Ethical issues in clinical neuropsychology: International diversity perspectives.

OBJECTIVE: Much of the information about the ethical practice of clinical neuropsychology has focused on North America. Additionally, of the scholarly publications on the intersection of ethical issues and cultural diversity practices in neuropsychology, most have focused on North America. The extent to which practitioners in other parts of the world are aware of, and find useful, such information is largely unknown. Similarly, the extent to which North American neuropsychologists are familiar with ethical issues and challenges encountered around the world is unknown. The purpose of this article is to advance the discussion of ethical issues in clinical neuropsychology from an international diversity perspective. METHOD: The article presents, via a panel interview format, the thoughts and experiences of a small sample of neuropsychologists who represent all continents except North America (and Antarctica). RESULTS: Neuropsychologists across continents share an ethical commitment to providing services that are beneficial, and not harmful, to the recipients of the services. Professional competence is at the heart of such services. CONCLUSIONS: Through continued and expanded dialogue about ethical issues with neuropsychology colleagues around the world, the potential exists for improvement in the provision of effective and compassionate care in our own towns.

Questioning What We Thought We Knew: Commentary on Leonhard's Performance Validity Assessment Articles.

Neuropsychologists have long understood that valid examinee performance is needed in order to understand the constructs of interest that are at the heart of clinical and forensic evaluations. The assessment of performance validity has evolved over time, from very rudimentary and subjective clinical impressions of examinee task engagement to psychometrically based, multi-method, algorithm-driven, and consensus-informed approaches. Christoph Leonhard has further advanced that evolution in a meaningful way, forcing us to reconsider much of what we thought we knew about the psychometric assessment of performance validity. Although a structured, systematic, and objective approach to validity assessment is necessary, Leonhard has brought to our attention some significant concerns that need to be addressed. This commentary describes professional, ethical, and legal implications of Leonhard's articles. Through an ongoing process of examining, revising, and improving our methods and procedures, we will be better positioned to provide services of value to those we serve. Leonhard has provided an opportunity for us to do just that.

Psychologists in Long-Term Care (PLTC) Guidelines for Psychological and Behavioral Health Services in Long-Term Care Settings.

To address concerns about limited training of psychologists working in long-term care (LTC) facilities, the Psychologists in Long-Term Care (PLTC) organization published Standards for Psychological Services in Long-Term Care Facilities (Lichtenberg et al., 1998). The expanding evidence base for knowledge and skills, the increasing diversity of LTC residents, and the complexity of presenting problems have compounded the guidance psychologists need when providing services in this setting. In this article, the PLTC Guidelines Revision Task Force presents PLTC guidelines based on the original prescriptive PLTC Standards. The content of the PLTC Standards was updated and the format changed from prescriptive standards to aspirational guidelines. We begin with general guidelines regarding knowledge and skills in LTC (education and training. understanding of LTC systems. end-of-life care), followed by specific guidelines covering the basic psychological service activities in LTC (referral, assessment, treatment, ethical issues, and advocacy). The PLTC Guidelines are designed to provide direction for psychologists who work, or plan to work, in LTC and to guide continuing education pursuits.

Use of practice guidelines and position statements in ethical decision making.

Professional ethics guide appropriate professional conduct through their reflection of the shared values of the profession. Professional ethics codes, such as the American Psychological Association's (APA) Ethical Principles of Psychologists and Code of Conduct (henceforth, APA Ethics Code) are intended to provide guidance across psychological activities, contexts, and specialties. As such, they must, by necessity, be rather general in nature. The APA Ethics Code provides aspirational general ethical principles and enforceable ethical standards. Despite the value of these principles and directives, psychologists commonly need more specific guidance for establishing and maintaining ethical practices in their specific professional contexts. The APA Ethics Code acknowledges in its Introduction and Applicability section the broad nature of the code and the importance of considering additional resources. The APA and other professional organizations provide practice guidelines and position statements that clarify appropriate professional behavior in specific aspects of practice. Although all U.S. psychologists are aware of the APA Ethics Code, far fewer are as familiar with the practice guidelines and position statements of professional organizations, and fewer utilize such valuable resources in their ethical decision making. Practice guidelines and position statements from professional organizations complement ethics codes and facilitate ethical decision making. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Deciding to adopt revised and new psychological and neuropsychological tests: an inter-organizational position paper.

OBJECTIVE: 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. METHOD: Ethical and professional issues were reviewed and considered. CONCLUSIONS: 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.

The Assessment of Symptom and Performance Validity in Neurorehabilitation.

Rehabilitation professionals provide valuable clinical services to persons who have sustained neurologic injuries and illnesses. Accurate diagnosis and treatment planning require that neurorehabilitation professionals base their decisions on true information and genuine patient performance. That is, the patient must have responded honestly to questions and put forth adequate effort on ability measures. When in possession of valid information about the patient's history, symptoms, and abilities levels, clinicians are well positioned to serve the patient. In contrast, inaccurate information and invalid functional presentations lead to misdiagnosis, unhelpful or potentially harmful interventions, and wasted resources. Ethically, consistent with the principles of beneficence and justice, clinicians have a responsibility to use the assessment measures and procedures that are needed to answer clinical questions and provide appropriate services, using and conserving valuable resources in the process. With validity assessment measures and procedures comprising an important part of clinical evaluations, a formal, structured approach to validity assessment promotes ethical practice. Interdisciplinary collaboration in validity assessment in neurorehabilitation contexts can often be more thorough and efficient than evaluations performed by a single discipline.

