Future of neuropsychology?

[Psychology 76]

Hi all, I've been pondering this for awhile now. I've heard a lot of opinions and speculations but not directly from this current board of SDN. I was fortunate to get a neuropsych internship and I do love it and I would love to be a neuropsychologist someday. Any thoughts on where this field is going? I've heard from some that neuropsych will die out due to the growing use of computers for tests and I've heard others say that neuropsych is a hot field in psychology that will continue to grow stronger and stronger. I always like hearing different points of view so what do you think about the future of clinical neuropsychology?

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[Regression]

I know cog and behavioral neuro are hot things in experimental

I don't think clinical np will die out anytime soon--probably make a surge in the near future, too

 

[Ollie123]

Any thoughts on where this field is going? I've heard from some that neuropsych will die out due to the growing use of computers for tests and I've heard others say that neuropsych is a hot field in psychology that will continue to grow stronger and stronger.

Don't really know enough about neuropsych to be qualified to comment, but even so, here I go

As for computerized testing...I've heard that concern voiced here before. Maybe there are super-complex tests out there I'm not aware of, but for the most part, I don't feel like administering a test is a doctoral level skill. Maybe something semi-structured like the SCID is. Certainly the clinical interview should be done by someone with extensive training. However, you could probably train a high schooler to administer any fully structured test as long as they were sufficiently motivated. It takes time, it takes training. Right now, these are generally what computers are doing.

Interpretation is a whole different ballgame. Computers suck at it. Check out a PAI printout. Will this change sometime in our lifetime? Maybe, but I don't see it happening anytime soon. AI is just not there yet. So far, computers aren't even at the state where they can displace bachelor's level psychometricians. That will have to happen DECADES before they could even stand a chance at displacing doctoral level neuropsychs.

As for the general state of the field I will add this. I think anyone who wants to be remotely respected as a psychologist in the upcoming decades is going to need to be strong on biology, neuroscience, etc. The time when psychology was closer to philosophy than to the sciences is over. We have ignored biology for a long time, I think we still tend to ignore it far more than we should, and its getting embarassing. I don't think going into neuropsych automatically allows one to escape this problem, but I do think neuropsychs are better off than average when it comes to understanding the biology-psychology relationship. I know I'm not alone in thinking that relationship is going to be the key over the next several decades.

 

[Regression]

It's probably a moot point, but the general public would respect "Clinical Neuropsychologist" more than "(Clinical) Psychologist" any day. A lot of people still refer to them as "shrinks" and "head doctors" and barely treat it as a respected profession.

 

[PsyDr]

IMO, imaging will kill neuropsych. to a lesser extent computerized testing will play a role in the death of this field.

i already see it happening in my practice.

 

[Therapist4Chnge]

IMO, imaging will kill neuropsych. to a lesser extent computerized testing will play a role in the death of this field.

i already see it happening in my practice.

I think the training needed to understand the testing is important going forward, though I'm not sure how day to day practice will be effected. I think certain places like the VA will be strong areas of growth, though I'm not sure if the field will be as strong across the board. From what I've heard from other professionals, there is still quite a demand, though there are more and more people coming out now....so that may change.

 

[Ollie123]

IMO, imaging will kill neuropsych. to a lesser extent computerized testing will play a role in the death of this field.

i already see it happening in my practice.

Hrmm. I was under the impression there were a number of neurological problems that imaging can't (and never will be) able to detect since its not necessarily a structural problem. I see how functional imaging could get around that to some extent, but would that not just be a different type of test that would need neuropsychs to interpret?

You would obviously know far better than I would, so I'm not questioning you on this, just trying to understand.

 

[PsyDr]

eh, i wish i could say it was about patient care. i really think it preferable to some because imaging can be billed for in house by referral sources (i.e., physicians) whereas neuropsych can't.

 

[Psychmeout]

Hi all, I've been pondering this for awhile now. I've heard a lot of opinions and speculations but not directly from this current board of SDN. I was fortunate to get a neuropsych internship and I do love it and I would love to be a neuropsychologist someday. Any thoughts on where this field is going? I've heard from some that neuropsych will die out due to the growing use of computers for tests and I've heard others say that neuropsych is a hot field in psychology that will continue to grow stronger and stronger. I always like hearing different points of view so what do you think about the future of clinical neuropsychology?

Most of what others have said on this board is accurate. Imaging has replaced the neuropsychologists' role with regard to diagnostic clarification issues. IMO, the 6-8 hour batteries will eventually die out in practice because most psychologists want more "bang for their buck" and (from my understanding managed care only allots a certain amount of hours for testing). Cognitive rehabilitation is a growing area, although in most hospitals, cognitive rehab is actually done by speech therapists.... so I'm not sure how much the practicing neuropsychologist will have a role in this area.

If you are interested in forensic-related work, this is a pretty lucrative area and good neuropsychological evaluations are needed with issues related to personal injury/head injury, etc. In addition, neuropsychological research, particularly neuromedical/neuropsychiatric research, is becoming an increasingly hot topic among academic neuropsychologists.

