Archives Of Clinical Neuropsychology[JOURNAL]
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200 papers
Case Reports in the Integration of Technology with Cognitive Rehabilitation for Individuals with Memory Concerns and Their Care Partners.
Grewal KS, Grewal ES, Cammer A … +3 more , McWilliams LA, Spiteri RJ, O'Connell ME
Arch Clin Neuropsychol · 2025 May · PMID 39709636 · Full text
OBJECTIVE: Technology can be combined with psychological interventions to support older adults with memory concerns. Using a bi-phasic design, cognitive rehabilitation (CR) was integrated with off-the-shelf technology an...
OBJECTIVE: Technology can be combined with psychological interventions to support older adults with memory concerns. Using a bi-phasic design, cognitive rehabilitation (CR) was integrated with off-the-shelf technology and delivered to two people with cognitive impairment, and one care partner. METHOD: Pre- and post-intervention assessments were completed for all participants. Individuals with memory problems received pre- and post-intervention remote neuropsychological assessment (i.e., Rey auditory verbal learning test; mental alternations test; animal fluency), and the hospital anxiety and depression scale (HADS). The care partner completed the HADS, Zarit burden interview, and neuropsychiatric inventory questionnaire. Change metrics incorporated reliable change indices where possible. Goals were tracked using the Canadian occupation performance measure; these data were analyzed through visual inspection. A research journal (used to document intervention process) was analyzed thematically. RESULTS: Results cautiously suggested our integration was feasible and acceptable across several technologies and varying goals. Across participants, significant changes in goal progress suggested the integration of technology with CR successfully facilitated goal performance and satisfaction. The research journal underscored the importance of a visual component, intervention flexibility, and a strong therapeutic alliance in integrating technology and CR. CONCLUSIONS: CR and technology present a promising avenue for supporting people living with cognitive impairment. Further exploration of technology and CR with a range of etiologies and target goals is warranted.
Examining the Discrepancy between Subjective Cognitive Complaints and Processing Speed Performance in Military Personnel with Traumatic Brain Injury.
Jackson DA, Lippa SM, Brickell TA … +2 more , French LM, Lange RT
Arch Clin Neuropsychol · 2025 May · PMID 39692441 · Publisher ↗
OBJECTIVE: To examine correlates of the discrepancy between subjective cognitive complaints and processing speed performance in a sample of military personnel with and without traumatic brain injury (TBI). METHOD: About...
OBJECTIVE: To examine correlates of the discrepancy between subjective cognitive complaints and processing speed performance in a sample of military personnel with and without traumatic brain injury (TBI). METHOD: About 235 U.S. military service members (31 noninjured controls [NIC], 69 injured controls [IC], 70 uncomplicated mild TBI [mTBI], and 65 complicated mild/moderate/severe TBI [sTBI]) prospectively enrolled in a longitudinal TBI study completed neuropsychological testing, performance validity tests, and self-report measures of cognitive complaints and psychological symptoms. Service members were categorized as "Accurate Estimators," "Underestimators," and "Overestimators" based on discrepancies between their subjective cognition and processing speed performance. RESULTS: The NIC group was less likely to underestimate their cognitive abilities than the mTBI group (p < .05). Discrepancy groups significantly differed in processing speed scores (p < .001), with underestimators demonstrating the best objective cognitive performance. Spearman correlations revealed significant positive correlations between unadjusted discrepancy scores and psychological symptoms in the NIC, IC, and sTBI groups (ps < 0.05) but not the mTBI group (ps > 0.05). In contrast, discrepancy scores adjusted for premorbid intelligence were consistently and positively correlated with psychological symptoms across all injury groups (ps < 0.05). CONCLUSIONS: Findings suggest that mTBI injuries may increase the likelihood of a patient underestimating their cognitive performance. Further, premorbid cognitive functioning is an important factor in evaluating discrepancies in self-reported cognitive complaints and processing speed performance.
Correction to: Language and Cognitive Impairments in Multiple Sclerosis: a Comparative Study of RRMS and SPMS Patients.
Arch Clin Neuropsychol · 2025 Feb · PMID 39688225 · Publisher ↗
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The Moderating Role of Online Awareness in the Association between Strategy Use and Performance Accuracy on a Test of Functional Cognition in Individuals with Acquired Brain Injury.
