.

Aims To identify the characteristics and outcomes associated with late relapse in stage I seminoma. Materials and methods A retrospective review was carried out of all patients with stage I seminoma managed at our institution between 1981 and 2011. Data were obtained from a prospectively maintained database. Late relapse was defined as tumour recurrence > 2 years after orchiectomy. Results Overall, 1060 stage I seminoma patients were managed with active surveillance ( n =766) or adjuvant radiotherapy ( n =294). At a median follow-up of 10.6 years (range 1.2–30), 142 patients relapsed at a median (range) of 14 (3–129) months; 128 on active surveillance and 14 after adjuvant radiotherapy. The late relapse rate for the active surveillance and adjuvant radiotherapy groups was 4% and 1%, respectively. There was no specific clinicopathological factor associated with late relapse. Isolated para-aortic node(s) was the most common relapse site in active surveillance patients either in late (88%) or early relapse (82%). Among the active surveillance group, no patients with late relapse subsequently developed a second relapse after either salvage radiotherapy ( n =25) or chemotherapy ( n =6), whereas in early relapse patients a second relapse was reported in seven (10%) of 72 patients treated with salvage radiotherapy and one (4%) of 23 patients who received chemotherapy; all second relapses were subsequently salvaged with chemotherapy. No patient in the adjuvant radiotherapy group developed a second relapse after salvage chemotherapy ( n =10) or inguinal radiotherapy/surgery ( n =4). Of seven deaths, only one was related to seminoma. Among active surveillance patients, the 10 year overall survival for late and early relapse groups were 100% and 96% ( P = 0.2), whereas the 10 year cancer-specific survival rates were 100% and 99% ( P = 0.3), respectively. Conclusions In stage I seminoma, the extent and pattern of late relapse is similar to that for early relapse. For active surveillance patients, selective use of salvage radiotherapy/chemotherapy for relapse results in excellent outcomes regardless of the timing of relapse, whereas salvage radiotherapy for late relapse seems to be associated with a minimal risk of second relapse.

Cross-sectional data suggest that many individuals with breast cancer experience significant sleep disturbance across the continuum of care. Understanding the longitudinal trajectory of sleep disturbance may help identify factors associated with its onset, severity, or influence on health-related quality of life (HRQL). Study objectives were to observe sleep quality in breast cancer patients prior to, during, and after completion of adjuvant chemotherapy, evaluate its relationship with HRQL and explore correlates over time.Participants were administered patient-reported outcome measures including the Pittsburgh Sleep Quality Index (PSQI) and the Functional Assessment of Cancer Therapy--General (FACT-G), which assesses HRQL. Data were collected prospectively 3-14 days prior to beginning chemotherapy, cycle 4 day 1 of chemotherapy, and 6 months following initiation of chemotherapy.Participants (n = 80) were primarily women (97.5 %) with stage II (69.0 %) breast cancer. Total FACT-G scores were negatively correlated with global PSQI scores at each time point (rho = -0.46, -0.41, -0.45; all p 0.001). Poor sleep quality (PSQI ≥ 5) was prevalent at all time points (48.5-65.8 %); however, there were no significant changes within participants over time. Correlates with sleep quality varied across time points. Participants with poor sleep quality reported worse overall HRQL, fatigue, depression, and vasomotor/endocrine symptoms.These findings suggest that early identification of sleep disturbance and ongoing assessment and treatment of contributing factors over the course of care may minimize symptom burden associated with chemotherapy and prevent chronic insomnia in survivorship.

A conference specific to the education and training of clinical neuropsychology was held in 1997, which led to a report published in the Archives of Clinical Neuropsychology (Hannay, J., Bieliauskas, L., Crosson, B., Hammeke, T., Hamsher, K.,Koffler, S. (1998). Proceedings of the Houston Conference on Specialty Education and Training in Clinical Neuropsychology. Archives of Clinical Neuropsychology, 13, 157-250.). The guidelines produced by this conference have been referred to as the Houston Conference (HC) guidelines. Since that time, there has been considerable discussion, and some disagreement, about whether the HC guidelines produced a positive outcome in the training of neuropsychologists. To explore this question and determine how widely the HC guidelines were implemented, a meeting was held in 2006. Present and past leaders of the American Psychological Association Division 40 (Clinical Neuropsychology), the National Academy of Neuropsychology, and the Association of Postdoctoral Programs in Clinical Neuropsychology met to discuss the possible need for an Inter-Organizational Summit on Education and Training (ISET). A decision was reached to have the ISET Steering Committee conduct a survey of clinical neuropsychologists that could address the extent to which HC guidelines were present in the specialty and whether the influence of the HC guidelines was positive. An online survey was constructed, with data gathered in 2010. The current paper presents and discusses the ISET survey results. Specific findings need to be viewed cautiously due to the relatively low response rate. However, with some direct parallels to a larger recent survey of clinical neuropsychologists, the following general conclusions appear well founded: (a) the demographics of respondents in the ISET survey are comparable with a recent larger professional practice survey and thus may reasonably represent the specialty; (b) the HC guidelines appear to have been widely adopted by training programs, in that a large proportion of younger practitioners endorsed having had HC-adherent training; and (c) HC-adherent training is associated with a higher frequency endorsement of being well prepared to engage in key professional activities subsequent to the completion of training when compared with those not having HC-adherent training. Overall, the ISET Steering Committee has concluded that the HC guidelines have been widely adopted and that trainees associate participation in HC-adherent training as advantageous. A potential revision based on unfavorable outcomes is deemed unnecessary. Nonetheless, the ISET Steering Committee recognizes that training needs change as a function of the broadening of our field and the introduction of related new technologies, which may prompt updates. The ISET Steering Committee supports the idea that periodic review and updating of training models may be is prudent.