Assessment of validity with polytrauma Veteran populations.

BACKGROUND: Veterans with polytrauma have suffered injuries to multiple body parts and organs systems, including the brain. The injuries can generate a triad of physical, neurologic/cognitive, and emotional symptoms. Accurate diagnosis is essential for the treatment of these conditions and for fair allocation of benefits. To accurately diagnose polytrauma disorders and their related problems, clinicians take into account the validity of reported history and symptoms, as well as clinical presentations. OBJECTIVES: The purpose of this article is to describe the assessment of validity with polytrauma Veteran populations. METHODS: Review of scholarly and other relevant literature and clinical experience are utilized. RESULTS: A multimethod approach to validity assessment that includes objective, standardized measures increases the confidence that can be placed in the accuracy of self-reported symptoms and physical, cognitive, and emotional test results. CONCLUSIONS: Due to the multivariate nature of polytrauma and the multiple disciplines that play a role in diagnosis and treatment, an ideal model of validity assessment with polytrauma Veteran populations utilizes neurocognitive, neurological, neuropsychiatric, and behavioral measures of validity. An overview of these validity assessment approaches as applied to polytrauma Veteran populations is presented. Veterans, the VA, and society are best served when accurate diagnoses are made.

Notation of professional qualifications and affiliations: avoiding puffery and deception.

Neuropsychologists are ethically charged with communicating their qualifications and credentials in ways that promote understanding and avoid deception. However, there exist few if any concrete guidelines about how and when to cite qualifications when rendering professional neuropsychological opinions. This article attempts to clarify the issues relevant to the signatory process, offering guidelines based on principles of accuracy, relevancy, and necessity. Common practices and problems are outlined, and recommended solutions offered.

A model to approaching and providing feedback to patients regarding invalid test performance in clinical neuropsychological evaluations.

The use of symptom validity assessment has become commonplace in clinical neuropsychological evaluations. However, clinicians often struggle with how to provide patients with feedback regarding invalid responding or effort, because of the sensitive nature of the information that must be conveyed. A conceptual framework for providing such feedback is outlined in clinical neuropsychological evaluations, and recommendations for how to handle complaints are offered. Our feedback model is not meant to apply to individuals referred by attorneys or other non-clinical third parties (e.g., independent medical examination companies).

Determining whether or when to adopt new versions of psychological and neuropsychological tests: ethical and professional considerations.

Test selection has significant implications for inferences that can be drawn from test data. Some tests undergo revisions, typically to improve their psychometric properties, normative data, relevance of stimuli, and ease of administration. Although revisions of psychological and neuropsychological tests are published periodically, little information is available regarding whether or when clinicians should transition to the most recent versions of the tests. The 2002 APA Ethics Code (Standard 9.08b) requires that psychologists not base their assessment or intervention decisions or recommendations "on tests and measures that are obsolete and not useful for the current purpose." However, there is no consensus regarding when tests should no longer be considered acceptable, and there may be sound reasons for delaying or foregoing the purchase and use of new versions of assessment measures. Determining whether or when to transition to a new version of a test can be particularly difficult for clinicians in psychological specialties because it can take years after publication of a revised test for research with special patient populations to be performed and published. As a result, different clinicians may adopt newer versions of tests at different times or elect not to use the newest version, depending on the specific patient population and referral questions. Decisions regarding transitioning to new test revisions should be based on the scientific merits of the tests, not on an arbitrarily defined time frame. Clinicians ultimately must use their judgment regarding which test version is best for a given patient at a given point in time.

Beyond diagnosis: understanding the healthcare challenges of injured veterans through the application of the International Classification of Functioning, Disability and Health (ICF).

Psychiatric and neurological disorders brought about by exposure to combat can create serious obstacles to community reintegration. Effective therapeutic and rehabilitative methods designed to address disorders that arise from combat are available. Yet there continues to be a need to develop both a deeper understanding of veterans' needs and best-practice methods to alleviate distress and facilitate community participation. Awareness of these needs served as the catalyst for the International Conference on Behavioral Health and Traumatic Brain Injury and is the basis for developing numerous new programs and service refinements across government and non-government organizations. Despite advances, community reintegration remains a complicated endeavor for many veterans returning home who are experiencing traumatic brain- and stress-related disorders. Accurately conceptualizing and codifying symptoms and barriers to community participation, beyond impairment analysis and diagnostic inclusion, is necessary to guide treatment planning and inform programmatic refinements. The International Classification of Function, Disability and Health (ICF) offers a useful taxonomic tool that can assist in refining an understanding of the challenges confronting our returning veterans. In turn, resources can be appropriately allocated, and neuropsychological therapies and other rehabilitation interventions, which assist veterans to resume productive and satisfying lives, will more likely be developed and implemented.