Salazar-Frías D, Funes MJ, Szot AC … +3 more , Laffarga L, Navarro-Egido A, Rodríguez-Bailón M
Arch Clin Neuropsychol · 2025 May · PMID 39679809 · Full text
OBJECTIVE: Deficits in online self-awareness (SA) are common after acquired brain injury (ABI), leading to safety concerns and impacting daily activities and rehabilitation outcomes. Early identification is recommended a...
OBJECTIVE: Deficits in online self-awareness (SA) are common after acquired brain injury (ABI), leading to safety concerns and impacting daily activities and rehabilitation outcomes. Early identification is recommended as a critical first step in cognitive rehabilitation following ABI. The aim of this observational study was to examine differences in online SA and strategy use between individuals with ABI and healthy controls. It also investigated whether online SA moderates the relationship between strategy use and performance accuracy on a test designed to assess cognitive-functional deficits. METHOD: 80 individuals with ABI and 76 controls completed the Spanish Weekly Calendar Planning Activity-10. Measures of online SA included strategy use and self-recognized errors assessed during task. An after-task interview assessed individuals' self-evaluation of task difficulty and accuracy of performance. RESULTS: Individuals with ABI performed worse than controls on most measures of online SA. They were less likely to self-recognize errors and use self-monitoring strategies. They also tended to overestimate their performance and showed greater discrepancy between self-rated and actual performance. Moderation analyses show that better performance was significantly associated with greater strategy use among ABI individuals who were aware of their performance. CONCLUSIONS: Online SA appears to moderate the use of cognitive strategies during functional cognitive performance after ABI. Therefore, it is important to include assessments of online SA and strategy use for individuals with ABI. Furthermore, these findings highlight the importance of focusing on SA and self-generated strategies as key goals of cognitive rehabilitation aimed at improving daily functioning after ABI.
The Ubiquity of Cognitive Impairment in Human Illness: a Systematic Review of Meta-Analyses.
Schretlen DJ, Finley JA, Del Bene VA … +1 more , Varvaris M
Arch Clin Neuropsychol · 2025 May · PMID 39667720 · Publisher ↗
OBJECTIVE: Cognitive dysfunction occurs in many neurological, psychiatric, and other health conditions. This review aimed to characterize the breadth and degree of cognitive morbidity associated with varied health condit...
OBJECTIVE: Cognitive dysfunction occurs in many neurological, psychiatric, and other health conditions. This review aimed to characterize the breadth and degree of cognitive morbidity associated with varied health conditions. METHOD: We systematically reviewed Medline, EMBASE, and Cochrane databases for meta-analyses of cognitive dysfunction associated with any health condition. Meta-analyses were eligible if they reviewed studies that compared patients with health conditions to healthy controls on cognitive testing and provided effect sizes. RESULTS: We found 91 meta-analyses for 94 health conditions. Among >800,297 participants, healthy controls out-performed clinical participants in every condition on cognitive testing. Mean effect sizes ranged from -2.02 to -0.00 across conditions and were ≤ -0.5 on average, denoting moderate to very severe dysfunction for 41% of them. CONCLUSIONS: Cognitive dysfunction is ubiquitous in medicine. Both primary care and specialist physicians likely treat patients with cognitive dysfunction. Depending on its severity, cognitive dysfunction can affect treatment adherence, everyday functioning, quality of life, and the capacity to provide informed consent for treatment. These findings highlight the transdiagnostic nature of cognitive symptoms and the potential value of establishing collaborations between physicians and clinical neuropsychologists to integrate cognitive assessment into patient care. Even brief assessments can identify cognitive deficits that likely affect treatment adherence and functional outcomes.
Relationship Between Cognitive Estimation, Executive Functions, and Theory of Mind in Patients With Prefrontal Cortex Damage.
Ouerchefani R, Ouerchefani N, Rejeb MRB … +1 more , Le Gall D
Arch Clin Neuropsychol · 2025 May · PMID 39607752 · Publisher ↗
OBJECTIVE: Conflicting evidence has arisen from the few studies that have examined the role of the prefrontal cortex and executive control functions in theory of mind (ToM). Moreover, the involvement of other cognitive d...