Clinical research interest in the symptom reporting validity scale currently known as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Symptom Validity Scale (FBS) has continued to be strong, with multiple new publications annually in peer-reviewed journals that publish psychological and neuropsychological assessment research. Related to this growth in relevant literature, the present study was conducted to update the Nelson, Sweet, and Demakis (2006b) FBS meta-analysis. A total of 83 FBS studies (43 new studies) were identified, and 32 (38.5%) met inclusion criteria. Analyses were conducted on a pooled sample of 2218 over-reporting and 3123 comparison participants. Large omnibus effect sizes were observed for FBS, Obvious-Subtle (O-S), and the Dissimulation Scale-Revised (Dsr2) scales. Moderate effect sizes were observed for the following scales: Back Infrequency (Fb), Gough's F-K, Infrequency (F), Infrequency Psychopathology (Fp), and Dissimulation (Ds2). Moderator analyses illustrate that relative to the F-family scales, FBS exhibited larger effect sizes when (1) effort is known to be insufficient and (2) evaluation is conducted in the context of traumatic brain injury. Overall, current results summarize an extensive literature that continues to support use of FBS in forensic neuropsychology practice.

Decrements in cognitive function are common in cancer patients and other clinical populations. As direct neuropsychological testing is often not feasible or affordable, there is potential utility in screening for deficits that may warrant a more comprehensive neuropsychological assessment. Furthermore, some evidence suggests that perceived cognitive function (PCF) is independently associated with structural and functional changes on neuroimagery, and may precede more overt deficits. To appropriately measure PCF, one must understand its components and the underlying dimensional structure. The purpose of this study was to examine the dimensionality of PCF in people with cancer. The sample included 393 cancer patients from four clinical trials who completed a questionnaire consisting of the prioritized areas of concerns identified by patients and clinicians: self-reported mental acuity, concentration, memory, verbal fluency, and functional interference. Each area contained both negatively worded (i.e., deficit) and positively worded (i.e., capability) items. Data were analyzed by using Cronbach's alpha, item-total correlations, one-factor confirmatory factor analysis, and a bi-factor analysis model. Results indicated that perceived cognitive problem items are distinct from cognitive capability items, supporting a two-factor structure of PCF. Scoring of PCF based on these two factors should lead to improved assessment of PCF for people with cancer.

Objective The current survey updated professional practice and income information pertaining to clinical neuropsychology. Methods Doctoral-level members of the American Academy of Clinical Neuropsychology, Division 40 (Clinical Neuropsychology) of the American Psychological Association, and the National Academy of Neuropsychology and other neuropsychologists, as well as postdoctoral trainees in the Association of Postdoctoral Programs in Clinical Neuropsychology and at other training sites were invited to participate in a web-based survey in early 2015. The sample of 1777 respondents, of whom 1579 were doctoral-level practitioners and 198 were postdoctoral trainees, was larger than the prior 2010 income and practice survey. Results The substantial proportional change in gender has continued, with women now a clear majority in the postdoctoral trainee sample as well as in the practitioner sample. Dissimilar from the median age trajectory of American Psychological Association members, the median age of clinical neuropsychologists remains essentially unchanged since 1989, indicating a substantial annual influx of young neuropsychologists. The question of whether the Houston Conference training model has become an important influence in the specialty can now be considered settled in the affirmative among postdoctoral trainees and practitioners. Testing assistant usage remains commonplace, and continues to be more common in institutions. The vast majority of clinical neuropsychologists work full-time and very few are unemployed and seeking employment. The numbers of neuropsychologists planning to retire in the coming 5-10 years do not suggest a "baby boomer" effect or an unexpected bolus of planned retirements in the next 10 years that would be large enough to be worrisome. Average length of time reported for evaluations appears to be increasing across time. The most common factors affecting evaluation length were identified, with the top three being: (1) goal of evaluation, (2) stamina/health of examinee, and (3) age of examinee. Pediatric specialists remain more likely than others to work part-time, more likely to work in institutions, report lower incomes than respondents with a lifespan professional identity, and are far more likely to be women. Incomes continue to vary considerably by years of clinical practice, work setting, amount of forensic practice, state, and region of country. Neurologists are the number one referral source in institutions and in private practice, as well as for pediatric, adult, and lifespan practitioners. Learning disability is no longer among the top five conditions seen by pediatric neuropsychologists; traumatic brain injury and seizure disorder are common reasons for clinical evaluations at all age ranges. There is a continued increase in forensic practice and a clear consensus on the use of validity testing. There is a substantial interest in subspecialization board certification, with the greatest interest evident among postdoctoral trainees. Income satisfaction, job satisfaction, and work-life balance satisfaction are higher for men. Job satisfaction varies across general work setting and across age range of practice. Work-life balance satisfaction is moderately correlated with income satisfaction and job satisfaction. Again in this five-year interval survey, a substantial majority of respondents reported increased incomes, despite experiencing substantial negative practice effects related to changes in the US health care system. Numerous breakdowns related to income and professional activities are provided. Conclusions Professional practice survey information continues to provide valuable perspectives regarding consistency and change in the activities, beliefs, and incomes of US clinical neuropsychologists.

