Clinical neuropsychology
Encyclopedia
Clinical neuropsychology is a sub-field of psychology
Psychology
Psychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...

 concerned with the cognitive function of individuals with neurological
Neurological disorder
A neurological disorder is a disorder of the body's nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord, or in the nerves leading to or from them, can result in symptoms such as paralysis, muscle weakness, poor coordination, loss of sensation, seizures,...

 and psychiatric disorders. Neuropsychological assessment
Neuropsychological assessment
Neuropsychological assessment was traditionally carried out to assess the extent of impairment to a particular skill and to attempt to locate an area of the brain which may have been damaged after brain injury or neurological illness...

 examines cognitive function in the broadest sense, including the behavioural, emotional, social and functional status of patients. Assessment is primarily by way of neuropsychological tests, but also includes patient history, qualitative observation and may draw on findings from neuroimaging and other diagnostic medical procedures. Clinical neuropsychology requires knowledge of: neuroanatomy
Neuroanatomy
Neuroanatomy is the study of the anatomy and organization of the nervous system. In contrast to animals with radial symmetry, whose nervous system consists of a distributed network of cells, animals with bilateral symmetry have segregated, defined nervous systems, and thus we can begin to speak of...

, neurobiology, psychopharmacology
Psychopharmacology
Psychopharmacology is the scientific study of the actions of drugs and their effects on mood, sensation, thinking, and behavior...

 and neurological illness or injury.

Assessment

Neuropsychologists use models of brain-behavior relationships to determine whether expected neurobehavioral function is different from normal, or has changed to a degree that is consistent with impairment. Findings may be augmented with neuroimaging (PET
Positron emission tomography
Positron emission tomography is nuclear medicine imaging technique that produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide , which is introduced into the body on a...

, MRI, fMRI etc). Such relationships are demonstrated through the interpretation of performance that is derived from a variety of specialized assessment procedures. An example of one commonly used instruments is the Weschler Adult Intelligence Scale IV, which provides an interpretable Intelligent Quotient (IQ). Thus, the domain of neuropsychologists is expressed brain function: for example, reasoning/problem-solving, learning/recall processes, selective attention/concentration processes, perception, sensation, language processes, controlled/directed movement processes. Serial neuropsychological examinations may be used to monitor deteriorating neurobehavioral performance (as with dementing disorders) or to monitor improving neurobehavioral function (as during the recovery after an acquired brain injury or in response to pharmacological or surgical intervention). Some neuropsychologists, who specialize in childhood neurodevelopmental and acquired disorders, specialize in the differing course of learning, behavioral and social development that results from genetic, congenital, and acquired changes in the brain structure and function of children.

What distinguishes a clinical neuropsychologist from other clinical psychologists is a more extensive knowledge of the brain, including an increased understanding of areas such as:neuroanatomy
Neuroanatomy
Neuroanatomy is the study of the anatomy and organization of the nervous system. In contrast to animals with radial symmetry, whose nervous system consists of a distributed network of cells, animals with bilateral symmetry have segregated, defined nervous systems, and thus we can begin to speak of...

, neurobiology, psychopharmacology
Psychopharmacology
Psychopharmacology is the scientific study of the actions of drugs and their effects on mood, sensation, thinking, and behavior...

, neurological illness or injury, the use of neuropsychological test
Neuropsychological test
Neuropsychological tests are specifically designed tasks used to measure a psychological function known to be linked to a particular brain structure or pathway. Tests are used for research into brain function and in a clinical setting for the diagnosis of deficits. They usually involve the...

s to accurately assess cognitive deficits, and the management, treatment and rehabiliation
Rehabilitation (neuropsychology)
Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that has been diminished by disease or traumatic injury....

 of brain injured
Acquired brain injury
An acquired brain injury is brain damage caused by events after birth, rather than as part of a genetic or congenital disorder such as fetal alcohol syndrome, perinatal illness or perinatal hypoxia. ABI can result in cognitive, physical, emotional, or behavioural impairments that lead to permanent...

 and neurocognitive
Neurocognitive
Neurocognitive is a term used to describe cognitive functions closely linked to the function of particular areas, neural pathways, or cortical networks in the brain substrate layers of neurological matrix at the cellular molecular level...

ly impaired patients. Clinical neuropsychologists perform a number of tasks, usually within a clinical setting. They are often involved in conducting neuropsychological assessment
Neuropsychological assessment
Neuropsychological assessment was traditionally carried out to assess the extent of impairment to a particular skill and to attempt to locate an area of the brain which may have been damaged after brain injury or neurological illness...

s to assess a person's cognitive skills, usually after some sort of brain injury or neurological impairment. This may be for the purposes of planning treatments, to determine someone's neurocognitive functioning or mental capacity (often done for presentation as evidence in court cases or legal proceedings) or to detect changes over time.