OBJECTIVE: Conflicting evidence has arisen from the few studies that have examined the role of the prefrontal cortex and executive control functions in theory of mind (ToM). Moreover, the involvement of other cognitive domains in the ability to infer mental states is still under debate. This study aims to examine, in addition to the potential contribution of executive functions, the role of cognitive estimation in ToM abilities, given that cognitive estimation processes are strongly associated with some aspects of executive control functions. METHOD: The cognitive estimation task, along with a set of neuropsychological tasks assessing executive functions, was administered to 30 patients with prefrontal cortex damage and 30 control subjects matched by gender, age, and education level. RESULTS: Patients with prefrontal cortex damage were impaired in all measures of executive functions, cognitive estimation, and theory of mind compared with control subjects. Regression analysis showed a significant interaction between executive measures and cognitive estimation in predicting ToM performance for patients with prefrontal cortex damage. Additionally, voxel-based lesion analysis identified a partially common bilaterally distributed prefrontal network involved in all three domains, centered within the ventral and dorsomedial areas with extension to the dorsolateral prefrontal cortex. CONCLUSION: Our findings highlight that, apart from executive functions, cognitive estimation plays a crucial role in the ability to interpret others' cognitive and emotional states in both patients with prefrontal cortex damage and control subjects.
Language and Cognitive Impairments in Multiple Sclerosis: a Comparative Study of RRMS and SPMS Patients.
Martzoukou M, Nousia A, Messinis L … +2 more , Konstantopoulos K, Nasios G
Arch Clin Neuropsychol · 2025 May · PMID 39607750 · Publisher ↗
OBJECTIVE: Previous studies have reported that patients with Multiple Sclerosis (MS) face cognitive difficulties. Much less, however, is known about their language abilities. The present study aims to provide a clear vie...
OBJECTIVE: Previous studies have reported that patients with Multiple Sclerosis (MS) face cognitive difficulties. Much less, however, is known about their language abilities. The present study aims to provide a clear view of the language abilities of adults with MS, considering their cognitive skills and the type of the disorder. METHOD: Specifically, 20 patients with Relapsing-Remitting MS, 17 patients with Secondary Progressive MS, and two healthy control groups demographically matched with the clinical groups, took part in the study. Their language abilities were examined using the Adult Language Abilities Test, which explores morpho-syntactic and semantic phenomena of the Greek language in both comprehension and production modes. RESULTS: Our results did not reveal statistically significant differences between the two clinical groups on any cognitive or language subtest. Both groups, however, performed poorer than the control groups in producing the correct form of verbs, possessive and weak personal pronouns, and in comprehending relative and passive clauses. Participants' performance in morphosyntax was found to be related to their processing speed. CONCLUSION: Mapping the cognitive and language abilities of patients with MS is crucial for designing effective targeted interventions, which can help them adopt strategies to manage their specific cognitive and language symptoms.
Improving Access to Dementia Care in the Era of Monoclonal Antibody Treatments for Alzheimer's Disease: a Pilot Clinical Protocol Using Abbreviated Neuropsychological Assessment.
Naini SM, Thompson RC, Rossetti MA … +6 more , Gallagher VT, Manning CA, Fuchs K, D'Abreu A, Prachar T, Reilly SE
Arch Clin Neuropsychol · 2025 May · PMID 39607748 · Publisher ↗
OBJECTIVE: To meet the growing demand for timely diagnosis in the new era of disease-modifying medications for Alzheimer's disease (AD), the present study aimed to reduce clinic wait times by developing and refining an a...
OBJECTIVE: To meet the growing demand for timely diagnosis in the new era of disease-modifying medications for Alzheimer's disease (AD), the present study aimed to reduce clinic wait times by developing and refining an abbreviated neuropsychological battery to assess individuals with a suspected amnestic process (i.e., Early-Stage AD Pathway). METHOD: Early-Stage AD Pathway patients were referred by an internal neurology provider who determined that the patient had: (1) an amnestic clinical presentation, (2) a normal neurological examination, and (3) a Montreal Cognitive Assessment total score between 18 and 25. These patients were scheduled for a 2-h neuropsychological evaluation, including a brief clinical interview and an abbreviated testing battery. We evaluated n = 19 patients in the Early-Stage AD Pathway and compared them to 114 older adults referred via traditional clinic procedures (i.e., General Clinic). RESULTS: Most individuals evaluated via the Early-Stage AD Pathway were diagnosed with mild cognitive impairment (MCI; 68.4%) or mild dementia (21.1%) through the neuropsychological evaluation. Rate of diagnosis of MCI/dementia was comparable between groups. The average number of days between initial referral and completion of the neuropsychological evaluation was significantly lower (Mdiff = 145.8 days, U = 1867.500, p < 0.001) for the Early-Stage AD Pathway group than for the General Clinic group, as the former could be scheduled more flexibly. CONCLUSIONS: Implementing an abbreviated neuropsychological assessment process significantly reduced the time between referral and evaluation to identify individuals who may be eligible for emerging pharmacological treatments for AD and/or non-pharmacological interventions in a timely manner.
