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WEDNESDAY, NOVEMBER 7, 2012
7:00am – 9:00am
SPECIAL TOPIC PRESENTATION – NO CE
COURSE 1
Preparing for Examination for ABPP Board Certification in Clinical Neuropsychology: ABCN Policies and Procedures
LINUS BIELIAUSKAS, PH.D.
ANN ARBOR VA HEALTHCARE SYSTEM AND UNIVERSITY OF MICHIGAN HEALTH SYSTEM
Specialty board certification in Clinical Neuropsychology through the American Board of Clinical Neuropsychology (ABCN) for all practicing and teaching clinical neuropsychologists is a major goal of the American Academy of Clinical Neuropsychology (AACN). This includes clinical neuropsychologists who work with children, as well as those who work with adults. This workshop is designed to familiarize the potential candidate with the policies and procedures of the ABCN examination and to provide advice on study and preparation. The history of the development of board certification is reviewed, current procedures are described, and the process of examination is explained. Hands-on practice with the kinds of questioning which may occur during different sections of the examination is available during the accompanying practical workshop for ABCN. Nevertheless, the extensive resources available for exam preparation through AACN will be described and access to them explained. At the end of this workshop, participants should be thoroughly familiar with the ABCN process and understand how to submit their credentials, prepare for the written examination, and become ready for submitting their work for peer review and examination.
9:00am – 12:00pm
CE WORKSHOPS – 3 CE
COURSE 2
Reasons for Symptom Validity Test Failure Other Than Malingering
DANIEL DRANE, PH.D.
EMORY UNIVERSITY SCHOOL OF MEDICINE
DAVID LORING, PH.D.
EMORY UNIVERSITY SCHOOL OF MEDICINE
DAVID WILLIAMSON, PH.D.
JANSSEN SCIENTIFIC AFFAIRS, LLC, UNIVERSITY OF SOUTH ALABAMA
Factors contributing to symptom validity test (SVT) failure other than intentional response distortion are considered in this symposium. While most SVT research has focused on effort or volitional influences, there are multiple factors that may be associated with abnormal SVT performance. Studies have demonstrated various non-volitional factors associated with impaired SVT performance, including medications, even in healthy controls, psychological variables such as emotional or sexual trauma in patients with psychogenic nonepileptic seizures (PNES), and interictal or subclinical epileptiform discharges. Such factors are often underappreciated by neuropsychologists, which can result in erroneous clinical conclusions and obscure outcome data and overall research trends. We will present examples of poor SVT performance outside the context of volitional factors, and provide an overview of broader patient implications where these concerns are likely to exist. We will suggest approaches to recognize when abnormal SVT performance may reflect a non-volitional cause, which can sometimes involve a transient disruption of brain function. We will provide strategies for handling such data, and suggest some clinical situations in which poor SVT performance may yet provide clinicians with relevant localizing or lateralizing information. Upon completion of this workshop, participants will be better equipped to recognize non-volitional contributions to impaired SVT performance, maximize the use of neurocognitive data tainted by the noise of non-volitional factors, and be prepared to address these factors in formal neuropsychological reports.
As a result of attending this presentation, the participant will be able to:
1. Recognize non-volitional disruptions of neuropsychological testing when they occur, based on performance patterns across neurocognitive and SVT measures as well as consideration of clinical history.
2. Recognize that useful clinical data can be obtained even in assessments that might be invalid or impacted by transient disruptions of brain function.
3. Develop strategies for dealing with assessment results impacted by non-volitional factors and learn to incorporate these findings into a cohesive, informative report.
COURSE 3
Pervasive Computing for Assessing Health & Functional Change
JEFFREY KAYE, M.D.
OREGON HEALTH & SCIENCE UNIVERSITY
KATHERINE WILD, PH.D.
OREGON HEALTH & SCIENCE UNIVERSITY
Advances in pervasive, “everywhere” computing, increased emphasis on home-based care models, and awareness of limitations on current assessment approaches create the ingredients for envisioning a significant change in the way we assess health and function. This workshop will review the current limitations of assessments and present a framework for new ecologically valid and minimally intrusive assessment that ultimately can be integrated into the stream of life. This approach provides the opportunity to obtain real-time, real-world information about everyday function on a 24/7 basis. Examples from several ongoing longitudinal studies that have applied these pervasive computing approaches to assessment of health, cognition, function and life events will be presented. Importantly, the attitudes and beliefs of older adults and other key stakeholders with regard to the deployment of these technologies and the use of this data will be reviewed. Implications for the future of our national research and clinical enterprise going forward will conclude the workshop.
As a result of attending this presentation, the participant will be able to:
1. Describe the major shortcomings of current episodic assessments.
2. Outline new pervasive computing approaches to assessing everyday cognition, behavior and function.
3. List the perceived benefits and risks of continuous home-based assessment.
4. Apply these methods toward research and practice.
COURSE 4
Bilingual Language and Cognition: Juggling Two Languages in One Mind and Brain
JUDITH F. KROLL, PH.D.
THE PENNSYLVANIA STATE UNIVERSITY
Until recently, research on language and its neurocognitive interface focused almost exclusively on monolingual speakers of a single language and typically speakers of English as the native language. In the past decade, the recognition that more of the world’s speakers are bilingual than monolingual has led to a dramatic increase in research that assumes bilingualism as the norm rather than the exception. This new research investigates the way in which bilinguals negotiate the presence of two languages in a single mind and brain. It demonstrates that both of a bilingual’s languages are always active and that the control required to enable fluent performance in one language alone has enduring consequences not only for language but for cognition more generally. A critical insight is that bilingualism provides a tool for examining aspects of the cognitive architecture that are otherwise obscured by the skill associated with native language performance. From this perspective, bilinguals are model subjects of study for cognitive scientists and cognitive neuroscientists who wish to identify constraints and plasticity in learning and the way in which competition is resolved across cognitive systems. In this workshop, we will overview this approach to bilingual language processing and consider the consequences that bilingualism holds for cognition and for neuropsychological assessment. We will consider a range of methods, including patient data, and take a comparative approach to bilingualism, which consider the implications of the different forms that bilingualism takes.
As a result of attending this presentation, the participant will be able to:
1. Review the state of research on bilingual language processing and its neural basis.
2. Consider the methods that have been used to reveal the way that two languages are represented and processed.
3. Examine the role that cognitive control mechanisms revealed by the research findings within the experimental literature may capture the findings within the literature on bilingual aphasia.
COURSE 5
Pharmacotherapy for Promoting Cognitive Functioning and Optimal Outcome Following Traumatic Brain Injury and Stroke
WILLIAM N. SCHNEIDER, PH.D.
UNITY HEALTH SYSTEM
MARY DOMBOVY, M.D.
UNITY HEALTH SYSTEM
Major advances in pharmacotherapy for enhancing cognitive functioning and outcome following brain injury and stroke have been made in the past three decades. In light of these advances, the authors will provide a “state of the art” literature review covering both preclinical and clinical pharmacological interventions, and highlighting the role of psychostimulants, dopamine agonists, acetylcholinesterase inhibitors, NMDA antagonists, and antidepressants. Results of peer-reviewed studies conducted by the authors will be discussed, detailing the first double-blind placebo-controlled study of amantadine with Traumatic Brain Injury (TBI) patients. Recommendations for clinical pharmacotherapy trials will be presented. Case studies will be used to illustrate pharmacotherapy effects, with caveats regarding the use of pharmacotherapy and polypharmacy described. The importance of cognitive and other therapies concurrent with pharmacological interventions will be also be reviewed. In addition to interventions for adult patients with TBI, consideration will be given to special situations such as pharmacotherapy with pediatric TBI and stroke patients with aphasia. The session will conclude with clinical recommendations and suggestions for further research, as well as discussion of case-specific questions provided by participants.
As a result of attending this presentation, the participant will be able to:
1. Describe specific beneficial cognitive effects of several classes of pharmacological agents employed following brain injury and stroke.
2. Identify several pharmacological agents that have been shown to be associated with adverse outcome following brain injury.
3. Discuss the benefits of combining specific pharmacological interventions with other therapeutic approaches such as cognitive therapy.
COURSE 6
Clumsiness in the Neuropsychological Evaluation: Disorders of Motor Control
DAVID E. TUPPER, PH.D.
HENNEPIN COUNTY MEDICAL CENTER AND UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
Despite an insidious trend towards decreasing utilization, motor skills assessment remains a vital tool in the evaluation of individuals for their neurocognitive and functional capabilities. This workshop will discuss the importance of incorporating assessment of motor skills into a comprehensive neuropsychological evaluation. Presentation of neuromotor control issues such as associated movements, motor equivalence, variability, synergy, and self-regulation/inhibition will be covered. Quantitative and qualitative methods of assessing motor skills will be reviewed, and the relationship between motor control and other higher cognitive capabilities will be emphasized for both children and adults with and without more obvious motor proficiency difficulties. Lessons to be learned from specific examples of individuals with problems in motor control and coordination will be provided. Neuropsychologists will be encouraged to reinvest in motor skills assessment as a regular component of comprehensive evaluations.
As a result of attending this presentation, the participant will be able to:
1. Describe the importance of motor skills assessment in the context of a comprehensive neuropsychological evaluation.
2. Discuss aspects of motor control, including associated movements, synergy, motor equivalence, and motor inhibition.
3. Utilize quantitative and qualitative motor assessment measures in working with individuals (children and adults) in their clinical practice.
12:00pm – 1:30pm
STUDENT LUNCH (Attendance is limited to students only)
COURSE 7
Grantsmanship and Research Careers in Clinical Neuropsychology: A Guided Tour for Trainees
STEVEN PAUL WOODS, PSY.D.
UNIVERSITY OF CALIFORNIA SAN DIEGO
ERICA WEBER, M.S.
SDSU/UCSD JOINT DOCTORAL PROGRAM
Clinical research is a cornerstone of the scientist-practioner model of clinical neuropsychology, but the mechanics, motivations, and strategies involved in securing funding for one’s research (i.e., grantsmanship) can be elusive for clinically-focused trainees. The aim of this session is to provide an overview of grantsmanship and research careers in clinical neuropsychology for predoctoral students. The presenters will draw from their own experiences to lead a discussion on: 1) the “dos and don’ts” of embarking on a clinical research career path; 2) the sources and mechanisms of grant funding available to trainees; and 3) pragmatic advice on grant writing.
1:30pm – 4:30pm
CE WORKSHOPS – 3 CE
COURSE 8
Preparing for Examination for ABCN/ABPP Board Certification in Clinical Neuropsychology: Hands-On Test Preparation
LINAS A. BIELIAUSKAS, PH.D.
