Clinical Neuropsychology: A Window to Understanding Brain and Behavior Relationships State Farm Insurance April 12, 2004 Antonio E. Puente Department of Psychology University of North Carolina at Wilmington Wilmington, North Carolina

APA Membership YearDoctorateMastersBachelors

APA Membership by Division Approximately 150,000 members Approximately 150,000 members Approximately 50 different divisions Approximately 50 different divisions Top three divisions are: Top three divisions are: Clinical Psychology Clinical Psychology Clinical Neuropsychology Clinical Neuropsychology Independent Practice Independent Practice

What is Clinical Neuropsychology? Study and practrice of the relationship between brain (nervous system?) and behavior, especially in neurological patients Study and practrice of the relationship between brain (nervous system?) and behavior, especially in neurological patients Approximately 4-5,000 (out of 150,000) Approximately 4-5,000 (out of 150,000) Doctorate with post-doctorate training is minimum requirement Doctorate with post-doctorate training is minimum requirement

History: Organizational American Psychological Association (APA) American Psychological Association (APA) Division of Clinical Neuropsychology (40) National Academy of Neuropsychology (NAN) National Academy of Neuropsychology (NAN) International Neuropsychological Society (INS) International Neuropsychological Society (INS)

History: Informational Publications Publications Books (Goldstein, 1974) Books (Goldstein, 1974) Journals (ACN, JCEN, TCN, Neuropsychology, NR) Journals (ACN, JCEN, TCN, Neuropsychology, NR) Online Online Trends Trends Assessment (1970s-…) Assessment (1970s-…) Rehabilitation (1990s-…) Rehabilitation (1990s-…) Forensic (1995-…) Forensic (1995-…) Other Sub-specialties (2000-…) Other Sub-specialties (2000-…)

History: Clinical Activities Assessment Assessment Individual Tests (Wecshler Intellingence Scales) Individual Tests (Wecshler Intellingence Scales) Fixed Battery (Halstead-Reitan Vs. Luria-Nebraska) Fixed Battery (Halstead-Reitan Vs. Luria-Nebraska) Flexible Approach (Boston) Flexible Approach (Boston) Rehabilitation Rehabilitation Cognitive Rehabilitation Cognitive Rehabilitation Medical Compliance and beyond Medical Compliance and beyond Forensic Forensic Social Security Social Security Worker’s Compensation Worker’s Compensation Personal Injury Personal Injury Death Penalty Death Penalty

Current Status: Review of the Surveys Brief History of Surveys Brief History of Surveys Hartlage; others Hartlage; others DeLuca & Putnam DeLuca & Putnam Current Survey Methodology Current Survey Methodology Sweet & Peck (and others; 2002) Sweet & Peck (and others; 2002) Knauss, Schatz, & Puente (2004) Knauss, Schatz, & Puente (2004)

Organizational Membership (All Doctoral Licensed Clinicians) Percent

Type of Doctoral Degree (All Doctoral Licensed Clinicians) Percent

Field of Doctoral Degree (All Doctoral Licensed Clinicians) Percent

Work Setting (All Doctoral Licensed Clinicians) Percent

Board Certification Status (Doctoral Licensed Clinicians) Percent

Weekly Professional Activities by Organization Percent

Weekly Professional Activities by Organization Percent

Time-Related Case Activities (All Doctoral Licensed Clinicians) Hours billed: Private=11.1 (SD=5.0); Institution=8.2 (SD=3.3) * Only scoring is not significant between groups; covarying amount of forensic practice did not eradicate group differences Minutes

Use of Testing Assistants (All Doctoral Licensed Clinicians) Percent

Professional Activity (in order of prevalence) Determination of Diagnosis Determination of Diagnosis Determination of Effects of Deficits Determination of Effects of Deficits Treatment Planning Treatment Planning Documentation of Baseline Functioning Documentation of Baseline Functioning Educational Evaluation/IEP Educational Evaluation/IEP Forensic Activities (civil & criminal) Forensic Activities (civil & criminal) Disability/Workers Compensation Disability/Workers Compensation Monitoring Cognitive Recovery Monitoring Cognitive Recovery Pre/Post Medical Procedure Pre/Post Medical Procedure Independent Medical Examinations Independent Medical Examinations

Overall Summary Personnel Personnel Clinical Activities Clinical Activities

Forensic Issues Effort Effort Effort versus Malingering Effort versus Malingering Second Opinions Second Opinions Data are Data Data are Data Limits of “Neuro” Knowledge Limits of “Neuro” Knowledge Limits of Neuro-radiological Knowledge Limits of Neuro-radiological Knowledge Limits of Neurological Knowledge Limits of Neurological Knowledge Limits of Neuropsychological Knowledge Limits of Neuropsychological Knowledge

Forensic Issues The Problem of the Expert Witness The Problem of the Expert Witness The Problem of Causality The Problem of Causality In general In general In North Carolina In North Carolina

Viewing the Patient as a System Premorbid Premorbid Accident Accident Immediate Residuals Immediate Residuals Long Term Residuals Long Term Residuals Impact to a Social System Impact to a Social System Coping and Alternative Living and Vocational Opportunities Coping and Alternative Living and Vocational Opportunities

Summary Continued Growth Continued Growth Excellent Source of Information Excellent Source of Information Vibrant and Unpredictable Vibrant and Unpredictable