Diagnosed and Nondisclosed Concussions Among Young Athletes With ADHD.
Schmitt AJ, Matta M, Bretzin AC … +3 more , Benno MT, Franklin K, Beidler E
Arch Clin Neuropsychol · 2025 May · PMID 39565280 · Publisher ↗
OBJECTIVE: Within a sample of young athletes with attention-deficit/hyperactivity disorder (ADHD), to explore the frequency of disclosed and nondisclosed concussions, identify reasons the youth did not report a suspected...
OBJECTIVE: Within a sample of young athletes with attention-deficit/hyperactivity disorder (ADHD), to explore the frequency of disclosed and nondisclosed concussions, identify reasons the youth did not report a suspected concussion, and learn the frequency that the youth still practiced or played in a game after a suspected concussion. METHOD: Cross-sectional surveys were completed by 448 youth athletes (ages 8-14 years) and a corresponding parent (or caregiver). As part of larger respective surveys, questions regarding ADHD status and concussion history were asked of the youth and parents. Data regarding 40 youth with ADHD were available for analyses. Due to the low frequency of concussive injuries within the total sample, descriptive statistics and qualitative techniques were used to contextualize the data. RESULTS: The youth with ADHD were not more likely to experience at least one diagnosed concussion or nondisclosed concussion as compared to non-ADHD controls. Three of 40 youth athletes with ADHD (8%) had been diagnosed with a concussion, whereas 5 (13%) self-reported a nondisclosed concussion. Not wanting to lose playing time and not wanting to miss a game were the two most endorsed reasons for concussion nondisclosure. CONCLUSIONS: More research is needed to understand the present results considering other research that puts similarly aged athletes with ADHD at greater risk for concussion. Education for youth with ADHD might help reduce the number of nondisclosed concussions that have a more complex recovery trajectory in this population.
Critical Review of Recently Published Studies Claiming Long-Term Neurocognitive Abnormalities in Mild Traumatic Brain Injury.
Boone KB, Vane RP, Victor TL
Arch Clin Neuropsychol · 2025 Feb · PMID 39564962 · Publisher ↗
Mild traumatic brain injury (mTBI) is the most common claimed personal injury condition for which neuropsychologists are retained as forensic experts in litigation. Therefore, it is critical that experts have accurate in...
Mild traumatic brain injury (mTBI) is the most common claimed personal injury condition for which neuropsychologists are retained as forensic experts in litigation. Therefore, it is critical that experts have accurate information when testifying as to neurocognitive outcome from concussion. Systematic reviews and six meta-analyses from 1997 to 2011 regarding objective neurocognitive outcome from mTBI provide no evidence that concussed individuals do not return to baseline by weeks to months post-injury. In the current manuscript, a critical review was conducted of 21 research studies published since the last meta-analysis in 2011 that have claimed to demonstrate long-term (i.e., ≥12 months post-injury) neurocognitive abnormalities in adults with mTBI. Using seven proposed methodological criteria for research investigating neurocognitive outcome from mTBI, no studies were found to be scientifically adequate. In particular, more than 50% of the 21 studies reporting cognitive dysfunction did not appropriately diagnose mTBI, employ prospective research designs, use standard neuropsychological tests, include appropriate control groups, provide information on motive to feign or use PVTs, or exclude, or adequately consider the impact of, comorbid conditions known to impact neurocognitive scores. We additionally analyzed 15 studies published during the same period that documented no longer term mTBI-related cognitive abnormalities, and demonstrate that they were generally more methodologically robust than the studies purporting to document cognitive dysfunction. The original meta-analytic conclusions remain the most empirically-sound evidence informing our current understanding of favorable outcomes following mTBI.
Forensic Neuropsychological Foundations in Competency to Stand Trial Evaluations.
