Clinical neuropsychology

Clinical neuropsychology is a sub-specialty of clinical psychology that specializes in the diagnostic assessment and treatment of patients with brain injury or neurocognitive deficits.

Typically, a clinical neuropsychologist will hold an advanced degree in clinical psychology (in most countries, this requires a doctorate level qualification: Ph.D., Psy.D., or M.D.) and will have completed further studies in neuropsychology, or in some countries, neurology.

In the USA, a neuropsychologist is a clinical or counseling psychologist who, in addition to completing a Doctoral Degree in Psychology, also completes a Clinical Internship (1 year) and specialized Post-Doctoral training in Clinical Neuropsychology. Such Post-Doctoral training (i.e. Fellowship/Residency) currently ranges from 2 to 4 years. Neuropsychologists use models of brain-behavior relationships to determine whether expected neurobehavioral function is different from normal, or has changed to a degree that is consistent with impairment. Such relationships are demonstrated through the interpretation of performance that is derived from a variety of specialized assessment procedures. Thus, the domain of neuropsychologists is expressed brain function: for example, reasoning/problem-solving, learning/recall processes, selective attention/concentration processes, perception, sensation, language processes, controlled/directed movement processes. Serial neuropsychological examinations may be used to monitor deteriorating neurobehavioral performance (as with dementing disorders) or to monitor improving neurobehavioral function (as during the recovery after an acquired brain injury or in response to pharmacological or surgical intervention). Some neuropsychologists, who specialize in childhood neurodevelopmental and acquired disorders, specialize in the differing course of learning, behavioral and social development that results from genetic, congenital, and acquired changes in the brain structure and function of children.

What distinguishes a clinical neuropsychologist from other clinical psychologists is an extensive knowledge of the brain, including an understanding of areas such as: neuroanatomy, neurobiology, psychopharmacology, neurological illness or injury, the use of neuropsychological tests to accurately assess cognitive deficits, and the management, treatment and rehabiliation of brain injured and neurocognitively impaired patients. Clinical neuropsychologists who have obtained the training needed to practice in this specialty can be identified by their board certification. The American Board of Clinical Neuropsychology, The American Board of Professional Neuropsychology, and The American Board of Pediatric Neuropsychology all award board certification to neuropsychologists that demonstrate competency in specific areas of neuropsychology, by requiring a review of the neuropsychologist's training, experience, submitted case samples, and both written and oral examinations.

Clinical neuropsychologists perform a number of tasks, usually within a clinical setting. They are often involved in conducting neuropsychological assessments to assess a person's cognitive skills, usually after some sort of brain injury or neurological impairment. This may be for the purposes of planning treatments, to determine someone's neurocognitive functioning or mental capacity (often done for presentation as evidence in court cases or legal proceedings) or to detect changes over time.

A clinical neuropsychologist's typical caseload may include people with traumatic brain injury (TBI), cerebrovascular accidents (CVA) such as stroke and aneurysm ruptures, brain tumors, encephalitis, epilepsy/seizure disorders, dementias, mental illnesses (e.g. schizophrenia), and a wide range of developmental disorders, including attention-deficit/hyperactivity disorder (ADHD), learning disabilities, autism and Tourette's syndrome.

Clinical neuropsychologists' training has included methods of psychotherapy and counseling. They can also provide therapeutic services to patients in need of education and emotional support concerning their neurological injuries or illness. In two U.S. States (New Mexico and Louisiana), the Territory of Guam, and the U.S. Departments of Defense and Public Health Services clinical neuropsychologists (as well as generalist clinical psychologists) who complete additional postdoctoral training in clinical psychopharmacology and pass a national examination may prescribe psychotropic medications.

Many clinical neuropsychologists are employed by medical schools and hospitals, especially neurology, psychiatry, and rehabilitation facilities. Some work in private practice. They are frequently active in teaching at the university level and conducting research into a wide range of issues concerning human brain-behavior relationships. Some clinical neuropsychologists are also employed by pharmaceutical companies to help develop and test neuropsychological assessment tools for use in clinical trials.

The practice of cognitive neuropsychology and cognitive neuropsychiatry involves studying the cognitive effects of injury or illness to understand normal psychological function. Because of their day-to-day contact with people with brain impairment, many clinical neuropsychologists are active in these research fields.