I wouldn't worry too much about where the field is going because remember you have more skills than just being a neuropsychologist and you dictate your own path (whatever that may be years from now). Fortunately, psychology is one of those areas where you learn a number of valuable skills such as writing, critical thinking, organization, testing, etc. Even if the traditional hallmarks of clinical-neuropsychology begin to fade, there will be new emerging areas where you can incorporate your skills.

 

[Psychology 76]

Thanks for all the input! I appreciate it. I'll probably PM some of you on follow up questions instead of taking over this board. I'd enjoy discussing this matter further but if your too busy to reply I won't be offended.

 

[IT514]

Interpretation is the key piece. That's what we're paid to do. And no, imaging doesn't replace this. Imaging is just another tool to aid interpretation. Sure, it has greatly augmented/improved localization efforts. But, there's a lot more to the equation. QUOTE]

Where I work (for a private neuropsych practice), many of the referrals come after imaging takes place and when there are still many questions left unanswered. The head neuropsychologist has great referral relationships from all kinds of physicians around the area - neurologists, physical medicine & rehab, familily docs, etc - and I think this plays a huge role in the success of his practice. The point to be made is that we as a field know how necessary and valuable a neuropsych assessment is, but the key is knowing how to communicate across the healthcare disciplines in a way that is effective.

Also, I will be doing a neuropsych assessment/rehabilitation practicum at a VA hospital this year, and I have been told that we will use imaging to help guide the test selection and assessment process, which aligns well with my work experience...and just makes plain sense. If you take two people with the same injury in about the same place, and you see two different manifestations of the injury, there is your need for a neuropsych assessment on top of brain imaging.

 

[futureapppsy2]

school psychologists

To be fair, many school psychologists have a PhD in psychology and all programs that I've seen require at least some neuropsych training.

 

[AryaStark]

You're right. I performed neuropsych assessments at Boston University as a senior in college. I know there were also some people younger than me doing it too.

Don't really know enough about neuropsych to be qualified to comment, but even so, here I go

As for computerized testing...I've heard that concern voiced here before. Maybe there are super-complex tests out there I'm not aware of, but for the most part, I don't feel like administering a test is a doctoral level skill. Maybe something semi-structured like the SCID is. Certainly the clinical interview should be done by someone with extensive training. However, you could probably train a high schooler to administer any fully structured test as long as they were sufficiently motivated. It takes time, it takes training. Right now, these are generally what computers are doing.

Interpretation is a whole different ballgame. Computers suck at it. Check out a PAI printout. Will this change sometime in our lifetime? Maybe, but I don't see it happening anytime soon. AI is just not there yet. So far, computers aren't even at the state where they can displace bachelor's level psychometricians. That will have to happen DECADES before they could even stand a chance at displacing doctoral level neuropsychs.

As for the general state of the field I will add this. I think anyone who wants to be remotely respected as a psychologist in the upcoming decades is going to need to be strong on biology, neuroscience, etc. The time when psychology was closer to philosophy than to the sciences is over. We have ignored biology for a long time, I think we still tend to ignore it far more than we should, and its getting embarassing. I don't think going into neuropsych automatically allows one to escape this problem, but I do think neuropsychs are better off than average when it comes to understanding the biology-psychology relationship. I know I'm not alone in thinking that relationship is going to be the key over the next several decades.

 

[AryaStark]

"I don't feel like administering a test is a doctoral level skill. Maybe something semi-structured like the SCID is. Certainly the clinical interview should be done by someone with extensive training. However, you could probably train a high schooler to administer any fully structured test as long as they were sufficiently motivated. It takes time, it takes training. Right now, these are generally what computers are doing."

This was what I was referring to. I never meant to say I assessed or interpreted. I was saying that actually PERFORMING the neuropsych assessments can be done by someone without a PhD. I also did all of the standardization so that it could go to consensus for the doctors to make a prognosis. This was a clinical experience however the data was used for a longitudinal study. I was trained by the person who actually created the neuropsychological assessment we used. Perhaps I am using the incorrect term saying assessment but I did all the UDS, NAB, and other tests like list learning, daily living memory, etc. The person who created the test said I was "performing the neuropsychological assessment" thus that is what I call it. I wasn't saying that someone with a BA/BS could do the interpreting, but a BS/BA is sure enough capable of the patient interaction and performing the assessments.I guess it might have just been a confusion of terms, but if not I am not quite sure what your issue was.

You performed standardized testing (psychometrician). You were likely trained by a neuropsychologist or neuropsychologist trained psychometrician to administer the tests. And, you did no interpretation (I assume).

I've trained psychometricians for this purpose and undergrads for research purposes. That's not the same thing as doing an assessment.

For example, it's easy enough to go tap on someone's forehead and see if they blink. I could train someone how to do that properly in about 30 seconds. This is a common neurological test. Administering the tests isn't necessarily difficult, though you do need to be trained. In fact, I think compared to many medical tests, there are quite a few pitfalls in administering standardized cognitive tests.