UNIVERSITY OF MICHIGAN HEALTH CENTER, ANN ARBOR VA HEALTHCARE CENTER
DIANE HOWIESON, PH.D.
OREGON HEALTH & SCIENCE UNIVERSITY, C. REX AND RUTH H. LAYTON AGING & ALZHEIMER’S DISEASE CENTER
This workshop is designed to provide hands-on practice with the kinds of questioning which may occur during different sections of the examination for board certification conducted by the American Board of Clinical Neuropsychology. Participants will have the opportunity to participate in, or observe, simulations of the Fact Finding (Case Finding) and Ethics/Professional Issues parts of the examination. Participants are also encouraged to bring along a single clinical case report (without raw data), appropriately blinded, to be reviewed either during the examination or shortly afterward, and for which a brief evaluation will be provided. At the end of this workshop, participants should be thoroughly familiar with the ABCN process and feel prepared to submit their credentials and work for peer review and examination.
As a result of attending this presentation, the participant will be able to:
1. Analyze critique of submitted work sample and analyze approaches to improve submission.
2. Practice participation in the fact-finding portion of the oral exam and employ techniques to aid with effective questioning of the examiner and formulation of diagnostic conclusions.
3. Practice participation in the ethics and professional issues portion of the oral exam and prepare for responding to examiner’s questions.
4. List appropriate strategies to be ready for all parts of the oral examination.
COURSE 9
Turning Evidence into Practice for your Patient’s Benefit – The Method of Critically Appraised Topics
STEPHEN C. BOWDEN, PH.D.
UNIVERSITY OF MELBOURNE
DAVID W. LORING, PH.D.
EMORY SCHOOL OF MEDICINE
One of the biggest challenges facing clinicians in this era of evidence-based practice is identifying high-quality information that is relevant to patient-oriented decision making and outcomes. While repositories of evidence are increasing (e.g., the Cochrane Collaboration, www.cochrane.org), many clinical questions are not addressed by these resources. The method of Critically Appraised Topics (CATs) has been developed to assist clinicians to evaluate published studies for methods quality and patient relevance. CATs can be used to assist analysis of published 1) systematic reviews, 2) treatment or 3) diagnostic studies, and are increasingly being taught as part of medical education. The technique provides clinicians with a guided structure to evaluate published studies and, if appropriate quality criteria are satisfied, help establish the practical impact of research findings for specific patients or for patient groups. CATs utilize online resources and structured worksheets to interpret published evidence for patient application in a time efficient manner. In this workshop, the rationale and content of CATs will be described. Participants will be given detailed guidance to work through CAT examples and shown how to calculate practical impact statistics such as diagnostic likelihood ratios, risk reduction and number-needed-to-treat. The importance of integrating research evidence with specific patient needs and preferences is a primary motivating factor for developing CATs.
As a result of attending this presentation, the participant will be able to:
1. Identify source criteria for a high-quality diagnostic or treatment study.
2. Explain the difference between statistical significance and practical impact.
3. Recognize the importance of integrating high-quality evidence with individual patient needs and preferences.
COURSE 10
Neuropsychological Assessment and the Paradox of ADHD
LEONARD F. KOZIOL, PSY.D.
PRIVATE PRACTICE
The past three decades of neuroimaging research present overwhelming evidence that ADHD symptoms are a manifestation of abnormally functioning brain circuitry. Despite the fact that neuropsychological tests have typically been used successfully as “probes” to investigate the functional neuroanatomy of ADHD in these research paradigms, these tests have been of surprisingly limited utility in the clinical diagnosis of the disorder. This presentation examines this paradox by reviewing the characteristics of DSM diagnosis versus neuropsychological nomenclature, by reviewing the assumptions about etiologies for ADHD, and by demonstrating how an emerging dimensional approach to diagnostic assessment can be combined with large-scale brain network studies to enhance the role of neuropsychological evaluation within clinical settings. Cortico-cortical, cortico-striatal, and cerebro-cerebellar functional network connectivity profiles will be reviewed and critically examined. This selective topical review is intended to arm practicing neuropsychologists with knowledge of new ideas and theories related to the causes of ADHD, and to provide clinicians with methodologies for neuropsychological assessment. As such, this will prepare clinical practitioners for meaningful advances in understanding and assessing the disorders that are possible over the next decade, including the possibility of establishing neuropsychologically-based subtypes of ADHD.
As a result of attending this presentation, the participant will be able to:
1. Explain at least three reasons why neuropsychological tests currently play a limited role in the diagnosis of ADHD.
2. Describe the absence of a “smoking gun” brain region whose dysfunction causes ADHD and why it is no longer appropriate to think of ADHD as a “frontal lobe” disorder.
3. Define and describe cortico-striatal and cerebro-cerebellar circuitry profiles and how these systems appear to interact with the functional connectivity of large brain networks in generating the symptoms of ADHD.
4. Explain ADHD from a dimensional, symptomatic perspective, and the manner in which multiple neural network dynamics are associated with seemingly “dimensional” cognitions and behaviors.
COURSE 11
Ethical Considerations in Cross-Cultural Assessment
VALERIE MASTEN HOESE, PH.D.
ORLANDO VETERANS AFFAIRS MEDICAL CENTER
TEDD JUDD, PH.D.
INDEPENDENT PRACTICE
TONY L. STRICKLAND, M.S., PH.D.
SPORTS CONCUSSION INSTITUTE AND DAVID GEFFEN SCHOOL OF MEDICINE UCLA
A critical consideration in neuropsychological evaluations is the potential impact of language, ethnicity, and culture. When there is a mismatch among the language and/or culture of the examiner, examinee, tests, and norms, there is increased risk of inaccurate findings. Such inaccuracy may result from lack of knowledge of each other’s language and culture, differing communication styles, poor rapport, differing presuppositions regarding test expectations, inappropriate item content, and differential prior exposure to test material. Nevertheless, it may also reflect substantive differences in educational quality, genuine discrepancies in certain cognitive aptitudes, and other non-artifactual influences. Given that neuropsychologists (NPs) attempt to gather information that is most valid to the referral questions, it is essential that NPs are knowledgeable about diversity issues and practices. APA’s Ethical Principles of Psychologists and Code of Conduct (2010) and Guidelines on Multicultural Education, Training, Research, Practice and Organizational Change for Psychologists (2002) offer guidance. These and other pivotal documents will be used to create a framework for consideration of the ethical practice of neuropsychology, as well as application of psychological skills that integrate a focus on the examinee based on his or her cultural context.
As a result of attending this presentation, the participant will be able to:
1. Describe valid assessment approaches for individuals from diverse ethnic, cultural and linguistic backgrounds, including consideration of when and how to refer out.
2. Identify strategies to discern and incorporate examinees’ broad cultural background (including linguistic, immigration and acculturation influences), in the provision of neuropsychological services.
3. Identify the ethical concerns regarding the use of assessment tools that are not standardized or normed on ethnic/racially diverse populations.
4. Identify appropriate use of interpreters/translators in cross-cultural assessment and ethical issues surrounding use of family, friends, and non-certified interpreters.
COURSE 12
The Rational/Irrational Use of Psychoactive Drugs in Cognitively Impaired Persons
MYRON F. WEINER, M.D.
UT SOUTHWESTERN MEDICAL CENTER
This presentation will cover the most commonly employed psychoactive drugs encountered by neuropsychologists, their uses, and their side effects and their impact on cognition in persons with cognitive impairment. Despite the commonly expressed view that behavioral/emotional symptoms of cognitively impaired persons should be treated first by behavioral means and only later with drugs, exhausted caregivers understandably want a treatment that does not demand additional work, and it is often them we are treating when prescribing for their loved ones. Although there is no FDA-approved drug for behavioral/emotional symptoms in cognitively impaired persons, major depressive symptoms are conventionally treated with antidepressants, anxiety states with anxiolytics, and psychotic symptoms with antipsychotic drugs. The bulk of behavioral/emotional symptoms are treated “off label” with a variety of symptomatic drugs whose mechanism of action in these persons is unclear. These include antidepressants, mood stabilizers, antipsychotics, anxiolytics, hypnotics, beta blockers and antiandrogens, with highly variable effectiveness. FDA-approved psychoactive drugs are also used for cognitive enhancement. Present-day cognitive enhancers are modestly effective and act by blocking the reuptake of acetylcholine in the synapse or by making neurons less vulnerable to the excitatory action of glutamate.
As a result of attending this presentation, the participant will be able to:
1. Describe the role of cognitive enhancers.
2. Describe the role of psychotropic drugs in the management of cognitively impaired persons.
3. Recognize the limitations of psychotropic drugs for behavioral/emotional symptoms in cognitively impaired persons.
4. Recognize side effects and neuropsychological impact of these drugs.
5:00pm – 5:15pm
OPENING WELCOME
5:15pm – 6:15pm
PRESIDENTIAL ADDRESS ROBIN HILSABECK, PH.D.
6:15pm – 7:15pm
NAN BUSINESS MEETING
7:30pm – 9:30pm
WOMEN IN LEADERSHIP NETWORKING EVENT
This year’s NAN Women in Leadership Committee’s Annual Networking Event will feature speaker Pauline M. Maki, Ph.D., Professor of Psychiatry and Psychology and Director of Women’s Mental Health Research at the University of Illinois at Chicago. Dr. Maki has a longstanding interest in the effects of sex hormones and phytoestrogens on cognition, brain function, and psychological wellbeing in young, midlife and elderly women, and will speak on “How Estrogen Affects Our Brain and Careers.” Held at the Gaylord Opryland Resort, the event will feature networking opportunities and light refreshments. Purchase your tickets early as space is limited!
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THURSDAY, NOVEMBER 8, 2012
8:30am – 11:30am
CE WORKSHOPS – 3 CE
COURSE 13
The Quest for Continuous Measurement of Response Bias: Selection and Use of Multiple Symptom Validity Measures
KYLE BRAUER BOONE, PH.D.
ALLIANT INTERNATIONAL UNIVERSITY
Recent clinical practice recommendations indicate that symptom validity tests (SVTs) are to be interspersed throughout a neuropsychological exam (National Academy of Neuropsychology; Bush et al., 2005), and that both free-standing and embedded measures of response bias should be relied upon in determination of adequacy of effort (American Academy of Clinical Neuropsychology; Heilbronner et al., 2009). This workshop will outline considerations in selection of SVTs, and compare sensitivity rates across the various symptom validity measures. Available embedded SVTs will be described, followed by a discussion regarding how the information they provide compliments that from dedicated SVTs. The workshop will conclude with recommendations as to how to appropriately interpret data from multiple SVTs in combination, accompanied by illustrative case examples.
