Opinions about child psychology and neuropsychology as career paths?

[August2008]

In thinking about clinical psych career paths, there are 2 that interest me most (in no particular oder):
1) Child clinical
2) Clinical neuropsych

What are your opinions regarding the future of these specialized paths? Which area do you think offers most job opportunities? In which area do you think there is a greater need for professionals? Which area (if any) do you think is more well-regarded?
Any thoughts/opinions would be greatly appreciated!! Any sources to back up opinions would also be great.
I am so torn...

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[BuckeyeAlum]

Why not find a way to do both? There are a bunch of pediatric neuropsych PIs out there! You would get the best of both that way!

I'm a ped psych person, so I'm biased re. my opinion of child clinical. I think that neuropsych is really promising right now though, so not a bad way to go.

 

[MiJac]

Thats what I plan to do, child assessments at a PNI

I wouldn't also mind ending up in the courts for forensic psych too

actually anything with assessments turns me on so whoever will take me I would love to work there

 

[VeggieDelight]

Why not find a way to do both? There are a bunch of pediatric neuropsych PIs out there! You would get the best of both that way!

I'm a ped psych person, so I'm biased re. my opinion of child clinical. I think that neuropsych is really promising right now though, so not a bad way to go.

I second the ped. neuropsych advice. It's a good field to get into because you can do anything from LD in schools, to neurogenetic/developmental disorders, to forensic. Not exactly where I see myself clinically, but I think it would yield some great career options for you.

 

[RileyG]

univ of southern mississippi has several great faculty members who specialize in child neuropysch.

 

[Therapist4Chnge]

I think both areas have great promise, though it depends what you want to do. I admittedly don't know as much about child work, though all of the normal areas of practice apply AND some additional areas in school. Competition will include non-doctoral therapist (A LOT of them) and also school psychologists.

One of the biggest challenge working with children....their parents. There will probably be a good amount of time you can't bill for, and then more time you will spend that will get questioned when you bill it. There are things you can do to minimize non-billable time, but it is still a consideration.

Neuropsychology is a great area, though not without its own pitfalls. The path is very competitive (if you want to be ABPP boarded), and it attracts a lot of over-achievers. One of the biggest threats to neuropsychology is declining reimbursements and marginalization. Many jobs don't offer that much more for a neuropsychologist, though a boarded neuropsychologist can do quite well if they find their niche.

As for combining the two.....the most competitive. There are far fewer ped neuro post-doc fellowships, though if you can get licensed and boarded, it can offer some nice $. You'll still deal with a lot of the same issues as I listed working with children, AND you are much more likely to be sued and/or dragged into court if the parents get pissed off.

Any of these routes can yield a great career, though you can still struggle if you don't get quality training, attend the right programs, internships, post-docs, etc. This doesn't mean you need to attend a "top" program, but everything needs to be APA-acred, and you need good mentorship throughout. These areas have a lot of generalists who get into positions well after they are licensed, and they aren't adequately trained. It can degrade the field and also increase your liability. I see it most in neuro, but I am sure there are people who work with kids who didn't have previous experience and/or haven't seen a kid since early on in graduate school.

 

[AcronymAllergy]

I think both areas have great promise, though it depends what you want to do. I admittedly don't know as much about child work, though all of the normal areas of practice apply AND some additional areas in school. Competition will include non-doctoral therapist (A LOT of them) and also school psychologists.

One of the biggest challenge working with children....their parents. There will probably be a good amount of time you can't bill for, and then more time you will spend that will get questioned when you bill it. There are things you can do to minimize non-billable time, but it is still a consideration.

Neuropsychology is a great area, though not without its own pitfalls. The path is very competitive (if you want to be ABPP boarded), and it attracts a lot of over-achievers. One of the biggest threats to neuropsychology is declining reimbursements and marginalization. Many jobs don't offer that much more for a neuropsychologist, though a boarded neuropsychologist can do quite well if they find their niche.

As for combining the two.....the most competitive. There are far fewer ped neuro post-doc fellowships, though if you can get licensed and boarded, it can offer some nice $. You'll still deal with a lot of the same issues as I listed working with children, AND you are much more likely to be sued and/or dragged into court if the parents get pissed off.