Secretive recording of neuropsychological testing and interviewing: official position of the National Academy of Neuropsychology.

Neuropsychologists are occasionally asked to have neuropsychological testing observed via the presence of a third party, through one-way mirrors, or with audio or video monitoring or recording devices. The primary reasons for not allowing observation are its effect on the validity of the examination results and the security of copyrighted test materials. To overcome the problem of observer effects on the examinee's performance, some individuals have suggested that examinations be monitored or recorded without the examinee's awareness (i.e., secretly). However, secretive recording of neuropsychological interviews and testing is deceptive, which is inconsistent with ethical principles. In addition, such recording may affect the behavior of the examiner. For these reasons, neuropsychologists do not, and should not, encourage, condone, or engage in secret recording of neuropsychological interviews or testing.

Recommendations for diagnosing a mild traumatic brain injury: a National Academy of Neuropsychology education paper.

A special interest group of the American Congress of Rehabilitation Medicine [ACRM; Mild Traumatic Brain Injury Committee. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8 (3), 86-87.] was the first organized interdisciplinary group to advocate four specific criteria for the diagnosis of a mild traumatic brain injury (TBI). More recently, the World Health Organization (WHO) Collaborative Center Task Force on Mild Traumatic Brain Injury [Carroll, L. J., Cassidy, J. D., Holm, L., Kraus, J., & Coronado, V. G. (2004). Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, (Suppl. 43), 113-125.] conducted a comprehensive review of the definitions utilized in evidence-based studies with mild TBI patients. Based on this review, the WHO task force maintained the same four criteria but offered two modifications. The similarities and differences between these two definitions are discussed. The authors of the ACRM and the WHO definitions do not provide guidelines or specific recommendations for diagnosing the four criteria. Thus, we provide recommendations for assessing loss of consciousness, retrograde and post-traumatic amnesia, disorientation and confusion as well as clarification of the neurologic signs that can be indicative of a diagnosis of mild TBI. Finally, confounding factors mentioned in both definitions that should exclude a mild TBI diagnosis are summarized.

Neuropsychological consequences of boxing and recommendations to improve safety: a National Academy of Neuropsychology education paper.

Boxing has held appeal for many athletes and audiences for centuries, and injuries have been part of boxing since its inception. Although permanent and irreversible neurologic dysfunction does not occur in the majority of participants, an association has been reported between the number of bouts fought and the development of neurologic, psychiatric, or histopathological signs and symptoms of encephalopathy in boxers. The purpose of this paper is to (i) provide clinical neuropsychologists, other health-care professionals, and the general public with information about the potential neuropsychological consequences of boxing, and (ii) provide recommendations to improve safety standards for those who participate in the sport.

Ethical considerations in geriatric neuropsychology.

The practice of geriatric neuropsychology demands specialized training and experience that enables the practitioner to appreciate the unique challenges and opportunities that are encountered when working with older adults. In addition to maintaining advanced knowledge regarding medical and psychological conditions, assessment issues, and treatment needs specific to older persons, clinicians working with older adults must be prepared to recognize and confront ethical dilemmas that arise. For example, ethical challenges related to professional competence, informed consent, assessment, and privacy and confidentiality may be prominent when working with older persons. Maintaining an emphasis on "positive ethics" and utilizing an ethical decision-making model will promote the practitioner's ability to avoid, identify, and resolve ethical challenges. The present article reviews (1) the concept of positive ethics, (2) a comprehensive ethical decision-making model, and (3) ethical issues that are commonly encountered by geriatric neuropsychologists. A case vignette is presented to illustrate the application of the aforementioned tools to promote ethical practice.

Learning disabilities: the need for neuropsychological evaluation.

A learning disability (LD) is a neurobiological disorder that presents as a serious difficulty with reading, arithmetic, and/or written expression that is unexpected, given the individual's intellectual ability. A learning disability is not an emotional disorder nor is it caused by an emotional disorder. If inadequately or improperly evaluated, a learning disability has the potential to impact an individual's functioning adversely and produce functional impairment in multiple life domains. When a learning disability is suspected, an evaluation of neuropsychological abilities is necessary to determine the source of the difficulty as well as the areas of neurocognitive strength that can serve as a foundation for compensatory strategies and treatment options.

A panel interview on the ethical practice of neuropsychology.

Neuropsychologists who have considerable experience reflecting, presenting, publishing, and advising on ethical matters are a rich resource for clinicians who have ethics questions. Consultation with such colleagues can be an important part of the ethical decision-making process. The purpose of the present article is to provide the opinions and perspectives of three neuropsychologists who, based on their experience and scholarly activities, served as panelists regarding ethical matters. Although the advice and opinions of colleagues are not a substitute for familiarity with relevant ethical requirements, guidelines, and professional literature, they offer valuable information that enhances the ethical decision-making process.