A clinical neuropsychologist's typical caseload may include people with traumatic brain injury
Traumatic brain injury
Traumatic brain injury , also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism , or other features...

 (TBI), cerebrovascular accidents (CVA) such as stroke and aneurysm
Aneurysm
An aneurysm or aneurism is a localized, blood-filled balloon-like bulge in the wall of a blood vessel. Aneurysms can commonly occur in arteries at the base of the brain and an aortic aneurysm occurs in the main artery carrying blood from the left ventricle of the heart...

 ruptures, brain tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...

s, encephalitis
Encephalitis
Encephalitis is an acute inflammation of the brain. Encephalitis with meningitis is known as meningoencephalitis. Symptoms include headache, fever, confusion, drowsiness, and fatigue...

, epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...

/seizure disorders, dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...

s, mental illnesses (e.g. schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

), and a wide range of developmental disorder
Developmental disorder
Developmental disorders occur at some stage in a child's development, often retarding the development. These may include,psychological or physical disorders. The disorder is an impairment in the normal development of motor or cognitive skills that are developed before age 18 in which they are...

s, including attention-deficit/hyperactivity disorder (ADHD), learning disabilities, autism
Autism
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...

 and Tourette's syndrome
Tourette syndrome
Tourette syndrome is an inherited neuropsychiatric disorder with onset in childhood, characterized by multiple physical tics and at least one vocal tic; these tics characteristically wax and wane...

.

Clinical neuropsychologists' training has included methods of psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

 and counseling. They can also provide therapeutic services to patients in need of education and emotional support concerning their neurological injuries or illness.
They are frequently active in teaching at the university level and conducting research into a wide range of issues concerning human brain-behavior relationships. Some clinical neuropsychologists are also employed by pharmaceutical companies to help develop and test neuropsychological assessment tools for use in clinical trials.

The practice of cognitive neuropsychology
Cognitive neuropsychology
Cognitive neuropsychology is a branch of cognitive psychology that aims to understand how the structure and function of the brain relates to specific psychological processes. It places a particular emphasis on studying the cognitive effects of brain injury or neurological illness with a view to...

 and cognitive neuropsychiatry
Cognitive neuropsychiatry
Cognitive neuropsychiatry is a sub-discipline of psychology and psychiatry that aims to understand mental illness and psychopathology in terms of models of normal psychological function. It is also a way of uncovering normal psychological processes by studying the effects of their change or...

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

Educational requirements of different countries

The educational requirements for becoming a clinical neuropsychologist differ between countries. In some countries it may be necessary to complete a clinical psychology
Clinical psychology
Clinical psychology is an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development...

 degree, before specialising with further studies in clinical neuropsychology. While some countries offer clinical neuropsychology to students who have completed 4 years of psychology
Psychology
Psychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...

 studies. All clinical neuropsychologists require a post graduate qualification, whether it be Masters or Doctorate (Ph.D, Psy.D. or D.Psych
Doctor of Psychology
The Doctor of Psychology degree is a professional doctorate earned through one of two established training models for clinical psychology...

).

Australia

To become a clinical neuropsychologist in Australia requires the completion of a 3-year Australian Psychology Accreditation Council
Australian Psychology Accreditation Council
The Australian Psychology Accreditation Council is a not-for-profit organisation appointed by the Australian Government to assess university level psychological education and training in Australasia. APAC assesses and accredits undergraduate, honours and postgraduate psychology courses...

 (APAC) approved undergraduate degree in psychology, a 1-year psychology honours, followed by a 2-year Masters or 3-year Doctorate of Psychology (D.Psych) in clinical neuropsychology. These courses involve coursework (lectures, tutorials, practicals etc.), supervised practice placements and the completion of a thesis.
Masters and D.Psych courses involve the same amount of coursework units, but differ in the amount of supervised placements undertaken. Masters courses require a minimum of 1,000 hours (125 days) and D.Psych courses require a minimum of 1,500 hours (200 days), it is mandatory that these placements expose students to acute neurology/neurosurgery, rehabilitation, psychiatric, geriatric and paediatric populations. The Australian Psychological Society does not specify a minimum word count for the research component of either degree, but this is generally around 15,000 words or more.
Entry to these courses is very competitive and is generally decided on the basis of academic merit (a H1 or H2A honours mark), referee reports and an interview process.
Australian universities offering a D.Psych or Masters degree in clinical neuropsychology include: La Trobe University
La Trobe University
La Trobe University is a multi-campus university in Victoria, Australia. It was established in 1964 by an Act of Parliament to become the third oldest university in the state of Victoria. The main campus of La Trobe is located in the Melbourne suburb of Bundoora; two other major campuses are...