Problems come into play when you have people administering the tests that have never been properly trained (e.g., neurologists) AND then they also proceed to interpret them.

 

[AryaStark]

Totally agree. Glad we got that settled haha.

 

[Johnson42]

I think NP is still critically relevant and will be for a long time. Completing my current practicum at a children's hospital that does a lot of work with TBI and neuro-oncology, I see a huge realm in which neuro is critical. Common imaging techniques in clinical settings only give you a picture, they do not reveal cognitive function. fMRI and DTI may be the closest to helping localize function, but NP has not been about localizing function for a long time; rather NP is about identifying cognitive strengths and weaknesses. In medical hospital settings NP can inform critical components of patient care within the treatment teams. In psychiatric settings NP can help to rule out the presence of neurological disorders, as well as aid in dx clarification. NP can be critical in civil forensic cases such as determining short and long-term cognitive effects of work related injuries. Even in Wellness and Recovery settings such as in-patient addiction treatment facilities, NP can be utilized to identify strengths and weaknesses to help guide treatment and determine optimal treatment modalities. I can't really see a setting in which NP cannot be used (sorry for the double negative).

I think the key is for the Neuropsychologists in the field to bring additional awareness about the benefits of NP. Professionals need to market the business of NP and work with M.D.s to further develop the utility of NP in all fields.

 

[Enkidu]

Just, as I agree that these same people could administer pretty much any medical test with the proper training (outside of surgeries and the like).

I'm not exactly sure which medical tests you have in mind, but I think you're probably off base.

I think that you're probably talking about parts of the physical exam as "tests", you mentioned testing the cranial nerves for a blink response. While it's true that it doesn't take much to check if a person blinks, that example ignores the reality of the exam.

When physicians are doing a physical exam, they don't write out their results and interpret them later; interpretation occurs simultaneously. You can't just put a stethoscope up to a person's chest and write down what you hear. You interpret it there and that interpretation informs the remainder of your exam.

Of course, some things are routinely done by non-physicians, like taking blood pressures, for instance. This may be more analogous to Neuropsych exams (I'm not sure), in that the test yields numerical results to be interpreted. Most of the physical exam is not like this, however, and I don't think it would be safe for a technician to perform.

 

[Enkidu]

Hi Jon Snow,
I certainly don't mean to suggest that neurologists should interpret neuropsych tests. In fact, I don't know the reasons that a neurologist would even order a neuropsych test. What are they?

As far as physical exams go, I think that inasmuch as a component of the exam can be easily annotated on a form, like bp or presence/absence of a blink reflex, then I think a technician could be taught to do it... not ethically, as you say, but possibly.

Other important aspects of the physical exam, however, I don't think can reasonably taught to technicians. Listening to the heart with a stethoscope, for instance, requires a pretty sophisticated understanding of physiology to even be able to write the result down.

As far as nurse practitioners being essentially equivalent to technicians... I'm impressed that you said it, but my points were not directed at them. Although their base of physiological knowledge is admittedly not equal to a physicians, it is certainly sufficient for an exam.

What I am trying to say is that a purely algorithmic approach to a physical exam can't be safely taught to a generic college graduate without teaching them a significant amount of medical science to go along with it... Which would make them no longer "technicians" in my eyes.

 

[MNIkid87]

Neurologists and psychiatrists tend to be primary referral sources for neuropsychology. I actually work in a neurology department. We work well together (neurology and neuropsychology). A couple of reasons a neurologist might refer to neuropsychology:

- differential diagnosis. . . neuropsychology is able to inform on a fairly wide range of medical and neurological population. . .our specialty is geared towards assessment, though many do participate in rehab units with respect to treatment. We use an array of tools that have been developed specifically for this purpose. For example, distinguishing between different forms of memory deficits can be fairly tricky (a lot of things can cause a seeming memory problem) and important for making a differential in various dementia types (e.g., a source memory problem with good recognition would be a memory problem, but not a memory problem typically seen in say Alzheimer's disease.

- documentation of status - our testing can offer a fairly good repeatable barometer of a range of behavior relevant to neurological disease. This is imporant in establishing treatment efficacy and disease progression.

Excellent explanation.

IMO, the 6-8 hour batteries will eventually die out in practice because most psychologists want more "bang for their buck" and (from my understanding managed care only allots a certain amount of hours for testing).

Very interesting point. You can actually see that starting already. Evaluation times (at least in certain sub-specialties such as epilepsy) seem to be shortening (as compared to the early nineties)

 

[erg923]

I would just add to JNs explanation that refferals to neuropsychs from neurologists can also seek to find out how much "psychiatric overlay" is present on a given (or suspected) neurological condition, and how psychiatric factors (anxiety, depression, somatization) may or may not be affecting cognition. And lastly, to differentiate what is true impairment due to brain disease/disorder and what maybe exaggeration and/or somatization or conversion. To get some objectivity to the subjective cognitive complaints, in other words.