The Malingered Depression (Md) scale for the MMPI-2 (Steffan, Clopton,Morgan, 2003) was recently developed to detect attempts at malingering depressive symptomatology. The Steffan et al. cutoffs for the Md scale were derived through comparisons of undergraduate malingering simulators with depressed undergraduates. In order to explore the potential utility for neuropsychological practice, we examined the Md scale among 160 individuals with and without a context of secondary gain referred for neuropsychological evaluation. Md results were compared to other MMPI-2 validity indices and performance on effort testing. While Md was found to correlate highly with other validity indices from the MMPI-2, it was also correlated significantly with measures of depression, both in individuals with and without a secondary gain context. Md scores were not significantly different between secondary gain and no secondary gain groups, whereas FBS and L were significantly different. The effect of passing or failing validity indicators on rates of Md scores exceeding the Steffan et al. cutoffs was limited. Only among the few individuals exceeding a high threshold on the F scale or combinations of F, FBS, and effort indicators was it common to also surpass the Md cutoff. Overall, Md showed relatively little relationship to either secondary gain status or cognitive malingering in our sample. Given that such factors do not necessarily produce high scores on Md, the utility of the scale to clinical neuropsychologists appears low.

Some clinical researchers disagree regarding the clinical utility of the MMPI-2 Fake Bad scale (FBS ) within forensic and clinical settings. The present meta-analysis summarizes weighted effect size differences among the FBS and other commonly used validity scales (L, F, K, Fb, Fp, F-K, O-S, Ds2, Dsr2 ) in symptom overreporting and comparison groups. Forty studies that included FBS were identified through exploration of online databases, perusal of published references, and communication with primary authors. Nineteen of the 40 studies met restrictive inclusion criteria, resulting in a pooled sample size of 3664 (1615 overreporting participants and 2049 comparison participants). The largest grand effect sizes were observed for FBS (.96), followed by O-S (.88), Dsr2 (.79), F-K (.69), and the F- scale (.63). Significant within-scale variability was observed for seven validity scales, including FBS (Q = 119.11, p < .001). Several subsequent FBS moderator analyses yielded moderate to large effect sizes and were statistically significant for level of cognitive effort, type of overreporting comparison group, and condition associated with overreporting (e.g., traumatic brain injury, posttraumatic stress, chronic pain). Findings suggest that the FBS performs as well as, if not superior to, other validity scales in discriminating overreporting and comparison groups; the preponderance of the present literature supports the scale's use within forensic settings.

Background Cognitive deficits have been reported to occur in a significant proportion of patients undergoing coronary artery bypass grafting (CABG), but the extent to which these deficits were preexistent or related to the natural history of cognitive decline in this patient population remains poorly defined. Methods After excluding patients with conditions known to cause brain dysfunction (eg, hepatic dysfunction, stroke), a group of patients referred for percutaneous coronary intervention (PCI) or CABG (n = 82) was compared with an age- and education-matched control group that did not have clinical evidence of coronary artery disease (n = 41). These subjects underwent a battery of neurocognitive and emotional testing. Results Test score means for 5 of 14 different measures were significantly greater (impaired) in cardiac compared with control group subjects. Of cardiac subjects, 20% demonstrated clinical impairment (test result ≥ 1 SD worse than mean for normative standards) in 6 of 14 tests, compared with 10% of the controls. By clinical standards, 46% of cardiac subjects would be considered to be impaired (score 1 SD or more below the control group mean) on 3 or more neuropsychologic measures, compared with 29% of the controls. By this (control group mean) standard, cardiac subjects demonstrated impaired scores on 3.06 ± 2.6 tests compared with impairment in 2.0 ± 2.35 tests for the control group ( p = 0.01). Conclusions Even excluding patients at high risk for brain dysfunction, cognitive impairment is found in patients with coronary artery disease before interventional therapy. Baseline impairment must be considered when evaluating outcomes after intervention.

The Behavioral Dyscontrol Scale is a measure of executive abilities initially designed to predict functional independence in geriatric populations. The current study examined the utility of two Behavioral Dyscontrol Scale (BDS) scoring systems in a nongeriatric sample. The BDS was administered to 49 TBI patients undergoing inpatient and outpatient rehabilitation. The results demonstrate slightly greater utility of the BDS-II scoring system, and support clinical utility of the instrument with nongeriatric patients. Specifically, the Motor Programming Factor and Environmental Independence Factor were more impaired among patients with severe, as compared to mild to moderate, TBIs. In contrast, the Fluid Intelligence Factor was more impaired among patients with frontal, as compared to nonfrontal, injuries. However, when patients were categorized by severity, lesion location differences on the BDS total score and factors were found only for patients with mild to moderate injuries. Similarly, when patients were categorized by lesion location, severity effects were only present among the nonfrontal group. Receiver Operating Characteristic curves demonstrated sensitivity and specificity rates that ranged from 60% to 100% for clinically meaningful cutting scores.