, Macquarie University
Macquarie University
Macquarie University is an Australian public teaching and research university located in Sydney, with its main campus situated in Macquarie Park. Founded in 1964 by the New South Wales Government, it was the third university to be established in the metropolitan area of Sydney...

, Monash University
Monash University
Monash University is a public university based in Melbourne, Victoria. It was founded in 1958 and is the second oldest university in the state. Monash is a member of Australia's Group of Eight and the ASAIHL....

, University of Queensland
University of Queensland
The University of Queensland, also known as UQ, is a public university located in state of Queensland, Australia. Founded in 1909, it is the oldest and largest university in Queensland and the fifth oldest in the nation...

, University of Sydney
University of Sydney
The University of Sydney is a public university located in Sydney, New South Wales. The main campus spreads across the suburbs of Camperdown and Darlington on the southwestern outskirts of the Sydney CBD. Founded in 1850, it is the oldest university in Australia and Oceania...

 and University of Western Australia
University of Western Australia
The University of Western Australia was established by an Act of the Western Australian Parliament in February 1911, and began teaching students for the first time in 1913. It is the oldest university in the state of Western Australia and the only university in the state to be a member of the...

.
Depending on the university, courses may be offered as Commonwealth supported places
Tertiary education in Australia
Tertiary education in Australia is primarily study at University or a Technical college in order to receive a qualification or further skills and training....

 (HECS/HELP) or full-fee courses.

Canada

Clinical neuropsychology courses are offered at the following Canadian universities:Université de Montréal
Université de Montréal
The Université de Montréal is a public francophone research university in Montreal, Quebec, Canada. It comprises thirteen faculties, more than sixty departments and two affiliated schools: the École Polytechnique and HEC Montréal...

, University of Victoria
University of Victoria
The University of Victoria, often referred to as UVic, is the second oldest public research university in British Columbia, Canada. It is a research intensive university located in Saanich and Oak Bay, about northeast of downtown Victoria. The University's annual enrollment is about 20,000 students...

 and University of Windsor
University of Windsor
The University of Windsor is a public comprehensive and research university in Windsor, Ontario, Canada. It is Canada's southernmost university. It has a student population of approximately 15,000 full-time and part-time undergraduate students and over 1000 graduate students...

.

United States

In the USA, a neuropsychologist is a clinical psychologist who, in addition to completing a Doctoral Degree in Clinical Psychology (with a focus on the neuro-anatomical and neurotransmitter bases of behavior), also completes a Clinical Internship (1 year) and specialized Post-Doctoral training in Clinical Neuropsychology. Such Post-Doctoral training (i.e. Fellowship/Residency) currently ranges from 2 to 4 years.
In the US, clinical neuropsychologists who have obtained the training needed to practice in this specialty can be identified by their board certification. The American Board of Clinical Neuropsychology, The American Board of Professional Neuropsychology, and The American Board of Pediatric Neuropsychology all award board certification to neuropsychologists that demonstrate competency in specific areas of neuropsychology, by requiring a review of the neuropsychologist's training, experience, submitted case samples, and both written and oral examinations.

Most American states do not permit clinical neuropsychologists to prescribe medications. However, psychotropic medications can be prescribed by clinical neuropsychologists in New Mexico, Louisiana, Guam or who work for the Department of Defense or the Public Health Service, after the completion of post-doctoral training in clinical psychopharmacology.

Clinical neuropsychology courses are offered at the following US universities:
Adler School of Professional Psychology
Adler School of Professional Psychology
Adler School of Professional Psychology is a non-profit institution of higher education and independent graduate school of psychology located in Chicago, Illinois and Vancouver, British Columbia. Founded in 1952 as The Adler Institute, the school offers a doctorate in clinical psychology and...

,
Ananda Institute,
Argosy University
Argosy University
Argosy University is a for-profit university owned by Education Management Corporation, with 19 locations in 13 U.S. states and online. The university offers numerous programs at various levels, including certification; associates, bachelors, masters, specialist, and doctoral degrees, postdoctoral...