Tussey C, Lacritz M, Arredondo BC … +1 more , Marcopulos B
Arch Clin Neuropsychol · 2025 Feb · PMID 39564961 · Publisher ↗
Neuropsychological assessment can play a vital role in competency to stand trial (CST) evaluations. This article provides an overview of the brain and behavior-based conditions that may impact an individual's ability to...
Neuropsychological assessment can play a vital role in competency to stand trial (CST) evaluations. This article provides an overview of the brain and behavior-based conditions that may impact an individual's ability to participate in their legal proceedings, as well as the relevant legal parameters that guide these types of forensic mental health evaluations. Circumstances that may warrant the involvement of a neuropsychologist in these evaluations are reviewed. For example, neuropsychologists' expertise with validity testing, as well as their specialized knowledge of cognition, is useful from the onset of the evaluation through the end, where involved parties often want to know about restoration interventions and feasibility. Select neuropsychological testing measures and cultural considerations are also addressed. The article concludes with illustrative case examples that demonstrate the real-world application of neuropsychological involvement in this specific forensic context. Given the expanding opportunities for neuropsychologists to assist triers of fact, this work contributes to the necessary and developing education base for neuropsychologists who wish to provide informed, effective, and culturally sensitive CST evaluations or related consultation to the legal system.
Traumatic Brain Injury and Risk of Incident Dementia: Forensic Applications of Current Research.
Clem MA, LoBue C, Schaffert J … +1 more , Cullum CM
Arch Clin Neuropsychol · 2025 Feb · PMID 39564947 · Publisher ↗
OBJECTIVE: Traumatic Brain Injury (TBI) has been identified as a risk factor for later developing neurodegenerative disorders, and there has been significant attention on this association in forensic settings. As a resul...
OBJECTIVE: Traumatic Brain Injury (TBI) has been identified as a risk factor for later developing neurodegenerative disorders, and there has been significant attention on this association in forensic settings. As a result, forensic neuropsychologists are frequently asked to comment on risk for dementia after an alleged TBI in litigation and criminal cases. This article provides an evidence-based foundation to aid forensic practice by synthesizing comprehensive information pertaining to: (i) the role of the neuropsychologist in TBI-related litigation, (ii) the complexities associated with identifying TBIs in forensic cases, (iii) the science of TBI in relation to incident dementia, and (iv) current scientific evidence for chronic traumatic encephalopathy. RESULTS: Developing a neurodegenerative disorder after TBI is the exception rather than the rule. Prevalence rates suggest that only a small subset (< 5%) of individuals with moderate-to-severe TBI, and even fewer (< 1%) with mild TBI (mTBI), appear to develop certain neurodegenerative diseases, and the characteristics that place some at risk remain unclear. The literature is mixed in terms of identifying a relationship between mTBI and later-in-life dementia risk. Also, the quality of positive evidence for risk of dementia after mTBI is weak and mostly consists of observational studies characterized by methodological limitations. CONCLUSIONS: Methods used to establish the likely occurrence of a TBI in a forensic context are typically more extensive than those used in a routine clinical evaluation. Research methodology to define TBI is often even more rudimentary and inconsistent. Applying clinical research results of TBI and dementia outcomes to forensic cases at an individual level carries significant limitations. Estimating the contribution of remote head hits or concussion in a causal manner to dementia is a challenge forensic experts sometimes face, yet at present, the task is impossible beyond correlations and speculation.
Constitutional and Judicial Foundations for Competency-Related Assessment in Criminal Forensic Neuropsychology.
Denney RL
Arch Clin Neuropsychol · 2025 Feb · PMID 39564679 · Publisher ↗
OBJECTIVE: Clinical neuropsychologists wishing to consult in criminal cases have ethical requirements to familiarize themselves with this specialty prior to initiating services. This paper presents foundational knowledge...