As a result of attending this presentation, the participant will be able to:
1. Describe considerations in the selection of SVTs.
2. List several embedded SVTs, along with their relative effectiveness in identifying symptom invalidity.
3. Competently interpret data from multiple SVTs in case examples.
COURSE 14
Spina Bifida: Gene, Brain, and Behavior Over the Lifespan
MAUREEN DENNIS, PH.D.
THE HOSPITAL FOR SICK CHILDREN, UNIVERSITY OF TORONTO
Spina bifida is a complex neurodevelopmental disorder with distinct profiles of gene, brain, and behavior. This presentation discusses the history of spina bifida, reviews current research on cognitive and educational outcomes in this condition, and relates them to anomalies of gene and brain. The cognitive-educational profile of spina bifida in the school age years emerges from atypical development in infancy and toddlerhood, and continues to shape adult outcome, which involves not only persisting challenges originating in childhood but also new challenges emerging in adult life. Spina bifida is unlike any other neurodevelopmental disorder, and we will discuss the implications of these unique genetic, brain, and behavioral profiles for clinical assessment, education, quality of life, and independence.
As a result of attending this presentation, the participant will be able to:
1. Describe the genetic, brain, and behavioral profiles of spina bifida.
2. Compare profiles in preschoolers, school age children, and young adults.
3. Identify the implications of these profiles for clinical assessment, education, quality of life, and independence.
COURSE 15
The Neurologic Examination: Neuroanatomic Localization and Application for Common Pathologies Evaluated by the Neuropsychologist
LOLA MORGAN, M.D.
UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER SAN ANTONIO, UNIVERSITY HOSPITAL
The course is designed to review key elements of the neurologic examination with emphasis on significance of findings and relevance in the clinical setting. The traditional examination consists of an evaluation of mental status, cranial nerves, motor, reflexes, sensory, cerebellar, and gait. The course will detail each component to build the practicing neuropsychologist’s repertoire of testing and knowledge for a complete assessment of the patient. The attendees will be able to assimilate the components and assign a neuroanatomic localization for findings. In addition, review of common disease states evaluated by the neuropsychologist will be addressed in the context of the neurologic examination. Specifically, neurodegenerative, vascular, traumatic brain injury, epilepsy and psychosomatic disease will be discussed in the setting of expected neurologic manifestations.
As a result of attending this presentation, the participant will be able to:
1. Integrate the neurologic examination and interpret the significance of components.
2. Localize the neuroanatomic origin of abnormal and normal findings.
3. Organize clinical findings important to disease processes of neurodegenerative, vascular, traumatic brain injury, epilepsy and psychosomatic conditions.
COURSE 16
An Exploration of the Long Term Effects of Delirium, Critical Illness and Intensive Care Unit (ICU) Treatment on Cognition Functioning: What We Know and What We Need to Know
JAMES C. JACKSON, PSY.D.
VANDERBILT UNIVERSITY SCHOOL OF MEDICINE
Over the last decade, increasing attention has been paid to the adverse and long-term consequences of medically and surgically related critical illness on brain functioning, although this topic remains little studied both inside and outside of the neuropsychological community. Numerous recent investigations have demonstrated that as many as 1 in 2 survivors of intensive care may suffer from new cognitive impairment, typically of a severity that impacts daily functional ability. In some instances, this newly observed impairment improves, though rarely to baseline levels. Reasons for cognitive impairment following critical illness are unclear but are thought to be due to the effects of wide-ranging syndromes and conditions such as delirium (which occurs in up to 80% of ICU patients) and sepsis, a prototypic disease of inflammation, among others. As they are rarely viewed as “brain injured” patients by their medical providers, survivors of critical illness are rarely referred for neuropsychological evaluations or rehabilitation, though preliminary evidence suggests that cognitive rehabilitation may be effective. As critical illness associated cognitive impairment represents a significant unrecognized public health problem, it would behoove neuropsychologists to learn about and clinically engage patients with this serious condition.
As a result of attending this presentation, the participant will be able to:
1. Rapidly identify delirium in ICU patients using validated instruments.
2. Describe the risk factors, including ICU delirium, that contribute to adverse cognitive outcomes following critical illness.
3. Describe the phenomenon of cognitive impairment in survivors of critical illness, including the characteristic features of this condition.
4. Clinically engage survivors of critical illness with increased knowledge and specificity in the context of neuropsychological testing, assessment, and consultation.
COURSE 17
Neuroscience of Alcohol and Other Substance Abuse
RALPH E. TARTER, PH.D.
CENTER FOR EDUCATION AND DRUG ABUSE RESEARCH, UNIVERSITY OF PITTSBURGH
This workshop consists of three sections.
Part 1, focusing on the concept of liability to addiction, reviews the neurobehavioral empirical literature pertaining to children and adolescents who are at high risk for addiction. The cardinal liability phenotype, psychological dysregulation, is discussed in relation to the interaction between biobehavioral vulnerability interacting with environmental (family, peer, neighborhood) context. This aspect of the workshop concludes with a discussion of a) instrumentation for determining severity of addiction risk and b) current research/practice in prevention.
Part 2 addresses the neurological and psychological sequelae of chronic substance abuse. The various addiction syndromes are considered in relation to anatomy, physiology and clinical manifestations. Emphasis is given to the role of co-occurring medical diseases nutritional disorders, psychiatric disorders, trauma, and stress mechanisms on neuropsychological functioning.
Part 3 integrates the neuropsychological antecedents and consequences of addiction within an ontogenetic perspective spanning the intrauterine period to old age. Emphasis is given to neurobiological development during the adolescent period and substance use among the elderly.
At the conclusion of the workshop, the participants will become familiar with and be prepared to conduct evaluations that reflect understanding of the complex and heterogeneous array of cognitive, emotional and behavioral disturbances that precede and ensue from habitual substance abuse, as well as identify opportunities to spearhead innovative prevention and rehabilitation from the neuropsychological perspective.
As a result of attending this presentation, the participant will be able to:
1. Identify youths at high risk for addiction.
2. Evaluate and accurately interpret neuropsychological test results of substance abusers.
3. Tailor neuropsychological assessment to the client’s age and stage of substance involvement.
8:30am – 10:00am
STUDENT/TRAINEE TRACK (Attendance is limited to students, interns and post-docs only)
COURSE 18
Introduction to Pediatric Neuropsychology
TARA V. SPEVACK, PH.D.
INDEPENDENT PRACTICE
This course is designed for trainees with limited exposure to pediatric neuropsychology and will provide a practical, clinically-focused introduction to the field. Topics will include: (1) core principles of brain-behavior development; (2) central tenets of assessment, case conceptualization, and intervention using a developmental approach; (3) techniques for optimizing child participation during the evaluation; and (4) communication of results and recommendations through the feedback session and written report. The course will conclude with an informal question-and-answer session that emphasizes training and professional development issues unique to pediatric neuropsychology.
10:00am – 11:30am
STUDENT/TRAINEE TRACK (Attendance is limited to students, interns and post-docs only)
COURSE 19
Sports Neuropsychology: From Dings to Dementia
JEFFREY T. BARTH, PH.D.
UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE
Sports Neuropsychology is a new subspecialty within Neuropsychology which has gained prominence through popular press headlines, a proliferation of industry and Department of Defense concussion research, the formation of the Sports Neuropsychology Society, and state mandated concussion education programs. This seminar will begin with an historical account of the discovery of the silent epidemic of mild head injury in clinical populations and the subsequent rationale for studying sports concussions. We will explore the defining characteristics and assessment of concussions, typical recovery curves, and the research and consensus conferences which have helped to formulate return-to-play guidelines. Individual vulnerability and risk factors for poor recovery will be discussed, along with the possible neurodegenerative effects of multiple concussive and sub-concussive injuries. Finally, the similarities and differences between sports and combat concussions will be explored.
1:30pm – 3:30pm
SPECIAL TOPIC PRESENTATIONS – NO CE
COURSE 20
Pediatric Grand Rounds
PHILIP FASTENAU, PH.D.
CASE WESTERN RESERVE UNIVERSITY SCHOOL OF MEDICINE
RENEE LAJINESS-O’NEILL, PH.D.
UNIVERSITY OF MICHIGAN SCHOOL OF MEDICINE
Neuropsychological evaluation and intervention with children necessitates knowledge of the developing central nervous system as well as an understanding of potential sequelae of developmental disorders, brain disease, and traumatic injury. Another critical component is the choice of valid assessment instruments for children and adolescents. Pediatric Grand Rounds is an annual Special Topics Presentation designed to provide information about these components of assessment via the format of case studies. These cases were selected to represent varied neuropsychological issues, and presentations will be followed by an opportunity for questions and discussion.
COURSE 21
Adult Grand Rounds
RICHARD I. NAUGLE, PH.D.
CLEVELAND CLINIC FOUNDATION
MIKE R. SCHOENBERG, PH.D.
UNIVERSITY OF SOUTH FLORIDA COLLEGE OF MEDICINE
SID O’BRYANT, PH.D.
UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER
CLEA EVANS, PH.D.
METHODIST REHABILITATION CENTER
This symposium involves a review of significant clinical cases from neuropsychologists’ practices. This year’s cases include an active duty service member who demonstrated an uncommon visual disturbance following a penetrating head injury, a small series of cases that demonstrate the role of the cerebellum in higher cognitive functioning and affect, and a 36 year old female who suffered a lightning strike. Neuropsychological examination data, relevant medical and laboratory findings, and, when available, neuroimaging results will be presented. Follow-up data may also be included. In their presentations, speakers will provide patients’ histories, information regarding the natural histories of disease entities, and the clinical significance of their cases. Drs. Sid O'Bryant, Clea Evans, and Michael Schoenberg will serve as discussants and will elaborate on speakers’ comments and make references to relevant literature. Audience members will be invited to comment and ask questions of presenters and discussants.
COURSE 22
The American Board of Professional Neuropsychology: Preparation for Application, Work Sample Submission, and Examination
MICHAEL RAYMOND, PH.D.
JOHN HEINZ INSTITUTE OF REHABILITATION MEDICINE
GEOFFREY KANTER, PH.D.
PRIVATE PRACTICE
JOHN E. MEYERS, PSY.D.
PRIVATE PRACTICE
JOHN KNIPPA, PH.D.