Any of these routes can yield a great career, though you can still struggle if you don't get quality training, attend the right programs, internships, post-docs, etc. This doesn't mean you need to attend a "top" program, but everything needs to be APA-acred, and you need good mentorship throughout. These areas have a lot of generalists who get into positions well after they are licensed, and they aren't adequately trained. It can degrade the field and also increase your liability. I see it most in neuro, but I am sure there are people who work with kids who didn't have previous experience and/or haven't seen a kid since early on in graduate school.

Agreed on both fronts. I was just speaking with someone the other day about how much demand there appears to be for pediatric neuropsych in comparison to the supply. I personally could probably count on one hand the number of students I've met at conferences who're planning on going the "kiddie" neuropsych route.

That being said, it leads to a lot of the problems we're seeing in the second bolded point above--either generally-trained child clinical psychologists attempting to bill themselves as neuropsychologists, or adult neuropsychologists attempting to venture blindly into the child arena. The latter is, in my opinion, just slightly more forgivable than the former, given that there is at least a base of neuropsychological knowledge and training from which to draw.

However, as forensic challenges in these cases increase, and as board certification in neuropsychology becomes more common, I'd imagine there will be fewer people willing to risk deposition and/or cross-examination regarding their findings and interpretations if they don't have concrete proof of their competence in the specialty.

 

[Therapist4Chnge]

This is an area of frustration for me, so pardon my long response....

That being said, it leads to a lot of the problems we're seeing in the second bolded point above--either generally-trained child clinical psychologists attempting to bill themselves as neuropsychologists, or adult neuropsychologists attempting to venture blindly into the child arena. The latter is, in my opinion, just slightly more forgivable than the former, given that there is at least a base of neuropsychological knowledge and training from which to draw.

Sometimes it is the practitioner, and other times it is the employer, but in the end people are in a position to practice outside of their scope of practice. It can particularly be a challenge for school psychologists, who often get a referral that is better handled by a peds neuro person, but they are stuck between a rock and a hard place. Some school systems refer out for assessment (and therapy), while others try to keep it in-house to keep costs down. A mediocre clinician can clean up if they can establish a good relationship with a school system. A good clinician can go cash pay and maximize their $$ in the right situation.

Speaking of proper training....I did a year-long therapy/assessment/consultation rotation through a school system, have an extensive assessment background (including adult neuro), have multiple years of research with children, and I STILL wouldn't feel comfortable seeing a child for a neuro assessment without direct supervision and mentorship. Most of my favorite neuro assessments weren't normed on children, and I'd have to add a considerable number of assessments to my list and read up on the various supporting research to even select a halfway decent battery. To complicate things further, I'd need to understand how developmental milestones impact each assessment, how well or not so well each assessment generalizes to the others, and then know how childhood learning disorders and medical complications could be impacting the child's performance.

The issue is that many generalists don't know what they don't know about neuropsychology, let alone peds neuro. It is one thing to receive supervision and mentorship while doing it, but it is completely different when you are practicing solo and on your own license. This topic is popular on listservs: "I was asked to do an assessment on [a population I don't normally see] and [in an area I am not that familar]. What do I need to get up to speed?" In smaller communities I am sure it happens more often, because there are very few generalists, let alone speciality-trained psychologists. It is important for the professional to protect him or herself from potential legal and professional liability.

However, as forensic challenges in these cases increase, and as board certification in neuropsychology becomes more common, I'd imagine there will be fewer people willing to risk deposition and/or cross-examination regarding their findings and interpretations if they don't have concrete proof of their competence in the specialty.

I had a professor in graduate school who would drill home this point. There are a handful of seasoned professions who will get a pass for credentials because they have been testifying for decades....but everyone else is definitely at risk to having to answer some very pointed questions about training, at least until they are a "regular" in the system. There is definitely money to be made in this setting, but a good lawyer can make a mediocre psychologist look incompetent if the psychologist doesn't have a solid background and isn't coached about how to address "credential" related issues.

 

[August2008]

Than you all so much for your comments. After reading through them, I realized that what I am most confused about is the difference between a regular child clinical psychologist and a clinical neuropsychologist (who works with children). What is one qualified to do that the other isn't? Can't the neuropsychologist provide the same services as other psychologist PLUS the neuro? So wouldn't that give the neuropsychologist an advantage? I'm having a hard time understand what the difference is here. Would it be that the regular child psychologist deals more with emotional/social mental health issues whereas the neuropsychologist deals more with cognitive issues?