OBJECTIVE: Clinical neuropsychologists wishing to consult in criminal cases have ethical requirements to familiarize themselves with this specialty prior to initiating services. This paper presents foundational knowledge for professional neuropsychological consulting in cases where competence to proceed through the criminal adjudication process is in question. METHOD: Reviewed are key foundations of knowledge for practice of clinical neuropsychology in relation to competency to stand trial or to proceed examinations. These foundations include a review of the criminal judicial system, relevant US Constitutional Amendments, and select mental health case law. RESULTS: First, Fifth, Sixth, and Fourteenth Amendments to the US Constitution establish the rights of freedom of thought, due process, freedom from self-incrimination, assistance of counsel, and equal protection. As used in criminal legal proceedings, capacity generally refers to abilities (i.e., functional capabilities), while competency is a legal determination based on a set of capacities. Although competency to proceed is assumed, Dusky v United States (1960) establishes that defendants are not competent if they lack sufficient present ability to consult with their lawyers using a reasonable degree of rational and factual understanding. Case law and statutory law establish that the loss must be due to mental disease or defect. CONCLUSIONS: Clinical neuropsychologists wishing to consult in criminal forensic cases have ethical requirements to become familiar with this unique consultative arena before choosing to enter. The foundational knowledge for clinical consulting within the criminal forensic context is presented to help clinical neuropsychologists begin developing authentic professional competence in the criminal forensic arena.
Neuropsychological Validity Assessment Beliefs and Practices: A Survey of North American Neuropsychologists and Validity Assessment Experts.
Martin PK, Schroeder RW, Odland AP
Arch Clin Neuropsychol · 2025 Feb · PMID 39564677 · Publisher ↗
OBJECTIVE: The present study sought to identify changes in neuropsychological validity assessment beliefs and practices relative to surveys of North American neuropsychologists conducted in 2015 and 2016, obtain a more n...
OBJECTIVE: The present study sought to identify changes in neuropsychological validity assessment beliefs and practices relative to surveys of North American neuropsychologists conducted in 2015 and 2016, obtain a more nuanced understanding of such beliefs and practices, and examine salient validity assessment topics not addressed by previous surveys. METHODS: Adult focused neuropsychologists (n = 445) and neuropsychological validity assessment experts (n = 16) were surveyed regarding their perceptions and practices related to the following topics: (i) importance of validity testing; (ii) multiple performance validity test (PVT) administration and interpretation; (iii) suspected causes of invalidity; (iv) reporting on malingering; (v) assessment of examinees of diverse language, culture, and nation of origin; (vi) terminology; and (vii) most frequently utilized validity measures. RESULTS: There was general agreement, if not consensus, across multiple survey topics. The vast majority of neuropsychologists and experts view validity testing as mandatory in clinical and forensic evaluations, administer multiple PVTs regardless of setting, believe validity assessment to be important in the evaluation of all individuals including older adults and culturally diverse individuals, and view evaluations with few to no validity tests interspersed throughout the evaluation as being of lesser quality. Divergent opinions were also seen among respondents and between neuropsychologists and experts on some topics, including likely causes of invalidity and assessment and formal communication of malingering. CONCLUSIONS: Current results highlight the necessity of formal validity assessment within both clinical and forensic neuropsychological evaluations, and findings document current trends and reported practices within the field.
Do MMPI-3 Validity Scale Findings Generalize to Concurrently Administered Measures? Validation with a Forensic Disability Sample.
Holmes KF, Whitman MR, Gervais RO … +1 more , Ben-Porath YS
Arch Clin Neuropsychol · 2025 Feb · PMID 39564676 · Publisher ↗
OBJECTIVE: Research has demonstrated that over-reporting and under-reporting, when detected by the MMPI-2/-RF Validity Scales, generalize to responses to other self-report measures. The purpose of this study was to inves...
OBJECTIVE: Research has demonstrated that over-reporting and under-reporting, when detected by the MMPI-2/-RF Validity Scales, generalize to responses to other self-report measures. The purpose of this study was to investigate whether the same is true for the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) Validity Scales. We examined the generalizability of over-reporting and under-reporting detected by MMPI-3 Validity Scales to extra-test self-report, performance-based, and performance validity measures. METHOD: The sample included 665 majority White, male disability claimants who, in addition to the MMPI-3, were administered several self-report measures, some with embedded symptom validity tests (SVTs), performance-based measures, and performance validity tests (PVTs). Three groups were identified based on MMPI-3 Validity Scale scores as over-reporting (n = 276), under-reporting (n = 100), or scoring within normal limits (WNL; n = 289). RESULTS: Over-reporting on the MMPI-3 generalized to symptom over-reporting on concurrently administered self-report measures of psychopathology and was associated with evidence of over-reporting from other embedded SVTs. It was also associated with poorer performance on concurrently administered measures of cognitive functioning and PVTs. Under-reporting on the MMPI-3 generalized to symptom minimization on collateral measures of psychopathology. On measures of cognitive functioning, we found no differences between the under-reporting and WNL groups, except for the Wisconsin Card Sorting Test-64 Card Version and Wide Range Achievement Test-Fifth Edition (each with negligible effect sizes). CONCLUSIONS: MMPI-3 Validity Scales can identify possible over- and under-reporting on concurrently administered measures. This can be of particular value when such measures lack validity indicators.