The clinical utility of the Behavioral Dyscontrol Scale (BDS) was compared to that of verbal fluency, the Trail Making Test, and the Stroop Color-Word Test, as well as measures of processing speed/cognitive efficiency and manual dexterity. The ability of these measures to classify 49 TBI patients into frontal versus nonfrontal and mild to moderate versus severe groups was examined. The results showed that the Fluid Intelligence Factor of the BDS improved classifications above and beyond traditional executive measures, but was particularly successful at classifying patients who sustained mild injuries. In contrast, traditional executive instruments were successful at lesion location classifications only among the patients with severe injuries. Severity classifications were successful both for traditional measures of processing speed/cognitive efficiency and for the Motor Programming Factor of the BDS, but only among patients with nonfrontal injuries. These results demonstrate that severity of injury may be an important moderator of tests' sensitivity to frontal lobe involvement.

This study examined qualitative aspects of phonemic and semantic fluency before and after unilateral pallidotomy in patients with intractable Parkinson's Disease (PD). Specifically, clustering (number of similar words generated sequentially) and switching (number of changes or switches from one cluster to another) were evaluated for both fluency tasks. Twenty-five PD patients participated and were grouped according to whether they improved or declined on each of the fluency measures after surgery. Decliners evidenced decreased switching, but not clustering, suggesting difficulties with set-shifting and cognitive flexibility rather than a diminished semantic store of information or retrieval difficulties. Though consistent with hypotheses about difficulties with executive processing after pallidotomy, a series of correlational analyses with composite measures of neuropsychological functioning (attention, language, executive processing, and memory) suggest caution in interpreting these findings. In these analyses, clustering was not meaningfully related to any of the composites whereas switching was significantly and positively related to the composites; this pattern emerged, for the most part, on both fluency measures before and after surgery. Switching, but not clustering, was also significantly and positively correlated with total words generated on both semantic and phonemic fluency. Switching changes across time were also related to DRS changes post-pallidotomy. These correlational analyses challenge the specificity of the switching variable and, more broadly, the validity of these qualitative measures of verbal fluency.

This study examined the short-term motor and cognitive sequelae of unilateral posterolateral pallidotomy for patients with intractable Parkinson's Disease (PD). Unique to this study was the inclusion of electronic motor steadiness instrumentation among pre- and postsurgical assessment procedures. Fifteen PD patients underwent right-sided surgery and 10 underwent left-sided surgery; patients were evaluated 1 month presurgery and approximately 3 months postsurgery. Motorically, there were no significant changes in grooved pegboard or maze-drawing performances, but patients evidenced significantly improved steadiness, particularly in the hand contralateral to the side of surgery. Cognitively, there were no significant decrements on postsurgery composite variables comprised of well-known tests of attention, executive functioning, delayed memory or recognition memory; these findings were similar for patients with either left- or right-sided surgery. There was, however, a significant change in language abilities among a subset of patients. This change was evident in the decline in verbal fluency in PD patients who underwent left-sided pallidotomy, a finding that has consistently emerged in pallidotomy outcome studies. This decline is discussed in terms of evidence that suggests that the basal ganglia consist of several separate, but parallel circuits, some of which are important for cognition.

Analyses of a 10-year follow-up survey of clinical neuropsychologists demonstrated significant changes in employment settings away from institutions, placing a clear majority of the field in private practice settings in 1999 (Sweet, Moberg, & Suchy, 2000). The present paper compares characteristics of practices and beliefs of clinical neuropsychologists who work in institutions versus private practice, using data from 1989, 1994, and 1999. Previous survey data had not been analyzed along the dimension of work setting. Among the significant findings are differences in age, referral sources, hours per week engaged in specific professional activities (clinical, neuropsychological, forensic, supervisory, research, teaching), ages of patients, type and frequency of data gathered in assessments, hours spent per evaluation, use of an assistant to gather data, and journal subscriptions. Economic changes within the last 5 years have had a differential impact for the two groups in terms of yearly income and hourly reimbursement. However, approximately half of the neuropsychologists in both groups have increased hours performing clinical work, hours performing administrative duties, and patient load to compensate for economic changes in the last 5 years. Decreases in clinical research and teaching activities are apparent in both groups, but in different amounts.

Recent studies using the California Verbal Learning Test (CVLT) to investigate the learning and memory capacities of traumatically-brain injured (TBI) individuals have suggested that this population does not show the expected buildup of proactive interference (PI). The purpose of this study was to investigate whether PI could be detected on the CVLT, in a TBI sample, if PI were calculated using alternative methods. CVLT data from 25 TBI individuals with varying degrees of brain injury and 21 healthy controls were compared. Results from the various analyses suggested that TBI individuals show buildup and release from PI when learning and attempting to recall competing forms of information if appropriate methods of analysis are used. Although the CVLT differs considerably from traditional PI paradigms (e.g., Wickens, 1970), our results suggest it can be used to detect PI in TBI individuals.

Two experiments using a P300-enhanced Forced Choice Procedure (P3FCP) investigated simulated amnesia in a matching-to-sample task. In Experiment 1, successful manipulation of subjects towards different behavioral hit rates (75-80% vs. 85-90%) did not adversely affect the diagnostic sensitivity of match-mismatch Pz-P300 amplitude analyses, allowing detection of 69% of simulators. P300 amplitudes of simulators (Malinger group) were as large as those of truth-tellers (truth group, a control), indicating no dual task-related (Malingering) reduction across different behavioral hit rates. Experiment 2 found no main effect of oddball type, match vs. mismatch, on P300 (P3) amplitude with a mismatch-rare variant of the P3FCP. This study also revealed larger Pz-P3s in the Malingering (vs. Truth-telling) condition. Subsequent topographic analyses suggested different Truth and Malinger scaled P3 amplitude topographies in both these sets of P3FCP data and in those from a previous autobiographical memory paradigm. Further analysis yielded preliminary evidence for a common deception-related P3 amplitude topography across different paradigms/conditions.