PRIVATE PRACTICE
The American Board of Professional Neuropsychology (ABN) is dedicated to the pursuit of excellence in the practice of applied neuropsychology. Incorporated in 1982, ABN has developed a background review and examination process that evaluates competency with the field of applied neuropsychology. This special topic presentation will focus on the application, work sample submissions, and the examination process for diplomate status in ABN. Recent changes to the application submission procedure, the examination process, and the development of examination in specialty practice areas will be discussed. The format for the special topic presentation will include formal presentations as well as the opportunity for questions and answers. A reading list and relevant preparation materials will be distributed to attendees. Recent acceptance of ABN status listing by the National Register and other organizational development enhancements will be described.
COURSE 23
Legislative Action and Advocacy Committee: Introduction to Advocacy and an Update on Committee Activities. Time to Get Involved.
LAURA HOWE, J.D., PH.D.
VA PALO ALTO HEALTH CARE SYSTEM
BETH CAILLOUET, PH.D.
WESTERN STATE HOSPITAL
SHELLEY H.K. HOWELL, PH.D., J.D.
PGSP-STANFORD CONSORTIUM AT PALO ALTO UNIVERSITY
JOANNE R. FESTA, PH.D.
ST. LUKE’S-ROOSEVELT HOSPITALS
Now is a time of great change in healthcare. Multiple disciplines and specialties are fighting for the same limited resources. Scope of practice is being defined and in some cases threatened. Neuropsychologists need to have a say in how laws, regulations, and changes are crafted and implemented if we want to continue to be a viable and thriving specialty. It is critically important that individual neuropsychologists become involved to increase the awareness, utilization, and applicability of neuropsychological services on the micro, macro, and meta levels. NAN recognized the need for the development of a group to address the legislative needs of membership and created the Legislative Action and Advocacy Committee (LAAC) in 2008. The LAAC is dedicated to working toward the needs of NAN membership in areas of advocacy and legislation, both preventively as well as reactively. We will review the importance and basics of advocacy including potential roadblocks that sometimes inhibit individual’s involvement. We will also review the current and proposed LAAC activities. LAAC would like to reach out to membership to work with them regarding areas impacting their state and practice. The overall goal is to educate individuals and aid neuropsychologists in preparing to join the advocacy process.
COURSE 24
The Role of Stereotype Threat and Neuropsychological Test Performance: Not as Simple as Black and White
APRIL THAMES, PH.D.
UNIVERSITY OF CALIFORNIA LOS ANGELES
DESIREE BYRD, PH.D.
MOUNT SINAI SCHOOL OF MEDICINE
GAIL WYATT, PH.D.
UNIVERSITY OF CALIFORNIA LOS ANGELES
CHARLES HINKIN, PH.D.
UNIVERSITY OF CALIFORNIA LOS ANGELES
While neuropsychological testing is critical to the diagnosis of neurocognitive disorders, concerns have been raised about the validity of neuropsychological testing among certain ethnic minority groups. Studies show that African Americans underperform on standard neuropsychological measures compared to Whites; however, this is typically more likely to result from disadvantaged social conditions rather than actual CNS dysfunction. One factor, stereotype threat, has been consistently found to account for some of the performance discrepancies on IQ testing among populations who would otherwise be expected to perform similarly. Stereotype threat negatively affects minorities when placed in a position where they become hyper-aware that their performance could be judged as confirming the very stereotype they wish to avoid. The pressure to not conform to the stereotype creates anxiety, which in turn adversely affects performance.
In this Special Topics presentation, we review prior literature on stereotype threat and discuss data findings from a pilot study funded through the National Academy of Neuropsychology Clinical Research Grants program that examined the role of stereotype threat, perceived level of discrimination, and examinee-examiner racial discordance on neuropsychological test performance in a sample of African American (n = 50) and Caucasian participants (n = 52). Our results partially support the effects of stereotype threat on neuropsychological performance among African Americans. In particular, the adverse effects of stereotype threat are mediated by perceived level of discrimination and examiner race. This Special Topics presentation is particularly relevant for clinicians working with racially/ethnically diverse individuals, and extends the existing knowledge base on sources of performance discrepancies among minorities.
1:30pm – 3:30pm
TEST WORKSHOP – 2 CE
COURSE 25
Nonverbal Assessment of Cognitive, Attention, Memory, and Stroop Processes: Leiter-3
GALE H ROID, PH.D.
WARNER PACIFIC COLLEGE
CHRISTOPHER KOCH, PH.D.
GEORGE FOX UNIVERSITY
Nonverbal tests that do not require expressive or receptive English language directions and responses are now needed more often in serving the increasingly multi-cultural population. Instead of written or spoken English directions and English-language responses, instruments such as the Leiter International Performance Scale—Revised (Leiter-R) published by Stoelting (Roid & Miller, 1997) employ pantomime, gesture, and pictorial directions for the examiner and pointing, marking, or moving objects (blocks or cards) for examinee responses. Clinical cases including hearing impairment, elective mutism, speech difficulties, and autism are often more accurately assessed with nonverbal measures (Roid, 2003). The forthcoming (Spring, 2013) third edition of the Leiter (Leiter-3) will be the focus of the workshop, with administration and scoring procedures, demonstrations of materials, and case studies shown. The Leiter-3 includes cognitive subtests (Fluid Reasoning and Visual-Spatial) and 5 Diagnostic subtests (Sustained and Divided Attention, Forward and Reverse Memory (see reliability table), and Stroop Effect—all in nonverbal mode). Data from national standardization and validity studies will be presented based on 1,343 cases collected nationwide as of April, 2012. The samples include 946 typical (normative) cases, 101 Attention Deficit (ADHD), 58 Autism Spectrum Disorder (ASD), and 44 Learning Disability (LD) cases, as well as Deafness, Intellectual Deficiency, and other clinical and non-English cases.
As a result of attending this presentation, the participant will be able to:
1. Utilize skills in the administration and scoring of the non-verbal Leiter-3 test battery and increased commitment to employ nonverbal measures in certain cases within their clinical practice.
2. Acquire knowledge and skills in interpreting test score differences in the nonverbal battery and among various clinical disorders using analysis of standardized score profiles and observations.
3. Describe knowledge of adaptations or accommodations needed in the assessment of various clinical groups (e.g., ASD and Deafness) and the psychometric characteristics of the Leiter-3 compared to other nonverbal tests.
5:00pm – 6:00pm
KEYNOTE ADDRESS – 1 CE
COURSE 26
Medicine, Brain, and Behavior: Neuropsychology’s New Frontier
IGOR GRANT, M.D.
UNIVERSITY OF CALIFORNIA SAN DIEGO
Neuropsychology’s emergence as a mature clinical and scientific discipline owes much to its roots in systematic observations of brain-behavior relationships on the one hand, and psychometrics, on the other. The confluence of these themes has allowed neuropsychology to flourish in areas such as the evaluation and management of persons with neurologic and psychiatric diagnosis. More recent emergence of understanding that neurocognitive abilities are also altered in many systemic and infectious processes brings new opportunities and challenges to the doorsteps of clinical neuropsychologists. In particular, neuropsychology can make valuable contributions to understanding how processes such as systemic inflammation can affect brain function, and how drugs of abuse may interact with systemic disease to produce reversible or permanent brain injury. With neurocognitive and everyday function endpoints being increasingly recognized as important outcomes of medical treatment, neuropsychology needs to position itself as the go-to purveyors of valid and reliable tools in monitoring brain involvement in these challenging populations.
As a result of attending this presentation, the participant will be able to:
1. Explain the emerging implications of neurocognitive disorders in general medical conditions.
2. Describe the potential scientific and clinical contributions that neuropsychology can make in the diagnosis and treatment of neurocognitive disorders due to general medical conditions.
Go to: WEDNESDAY | THURSDAY | FRIDAY | SATURDAY | Download Brochure PDF
FRIDAY, NOVEMBER 9, 2012
8:30am – 11:30am
CE WORKSHOPS – 3 CE
COURSE 27
Mild Cognitive Impairment: Treatment after Diagnosis
MELANIE GREENAWAY, PH.D.
EMORY UNIVERSITY SCHOOL OF MEDICINE
Patients diagnosed with Mild Cognitive Impairment (MCI), like others with potentially chronic, progressive medical disease, seek the best therapeutic treatments to maximize quality of life and minimize disease burden. The absence of meaningful disease altering medical interventions for MCI has been a source of frustration for patients and health care providers alike. Neuropsychologists have been at the forefront of developing behavioral treatment interventions for MCI. There is growing evidence that behavioral interventions such as cognitive training, compensatory strategies, and education/support groups are beneficial not only to patients, but also their partners. These interventions are being adopted both at specialty memory disorders clinics and by interested private practitioners. Controversies associated with the most current diagnostic criteria for MCI as detailed by Albert, et al. in 2011 will be discussed. The variability in standards of general clinical care for MCI patients will be presented and the benefits and limitations of these approaches to clinical management will be critiqued. Behavioral interventions in MCI that have been demonstrated to be effective in MCI management will be discussed in detail, and multi-disciplinary approaches in which neuropsychology is the primary treatment component will be highlighted.
As a result of attending this presentation, the participant will be able to:
1. Describe the current diagnostic criteria for MCI and their use in clinical evaluations.
2. Identify the pros and cons of current standards of care for MCI.
3. Assess the current evidence for the efficacy of behavioral interventions in MCI, and consider how neuropsychologists may implement some of these techniques or incorporate appropriate referrals in their own practice.
COURSE 28
Sleep Disorders Medicine: An Update on Sleep Diagnostics and Therapeutics for the Clinical Neuropsychologist
PAUL T. INGMUNDSON, PH.D.
SOUTH TEXAS VETERANS HEALTH CARE SYSTEM, AND UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
Sleep disorders are high prevalence conditions, and untreated sleep disorders may cause significant impairments in attention, concentration, and emotional stability. Most sleep disorders are treatable, and effective treatment may have profound effects on adaptive functioning and quality of life. Undetected sleep disorders in childhood may result in impairments in memory and concentration that mimic attention deficit disorder, and unrecognized sleep disorders in adults may induce or exacerbate functional impairments. Untreated sleep disorders can also increase the risk for cardiovascular disorders and many other health problems.
This workshop will provide an overview of the sleep disorders, with an update on new approaches to diagnosis and new modalities of treatment. Special attention will be given to ways in which sleep disorders effect neuropsychological test performance. Attendees of this workshop will be provided with tools and techniques for detecting sleep disorders, approaches to making effective referrals, and strategies for educating patients about the importance of healthy sleep. Participants will also be introduced to the field of behavioral sleep medicine, a rapidly developing psychology subspecialty. Clinical neuropsychologists can play an important role in informing both patients and referral sources about the importance of healthy sleep, new, cost-effective approaches to assessment, and innovations in treatments.
