Selection Criteria for Clinical Neuropsychology Internships

Abstract Objective: Internship in clinical neuropsychology is an essential part of specialty training. This paper reports a survey of the applicant evaluation and selection criteria currently used at clinical neuropsychology internships. Method: Training sites were identified from listings published by INS, AITCN, APA Division 40, and APPIC. Internship information was reviewed for concordance with the Houston Conference and INS/APA Division 40 guidelines. Utilizing these criteria, 103 internships that offered a minimum of 50% of training devoted to clinical neuropsychology were identified. Supervising neuropsychologists were contacted and asked to complete a 10-item survey of candidate selection criteria used in a prior similar study. Results: 72.8% of sites (n = 75) responded to the survey. Clinical experience in neuropsychological assessment, specialization in neuropsychology during graduate school, the interpersonal skills of the applicant during the interview, and letters of recommendation from clinical neuropsychologists were reported as the most salient selection criteria. Applicants who had completed graduate school curricula that provided specialty education in neuropsychology, with clinical neuropsychologist faculty and supervisors, were preferred. Internship supervisors valued prior practicum experience with neurological cases at university affiliated or V.A. medical centers, flexible assessment approaches, and supervision by neuropsychologists. Research experience was also viewed important by most internship sites. Conclusions: Results indicate continued endorsement of the vertically integrated model of education and training outlined by the Houston Conference and INS/APA Division 40 guidelines for the didactic and experiential components of specialization in clinical neuropsychology. The number of neuropsychology internship sites has more than doubled during the past 10 years

Rates of Apparently Abnormal MMPI-2 Profiles in the Normal Population.

MMPI-2 standardization data were re-sampled using Monte Carlo simulations to estimate the base rate of apparently abnormal scores expected by chance in the normal population when multiple scales are interpreted. 36.8% of normal adults are likely to obtain a score that would otherwise be considered clinically significant at 65T on one or more of the 10 Clinical scales. The normal incidence of at least one apparently abnormal score was 38.3% on the Content and 55.1% on the Supplementary scales. When the Clinical, Supplementary, and Content scales and subscales are interpreted together, at least three seemingly meaningful scores will be found in 47.4% of perfectly normal individuals, and five or more scales that appear to be clinically significant can be expected in 30.1% of cases that are actually unremarkable. These results imply that the number of MMPI-2 scales that can be meaningfully interpreted in clinical practice is limited, and that high T-scores are necessary for an adequate level of confidence even when interpretation is appropriately limited to the Clinical scale

False Positive Diagnosis of Malingering Due to the Use of Multiple Effort Tests.

OBJECTIVE: Effort indicators are used to determine if neuropsychological test results are valid measures of a patient\u27s cognitive abilities. The use of multiple effort measures is often advocated, but the false positive rate for multiple indicators depends on the number of measures used and the correlation among indicators. This study presents a meta-analysis of correlations among effort measures. False positive rates for multiple correlated indicators are then estimated using Monte Carlo simulations. METHODS: a literature search of published studies identified 22 independent samples in which 407 correlations among 31 effort measures were available in 3564 participants with normal effort. Participants were patients with neurological or psychiatric disorders and healthy volunteers. RESULTS: Meta-analysis showed a mean correlation among effort indicators of 0.31. Monte Carlo simulation based on a 15% false positive rate for individual indicators showed that, when 10 effort indicators are used together, 38% of patients with valid performance will be incorrectly identified as malingering if two failures is the diagnostic standard. Failure on five of 10 measures is required for a false positive rate of 10% or less. If five effort indicators are interpreted, a false positive rate of 19% results when two test failures are assumed to characterize poor effort and failure on three measures is required to maintain 90% specificity. CONCLUSIONS: False positive rates for effort tests increase significantly as the number of indicators that are administered is increased

A Monte Carlo Study: Frequency of Normal Healthy Adults with Abnormal MMPI-2 Scores

Abstract Objective: Previous research suggests that as more scores are interpreted, there is a coinciding increase in the likelihood that abnormal scores will be obtained. Interpretation of the MMPI-2 can involve the analysis of as many as 98 or more separate scores, which suggests potential for a high frequency of seemingly abnormal scores amongst normal healthy adults. Method: The incidence of elevated MMPI-2 scores was calculated for the normal population using Monte Carlo simulations. Correlations amongst scales from the restandardization sample were used to determine the percentage of the population with seemingly abnormal scores. Simulations were conducted for all scales combined, and for the Clinical, Harris–Lingoes, Content, Content Component, and Supplementary scales separately at varying t-score cutoffs. Results: 36.8% of normal adults are likely to obtain a score that would otherwise be considered clinically significant at 65T on one or more of the 10 Clinical scales. The normal incidence of at least one apparently abnormal score was 38.3% on the Content, 55.1% on the Supplementary, and 71.3% on the Harris–Lingoes scales. When all scale groups are interpreted together, at least five seemingly meaningful scores will be found for about a third of normal persons, and seven or more scales that appear to be clinically significant can be expected in 25% of perfectly normal individuals. Conclusion: These results imply that interpretation of a large number of MMPI-2 scales should be conducted with caution, and that high t-scores may be necessary for an adequate level of confidence in the absence of corroborative test scores and extra test data

Attitudes toward Psychological Telehealth: Current and Future Clinical Psychologists’ Opinions of Internet‐Based Interventions

Objectives: The current study explored differences in acceptance of telehealth interventions amongst currently licensed and future clinicians with a focus on web camera-based intervention. The influence of theoretical orientation was also assessed. Method: An online survey assessed 717 participants comprising 409 licensed psychologists (40.8% female, mean age = 56.57, standard deviation [SD] = 11.01) and 308 doctoral-level students (78.9% female, mean age = 27.66, SD = 5.9) across domains of endorsement and rejection. Results: Binary logistic regression indicated no significant difference between currently licensed and future psychologists in their endorsement oftelehealth modalities. Cognitive-behavioral, cognitive, behavioral, and systems psychologists were significantly more accepting of telehealthinterventions than were dynamic/analytic or existential therapists. Conclusions: Increasing exposure to telehealth through education as well as continued research on efficacy for specific diagnoses may help psychologists to more effectively determine whether telehealth is the best fit for both clinician and client