The 20th anniversary of the Journal of Clinical Psychology in Medical Settings is celebrated by highlighting the scientist-practitioner philosophy on which it was founded. The goal of the Journal—to provide an outlet for evidence-based approaches to healthcare that underscore the important scientific and clinical contributions of psychology in medical settings—is discussed. The contemporary relevance of this approach is related to the current implementation of the Patient Protection and Affordable Care and its focus on accountability and the development of an interprofessional healthcare workforce; both of which have been foci of the Journal throughout its history and will continue to be so into the future. Several recommendations of future topic areas for the Journal to highlight regarding scientific, practice, policy, and education and training in professional health service psychology are offered. Successfully addressing these topics will support the growth of the field of psychology in the ever evolving healthcare system of the future and continue ensure that the Journal is a key source of professional information in health service psychology.

Traumatic brain injury (TBI) occurs at a high incidence, involving millions of individuals in the U.S. alone. Related to this, there are large numbers of litigants and claimants who are referred annually for forensic evaluation. In formulating opinions regarding claimed injuries, the present review advises experts to rely on two sets of information: TBI outcome and neuropsychological dose-response studies of non-litigants and non-claimants, and response bias literature that has demonstrated the relatively high risk of invalid responding among examinees referred within a secondary gain context, which in turn has resulted in the development of specific assessment methods. Regarding prospective methods for detecting possible response bias, both symptom validity tests, for measuring over-reporting of symptoms on inventories and questionnaires, and performance validity tests, for measuring insufficient effort on ability tests, are considered essential.

Doctoral-level members of the American Academy of Clinical Neuropsychology, Division 40 (Clinical Neuropsychology) of the American Psychological Association, and the National Academy of Neuropsychology, and other neuropsychologists, were invited to participate in a web-based survey in early 2010. The sample of respondents was 56% larger than a prior related income and practice survey in 2005. The substantial proportional change in gender taking place in the field has continued, with 7 of 10 post-doctoral residents being women and, for the first time ever, more than half of the total sample of respondents being women. Whereas the median age of APA members has been over 50 since the early 1990s, the current median age of clinical neuropsychologists remains at 47 and has remained essentially unchanged since 1989, indicating substantial entrance of young psychologists into the field. The Houston Conference training model has influenced the vast majority of residency training sites, and is endorsed as compatible with prior training by two-thirds of all respondents. Testing assistant usage remains commonplace, and is much more common in institutions. The "flexible battery" approach has again increased in popularity and predominates, whereas endorsement of the "fixed/standardized battery" approach has continued to decline. The vast majority of clinical neuropsychologists work full time. Average length of time reported for evaluations increased significantly from 2005, which does not appear to be explained by changes in common referral sources or common diagnostic conditions being evaluated. The most common factors affecting evaluation length were identified, with the top three being goal of evaluation, stamina/health of examinee, and age of examinee. Pediatric specialists are more likely than others to work part time, more likely to be women, more likely to work in institutions, and report lower incomes than respondents whose professional identity is purely adult or a combination of adult and pediatric. Incomes once again vary considerably by years of clinical practice, work setting, amount of forensic practice, state, and region of country. Job satisfaction has little relationship to income and is comparable across most variables (e.g., work setting, professional identity, amount of forensic activity), whereas income satisfaction has a stronger relationship to actual income, and income satisfaction and job satisfaction are moderately correlated. Job satisfaction of neuropsychologists in general is higher than reported for other US jobs. Fewer than 5% of respondents are considering changing job position. As was true in the 2005 survey, a substantial majority of respondents reported increased incomes over the last 5 years. Actual reported income values were meaningfully higher than in 2005 across general work settings and professional identities, and were also higher for entry-level positions. Numerous breakdowns related to income and professional activities are provided.

Serial assessments are now common in neuropsychological practice, and have a recognized value in numerous clinical and forensic settings. These assessments can aid in differential diagnosis, tracking neuropsychological strengths and weaknesses over time, and managing various neurologic and psychiatric conditions. This document provides a discussion of the benefits and challenges of serial neuropsychological testing in the context of clinical and forensic assessments. Recommendations regarding the use of repeated testing in neuropsychological practice are provided.

There are critical issues facing the neuropsychological community, such as inadequate reimbursement for services, a lack of familiarity among public policy makers regarding the science and practice of neuropsychology, and a lack of public policy awareness among professional neuropsychologists. Advocacy for the field is the most effective way to undertake positive change. Currently, a minority of psychological professionals actively engages in an advocacy process, while the majority is not involved, or is involved periodically or passively. With weak advocacy our field risks slower development in key areas, and without strong and constant advocacy we risk losing ground previously gained. The purpose of this article, and those that follow in this special issue of The Clinical Neuropsychologist, is to: (1) convey the importance of advocacy, (2) address and dispel unfounded mental obstacles that inhibit involvement in advocating for the specialty, and (3) aid neuropsychologists in preparing to join the advocacy process. To accomplish this, we acquaint readers with the advocacy process, delineate to practitioners how they can become involved, and encourage participation in advocacy.