A Précis of the Art and Science of Expert Witness Testimony: a Tribute to the Work and Ideas of Karen Postal.
Hebben N, Leritz E
Arch Clin Neuropsychol · 2025 Feb · PMID 39563633 · Publisher ↗
In this article, we present a summary of Dr. Karen Postal's life's work on communication in neuropsychological testimony. Her central thesis was that providing effective testimony as a neuropsychological expert requires...
In this article, we present a summary of Dr. Karen Postal's life's work on communication in neuropsychological testimony. Her central thesis was that providing effective testimony as a neuropsychological expert requires one to step outside of the traditional academic communication style to which we are accustomed. In her books, The Art and Science of Expert Witness Testimony (2022) and Testimony that Sticks (2019), Karen Postal described foundational principles she called "disruptive shifts," which she saw as the basis from which experts can develop credible and masterful testimony. These shifts begin with the fundamental and somewhat counterintuitive idea that the juror has the hardest job in the courtroom and it is our job as experts to create a direct, dynamic, and unique relationship with each juror. The article then focuses on ways to ensure jurors understand our testimony, including using good metaphors and analogies, showing visuals, avoiding jargon, and speaking in a way that conveys common sense. As Dr. Postal argued, following these principles will serve to establish, and ultimately bolster our credibility as experts with the people who have the most critical job in the courtroom. Finally, we discuss how these shifts can help us handle cross examination in a way that maintains the credibility we establish. The article concludes with a discussion of how mentorship, an incredibly important part of Dr. Postal's work, is of utmost value when embarking in the field of forensic neuropsychology.
Retainer Bias: Ethical and Practical Considerations for the Forensic Neuropsychologist.
Goldstein DS, Morgan JE
Arch Clin Neuropsychol · 2025 Feb · PMID 39563631 · Publisher ↗
How is it that practicing forensic neuropsychologists occasionally see substandard work from other colleagues, or more fundamentally, have such disparate opinions on the same case? One answer might be that in every profe...
How is it that practicing forensic neuropsychologists occasionally see substandard work from other colleagues, or more fundamentally, have such disparate opinions on the same case? One answer might be that in every profession, competence varies. Another possibility has little to do with competence, but professional conduct. In this paper we discuss the process by which retainer bias may occur. Retainer bias is a form of confirmatory bias, i.e., in assessment, the tendency to seek, favor, and interpret data and make judgments and decisions that support a predetermined expectation or hypothesis, ignoring or dismissing data that challenge that hypothesis ( Nickerson, 1998). The tendency to interpret data in support of the retaining attorney's position of advocacy may be intentional - that is, within conscious awareness and explicit, or it may be unintentional, outside of one's awareness, representing implicit bias. While some practitioners accept referrals from both sides in litigation, numerous uncontrollable factors converge in such a manner that one's practice may nevertheless become associated with one side. Such imbalance is not a reliable index of bias. With brief hypothetical scenarios, in this paper we discuss contextual factors that increase risk for retainer bias and problematic practice approaches that may be used to support one side in litigation, violating ethical principles, codes of conduct and guidelines for engaging in forensic work. We also discuss debiasing techniques recommended within the empirical literature and call on the subspecialty field of forensic neuropsychology to conduct research into retainer bias and other sources of opinion variability.
Forensic Neuropsychology Goes from Nowhere to Almost Everywhere: Lessons Learned During Decades of Practice.
Sweet JJ
Arch Clin Neuropsychol · 2025 Feb · PMID 39563622 · Publisher ↗
OBJECTIVE: To provide a narrative overview of the development of forensic neuropsychology (FN) in the last 40-plus years. METHODS: Personal history description, highlighted by key data-based publications. RESULTS: Anecdo...
OBJECTIVE: To provide a narrative overview of the development of forensic neuropsychology (FN) in the last 40-plus years. METHODS: Personal history description, highlighted by key data-based publications. RESULTS: Anecdotal and relevant data-based findings converge to present a perspective of a wealth of FN resources currently available to the well-documented growing numbers of practitioners. CONCLUSION: The de facto subspecialty of FN is now a visible and prominent part of the landscape of clinical neuropsychology.
