Neuropsychology

Training

Neuropsychology originated as a subspecialty of clinical psychology, and thus the majority of neuropsychologists are clinical psychologists with specialized training in neuropsychology. A smaller portion of neuropsychologists are trained by neurologists. Training in neuropsychology involves extensive knowledge of clinical psychology including conceptualizing abnormal behavior, diagnosis, and psychological assessment. In addition, neuropsychologists are trained in neuroanatomy, neurochemistry, and neuropathology. Thus neuropsychologists tend to begin their training in graduate school, obtain extensive training at the internship level, and receive further specialized training at the postdoctoral level. There have been calls by the specialty to require board certification to earn the label neuropsychologist, but that has not occurred to this point. Although neuropsychologists might receive training in working with culturally diverse populations as part of their general clinical training in graduate school, there is less emphasis on cultural issues in neuropsychology training at the internship and postdoctoral levels.

Practice

Neuropsychologists predominantly perform cognitive assessments. Historically, the assessments were designed to determine the localization of the brain lesion, as imaging techniques were not available. Currently, neuropsychological assessment is used to determine the specific extent of impairment within the following cognitive domains: attention, memory, visuospatial functioning, psychomotor functioning, processing speed, language, and executive functioning (reasoning, judgment, organization, planning, and initiation). In addition, neuropsychologists provide recommendations based on their findings with respect to remediation, adaptation, and adjustment. Neuropsychologists work with individuals who are experiencing difficulties because of brain impairment caused by traumatic brain injury, brain tumors, brain infections, strokes, dementia, psychological disorders with known brain impairment (i.e., schizophrenia), and so on.

As with general psychological assessment, neuropsychological performance is influenced by culture. Factors such as ethnicity, gender, socioeconomic status, language, education, and acculturation status are beginning to be examined with respect to their influence on neuropsychological performance. Culture affects several factors related to assessment. Factors such as testtaking attitudes, motivation, and exposure to content can affect neuropsychological performance. In addition, neurobehavioral factors such as handedness and brain lateralization appear to be influenced by culture. These cultural factors would then affect neuropsychological performance. Thus, although cognitive performance may be universal with respect to most cognitive domains, culture may influence some aspects of neuropsychological performance.

Ethnicity has also been found to affect neuropsychological performance. Ethnic minorities are generally grouped into four major groups. Criticisms of this approach point to the heterogeneity within each of the four major groups. That said, studies have found [Page 340]differences in test patterns when comparing ethnic minority individuals to norms based on European Americans. For example, African Americans have been found to exhibit more impairment on measures of complex attention, language, verbal learning, and factual knowledge. Asian Americans may have more difficulty with language-based tasks, particularly if English is not their first language. Similarly, Latino Americans are more likely to perform similarly to European Americans when the assessment occurs in their dominant language. Although there is very little information available on neuropsychological performance with Native Americans, there have been indications of differences in brain lateralization, communication styles, and decision-making strategies that might influence neuropsychological performance. As noted earlier, factors such as language, acculturation, education, and socioeconomic status interact with ethnicity to influence the differential performance found for ethnic minority groups on neuropsychological test measures.

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