Peds Neuropsych Q

[psyfiguy]

I’m a Psy.D. student in my pre-doctoral internship year at a healthcare organization in the US. I’m interested in eventually specializing in pediatric neuropsychology. I have experience in pediatrics, CBT, doing assessments for schools, and for ADHD in healthcare settings. Unfortunately, neither my practicum experiences nor my internship offered anything in the way of practicing neuropsychology. Is there any way for me to still find a postdoc that would let me specialize in pediatric neuropsych? How can I still earn this specialization? Or should I let this go and look for something else?

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[WisNeuro]

If you have nothing beyond surface level experience in neuropsych at the grad school or internship level, most of the decent postdocs will not seriously consider your application. Postdoc is for advanced instruction and experience in that specialty area, not laying foundational groundwork. There may be some private practice postdocs, but I suspect the majority would be far from offering a curriculum that would enable you to be board eligible.

Are you going into your internship year, or are you just finishing up?

 

[psyfiguy]

If you have nothing beyond surface level experience in neuropsych at the grad school or internship level, most of the decent postdocs will not seriously consider your application. Postdoc is for advanced instruction and experience in that specialty area, not laying foundational groundwork. There may be some private practice postdocs, but I suspect the majority would be far from offering a curriculum that would enable you to be board eligible.

Are you going into your internship year, or are you just finishing up?

Thank you for responding.

My program had 4 courses on assessment (measurement/behavior, cognitive/achievement, social/emotional/personality, and neuropsych) and one biopsych/psychopharm class. I also took a neural foundations of behavior course in undergrad.

I’m just starting my internship year right now- I haven’t found any opportunities for things neuropsych related here yet. I am open to other ways to get more training.

 

[WisNeuro]

The coursework is good, but that's kind of the bare minimum. They want to see experience of application of that info. Are there no dedicated neuropsych rotations on your internship?

 

[psyfiguy]

We do not have any official neuropsych rotations. We do specialty evaluations throughout the year (e.g. ASD, ADHD), but that’s it.

 

[WisNeuro]

To put it bluntly, your prospects are not looking good for a decent neuropsych postdoc. You can try to emphasize as much assessment as you can on internship, but with just ADHD/ASD stuff, which isn't really neuropsych, you will not be very competitive at most legitimate postdocs. You are competing against people who generally did 2+ prac placements in neuropsych clinics at children's hospitals/AMCs during grad school and who are getting at least one dedicated neuropsych rotation on internship.

My advice would be to reach out to the npsych board at ABPP to see if one of the peds speciality people would be willing to talk to you about what kind of training experiences you can supplement with to make this work if you are really passionate about this. It will take A LOT of work outside of what you are already doing to obtain competence. Personally, I'd also be looking at non-neuro career options as well.

 

[psyfiguy]

Thank you for your honesty. I’ll look into the options you’ve suggested. This has been really helpful.

 

[R. Matey]

To put it bluntly, your prospects are not looking good for a decent neuropsych postdoc. You can try to emphasize as much assessment as you can on internship, but with just ADHD/ASD stuff, which isn't really neuropsych, you will not be very competitive at most legitimate postdocs. You are competing against people who generally did 2+ prac placements in neuropsych clinics at children's hospitals/AMCs during grad school and who are getting at least one dedicated neuropsych rotation on internship.

Serious question (no snark intended): Help me understand how neuropsych is an inclusive specialty if the doors are closed on reputable training experience to students who want to specialize later in their academic careers. Posts like these lead me to believe that basically if you didn't get it in grad school, the doors to the guild are slammed shut unless you want to take a PP postdoc, which are widely seen as inferior to the accredited postdoctoral programs. This, in my mind, essentially creates a two-tiered training system that shuts out people who may have known about neuropsychology until later in their training, but otherwise may have been fine neuropsychologists.

 

[WisNeuro]

Serious question (no snark intended): Help me understand how neuropsych is an inclusive specialty if the doors are closed on reputable training experience to students who want to specialize later in their academic careers. Posts like these lead me to believe that basically if you didn't get it in grad school, the doors to the guild are slammed shut unless you want to take a PP postdoc, which are widely seen as inferior to the accredited postdoctoral programs. This, in my mind, essentially creates a two-tiered training system that shuts out people who may have known about neuropsychology until later in their training, but otherwise may have been fine neuropsychologists.

I didn't say the doors were closed, just that the OP would have a good deal of ground to make up by unconventional channels. I don't think it has anything to do with inclusivity, as much as just pragmatics. There is a certain foundational set of knowledge and supervised experinece that is thought to be needed to be competent. Most people gain this through grad school. It's more efficient. It can be done later, but the infrastructure isn't really there. As for when you get this, I know a lot of people who decided later on in grad school that they wanted this, and they were able to gain the appropriate experience to make it happen on internship and get a good postdoc. I'd disagree about the two-tiered system, personally. It should be easier for those who specialize earlier. Those who specialize later can still do it, they just need to make up ground. That is the consequence of their decision.