 (Seattle, Chicago & Atlanta campuses),
Binghamton University
Binghamton University
Binghamton University, also formally called State University of New York at Binghamton, , is a public research university in the State of New York. The University is one of the four university centers in the State University of New York system...

,
Brigham Young University
Brigham Young University
Brigham Young University is a private university located in Provo, Utah. It is owned and operated by The Church of Jesus Christ of Latter-day Saints , and is the United States' largest religious university and third-largest private university.Approximately 98% of the university's 34,000 students...

,
City University of New York
City University of New York
The City University of New York is the public university system of New York City, with its administrative offices in Yorkville in Manhattan. It is the largest urban university in the United States, consisting of 23 institutions: 11 senior colleges, six community colleges, the William E...

,
Drexel University
Drexel University
Drexel University is a private research university with the main campus located in Philadelphia, Pennsylvania, USA. It was founded in 1891 by Anthony J. Drexel, a noted financier and philanthropist. Drexel offers 70 full-time undergraduate programs and accelerated degrees...

,
F. R. Carrick Institute
F. R. Carrick Institute
The F. R. Carrick Institute for Clinical Ergonomics, Rehabilitation, and Applied Neuroscience of Leeds Metropolitan University, England consists of a faculty of world class scientists and clinical researchers in Biomedical Engineering and Rehabilitation, Experimental Psychology and Adult and...

,
Florida Institute of Technology
Florida Institute of Technology
Florida Institute of Technology, also known as Florida Tech, is an independent private technical research university located in Melbourne, Florida, United States. Founded in 1958 as Brevard Engineering College, the institute has been known by its present name since 1966. Florida Tech's curriculum...

,
Fordham University
Fordham University
Fordham University is a private, nonprofit, coeducational research university in the United States, with three campuses in and around New York City. It was founded by the Roman Catholic Diocese of New York in 1841 as St...

,
Forest Institute
Forest Institute
The School of Professional Psychology at the Forest Institute in Springfield, Missouri is a private non-profit academic institution that was founded in 1979 to provide, "an alternative to the traditional teaching Ph.D...

,
Illinois School of Professional Psychology,
Northwestern University
Northwestern University
Northwestern University is a private research university in Evanston and Chicago, Illinois, USA. Northwestern has eleven undergraduate, graduate, and professional schools offering 124 undergraduate degrees and 145 graduate and professional degrees....

,
Nova Southeastern University
Nova Southeastern University
Nova Southeastern University, commonly referred to as NSU or Nova, is a private, coeducational, nonsectarian, research university located in Broward County, Florida, with its main campus in the town of Davie...

,
Pacific University
Pacific University
Pacific University is a private university located in Oregon, United States. The first campus began more than 160 years ago and is located about 38 km west of Portland in Forest Grove...

,
San Diego State University
San Diego State University
San Diego State University , founded in 1897 as San Diego Normal School, is the largest and oldest higher education facility in the greater San Diego area , and is part of the California State University system...

-University of California
University of California
The University of California is a public university system in the U.S. state of California. Under the California Master Plan for Higher Education, the University of California is a part of the state's three-tier public higher education system, which also includes the California State University...

 (Joint Doctoral Program),
Temple University
Temple University
Temple University is a comprehensive public research university in Philadelphia, Pennsylvania, United States. Originally founded in 1884 by Dr. Russell Conwell, Temple University is among the nation's largest providers of professional education and prepares the largest body of professional...

,
University of Cincinnati
University of Cincinnati
The University of Cincinnati is a comprehensive public research university in Cincinnati, Ohio, and a part of the University System of Ohio....

,
University of Connecticut
University of Connecticut
The admission rate to the University of Connecticut is about 50% and has been steadily decreasing, with about 28,000 prospective students applying for admission to the freshman class in recent years. Approximately 40,000 prospective students tour the main campus in Storrs annually...

,
University of Florida
University of Florida
The University of Florida is an American public land-grant, sea-grant, and space-grant research university located on a campus in Gainesville, Florida. The university traces its historical origins to 1853, and has operated continuously on its present Gainesville campus since September 1906...

,
University of Georgia
University of Georgia
The University of Georgia is a public research university located in Athens, Georgia, United States. Founded in 1785, it is the oldest and largest of the state's institutions of higher learning and is one of multiple schools to claim the title of the oldest public university in the United States...

,
University of Houston
University of Houston
The University of Houston is a state research university, and is the flagship institution of the University of Houston System. Founded in 1927, it is Texas's third-largest university with nearly 40,000 students. Its campus spans 667 acres in southeast Houston, and was known as University of...

