The last decade has witnessed phenomenal growth in neuropsychology as a scientific and applied discipline. Clinical neuropsychology is in a unique position to integrate and apply recent developments in the clinical neurosciences with behavioral and medical knowledge. The resulting understanding of brain behavior relationships has been recognized in the legal field. Hence, neuropsychologists are playing an increasingly important role in the courts as expert witnesses in the area of brain-behavior relationships, especially for medico-legal cases involving personal injury, worker's compensation and disability determination. The development of forensic neuropsychology as a subspecialty of clinical neuropsychology reflects the need for special guidelines and standards for Clinical Neuropsychologists engaged in evaluation and treatment of litigated cases.
Accompanying this need has been the appearance of a number of texts attempting to elucidate guidelines and standards of practice for neuropsychologists engaged in forensic work (e.g., McCaffrey, Williams, Fisher and Laing; 1997). These texts have addressed critical areas of forensic practice during neuropsychological examination. Many of these issued during the past few years have taken a reactive stance toward questioning of the utility of neuropsychology and have represented attempts to justify neuropsychology's place in the courtroom. Undoubtedly, these texts were a necessary response and served to set the stage for incorporation into mainstream neuropsychology observations of "method skeptics" and criticisms from without, especially those issuing from the adversarial legal system.
Jerry Sweet's edited volume is the consequence of this incorporation, and reflects increased maturity of the advancing field. Notably, this book also follows on the heels of Carl Dodrill's (1997) "Myths of Neuropsychology", which represented an emerging maturity and capacity for nondefensive self-examination in the service of scientific advancement. Jerry Sweet's book represents a continued evolution of this maturity and is clearly a departure from defensiveness and self-serving guild protection. If the maturation of a field can be defined by its capacity for objective, critical self examination, and this book is the standard for evaluation, then Forensic Neuropsychology may have just experienced a Right of Passage from adolescence to young adulthood.
Sweet's book eloquently accomplishes its mission of utilizing a scientist practitioner model for integrating relevant clinical neuropsychological knowledge and focused applications of practice methodologies within the context of adversarial proceedings. This edited work employs high standards in defining the objective scientific practice of Forensic Neuropsychology and offering a scientist practitioner model for clinical neuropsychology more generally. Notably, the contributors were impeccably chosen and are a veritable Who's Who among the state-of-the-art thinkers in the most relevant and important areas. These contributors offer critical-self examination, a mature appreciation of complexity and practical guidelines for objective scientific practice and advancement. Further, the contributors do an excellent job of combining expertise from Forensic Neuropsychology with Clinical Psychology - another sign of maturity in the field.
The text includes four sections: Fundamentals; Practice Expertise; Relevant Populations; and Parameters of the Forensic Arena. Fifteen chapters are included. Most chapters are thorough, well conceived, stimulating and, in some cases, even entertaining (e.g., Lees Haley and Cohen's somewhat irreverent chapter on expert witness credibility).
The first section begins with a review of fundamental psychometrics as related to neuropsychological examination that sets the stage for the rest of the chapters. It concludes with a thorough and current review of premorbid functioning and variables that can influence neuropsychological findings. Gouvier's well-written chapter on base rates is essential reading on a too often neglected area, and he, like other contributors, addresses issues of test utility as well as sensitivity and specificity. His "ignorance is bliss" cartoon from Calvin and Hobbes (page 33) symbolizes the prevailing ignorance in standard clinical practice for which the text offers objective scientific remedies.
The second section, Practice Expertise, begins with Rankin and Adams' survey of the field and a model for neuropsychological evaluations that includes evaluation of the biological and behavioral factors that can produce abnormal neuropsychological test findings and a proposed model for interpretation. In a necessary chapter in an often overlooked area, Bieliauskas offers empirically supported guidelines for thorough assessment of personality and emotional functioning, with consideration of the Daubert ruling. Kay, in keeping with his previous writings, shows a comprehensive understanding of the multiple determinants of behavior in interpreting apparent deficits from neuropsychological test scores, emphasizing more challenging cases, including an interactional neuropsychological model of functional disability derived from his mild brain injury model. Sweet's chapter on malingering is an excellent review of the latest clinical research, including strategies for deception, and offers, along with a sophisticated conceptualization, useful suggestions regarding the most effective detection methods. Additional chapters in this section include a well integrated review of the somewhat untested research on executive functioning, an excellent consideration of ecological validity with suggestions for enhancing the utility of predictions of everyday and vocational functioning from neuropsychological data, and an illustration of improved assessment of malingered cognitive deficits from combining neuropsychological and psychophysiological assessment methods.
The third section, Relevant Populations, includes a well-conceptualized, comprehensive and extremely useful chapter on mild traumatic brain injury, as well as an elaboration of the special knowledge base necessary for pediatric litigation cases. David Hartman's chapter on Neuropsychologic Toxicology defines this area with its completeness. His chapter is well conceptualized, Daubert-friendly and full of useful guidelines and recommendations that are consistent with objective scientific practice.
The fourth section, Parameters of the Forensic Arena, begins with a succinct and insightful summary of the legal environment as germane to Clinical Neuropsychology. It is followed by Lees Haley's and Cohen's chapter on expert witness credibility. This delightfully irreverent chapter uses a mischievous and playful air to poke holes at rampant problems and defensiveness in typical neuropsychological practice. Constructive recommendations are offered, along with a table comparing scientific and pseudoscientific experts. The chapter leaks a subtle impression that the field is maturing to the point that it can appreciate an interesting mixture of pedagogery and fun-poking criticism. This chapter fits well with the tone and spirit of the book as captured in the Calvin and Hobbs cartoon relating "ignorance is bliss" in Drew Gouvier's chapter. They, along with Sweet, in his Conclusion chapter, and a few others, offer the most useful available guidelines for defending and promoting the scientific, ethical, objective and reasoned practice of Forensic Neuropsychology in an adversarial environment with contradictory ethics and influences.
Few criticisms can be made about this text. The important area of ethics was adequately covered, including generation of relevant recommendations for promotion of ethical conduct (e.g., in the Lees Haley and Cohen chapter). Clearly, promotion of the scientific objectivity offered in this text is the solution to most ethical dilemmas. Nonetheless, a chapter dedicated to ethics might have been even more helpful. This chapter also could have included Sweet's self-examination approach to reducing bias (Sweet and Moulthrop, 1999) and perhaps an expanded consideration of most major potential ethical dilemmas and targeted guidelines for reducing bias (e.g., Martelli, Zasler and Grayson, 1999).
Without qualification, Forensic Neuropsychology: Fundamentals and Practice is an exceptional text. It offers a scientist practitioner model for integrating relevant clinical neuropsychological knowledge and focused applications of practice methodologies for forensic settings. It defines the objective scientific practice of Forensic Neuropsychology that should also be the model for clinical neuropsychology more generally. This book should be considered required reading for forensic clinicians and clinical neuropsychologists.
Michael F. Martelli, Ph.D.
Director, Rehabilitation Neuropsychology
Concussion Care Centre, Pinnacle Rehabilitation and Tree of Life
Glen Allen, Virginia