Longitudinal Patterns and Predictors of Cognitive Impairment Classification Stability.
McDowell C, Tamburri N, Gawryluk JR … +1 more , MacDonald SWS
Arch Clin Neuropsychol · 2025 May · PMID 39558853 · Full text
OBJECTIVE: Classifications such as Cognitive Impairment, No Dementia (CIND) are thought to represent the transitory, pre-clinical phase of dementia. However, increasing research demonstrates that CIND represents a nonlin...
OBJECTIVE: Classifications such as Cognitive Impairment, No Dementia (CIND) are thought to represent the transitory, pre-clinical phase of dementia. However, increasing research demonstrates that CIND represents a nonlinear, unstable entity that does not always lead to imminent dementia. The present study utilizes a longitudinal repeated measures design to gain a thorough understanding of CIND classification stability patterns and identify predictors of future stability. The objectives were to i) explore patterns of longitudinal stability in cognitive status across multiple assessments and ii) investigate whether select baseline variables could predict 6-year CIND stability patterns. METHOD: Participants (N = 259) included older adults (aged 65-90 years) from Project MIND, a six-year longitudinal repeated measures design in which participants were classified as either normal cognition (NC) or CIND at each annual assessment. A latent transition analysis approach was adapted in order to identify and characterize transitions in CIND status across annual assessments. Participants were classified as either Stable NC, Stable CIND, Progressers, Reverters, or Fluctuaters. Multinomial logistic regression was employed to test whether baseline predictors were associated with cognitive status stability patterns. RESULTS: The sample demonstrated high rates of reversion and fluctuation in CIND status across annual assessments. Additionally, premorbid IQ and CIND severity (i.e., single vs. multi-domain impairment) at baseline were significantly associated with select stability outcomes. CONCLUSIONS: CIND status was unstable for several years following baseline assessment and cognitive reserve may delay or protect against demonstrable cognitive impairment. Further, consideration of cognitive impairment severity at the time of initial classification may improve CIND classifications.
Transdiagnostic Attentional Deficits Are Associated with Depressive and Externalizing Symptoms in Children and Adolescents with Neuropsychiatric Disorders.
DePamphilis GM, Legere C, Vigne MM … +4 more , Tirrell E, Holler K, Carpenter LL, Kavanaugh BC
Arch Clin Neuropsychol · 2025 May · PMID 39540608 · Full text
OBJECTIVE: Although inattention, impulsivity, and impairments to vigilance are most associated with attention-deficit/hyperactivity disorder (ADHD), transdiagnostic attentional deficits are prevalent across all psychiatr...
OBJECTIVE: Although inattention, impulsivity, and impairments to vigilance are most associated with attention-deficit/hyperactivity disorder (ADHD), transdiagnostic attentional deficits are prevalent across all psychiatric disorders. To further elucidate this relationship, the present study investigated parent-reported neuropsychiatric symptom correlates of attention deficits using the factor structure of the Conners' Continuous Performance Test (CPT-II), a neuropsychological test of attention. METHOD: Two-hundred and eighteen children and adolescents (7-21 years old) completed the CPT-II as part of standard clinical protocol during outpatient pediatric neuropsychology visits. The factor structure of the CPT-II was determined with a principal component analysis (PCA) using Promax rotation. Pearson correlation analyses and regression models examined the relationship between the generated factor structure, parent-reported clinical symptoms, and pre-determined clinical diagnoses. RESULTS: Results from the PCA suggested a three-factor model best supported the structure of the CPT-II, and were subsequently defined as inattention, impulsivity, and vigilance. Performance-based inattention was significantly correlated with parent-reported hyperactivity, aggression, conduct problems, and depression. Parent-reported depressive symptoms and conduct problems were the strongest correlates of performance-based inattention, not hyperactivity or aggression. Performance-based inattention was significantly associated with an ADHD diagnosis but not a depression or anxiety diagnosis. CONCLUSIONS: Findings suggest attentional deficits are not specific to any one disorder. To enhance the identification, classification, and treatment of neuropsychiatric disorders, both researchers and clinicians alike must diminish the importance of categorical approaches to child/adolescent psychopathology and continue to consider the dimensionality of transdiagnostic characteristics such as inattention.
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