,
University of Kentucky
University of Kentucky
The University of Kentucky, also known as UK, is a public co-educational university and is one of the state's two land-grant universities, located in Lexington, Kentucky...

,
University of Massachusetts
University of Massachusetts
This article relates to the statewide university system. For the flagship campus often referred to as "UMass", see University of Massachusetts Amherst...

,
University of South Florida
University of South Florida
The University of South Florida, also known as USF, is a member institution of the State University System of Florida, one of the state's three flagship universities for public research, and is located in Tampa, Florida, USA...

,
University of Utah
University of Utah
The University of Utah, also known as the U or the U of U, is a public, coeducational research university in Salt Lake City, Utah, United States. The university was established in 1850 as the University of Deseret by the General Assembly of the provisional State of Deseret, making it Utah's oldest...

,
University of Wisconsin,
Washington State University
Washington State University
Washington State University is a public research university based in Pullman, Washington, in the Palouse region of the Pacific Northwest. Founded in 1890, WSU is the state's original and largest land-grant university...

,
Washington University,
Wayne State University
Wayne State University
Wayne State University is a public research university located in Detroit, Michigan, United States, in the city's Midtown Cultural Center Historic District. Founded in 1868, WSU consists of 13 schools and colleges offering more than 400 major subject areas to over 32,000 graduate and...

 and
Yeshiva University
Yeshiva University
Yeshiva University is a private university in New York City, with six campuses in New York and one in Israel. Founded in 1886, it is a research university ranked as 45th in the US among national universities by U.S. News & World Report in 2012...

.
Many clinical neuropsychologists are employed by medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...

s and hospitals, especially neurology, psychiatry, and rehabilitation facilities. Some work in private practice.

Clinical neuropsychology journals

The following represents an (incomplete) listing of significant journals in or related to the field of clinical neuropsychology.
  • Applied Neuropsychology
  • Archives of Clinical Neuropsychology
  • Archives of Neurology
    Archives of Neurology
    Archives of Neurology is a monthly peer-reviewed medical journal published by the American Medical Association. Archives of Neurology publishes research on the nervous system as well as the various mechanisms of Neurological disease....

  • Brain
    Brain (journal)
    Brain is a neurological journal published by Oxford University Press. It was edited by John Newsom-Davis from 1997 to 2004. Under his editorship it became one of the first scientific journals to go online. Since 2004 the journal is edited by Alastair Compston, Professor and Head of Department of...

  • Child Neuropsychology
  • The Clinical Neuropsychologist
  • Cognitive Neuropsychology
  • Cortex
    Cortex (journal)
    Cortex is a scientific journal published semimonthly by Elsevier. It is devoted to the study of "cognition and of the relationship between the nervous system and mental processes". The journal was founded in 1964 and is currently edited by Sergio Della Sala....


  • Journal of Cognitive Neuroscience
    Journal of Cognitive Neuroscience
    The Journal of Cognitive Neuroscience is a peer-reviewed academic journal for scientific research on cognitive neuroscience and the interaction between brain and behavior...

  • Journal of the International Neuropsychological Society
  • Neurocase
    Neurocase
    Neurocase is a peer-reviewed journal specializing in case studies in the neuropsychology, neuropsychiatry and behavioral neurology of adults and children. The publisher also maintains a database of all patients from the various studies and articles for reference by Neurocase subscribers...

  • Neuropsychologia
    Neuropsychologia
    Neuropsychologia is a peer-reviewed scientific journal that focuses on cognitive neuroscience. It was established in 1963, and is published by Elsevier....

  • Neuropsychological Rehabilitation
  • Neuropsychology
  • Neuropsychology Review
    Neuropsychology Review
    Neuropsychology Review is a review journal published by Springer addressing topics in neurology....

  • Psychological Assessment


Further reading

  • Broks, P. (2003) Into the Silent Land: Travels in Neuropsychology. ISBN
  • Halligan, P.W., Kischka, U, & Marshall, J.C. (Eds.) (2003) Handbook of Clinical Neuropsychology. Oxford University Press. ISBN
  • Lezak, M.D. (2004). Neuropsychological Assessment (4th ed.). New York: Oxford University Press.
  • Snyder, P.J, Nussbaum, P.D., & Robins, D.L. (Eds.) (2005) Clinical Neuropsychology: A Pocket Handbook for Assessment, Second Edition. American Psychological Association. ISBN
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