As a result of attending this presentation, the participant will be able to:
1. Identify the signs and symptoms of the most common sleep disorders, including insomnia, restless legs syndrome, and obstructive sleep apnea, as well as sleep disorders that may present in the context of neurodegenerative disease, such as REM sleep behavior disorder.
2. Describe current approaches to sleep diagnostics, including questionnaires and actigraphy, as well as home- and laboratory-based sleep studies.
3. Identify current approaches to treatment for insomnia, restless leg syndrome, and obstructive sleep apnea.
4. Identify ways in which clinical neuropsychologists can monitor and facilitate adherence with sleep therapies and improve treatment outcomes.
COURSE 29
Evaluating and Managing Pediatric Mild TBI from Injury through Recovery: The Science, Clinical Practicalities, and Controversies
MICHAEL W. KIRKWOOD, PH.D.
CHILDREN’S HOSPITAL COLORADO & UNIVERSITY OF COLORADO SCHOOL OF MEDICINE
Concussion and other types of mild traumatic brain injuries occur frequently in pediatric populations. The goal of this workshop is to review the multiple roles a pediatric neuropsychologist can play in evaluating and managing these injuries. To date, little well-controlled research has focused on mild TBI management in younger populations. However, indirect evidence from multiple scientific sources is available to help empirically drive clinical care with children and adolescents. Recent research relevant to understanding the natural history of mild TBI will be reviewed, as will work important for developing appropriate assessment batteries and treatment recommendations. The workshop will present a framework for evaluating and managing pediatric mild TBI at multiple levels (e.g., child, family, school, sports), organized by time post-injury. Particular attention will be paid to clinical application and case examples. Several current controversies in the area will also be discussed (e.g., when to recommend retirement for a young athlete, the value of “baseline testing” in child athletes, the role of symptom/performance validity tests in pediatric assessment). Suggestions will also be provided for starting up or operating a youth concussion program.
As a result of attending this presentation, the participant will be able to:
1. Explain recent research relevant to understanding the natural history of pediatric mild TBI and to developing scientifically informed evaluation and treatment approaches.
2. Describe a framework for clinically evaluating and managing mild TBI in pediatric populations, organized by time post-injury.
3. Apply this framework clinically through the use of case data.
COURSE 30
Essential Clinical Neuroanatomy
GREGORY P. LEE, PH.D.
GEORGIA HEALTH SCIENCE UNIVERSITY
This workshop will examine the fundamental components of neuroanatomy by reviewing the major motor tracts, somatosensory pathways, and selected central brain structures including the cranium, ventricles, meninges, and cerebral vasculature and review their clinical relevance. The workshop will begin by describing the anatomy of the motor systems including the motor cortex, somatotopic organization, basic anatomy of the spinal cord, spinal cord and cerebral blood supply, and the lateral and medial corticospinal tracts. The motor clinical concepts will include upper versus lower motor neuron lesions and review of weakness patterns and localization. Next the basic anatomy of the somatosensory pathways will be detailed include the dorsal columns-medial lemniscal pathway, spinothalamic tract and other anterolateral pathways, somatosensory cortex, and thalamus. The somatosensory clinical concepts will include spinal cord lesion patterns and localization and key spinal cord syndromes. The final portion of the workshop will review the anatomy of the skull, meninges, ventricles, cerebrospinal fluid circulation, and related blood vessels, and the clinical topics will include intracranial mass lesions, elevated intracranial pressure, brain herniation, head trauma, intracranial hemorrhage, hydrocephalus, and brain tumors. Each section will conclude with an exemplary case study to help solidify the important neuroanatomical relationships examined.
As a result of attending this presentation, the participant will be able to:
1. Describe the basic anatomy of the corticospinal tract, other motor pathways, and spinal cord and relate these to patterns of weakness and localization.
2. Describe the dorsal column-medial lemniscal pathway, spinothalamic tract and other anterolateral pathways, somatosensory cortex, and the thalamus and apply these neuroanatomical essentials to somatosensory lesion patterns and localization.
3. Identify the structure and relative location of the ventricles and meninges and compare and contrast the primary clinical conditions associated with their pathology including increased intracranial pressure, herniation syndromes, tumors, and hydrocephalus.
COURSE 31
Advanced Reimbursement Issues - 2012 Update: Professional Affairs and Information Committee (PAIC)
DISCUSSANTS:
TIMOTHY F. WYNKOOP, PH.D.
PRIVATE PRACTICE AND UNIVERSITY OF TOLEDO MEDICAL CAMPUS
JENNIFER MORGAN, PSY.D.
NEUROPSYCHOLOGICAL SERVICES OF VIRGINIA, INC.
BRENDA AUSTIN, PH.D.
LAGUNA HONDA HOSPITAL AND REHABILITATION CENTER
TRESA ROEBUCK SPENCER, PH.D.
UNIVERSITY OF OKLAHOMA AND PAIC COMMITTEE
This advanced interactive workshop will address neuropsychologists’ interactions with health insurance companies with a focus on responsible and ethical care of patients in the context of increasingly complex industry reimbursement policies. Attendees will learn strategies to streamline the process of obtaining authorization for medically necessary patient care and to receive payment for services rendered. The presentation will begin with an update from the PAIC regarding lessons learned over the past year from interacting with health insurance companies (in our own practices and in our service to the NAN membership). Representatives from United Behavioral Health/United Healthcare (UBH/UHC) and CIGNA will also provide updates on their authorization and reimbursement policies and procedures including empirically driven outcomes. National and regional advocacy efforts by neuropsychologists on the individual and organizational level will be reviewed and discussed, as well as alternative reimbursement options such as physician’s associations. The session is meant to be interactive throughout, and will culminate in a PAIC panel discussion to address questions from the audience regarding patient care and advanced reimbursement issues. Where possible, this panel will project ahead to implications of the recently enacted health care legislation, as well as other timely issues, in an attempt to identify and suggest solutions for specific challenges facing neuropsychologists.
As a result of attending this presentation, the participant will be able to:
1. Learn strategies to streamline the process of obtaining authorization for patient care and to receive payment for services rendered.
2. Receive updates on insurance industry authorization and reimbursement policies and procedures.
3. Demonstrate the value of neuropsychological evaluation to health insurers.
4. Identify and be able to implement professional advocacy strategies in their regions.
8:30am – 10:00am
STUDENT/TRAINEE TRACK (Attendance is limited to students, interns, and post-docs only)
COURSE 32
Preparing for the Next Stage: Advice from Peer Mentors
DONNA K. BROSHEK, PH.D.
UNIVERSITY OF VIRGINIA HEALTH SYSTEM
MARC NORMAN, PH.D.
UNIVERSITY OF CALIFORNIA, SAN DIEGO
MELISSA CASTRO-COUCH, PSY.D.
MAYO CLINIC, ROCHESTER
ANTHONY DEMARCO, PSY.D.
UNIVERSITY OF VIRGINIA HEALTH SYSTEM
Becoming a clinical neuropsychologist takes place over several stages. Considering the specialized nature of the discipline, it is important for trainees to have access to individualized mentoring at each phase of early professional development. To address this issue, we present a Peer Mentoring workshop geared towards providing trainees with specific knowledge about navigating the complex process of applying for and obtaining adequate training in neuropsychology. The goal of Peer Mentoring is to provide prospective candidates, at any of the several key early career stages, with developmentally appropriate guidance by those who have recently completed or are currently completing that stage. After introductory remarks, small groups will focus on discussion of training related issues at the following stages: 1) applying for internship; 2) applying for postdoctoral fellowship; 3) the job hunt and early career issues. Issues of professionalism, gender, and diversity will be integrated into the discussion of training and career advancement. Small group leaders will include interns, postdoctoral fellows, and early career neuropsychologists who will provide in-depth guidance and advice in a focused yet informal forum.
10:00am – 11:30am
STUDENT/TRAINEE TRACK(Attendance is limited to students, interns, and post-docs only)
COURSE 33
The Art of Clinical Interviewing and Providing Feedback
SARAH BULLARD, PH.D.
GAYLORD HOSPITAL
MÉLINA GRISS, PH.D.
HARTFORD HOSPITAL/INSTITUTE OF LIVING
Real life scenarios and patients rarely mimic classroom didactics. Do you invite the spouse into the room? Do you interview the child with or without the parents? How do you redirect a tangential patient? How do you tell someone their child has mental retardation? How do you tell someone they have Alzheimer’s Disease? These are decisions and situations that face clinicians on a daily basis and often students are ill prepared to handle them. The aim of this presentation is to better prepare trainees for future independent clinical practice. This presentation is aimed at graduate students and current trainees, and will utilize a multi-media format to review the key elements of a comprehensive clinical interview in neuropsychology, as well as formats in which one can review neuropsychological results with patients within a feedback session. Strategies to adapt these skill sets when working with more challenging (e.g., dementia patients, psychiatric patients) and multi-cultural clinical populations will also be addressed.
1:30pm – 3:30pm
SPECIAL TOPIC PRESENTATIONS – NO CE
COURSE 34
Diversity Grand Rounds
VALERIE MASTEN HOESE, PH.D.
ORLANDO VETERANS AFFAIRS MEDICAL CENTER
TONY L. STRICKLAND, M.S., PH.D.
DAVID GEFFEN SCHOOL OF MEDICINE AT UCLA
CLEMENTE VEGA, PSY.D.
HARVARD MEDICAL SCHOOL AND CHILDREN’S HOSPITAL BOSTON
Due to rapidly changing demographics in our society, clinical neuropsychologists have been confronted with the increasing need to carefully consider ethno-cultural and other diversity-related factors in neuropsychological case formulation. However, despite the desire to coherently consider and integrate diversity factors into the neuropsychological evaluation process, it may not be clear how this might be achieved. In this symposium, cases from neuropsychologists’ practices, which involve significant cultural/diversity issues, will be presented. Amir Ramezani, PhD., will present a case of a middle-aged Iranian-American male with left temporal-parietal tumor and seizures, and Marika Maris, M.S., M.Ed., will discuss factors relevant to intraoperative language mapping in a Greek speaker. These will include the presentation of patient/case histories, neuropsychological examination data, and clinical case formulations, with an emphasis on the relevance and importance of cultural/diversity factors. Invited discussants, Tony Strickland, PhD, and Clemente Vega, PsyD, who are experienced in cross-cultural neuropsychology, will elaborate upon the case presentations and offer their comments, observations, and opinions on the cases. Audience members will be invited to offer their comments as well as to ask questions of the case presenters and the discussants. The goal of the session will be to encourage attendees, irrespective of their level of experience, to increase their cross-cultural competency in neuropsychology.
