Practices in forensic neuropsychology: perspectives of neuropsychologists and trial attorneys.

Members of the National Academy of Neuropsychology and the Association of Trial Lawyers of America were surveyed concerning current practices in forensic neuropsychology. The majority of neuropsychologists and attorneys reported that attorneys never observe neuropsychological testing. Attorneys reported receiving raw data in almost all of their brain injury cases, but neuropsychologists reported that they produce raw data in only a minority of their forensic cases. Similarly, fewer neuropsychologists than attorneys acknowledged that they are asked to provide information to assist the lawyer in preparing for the cross-examination of the opposition's expert or to prepare the plaintiff for the opposition's evaluation. Lawyers typically spend up to an hour preparing their clients for neuropsychological evaluations and commonly cover test content, detection of malingering, and brain injury symptoms. Other topics addressed include attorney influence on findings, fees and billing, board certification, use of technicians, and methods used to generate referrals or locate experts. Areas of agreement and divergence between the groups were identified and ethical issues raised by identified practices were examined.

Selection criteria for clinical neuropsychology internships.

Criteria used in the evaluation and selection of applicants for clinical neuropsychology internships were identified by a survey of the programs listed in The Clinical Neuropsychologist. Neuropsychologists from 40 programs replied to the survey, yielding an 80% response rate. Clinical experience in neuropsychological assessment, specialization in clinical neuropsychology during graduate training, personal interview, and letters of recommendation were reported to be the most salient selection criteria. Practica that provide experience with flexible batteries at university-affiliated medical centers and doctoral curricula that follow INS/APA Division 40 guidelines, with teaching and supervision provided by neuropsychologists were preferred prerequisites to internship. Selection criteria reflect a vertically integrated model of education and training in accordance with the Houston Conference model.

Diagnosis of mild head injury and the postconcussion syndrome.

Mild head injuries can cause acute transient cognitive inefficiency that typically resolves within 3 months. Postconcussion syndrome may initially be related to acute cerebral dysfunction but can also arise as a psychological consequence of head trauma. The syndrome persists beyond 3 months in a significant number of patients with mild head trauma as a psychological disorder. International Classification of Diseases diagnostic criteria for postconcussion syndrome are currently recommended for clinical purposes. These criteria are contrasted with research diagnostic criteria used in the Diagnostic and Statistical Manual of Mental Disorders. The differential diagnosis of persistent cognitive and postconcussive symptoms in forensic practice is reviewed.