Introduction to the Special Issue on Forensic Neuropsychology: Foundational Elements of Practice
Longitudinal Patterns and Predictors of Cognitive Impairment Classification Stability
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.
Retainer Bias: Ethical and Practical Considerations for the Forensic Neuropsychologist
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
To provide a narrative overview of the development of forensic neuropsychology (FN) in the last 40-plus years.
Identifying Factors that Increase False-Positive Rates on Embedded Performance Validity Testing in ADHD Evaluations
This study investigated why certain embedded performance validity indicators (EVIs) are prone to higher false-positive rates (FPRs) in attention-deficit/hyperactivity disorder (ADHD) evaluations. The first aim was to establish the relationship between FPRs and 15 EVIs derived from six cognitive tests when used independently and together among adults with ADHD who have valid test performance. The second aim was to determine which specific EVIs increase the FPRs in this population.
A Précis of the Art and Science of Expert Witness Testimony: a Tribute to the Work and Ideas of Karen Postal
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.
Constitutional and Judicial Foundations for Competency-Related Assessment in Criminal Forensic Neuropsychology
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.
Release of Protected Test Information Under Protective Order: Viable Solution or Illusory Safeguard? An Interorganizational† Position Paper
To critically examine the assumption that protective orders are adequately protective of sensitive psychological/neuropsychological test information. Attorneys at times claim that to adequately cross-examine neuropsychological experts, they require direct access to protected test information, rather than having test data analyzed by retained neuropsychological experts. As a compromise, judges sometimes order that protected test information be released to attorneys under a protective order.
Forensic Neuropsychological Foundations in Competency to Stand Trial Evaluations
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
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.
Critical Review of Recently Published Studies Claiming Long-Term Neurocognitive Abnormalities in Mild Traumatic Brain Injury
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.
Diagnosed and Nondisclosed Concussions Among Young Athletes With ADHD
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.
Improving Access to Dementia Care in the Era of Monoclonal Antibody Treatments for Alzheimer's Disease: a Pilot Clinical Protocol Using Abbreviated Neuropsychological Assessment
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).
Language and Cognitive Impairments in Multiple Sclerosis: a Comparative Study of RRMS and SPMS Patients
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.
Neuropsychological Validity Assessment Beliefs and Practices: A Survey of North American Neuropsychologists and Validity Assessment Experts
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.
Pediatric neuropsychological assessment in Southeast Asia: Current status and future directions with Vietnam as a scoping review case example
There is a concerning lack of systematic understanding regarding the availability and validity of neuropsychological assessment tools for children in Southeast Asia. This issue is further complicated by the unclear landscape for test development, adaptations, and translations in these countries. The purpose of this paper is twofold. First, we offer insights into the broader practice of pediatric neuropsychology within Southeast Asia communities based on their current medical infrastructural standings. Then, we provide a specific case study by examining the current status of pediatric neuropsychology for Vietnamese children.
Do MMPI-3 Validity Scale Findings Generalize to Concurrently Administered Measures? Validation with a Forensic Disability Sample
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.
The Impact of Cognitive Behavioral Therapy for Insomnia on Neurofilament Light and Phosphorylated Tau in Individuals with a Concussion
Concussions damage neurologic tissue, increasing release of intercellular proteins including phosphorylated Tau (pTau) and neurofilament light (NfL). Disrupted sleep from a concussion negatively impacts the ability of the glymphatic system to remove cellular waste from the brain.
Transdiagnostic Attentional Deficits Are Associated with Depressive and Externalizing Symptoms in Children and Adolescents with Neuropsychiatric Disorders
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.
Relationship Between Cognitive Estimation, Executive Functions, and Theory of Mind in Patients With Prefrontal Cortex Damage
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.
Japanese Performance Profile on the WAIS-IV and Purported Cultural Influences
The present exploratory study aimed to examine the potential impact of culture on cognitive skills and intelligence by comparing the Japanese Wechsler Adult Intelligence Scale-IV (WAIS-IV) (JW) subtests, IQs, and index scores to those of the U.S. WAIS-IV (USW).
Similarities and Differences in the WAIS-IV Performances in Korean and U.S. Populations
This exploratory study examines the cognitive profiles of South Koreans using the WAIS-IV. It compares scores from the original U.S. version (USW) with those from the Korean version (KW) to identify potential cultural influences on performance.
Introduction to the Special Series on the Wechsler Adult Intelligence Scale-IV Performances in Five Asian Countries Series
Indonesian WAIS-IV Cultural Research
This study examined regional differences between Indonesians on the Wechsler Adult Intelligence Scale-IV Indonesia (WAIS-IV ID) and, in comparison, to the US. Three hypotheses were examined: a) Java will demonstrate stronger WAIS-IV ID performances than non-Java (NJ) samples. b) WAIS-IV ID performances will be correlated with educational attainment. c) Indonesians with higher levels of education will perform comparably to US samples.
Special Series on the Wechsler Adult Intelligence Scale-IV Performances in Five Asian Countries: Summary of Findings, Clinical Implications, and Future Directions
This special series of exploratory studies compared WAIS-IV performances in five Asian countries: Japan, South Korea, Taiwan, India, and Indonesia with the U.S. The studies examined cognitive profiles across age groups to develop hypotheses on how culture can impact cognition. This summary article integrates the findings from each study to determine similarities and differences across Asian countries and proposes possible underlying cultural factors impacting cognition.
Cultural Considerations in Intelligence Test Adaptations: a Critical Review of the WAIS-IV India and Its U.K. and U.S. Counterparts
This study critically examined the adaptation and normative processes of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV)India.
Revealing Cultural Dynamics in WAIS-IV Performance: a Comparative Analysis of Age Cohorts in Taiwanese and U.S. Populations
This study examined the relationship between culture and cognitive abilities by comparing WAIS-IV subtests, index scores, and Full-Scale Intelligence Quotient (FSIQ) scores across various age groups in the Taiwanese and U.S. populations.
Neurocognitive Intraindividual Variability in Veterans with Mild Traumatic Brain Injury History and Posttraumatic Stress Disorder
Veterans with a history of blast-related mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) may be at risk for greater cognitive concerns and worse functional outcomes compared to those with either condition in isolation. However, traditional neuropsychological assessment approaches have yielded equivocal results in these populations. The present study examined an alternative method for detecting subtle cognitive inefficiencies: neurocognitive intraindividual variability (IIV), a measure of within-person performance consistency.
Association of Transient Global Amnesia (TGA) With Dietary Intake of Vitamin B12
Transient global amnesia (TGA), which is described as short-term amnesia, may be influenced by some dietary components involved in brain function. The aim of the present study was to assess the connection between TGA and dietary intake of vitamin B12.
Depression Symptoms Moderate Associations between Daily Functioning and Neuropsychological Performance in Mexican American Adults
The influence of depression on the relationship between cognition and daily living in aging Mexican American adults requires further investigation, given projected trends in general growth as well as prevalence of depression and Alzheimer's disease and related dementias (ADRD) in this population.