This study determined whether performance patterns on the California Verbal Learning Test-II (CVLT-II) could differentiate participants with traumatic brain injury (TBI) showing adequate effort from those with mild TBI exhibiting poor effort using a case-control design. The TBI group consisted of 124 persons with moderate to severe traumatic brain injury (TBI). The poor effort group consisted of 77 persons with mild head injury who were involved in litigation (LG) and failed at least one stand-alone symptom validity measure (SVT) and also either a second SVT or an effort indicator embedded within a standard clinical test. A total of 18 CVLT-II variables were investigated using Bayesian model averaging (BMA) for logistic regression to determine which variables best differentiated the groups. The CVLT-II variables having the most support were Long-Delay Free Recall, Total Recognition Discriminability (d'), and Total Recall Discriminability.

During the past two decades clinical and research efforts have led to increasingly sophisticated and effective methods and instruments designed to detect exaggeration or fabrication of neuropsychological dysfunction, as well as somatic and psychological symptom complaints. A vast literature based on relevant research has emerged and substantial portions of professional meetings attended by clinical neuropsychologists have addressed topics related to malingering (Sweet, King, Malina, Bergman, & Simmons, 2002). Yet, despite these extensive activities, understanding the need for methods of detecting problematic effort and response bias and addressing the presence or absence of malingering has proven challenging for practitioners. A consensus conference, comprised of national and international experts in clinical neuropsychology, was held at the 2008 Annual Meeting of the American Academy of Clinical Neuropsychology (AACN) for the purposes of refinement of critical issues in this area. This consensus statement documents the current state of knowledge and recommendations of expert clinical neuropsychologists and is intended to assist clinicians and researchers with regard to the neuropsychological assessment of effort, response bias, and malingering.

The peer-review process is an invaluable service provided by the professional community, and it provides the critical foundation for the advancement of science. However, there is remarkably little systematic guidance for individuals who wish to become part of this process. This paper, written from the perspective of reviewers and editors with varying levels of experience, provides general guidelines and advice for new reviewers in neuropsychology, as well as outlining benefits of participation in this process. It is hoped that the current information will encourage individuals at all levels to become involved in peer-reviewing for neuropsychology journals.

Neuropsychologists routinely rely on response validity measures to evaluate the authenticity of test performances. However, the relationship between cognitive and psychological response validity measures is not clearly understood. It remains to be seen whether psychological test results can predict the outcome of response validity testing in clinical and civil forensic samples. The present analysis applied a unique statistical approach, classification tree methodology (Optimal Data Analysis: ODA), in a sample of 307 individuals who had completed the MMPI-2 and a variety of cognitive effort measures. One hundred ninety-eight participants were evaluated in a secondary gain context, and 109 had no identifiable secondary gain. Through recurrent dichotomous discriminations, ODA provided optimized linear decision trees to classify either sufficient effort (SE) or insufficient effort (IE) according to various MMPI-2 scale cutoffs. After “pruning” of an initial, complex classification tree, the Response Bias Scale (RBS) took precedence in classifying cognitive effort. After removing RBS from the model, Hy took precedence in classifying IE. The present findings provide MMPI-2 scores that may be associated with SE and IE among civil litigants and claimants, in addition to illustrating the complexity with which MMPI-2 scores and effort test results are associated in the litigation context. (JINS, 2008, 14, 842–852.)

Validity scales were recently developed to improve assessment of symptom validity beyond original MMPI-2 validity scales. In an initial study, the Response Bias Scale (RBS; Gervais, 2005) was developed based upon non-head-injury claimant performances on a cognitive effort measure, the Word Memory Test (WMT). The present study examined relationships of the RBS with numerous MMPI-2 validity scales in a sample of 211 participants with secondary gain (SG) or no secondary gain (NSG). Of the validity scales observed, RBS yielded the largest effect size difference between groups (d = .65), followed closely by FBS (d = .60) and the L-scale (d = .51). Overall, RBS correlated most significantly (r = .74, p < .001) with FBS, but also showed significant correlations with most other validity scales for both groups. RBS further demonstrated significant correlations (p < .001) with all clinical scales except for Mf. Findings suggest that RBS and FBS may represent a similar construct of symptom validity, and may outperform other MMPI-2 validity scales in discriminating SG and NSG groups. Findings provide preliminary support for use of RBS within the forensic context.

Forensic neuropsychology studies usually address either cognitive effort or psychological response validity. Whether these are distinct constructs is unclear. In 122 participants evaluated in a compensation-seeking context, the present Exploratory Factor Analysis examined whether forced-choice cognitive effort measures (Victoria Symptom Validity Test, Test of Memory Malingering, Letter Memory Test) and Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2) validity scales (L, F, K, FBS, Fp, RBS, Md, Dsr2, S) load on independent factors. Regardless of factor rotation strategy (orthogonal or oblique), four response validity factors emerged by means of both Principal Components Analysis (82.7% total variance) and Principal-Axis Factor Analysis (74.1% total variance). The four factors were designated as follows: Factor I, with large loadings from L, K, and S--underreporting of psychological symptoms; Factor II, with large loadings from FBS, RBS, and Md-overreporting of neurotic symptoms; Factor III, with large loadings from VSVT, TOMM, and LMT--insufficient cognitive effort; and Factor IV, with the largest loadings from F, Fp, and Dsr2--overreporting of psychotic/rarely endorsed symptoms. Results reflect the heterogeneity of response validity in forensic samples referred for neuropsychological evaluation. Administration of both cognitive effort measures and psychological validity scales is imperative to accurate forensic neuropsychological assessment.