COURSE 35
Forensic Grand Rounds
ROBERT L. DENNEY, PSY.D.
THE SCHOOL OF PROFESSIONAL PSYCHOLOGY AT FOREST INSTITUTE
DIANA S. GOLDSTEIN, PH.D.
ISAAC RAY FORENSIC GROUP, LLC
ROBERT J. MCCAFFREY, PH.D.
ALBANY NEUROPSYCHOLOGICAL ASSOCIATES
This symposium involves a review of significant forensic cases from neuropsychologists’ practices. Shelley Peery, Ph.D., will present “Neuropsychological consultation regarding possible ‘low IQ’ in a Spanish speaker: Ethical considerations in a cross cultural forensic context.” This case was a criminal forensic referral for neuropsychological evaluation to determine whether multiple concussions may have resulted in dysfunction making a young Mexican woman susceptible to coercion. This case demonstrates a complicated forensic analysis in the context of cross cultural assessment and what to consider about potentially questionable ethical practice of an opposing expert. Michael Chafetz, Ph.D., ABPP, will present “A capital case involving the Atkins defense.” This case focuses on the assessment of Intellectual Disability regarding a 35-year-old man facing capital charges of 1st Degree Murder and Armed Robbery. The forensic analysis required consideration of the Flynn Effect for IQ and the assessment of adaptive living in an incarcerated criminal defendant. Panel discussants include Diana Goldstein, Ph.D., ABPP, and Robert McCaffrey, Ph.D., ABN. Robert Denney, Psy.D., ABPP, will moderate. Discussants will elaborate on speakers’ comments and provide recommendations. Audience members are invited to comment and ask questions of presenters and discussants.
COURSE 36
American Board of Pediatric Neuropsychology – Examination Preparation
PETER DODZIK, PSY.D.
FORT WAYNE NEUROLOGICAL CENTER
TED WASSERMAN, PH.D.
LYNN UNIVERSITY
NADIA WEBB, PSY.D.
PRIVATE PRACTICE & THE CHICAGO SCHOOL
The American Board of Pediatric Neuropsychology (ABPdN) is the oldest and only board certifying body devoted exclusively to assessing competence to practice pediatric neuropsychology. In this workshop, current officers of the ABPdN will discuss details regarding the board certification process. This workshop is designed to familiarize the potential candidate with the policies and procedures of the ABPdN examination and to provide advice on study and preparation. The history of the development of board certification in pediatric neuropsychology is reviewed, current procedures are described, and the process of examination is explained. Attendees will be provided details regarding each stage of the process, including the application, threshold training requirements, the written examination, as well as the professional work sample. Suggestions regarding preparation for the written examination, including a recommended reading list, will be provided. Workshop attendees will be provided with details regarding oral examination, which is comprised of the professional work sample, fact-finding, and ethics vignettes. Presenters will also discuss strategies for selecting a case for the professional work sample. In order to aid prospective applicants in understanding the specific scoring criteria, the workshop presenters will discuss the scoring criteria for each segment of the ABPdN examination. The establishment of the American Academy of Pediatric Neuropsychology and the relationship to the board will be discussed. Audience members will be encouraged to provide comments and ask questions of the presenters.
COURSE 37
Health Care Reform and Implications for Neuropsychology
Hosted by the PAIC and LAAC Committees
SPEAKERS:
ANTONIO E. PUENTE, PH.D.
UNIVERSITY OF NORTH CAROLINA WILMINGTON
KAREN SPANGENBERG POSTAL, PH.D.
HARVARD MEDICAL SCHOOL
DONNA RASIN-WATERS, PH.D.
VA NY HARBOR HEALTHCARE SYSTEMS - BROOKLYN CAMPUS
MODERATORS:
PAIC AND LAAC COMMITTEE MEMBERS
This presentation will address the opportunities for neuropsychological practice in the context of health care reform and some of the most significant changes to healthcare in over 25 years. Legislative, regulatory and private insurance trends will be discussed with a focus on helping clinicians understand how they can adjust their practices to thrive in the new climate. An overview will be provided of related health care reform topics, including reimbursement, integrated health care homes and the shift to servicing large populations. Given that health care reform is being implemented at the state level, examples of current and potential program transformation at the state level will be presented and discussed.
COURSE 38
Update on Delirium and Confusional States
DOUGLAS WATT, PH.D.
HARVARD MEDICAL SCHOOL, BOSTON UNIVERSITY SCHOOL OF MEDICINE
Although there are literally dozens of textbook chapters in many psychiatry and neurology textbooks on the subject of delirium and confusional states, delirium remains badly neglected in terms of empirical study. Despite the many reviews, there is still no consensually validated explanation for how a final common pathway emerges from etiologies as diverse as right parietal, thalamic, basal ganglia or brainstem infarction, anticholinergic and other CNS depressant medicines, commonplace bacterial infections, concussion, and many commonplace metabolic and physiologic problems. Additionally, although the DSM-IV criteria are typically regarded as canonical, we believe that they may contribute directly to the under diagnosis of delirium, serving to obscure the enormous spectrum of severity in altered mental status and confusional state. This review will address these issues, attempt to unify and integrate the diverse etiology space into three fundamental categories, and link these etiologies to a possible neural network model for delirium that avoids the neo-phrenology of neurotransmitter-centric thinking in psychiatry. These transmitter-centric models (that delirium necessarily reflects a shortage of acetylcholine and/or an over-abundance of dopamine), while appealing, cannot explain delirium, because they are not aimed at the antecedent levels of biological structure for behavior and conscious state – large-scale (global) networks integrating the complex vertical axis of the brain. A global network model for confusional states suggests that there cannot be one single biological pathway into this disorder, and instead emphasizes the multifactorial vulnerability of complex neural networks to a variety of illnesses, stressors and insults that drive global cognitive collapse.
COURSE 39
Three Methods of Inference in Clinical Neuropsychology: Is There a Fourth, and Can It Improve Practice?
DAVID SCHRETLEN, PH.D.
JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE
S. MARC TESTA, PH.D.
BALTIMORE VAMC
GILA RECKESS, PH.D.
JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE
How do we know when a neuropsychological examination is abnormal? What constitutes an “impaired” test performance? When does a set of abnormal test scores represent a clinically meaningful pattern? These questions are fundamental to clinical inference in neuropsychology, yet they defy simple answers. They also require careful consideration of how we formulate the results of diagnostic testing. This presentation will describe three basic approaches to clinical inference: (1) pathognomonic signs, (2) deficit measurement, and (3) pattern analysis. We will examine the logical assumptions, implementation, strengths, and threats to the validity of each inferential method. We will examine the conceptualization and assessment of pathognomonic signs and cognitive deficits, and we will discuss the risky practice of giving additional tests to clarify ambiguous findings. I will describe how calibrating test performance for demographic characteristics and estimated premorbid ability “personalizes” neuropsychological practice and can enhance the clinician’s ability to discern clinically meaningful patterns of test performance shown by individuals. We will discuss how this type of calibration fundamentally alters the meaning of test scores, and when raw test scores can be more informative than adjusted test scores. Finally, we will explore the potential usefulness of examining within-person measures of variability as a fourth method of inference in clinical neuropsychology. Here we will consider whether within-person measures of test score variability, skewness and kurtosis can increase the clinical yield of neuropsychological assessment.
COURSE 40
Student Research Platform Presentations
JARED BRUCE, PH.D.
UNIVERSITY OF MISSOURI-KANSAS CITY
RAEL LANGE, PH.D.
WALTER REED NATIONAL MILITARY MEDICAL CENTER & UNIVERSITY OF BRITISH COLUMBIA
ANDREA ZARTMAN, PH.D.
VA NORTH TEXAS HEALTH CARE SYSTEM
Each year NAN receives numerous poster abstract s ubmissions from students at many levels of training in Neuropsychology. Frequently these students are engaged in cutting-edge research. This presentation will highlight eight innovative and interesting research studies. The poster abstracts selected represent a variety of research topics in our field tackling issues in both the adult and pediatric populations alongside a variety of neurological disorders and testing concerns. Panel discussants include Drs. Jared Bruce, Rael Lange, and Andrea Zartman. Discussants will elaborate on speakers’ comments and provide audience members an opportunity to ask questions of presenters.
1:30pm – 3:30pm
TEST WORKSHOP – 2 CE
COURSE 41
Development, Application, and Interpretation of the Delis Rating of Executive Functions in Pediatric Populations
JAMES HOLDNACK, PH.D.
PEARSON PUBLISHING
DEAN DELIS, PH.D.
UNIVERSITY OF CALIFORNIA AT SAN DIEGO
The Delis Rating of Executive Functions (D-REF) is a new behavior rating scale developed to survey executive functioning problems in children and adolescents, ages 5 to 18 years. This workshop presents the content, structure, psychometric, and clinical properties of the D-REF. The D-REF has 3 forms for Parent, Teacher, and Self-Ratings. Each D-REF form is comprised of 36 items, which contribute to 3 core indexes: Behavioral, Emotional, and Executive Functioning. The D-REF also provides 4 clinical indexes assessing Attention/Working Memory, Activity Level/Impulse Control, Compliance/Anger Management, and Abstract Thinking/Problem Solving. Statistics-based inter-rater comparisons (e.g. parent versus teacher) and progress-monitoring reports are described. Clinical data are presented for children diagnosed with ADHD-Inattentive Type, ADHD-Combined Type, Autism, Asperger’s Syndrome, and Learning Disability. Concurrent validity data comparing the D-REF with the Behavioral Rating Inventory of Executive Function (BRIEF) are discussed. The integration of D-REF findings with results from formal cognitive tests of executive function will be illustrated with case presentations.
As a result of attending this presentation, the participant will be able to:
1. Describe the core and clinical index structure of the D-REF Parent, Teacher, and Child rating forms.
2. Evaluate the psychometric properties of the statistical data available for individual, multi-rater, and progress monitoring reports.
3. Describe the D-REF clinical findings for ADHD, Autism, Asperger’s Syndrome, and Learning Disability samples.
4:00pm – 4:15pm
AWARDS CEREMONY
4:15pm – 5:15pm
CE WORKSHOP – 1 CE
COURSE 42
The Effects of Recent Changes in the Current Procedural Terminology (CPT) on the Practice and Science of Psychology
ANTONIO E. PUENTE, PH.D.