 

[R. Matey]

I didn't say the doors were closed, just that the OP would have a good deal of ground to make up by unconventional channels.

I'm not saying you did. I'm just communicating my impressions.

I don't think it has anything to do with inclusivity, as much as just pragmatics. There is a certain foundational set of knowledge and supervised experinece that is thought to be needed to be competent. Most people gain this through grad school. It's more efficient. It can be done later, but the infrastructure isn't really there. As for when you get this, I know a lot of people who decided later on in grad school that they wanted this, and they were able to gain the appropriate experience to make it happen on internship and get a good postdoc. I'd disagree about the two-tiered system, personally. It should be easier for those who specialize earlier. Those who specialize later can still do it, they just need to make up ground.

We can agree that neuropsych is next level thus requiring time and effort to become competent. I'm glad to hear that other people were able to figure it out, but were they able to get a quality training experience or did they settle for a PP because they were competing with people who did two or more neuropsych pracs in graduate school?

That is the consequence of their decision.

Would you say that it also might be the effect of a training system that doesn't have the infrastructure to support re-specialization? When I did my generalist testing prac at the local AMC, I knew a handful of psychiatric residents that had been out of their MD 5-10 years before returning to residency to specialize. It seems like that similar mechanism doesn't really exist in neuropsych, but I'm open to being wrong.

 

[WisNeuro]

I'm not saying you did. I'm just communicating my impressions.



We can agree that neuropsych is next level thus requiring time and effort to become competent. I'm glad to hear that other people were able to figure it out, but were they able to get a quality training experience or did they settle for a PP because they were competing with people who did two or more neuropsych pracs in graduate school?


Would you say that it also might be the effect of a training system that doesn't have the infrastructure to support re-specialization? When I did my generalist testing prac at the local AMC, I knew a handful of psychiatric residents that had been out of their MD 5-10 years before returning to residency to specialize. It seems like that similar mechanism doesn't really exist in neuropsych, but I'm open to being wrong.

The few I know settled for a PP postdoc, after predictably not getting a postdoc in the match. As to the second point, I don't believe that the system has to set up contingencies to meet every situation. The onus is on the provider to get it done when it is outside the confines of the training sequence. Postdocs can take re-specialization providers, most choose not to. Those providers can pay someone for supervision and consultation, while gaining appropriate didactic experiences at their own expense, if they wish.

 

[R. Matey]

The few I know settled for a PP postdoc, after predictably not getting a postdoc in the match. As to the second point, I don't believe that the system has to set up contingencies to meet every situation. The onus is on the provider to get it done when it is outside the confines of the training sequence. Postdocs can take re-specialization providers, most choose not to. Those providers can pay someone for supervision and consultation, while gaining appropriate didactic experiences at their own expense, if they wish.

Appreciate it, I think it's important for students to know they need to start early if they want this path. If I were to wave a wand, I'd create non-predatory re-specialization programs for this and other psychology specialization paths.

 

[WisNeuro]

Appreciate it, I think it's important for students to know they need to start early if they want this path. If I were to wave a wand, I'd create non-predatory re-specialization programs for this and other psychology specialization paths.

No problem. Yeah, with most things, earlier the better. But, like I've said, I've seen plenty of people come to the table mid or late intro grad school. Still fairly easily doable, but, to start the process on internship, especially an internship with zero neuro experience, is a pretty tough go. I don't blame postdocs for not wanting to take students who are at the mid to late grad school level, for a postdoc position. The time suck of training that person is simply massive. And yeah, it'd be great to have non-Fielding options for re-specialization, but you have to have the funding source first.

 

[AcronymAllergy]

No problem. Yeah, with most things, earlier the better. But, like I've said, I've seen plenty of people come to the table mid or late intro grad school. Still fairly easily doable, but, to start the process on internship, especially an internship with zero neuro experience, is a pretty tough go. I don't blame postdocs for not wanting to take students who are at the mid to late grad school level, for a postdoc position. The time suck of training that person is simply massive. And yeah, it'd be great to have non-Fielding options for re-specialization, but you have to have the funding source first.

Agreed. At the fellowship level, it's not that the programs don't want to make up that ground (although some might not), it's that many/most aren't equipped to do so, and the time frame for fellowship is already pretty packed with extant training. There just isn't much time to cover foundational material, and to then afford the fellow time to fully understand it so they can then assimilate higher-level concepts.

Neuropsych is also a bit of an odd duck in that if you don't have a neuro-focused practicum, you really aren't going to learn much about it in grad school. Thus, there can be more material to cover than in many other situations. Plus, there's the seemingly-increasing trend of students getting less general assessment training in grad school.

 

[Therapist4Chnge]

I didn't say the doors were closed, just that the OP would have a good deal of ground to make up by unconventional channels. I don't think it has anything to do with inclusivity, as much as just pragmatics. There is a certain foundational set of knowledge and supervised experience that is thought to be needed to be competent. Most people gain this through grad school. It's more efficient. It can be done later, but the infrastructure isn't really there. As for when you get this, I know a lot of people who decided later on in grad school that they wanted this, and they were able to gain the appropriate experience to make it happen on internship and get a good postdoc. I'd disagree about the two-tiered system, personally. It should be easier for those who specialize earlier. Those who specialize later can still do it, they just need to make up ground. That is the consequence of their decision.