The Behavioral Dyscontrol Scale (BDS) is a brief measure of executive functioning originally designed for use primarily with older adults. Previous research suggests that factors derived from exploratory factor analysis of the BDS have clinical utility and are theoretically meaningful; however, the factor structure has not been previously submitted to confirmatory analysis, and there are several potential methodological problems with the previous exploratory factor analysis. In this study, we conducted a confirmatory factor analysis of the BDS. Findings were largely consistent with the original exploratory analysis (Grigsby, Kaye, & Robbins, 1992) in suggesting a three-factor model, although the three-factor model was a better fit if factors were allowed to correlate with one another. The findings of this study lend support to the current practice of using factor scores in clinical and research applications.

Cognitive dysfunction represents one of several neurological and psychiatric complications of Systemic Lupus Erythematosis (SLE). Additional manifestations of nervous system involvement subsumed under the term neuropsychiatric SLE (NPSLE) include cerebrovascular disorder, seizures, psychosis, acute confusional state, anxiety and mood disorders. Neuropsychological investigations have facilitated the identification and description of cognitive impairment in SLE and NPSLE. Salient findings from studies of SLE-related cognitive dysfunction are reviewed with respect to neuroimaging procedures, indices of disease activity, and potential moderator variables. Data on cognitive functioning are also discussed in reference to other disease aspects including fatigue, sleep disturbance, and impact on health-related quality of life (HRQL). To date, neuropsychological functioning has been studied extensively, albeit separately from other commonly reported SLE-related symptoms. Future research may profit from investigating relationships between cognitive impairment, sleep disturbance and fatigue and their collective impact on functional capacity and quality of life.

Leaders of the National Academy of Neuropsychology and Division 40 (Clinical Neuropsychology) of the American Psychological Association determined that current information on the professional practice of clinical neuropsychology within the United States was needed. These two organizations co-sponsored a national survey of U.S. clinical neuropsychologists that was conducted in September 2000. The primary goal of the survey was to gather information on such topics as: practitioner and practice characteristics, economic variables (e.g., experience with major third party payors, such as Medicare and managed care), practice expenses, billing methods, experiences with Current Procedural Terminology (CPT) codes, time spent on various clinical tasks, use of assistants, and income. In this second of two articles describing the survey results, reimbursement experiences, practice economics, billing practices, and incomes are highlighted. Survey results indicate that neuropsychologists frequently have difficulty gaining access to membership on managed care panels. For those who gain access, managed care companies often limit provision of services; this is quite often perceived as negatively affecting quality of patient care. It is very common for neuropsychologists to feel obligated to provide more services to managed care and Medicare patients than are allowed to be billed to the insurance carrier; these hours are typically "written off." Numerous CPT codes are used to bill the same clinical service. Awareness of Medicare practice and billing expectations is variable among practitioners, as is awareness of public aid/Medicaid billing status. Professional income is influenced by years of licensed practice, practice setting, gender, types and amounts of non-clinical professional activities, and types and amounts of reimbursement sources within one's clinical practice. Income of neuropsychologists has only a minimal relationship to percentage of clinical practice per week. Within the context of prior surveys, neuropsychologists are engaging in more clinical hours per week and, nevertheless, compared to data from 1993, are reporting decreased income. These and other findings are presented and discussed.

The Wisconsin Card Sorting Test (WCST) is a popular neuropsychological measure of executive dysfunction that has been researched with regard to invalid performances, a subset of which in a forensic context could be associated with malingering. In the first of three studies, WCST multivariate approaches identified in prior research (Bernard, McGrath, & Houston, 1996; Suhr & Boyer, 1999), as well as newly created variables, were used to differentiate 33 chronic traumatic brain injury (TBI) patients with good effort and 27 patients with probable insufficient effort (IE). Newly created variables that were derived logically based upon hypotheses regarding strategies that might be employed by malingerers were not effective in differentiating TBI and IE groups. Application of previously researched validity indicators based upon commonly used WCST variables, individually, and within new logistic regression findings were reasonably effective in differentiating TBI and IE groups. In order to determine whether results would vary in different TBI samples, these validity indicators were examined in Study 2 with 75 moderate and severe, acute TBI rehabilitation patients whose posttraumatic amnesia had just resolved. Statistically significant differences were present between the IE group of Study 1 and the rehabilitation patient group of Study 2 on failures to maintain set, number of trials to achieve first correct category, and number of categories completed. All these measures were performed more poorly by the IE group. However, previously used multivariate approaches and the logistic regression analysis developed in Study 1 ranged widely in the degree to which Study 2's more acute rehabilitation patients were correctly classified. Specifically, the discriminant function of Bernard and colleagues correctly classified 73% and the Suhr and Boyer logistic regression correctly classified 75% of the Study 2 participants. The Study 1 logistic regression classified 97% of the Study 2 participants correctly. In Study 3, 130 mild to severe TBI patients in the VA system were studied. The Study 1 IE group performed significantly worse than the more acute and more severe VA TBI group on all 10 common WCST variables of interest. Application of the three multivariate procedures resulted in good to excellent classification rates: Suhr and Boyer logistic regression 85%, Bernard et al. discriminant function 85%, and Study 1 logistic regression 99%. The aggregate discussion of the three studies focuses on apparent differences in samples associated with varying degrees of success in identifying TBI patients. Application of these validity indicators in forensic situations should consider that some of these multivariate approaches possess possible classification limitations associated with chronicity and severity of the reported TBI. Only the Study 1 logistic regression demonstrated improved classification rates with the more acute and severe patients of Study 2 and Study 3. As with all validity indicators, use of any WCST IE criteria in isolation would not be appropriate.