UNIVERSITY OF NORTH CAROLINA WILMINGTON
Major changes in health care policy are occurring within the federal government, as well as throughout the CPT system. As such, changes that will go into effect on 01.01.13 will be addressed. These include: 1) a new Psychiatric Diagnostic Interview system, 2) an entirely new set of Psychotherapy Code Family, 3) recent developments regarding the simultaneous use of both professional and technical testing codes (with focus on compliance officer and CMS interpretation), and 4) challenges and potential solutions for coding testing feedback. A new reimbursement structure for the Psychiatric Diagnostic Interview and all Psychotherapy codes will also be presented. Finally, a brief discussion regarding documentation and auditing (including fraud and abuse) will complete this presentation.
As a result of attending this presentation, the participant will be able to:
1. Describe the new Psychiatric Interview and Psychotherapy codes.
2. Describe provision of professional and technical codes, as well as feedback.
3. Increase understanding of evolving documentation and auditing requirements.
5:30pm - 6:30pm
DISTINGUISHED LIFETIME CONTRIBUTION TO NEUROPSYCHOLOGY AWARD ADDRESS - 1 CE
COURSE 43
Hemispheric Dominance for Movement
KATHLEEN Y. HAALAND, PH.D.
UNIVERSITY OF NEW MEXICO
Neuropsychologists use motor tests largely as an indicator of laterality of brain damage, which is reasonable given the fact that the brain primarily controls contralateral movements from each hemisphere. However, in addition, some aspects of movement are differentially controlled by the left or right hemisphere, as evidenced by bilateral, rather than strictly contralateral, deficits after unilateral damage. Limb apraxia is the most well known clinical example of such hemispheric dominance. However, it is not the only one; even a seemingly simple movement, like reaching for a glass of water, requires planning and response inhibition, facilitation, selection, and retrieval as well as online modification of the response based on monitoring sensory inputs. As such, different aspects of reaching are controlled differentially by the left and right hemisphere. I will discuss hemispheric dominance for movement with emphasis upon neuroanatomical substrates, cognitive mechanisms, and rehabilitation implications. My hope is to convince you that motor skills have a strong cognitive component, studies in focal lesion stroke patients using experimental paradigms can help us understand the neuroanatomical and cognitive underpinnings of movement, and hemispheric dominance for movement should be considered in rehabilitation in order to design more specific rehabilitation therapies.
As a result of attending this presentation, the participant will be able to understand:
- Hemispheric dominance for movement is reflected by bilateral motor deficits after unilateral damage.
- Limb apraxia is the best clinical example of hemispheric dominance for movement.
- Even a seemingly simple motor skill, like reaching for a glass of water, is influenced by hemispheric dominance for different aspects of the reaching movement.
Go to: WEDNESDAY | THURSDAY | FRIDAY | SATURDAY | Download Brochure PDF
SATURDAY, NOVEMBER 10, 2012
9:00am – 12:00pm
CE WORKSHOPS – 3 CE
COURSE 44
Assessing Somatoform Psychopathology with the MMPI-2-RF
YOSSEF S. BEN-PORATH, PH.D.
KENT STATE UNIVERSITY
The MMPI has been used to assess for somatoform psychopathology since its initial development. Two of the eight original Clinical Scales, 1 and 3, were designed specifically for this purpose. A 13/31 code type is one of the more common findings associated with somatoform dysfunction. The MMPI-2 Content Scale Health Concerns was developed for this purpose as well. These scales are not included on the MMPI-2-RF. A relatively new set of MMPI-2-RF somatic and cognitive scales serves this purpose instead. This workshop focuses on use the MMPI-2-RF to assess for somatoform psychopathology. Development and validation of the MMPI-2-RF somatic scales will be described, followed by a discussion of their use in conjunction with the validity scales in distinguishing between protocols reflecting actual medical conditions, somatoform psychopathology, and exaggeration or fabrication of somatic complaints. Use of the MMPI-2-RF to differentiate between these possibilities is illustrated with a series of case studies.
As a result of attending this presentation, the participant will be able to:
1. Describe the MMPI-2-RF measures of somatoform psychopathology.
2. Discuss associations between MMPI-2 and MMPI-2-RF measures of somatoform psychopathology.
3. Utilize the relevant MMPI-2-RF validity and substantive scales to differentiate somatoform psychopathology from actual medical conditions and exaggeration or fabrication of somatic complaints.
COURSE 45
Practical Approaches to Working with Families after Brain Injury and Other Neurological Disorders
JEFFREY S. KREUTZER, PH.D.
VIRGINIA COMMONWEALTH UNIVERSITY
Brain injury survivors often face long-term problems including dependence on others, vocational failures, neuropsychological impairments, emotional distress, and social isolation. Following hospital discharge, caregiving responsibilities are mostly assumed by ill-prepared parents and spouses. Clinical researchers have documented high levels of burden and distress among family members and high rates of marital breakdown. Many neuropsychologists practice assessment, treatment planning, and psychotherapy, making them well-suited to provide family services. The primary purpose of this workshop is to help clinical neuropsychologists develop and effectively apply their family intervention skills.
This workshop will begin with a review of research on families after neurotrauma relating to needs, family functioning, and well-being. Following, will be a discussion of family therapy principles and techniques. Detailed information will be provided on the Brain Injury Family Intervention (BIFI) developed at Virginia Commonwealth University Medical Center. The BIFI was formulated on the basis of empirical family research guided by family systems theory and cognitive behavioral therapy. The multi-component intervention includes family education, skill building, and psychological support. Each family, including the survivor, is seen face-to-face as an individual unit. BIFI evaluation research reflecting qualitative and quantitative methods will be reviewed. Concluding discussion will focus on research challenges and future directions.
As a result of attending this presentation, the participant will be able to:
1. Describe the impact of brain injury and other neurological disorders on family members, family functioning, and marriages.
2. Delineate the primary principles of family intervention.
3. Enable the participant to better educate, support and teach family members new skills to facilitate adaptation and functioning.
COURSE 46
Auditing: Documentation Standards and the Audit Experience
ANTONIO E. PUENTE, PH.D.
UNIVERSITY OF NORTH CAROLINA WILMINGTON
*This course is repeated at 1:30pm, see course 54.
According to a recent article in The National Psychologist, an exponential increase in auditing will begin occurring in both Medicare and Medicaid cases and also in insurance-based reimbursement systems. While this change will necessitate increased documentation, benefits to the profession as a whole can be enumerated. These include increased patient care (particularly in light of the upcoming requirement for electronic medical records, EMR, by 2014), enhanced delineation of services (e.g., interview and testing, testing and intervention), and augmented professionalism and standards of practice. This presentation will include information regarding specific methods of auditing, suggestions and guidelines for proper documentation and billing, and strategies for dealing with audits and avoiding charges of fraud and abuse. Case presentations will assist in developing audience interaction. Ultimately, the presentation will highlight the manner in which proper documentation and preparation for audits may translate to improved quality of care for our patients.
As a result of attending this presentation, the participant will be able to:
1. Describe basic documentation and billing needed for service reimbursement and provision of high quality care.
2. Identify and explain reasons for the increase in audits from a variety of agencies and companies.
3. Develop strategies for decreasing the chance of being audited, and if audited, how to successfully meet that challenge.
4. Explain how attention to these challenges may improve quality of patient care.
COURSE 47
Effective Accommodations Requests for Students with Disabilities: Tips and Strategies
MARLA B. SHAPIRO, PH.D.
PRIVATE PRACTICE
High-stakes tests are those such as the AP, SAT, ACT, GRE, LSAT, GMAT, MCAT, and NBME exams that are used for making decisions about program admissions and credentialing. If an individual’s disability is associated with significant functional limitations that impact test-taking, he or she may be eligible for test accommodations such as extended time. However, disability status alone does not mean that accommodations are always necessary or appropriate. Whereas students attending public schools are often eligible for testing accommodations through their IEP or 504 plan, it is the Americans with Disabilities Act Amendments Act (ADAAA) that requires testing agencies to provide reasonable accommodations to test-takers with disabilities that are associated with significant functional limitations. Unfortunately, many applicants are denied accommodations because of documentation that failed to provide a credible picture of functional impairments, or assessments that failed to make the case for accommodations. Drawing on her own experience working in the testing industry and relevant clinical cases, Dr. Shapiro will provide an overview of the testing accommodations process, as well as a roadmap for clinicians that includes a discussion of the impact of the ADAAA and recent case law, agency- and disability-specific factors impacting testing and documentation, common myths and misconceptions, and implications for twice-exceptional students.
As a result of attending this presentation, the participant will be able to:
1. Avoid the common pitfalls that can result in denials of accommodations requests by applying clinical, regulatory, and agency-specific standards to clinical evaluations.
2. Recognize how disability-specific characteristics can impede performance on particular high-stakes tests and relate this to individual patients through case examples.
3. Provide a roadmap for patients of all ages to navigate the accommodations application process.
COURSE 48
Clinical Applications of fMRI
J. MICHAEL WILLIAMS, PH.D.
DREXEL UNIVERSITY
The application of functional magnetic resonance imaging (fMRI) has moved beyond the laboratories of cognitive neuroscience to include the clinical assessment of neurological disorders. Functional methods are now associated with CPT billing codes and the clinical examination of brain function is now commonly conducted in the MRI scanner; however, the methods are still in development and all the possible neurological conditions that may benefit from fMRI clinical examination have not been discovered. Although some technical background will be covered, the presentation will focus on the clinical protocols used to examine language, memory, motor function, sensory abilities and other cognitive abilities. These protocols are most developed in surgery planning for seizure disorder and brain tumor and they are also used to examine dementia-related illnesses, traumatic brain injury and cerebral vascular accidents. Questions to be considered include: how does the fMRI examination compare to the WADA? How have fMRI studies enlightened us concerning conventional neuropsychological tests? How does emotion interact with cognitive assessment? The medical disciplines that conduct fMRI analyses need the input of neuropsychologists in order to design the activation protocols that make up the tests, therefore, neuropsychologists need to redesign their clinical tests in order to accommodate the scanner environment. Finally, fMRI has recently been applied to the study of forensic questions, such as the role functional activation in the examination of psychopathy, criminal responsibility and the detection of malingering and deception. This presentation will review these areas and provide an update for neuropsychologists in general clinical practice.