I am one of those people, though it took a lot of extra effort, strategic planning with my (non-neuro) mentor, and a bit of luck. I didn't really consider a neuropsych path until my 3rd year, though I had spent my first two years conducting research w a heavy emphasis on peds assessment. I also spent 6 months in the on-campus assessment clinic (through the research group) doing peds assessment. I didn't have a neuro mentor and I couldn't get into the neuro practicums bc they were highly competitive and I didn't have the required classes to apply for the neuro clinics in my 3rd year. I was able to take a number of classes outside of the program (Neuroanatomy I&II, Neurophysiology I&II, Organic Chemistry I&II), as well as take a more advanced stats class than was required. My fourth year was spent in a non-neuro practicum, taking more classes, and finishing my research to defend. I later enrolled in a campus-based Pharmacology program and then took a (5th) gap year to finish those classes while I continued to do research, TA, and apply to internship sites.

I did my internship site ranking based on who would be the best neuro mentor fit for me. I matched to a generalist program, though I worked primarily with an amazing neuro mentor and basically negotiated with my DCT to get as much neuro assessment experience as possible. I had other rotation supervisors with neuro training who were willing to work with me on cases. I was at a large VA hospital who happened to get a large influx of OEF/OIF veterans who needed TBI assessments, so I got lucky in some regard that I could take on additional neuro cases and also do TBI related C&P evals. It was a little rocky at times because I had to complete my regular internship duties (like therapy, ugh) and also squeeze in a ton of supplemental reading of articles. Since I had defended prior to going on internship, and the rest of my internship cohort had not, I was able to use the protected "research" time each week to review case studies w my mentor, who also taught me how to review imaging studies and interpret imaging reports.

Applications for fellowship spots started Dec 1st, so I tried to get as much setup in my rotations as I could, so I could talk about what I was doing to add to my foundational learning. I secured strong letters of rec. I benefited from personal connections I had made over the years for mentors who could vouch for my abilities, even though I didn't have a traditional training path for neuro. Connections matter in neuro, for better or worse. My pharma training added another dozen classes to my experience, and eventually I was able to secure a highly-competitive fellowship spot. I share all of this not to brag, but to demonstrate that it took *a lot* of extra work. I still had some weaknesses in my training that I had to address during my fellowship years, but I also had some strengths that made aspects of my fellowship easier. I still felt behind at times because I just didn't have the volume of neuropsych evals that the other fellows had, and my exposure to some adult measures was less. I did have other knowledge like more exposure and experience w peds assessments & associated research, so during the Adult & Peds combined didactics I could offer more. I also developed an excellent grasp on neuroanatomy and had a lot more knowledge about pharmacology, so brain cutting didactics w the pathology residents and team rounds were times when I could excel.

To the OP, you are definitely in a challenging position. Wis gave good advice about reaching out the the board and inquiring. They can best speak to competitiveness and what other options you may have if you aren't competitive for neuro-match. Depending on your other interests, maybe Rehab Psych or Health Psych might offer some of what you want, but they aren't the same as a more trad neuro career and I'd advise being pretty conservative with the types of assessments you consider offering. Pre-surg evals aren't heavy lifting if you know the supporting research, though I wouldn't suggest trying to do full battery assessments and doing everything soup to nuts bc you won't know what you don't know.

 

[Therapist4Chnge]

Agreed. At the fellowship level, it's not that the programs don't want to make up that ground (although some might not), it's that many/most aren't equipped to do so, and the time frame for fellowship is already pretty packed with extant training. There just isn't much time to cover foundational material, and to then afford the fellow time to fully understand it so they can then assimilate higher-level concepts.

I liken fellowship as "drinking from the fire hose." It's a great time to learn and soak up as much knowledge as you can, but if you don't have a solid foundation, it can just be a lot to sort through and organize in an already crammed day. I closed some of the gap during my internship year to build on my foundation, but I definitely struggled at times on fellowship to connect A-->B--> C on the fly. I took a ton of notes and would review them/ask questions later to make sure I understood what I needed to know.

Neuropsych is also a bit of an odd duck in that if you don't have a neuro-focused practicum, you really aren't going to learn much about it in grad school. Thus, there can be more material to cover than in many other situations. Plus, there's the seemingly-increasing trend of students getting less general assessment training in grad school.

Not having a traditional neuro practicum was definitely a drawback. I just didn't have the volume of cases to break down (done during supervision or group review), so I was slow in the beginning on internship during case reviews. Writing 20 page reports in practicum wasn't a huge loss, but knowing what to cut and why was the important part of that process. Being able to distill down data, organize it in such a way that makes sense, view it within the context of the case, and write a concise two paragraph summary is what differentiates a neuropsych from a generalist who does a lot of IQ assessment, etc. There is just a lot more than just the data to consider when doing assessment work.