Numerous authors have opined that forensic activities have become more prominent within clinical neuropsychology. To investigate the merits of these claims, the entire contents of Archives of Clinical Neuropsychology (ACN), Journal of Clinical and Experimental Neuropsychology (JCEN), and The Clinical Neuropsychologist (TCN) from 1990 through 2000 were reviewed and cataloged. These three journals were selected because they are the highest-ranking clinical subscription journals according to surveys of neuropsychology practitioners. Prior to rating journal content, various categories of interest were delineated and practice ratings were obtained until the two raters reached 92% agreement. Each of the raters read the journal contents and recorded content ratings for half of the journal issues under review. Results of the 8323 ratings demonstrated increases across time in the absolute numbers of articles related to forensic neuropsychology, although variable and different for each journal. Published articles that were partially or substantially forensic in nature in the three journals combined increased from 4% in 1990 to 14% in 2000. An annual peak in absolute number (n=32;16%) of forensic journal articles occurred in 1997. The most common topic of 139 articles published in ACN, JCEN, and TCN from 1990 to 2000 was malingering, which appeared in 86% of the general forensic articles. Forensic presentations at annual NAN meetings ranged from 3.9 to 11.3% (M=8%) of the convention programs, whereas within Division 40's programs at the American Psychological Association meeting, the average percentage ranged from 2.3 to 11.7% (M=6%). Results pertaining to each journal and to specific forensic topics are presented and implications of these and other results are discussed.

Leaders of the National Academy of Neuropsychology and Division 40 (Clinical Neuropsychology) of the American Psychological Association determined that current information on the professional practice of clinical neuropsychology within the United States (U.S.) was needed. These two organizations co-sponsored a national survey of U.S. clinical neuropsychologists that was conducted in September 2000. The primary goal of the survey was to gather information on such topics as: practitioner and practice characteristics, economic variables (e.g., experience with major third party payors, such as Medicare and managed care), practice expenses, billing methods, experiences with Current Procedural Terminology (CPT) codes, time spent on various clinical tasks, use of assistants, and income. The adjusted return rate of 33.5% (n = 1,406) reflects the number of surveys returned with sufficient data by licensed doctoral level clinicians with membership in one or both sponsoring organizations. In this first of two articles describing the survey results, characteristics of practitioners and practices, various types of professional activities, and time requirements for clinical tasks are presented and discussed. It was noted that the proportion of women in the field is increasing rapidly. Private practice is the predominant employment setting. Findings also document that members of the two sponsoring organizations are very similar with regard to employment setting, professional characteristics, and weekly activities. That is, involvement in clinical practice and research, as well as private practice versus institutional employment, was very similar between organizations. However, across organizations, work setting (private practice vs. institution) was associated with significant and meaningful differences. Private practitioners have a more diverse set of weekly clinical activities, are less likely to use assistants, and engage in more forensic activities. Across work setting, with the exception of forensic evaluations, those using assistants invest a greater number of hours per evaluation, but bill approximately the same numbers of hours per evaluation.

The purpose of this study was to examine how Alzheimer's (n = 37) and Parkinson's (n = 21) patients perform on the incidental recall adaptation to the Digit Symbol of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) and how such performance is related to established cognitive efficiency and memory measures. This adaptation requires the examinee to complete the entire subtest and then, without warning, to immediately recall the symbols associated with each number. Groups did not differ significantly on standard Digit Symbol administration (90 seconds), but on recall Parkinson's patients recalled significantly more symbols and symbol-number pairs than Alzheimer's patients. Using only the number of symbols recalled, discriminate function analysis correctly classified 76% of these patients. Correlations between age-corrected scaled score, symbols incidentally recalled, and established measures of cognitive efficiency and memory provided evidence of convergent and divergent validity. Age-corrected scaled scores were more consistently and strongly related to cognitive efficiency, whereas symbols recalled were more consistently and strongly related to memory measures. These findings suggest that the Digit Symbol recall adaptation is actually assessing memory and that it can be another useful way to detect memory impairment.

Earlier research has supported the use of a P300 (P3)-based procedure to detect simulated amnesia. In the present experiment, an attempt was made to model the behavior and event-related potentials (ERPs) that amnestic patients might demonstrate with relatively easy recognition memory tests, by increasing the difficulty of a match-to-sample recognition memory test taken by 18 memory-unimpaired undergraduates. None of the participants in the modeled amnesic condition were classified as having intact recognition memory as the result of P3-based intra-individual tests (specificity = 100%). The results support the utility of a P3 procedure for the detection of malingering by demonstrating the procedure to be a valid measure of impaired recognition with this model of amnesia.