As a result of attending this presentation, the participant will be able to:
1. Describe the basic concepts associated with fMRI image acquisition and analysis.
2. Explain the development of fMRI cognitive protocols applied to clinical examinations.
3. Discuss the neurological illnesses that have been examined using fMRI.
9:00am – 10:00am
STUDENT/TRAINEE TRACK (Attendance is limited to students, interns, and post-docs only)
COURSE 49
Publish or Perish: A Survival Guide
ROBERT J. MCCAFFREY, PH.D.
EDITOR-IN-CHIEF OF ARCHIVES OF CLINICAL NEUROPSYCHOLOGY, ALBANY NEUROPSYCHOLOGICAL ASSOCIATES, AND UNIVERSITY AT ALBANY, STATE UNIVERSITY OF NEW YORK
Successful scholarly writing requires that graduate students and postdoctoral fellows have a complete appreciation of the peer-review process, as well as a clear understanding of the expectations that Editors, Associate Editors, and the peer-reviewers have at each of the various stages. This workshop will begin with an over-view of the peer-review process so that you will know what to expect. Next, we will address issues associated with the form and content of a manuscript, in order to be certain that the paper meets the minimal acceptable standards. This stage is vital, as it sets the tone for how the manuscript will be received at the initial stage of the review process and will avoid your paper being “desk rejected” for non-content reasons. Once you have received the reviews of your paper, the next stage is how best to respond to the reviewers’ critiques and comments. This last stage involves the art of negotiation and how you frame your replies really does matter. Throughout this workshop, we will focus on identifying and avoiding common pitfalls and obstacles with the goal of you receiving an, “Accepted for Publication” e-mail.
10:00am – 12:00pm
STUDENT/TRAINEE TRACK (Attendance is limited to students, interns, and post-docs only)
COURSE 50
Internship and Residency Training in Clinical Neuropsychology
DOUG BODIN, PH.D.
NATIONWIDE CHILDREN’S HOSPITAL
MICHAEL DAVID HORNER, PH.D.
RALPH H. JOHNSON VA MEDICAL CENTER, MEDICAL UNIVERSITY OF SOUTH CAROLINA
Internship training and completion of a 2-year postdoctoral residency in clinical neuropsychology has become a standard pathway for preparing aspiring neuropsychologists for clinical practice. This workshop is intended for psychology graduate students, interns, and others who are interested in pursuing specialty training in clinical neuropsychology. Although research positions will be discussed briefly, the main emphasis of this presentation will be on furthering an understanding of, and preparation for, internship and residency programs that focus primarily on clinical training. Topics to be addressed include: (1) implications of the Houston Conference for internship and residency training in clinical neuropsychology; (2) how to prepare to be a competitive applicant; (3) what to look for in internship and residency programs; (4) the application and interview process; (5) the post-doc match process conducted by the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN); and (6) methods of evaluation for board certification in clinical neuropsychology by the American Board of Professional Psychology (ABPP). The workshop will be led by internship and residency program directors and will include time for a question and answer exchange.
1:30pm – 3:30pm
TEST WORKSHOP – 2 CE
COURSE 51
The Science of Executive Functioning: New Data, New Ideas and the Comprehensive Executive Functioning Inventory
JACK NAGLIERI, PHD.
UNIVERSITY OF VIRGINIA
This presentation begins with a brief overview of historical and current theories and definitions of executive functioning (EF). Next, data from a large national study of behaviors associated with EF in the general population will be described based on the standardization and validity studies of the Comprehensive Executive Functioning Inventory (CEFI; Naglieri & Goldstein, 2012). These data provide a science based foundation for appreciating the components of executive functioning. The presentation will provide an examination of how the CEFI can be used to evaluate behaviors associated with EF and relate these results to other measures of ability and neuropsychological functioning. Emphasis will be placed on the CEFI, the first nationally standardized norm referenced instrument designed to identify executive functioning in youth two through eighteen years of age. The presentation will include a discussion of intervention options and future challenges.
As a result of attending this presentation, the participant will be able to:
1. Describe the history and theory of executive function.
2. Relate new data about executive functioning to current assessment.
3. Detail knowledge of the Comprehensive Executive Functioning Inventory validity and utility.
1:30pm – 4:30pm
CE WORKSHOPS – 3 CE
COURSE 52
Integrative Treatment Approaches for Persistent Post-Concussive Symptoms in Military and Veteran Populations
DOUGLAS B. COOPER, PH.D.
SAN ANTONIO MILITARY MEDICAL CENTER
JON GRIZZLE, PH.D.
SAN ANTONIO MILITARY MEDICAL CENTER
Persistent post-concussive symptoms are commonly reported by Service Members and Veterans in post-deployment settings, and can be challenging to treat. Although the etiology of these symptoms remains the subject of considerable debate, the need for effective interventions is less controversial. Psychologists and neuropsychologists practicing in these settings are increasingly being asked to address such difficulties through the application of psychological interventions at the individual and/or program level. This course will describe some of the challenges inherent in providing treatment within this context and review relevant literature on psychological treatment of post-concussive symptoms, with an emphasis on individuals deployed in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Participants will learn several approaches to integrate psychological treatment in multidisciplinary treatment settings, including both theoretical constructs and practical skills. Case examples will be utilized to illustrate how specific treatment components can be applied, and participants will also learn to adapt/scale these interventions to most effectively meet the needs of OEF/OIF Service Members and Veterans in their practice setting.
As a result of attending this presentation, the participant will be able to:
1. Describe relevant literature of psychological treatments for post-concussive symptoms in OEF/OIF Service Members and Veterans.
2. Through the use of case examples, learn to apply psychological interventions to patients with persistent post-concussive symptoms.
3. Learn to scale the interventions to match treatment context and individual needs.
COURSE 53
Feedback that Sticks: The Art of Communicating Neuropsychological Assessment Results
KAREN SPANGENBERG POSTAL, PH.D.
HARVARD MEDICAL SCHOOL
KIRA ARMSTRONG, PH.D.
PRIVATE PRACTICE
Communicating complex neuropsychological assessment results to patients who are cognitively impaired is a significant challenge every neuropsychologist must face. Recent surveys have shown that the majority of neuropsychologists (71%) in clinical practice conduct feedback sessions with patients. Yet, given the difficulty of the task, it is striking that there is almost nothing written about how to provide effective neuropsychological feedback. This workshop will share the art of communicating complex neuropsychological assessment results to cognitively impaired patients, their families, and other professionals. It will include a discussion of various approaches to the feedback process as well as clinical pearls - compelling feedback messages, metaphors, and stories that effectively synthesize complex information. The content of this workshop is based on the upcoming book, Feedback that Sticks: The Art of Communicating Neuropsychological Assessment Results, (Karen Postal and Kira Armstrong, co-authors) published by Oxford University Press that synthesizes the results of in-depth interviews with over 85 seasoned neuropsychologists. The book and workshop capture the best feedback philosophies, strategies, techniques and pearls shared by preeminent neuropsychologists across specialty areas and professional settings.
As a result of attending this presentation, the participant will be able to:
1. Summarize the clinical components of feedback that makes it an integral part of neuropsychological assessment practice.
2. Flexibly apply multiple competent strategies for providing feedback tailored to specific patient characteristics and set the stage for optimal patient “buy in”.
3. Distinguish between dry feedback techniques that create barriers to patient and family understanding of assessment results and recommendations, and techniques that facilitate buy in, and “stick” with patients long after the feedback session is over.
4. Summarize the six principals of making your feedback communications more meaningful and long lasting.
COURSE 54
Auditing: Documentation Standards and the Audit Experience
ANTONIO E. PUENTE, PH.D.
UNIVERSITY OF NORTH CAROLINA WILMINGTON
*This course is a repeat of course 46 from the morning session.
According to a recent article in The National Psychologist, an exponential increase in auditing will begin occurring in both Medicare and Medicaid cases and also in insurance-based reimbursement systems. While this change will necessitate increased documentation, benefits to the profession as a whole can be enumerated. These include increased patient care (particularly in light of the upcoming requirement for electronic medical records, EMR, by 2014), enhanced delineation of services (e.g., interview and testing, testing and intervention), and augmented professionalism and standards of practice. This presentation will include information regarding specific methods of auditing, suggestions and guidelines for proper documentation and billing, and strategies for dealing with audits and avoiding charges of fraud and abuse. Case presentations will assist in developing audience interaction. Ultimately, the presentation will highlight the manner in which proper documentation and preparation for audits may translate to improved quality of care for our patients.
As a result of attending this presentation, the participant will be able to:
1. Describe basic documentation and billing needed for service reimbursement and provision of high quality care.
2. Identify and explain reasons for the increase in audits from a variety of agencies and companies.
3. Develop strategies for decreasing the chance of being audited, and if audited, how to successfully meet that challenge.
4. Explain how attention to these challenges may improve quality of patient care.
COURSE 55
Neuropsychological Assessment of Bilingual Children in the U.S.
CLEMENTE VEGA, PSY.D.
CHILDREN’S HOSPITAL BOSTON AND HARVARD MEDICAL SCHOOL
GUSTAVO REY, PH.D.
MIAMI CHILDREN’S HOSPITAL
MONICA RIVERA MINDT, PH.D.
MOUNT SINAI SCHOOL OF MEDICINE
MONICA OGANES MURRAY, MA, EDS
FLORIDA ASSOCIATION OF SCHOOL PSYCHOLOGISTS
Over the past decade, research and clinical trends in neuropsychology have highlighted an increased need for competent assessment to accommodate a growing Hispanic population in the US. As a result, new assessment measures and Spanish-language adaptations of existing tests have become available. However, an increasing number of children are being raised in Spanish-English bilingual households, which has introduced new challenges for neuropsychologists entrusted to identify developmental language disorders, academic disabilities, and other neuropsychological syndromes in this population. In general, growing up bilingual is viewed mostly as beneficial for cognitive development, as research has documented better working memory, selective attention, cognitive flexibility, and reasoning ability in bilinguals compared to monolinguals, although some challenges in language skills have also been identified among bilinguals. The clinical practice of neuropsychology must consider the impact of bilingualism on brain development in order to accurately diagnose bilingual children and design appropriate treatment recommendations. We will present recent research advances on the impact of learning multiple languages on the developing brain, introduce available assessment tools that can be exercised in the US, and provide examples for clinical application.
As a result of attending this presentation, the participant will be able to:
1. Understand cultural and linguistic diversity of US populations, and the impact of growing up bilingual on brain development and achievement.
2. Select and appropriately use evaluation measures that test language skills, intelligence, academic achievement, executive functions, etc.
3. Apply these concepts to individual patients in order to provide accurate diagnosis and make treatment recommendations to optimize developmental outcomes.
