Articles

For more than four decades, I have worked in clinical and forensic neuropsychology, evaluating children, adolescents, and adults with cognitive, emotional, developmental, neurological, and traumatic injuries. The most effective depositions focus on methodology, objectivity, scientific reasoning, differential diagnosis, and interpretive fairness...

The current debate in Utah over Rule 35 examinations highlights a deep divide between two professional frameworks that do not always align. On one side are attorneys and forensic experts who emphasize strict adherence to standardized testing conditions, while on the other are legal practitioners who focus on the realities of compelled examinations...

An issue presently before the Utah Supreme Court Advisory Committee on the Utah Rules of Civil Procedure, chaired by Rod Andreason, concerns whether URCP Rule 35 neuropsychological examinations should be presumed to occur without recording or whether the current Utah framework allowing recording unless it can ...

In traumatic brain injury (TBI) litigation, IQ scores often show up early and take on outsized importance. They feel objective. They look clean. They offer a single figure that seems to say something definitive about cognitive ability. For...

In traumatic brain injury (TBI) litigation, IQ scores often show up early and take on outsized importance. They feel objective. They look clean. They offer a single figure that seems to say something definitive about cognitive ability. For...

In the contemporary forensic landscape, attorneys increasingly encounter scientific evidence that purports to link cognitive test scores and neuroimaging findings to specific brain structures and behavioral outcomes. Understanding the scientific strengths and limitations of this evidence is essential for effective advocacy whether presenting or challenging expert testimony...

Imagine the brain as an airport control tower. A busy, coordinated command center where information is sorted, routed, and delivered without delay. Conversations move smoothly. Memories appear when needed. Focus stays...

Chronic Traumatic Encephalopathy (CTE) has transitioned from a rarely discussed neuropathological finding to a widely debated condition at the intersection of neuroscience, law, and forensic medicine. It is defined as a progressive tauopathy...

Traumatic brain injury (TBI) is one of the most complex conditions encountered in forensic and medical practice. While traditional diagnostic tools such as CT or MRI scans reveal structural damage, many patients with persistent cognitive, behavioral, or emotional symptoms have unremarkable imaging....

Recovering from a brain injury is a complex and multifaceted process shaped by a variety of biological, psychological, and social factors. The prognosis for individuals with brain injuries varies significantly depending...

Traumatic brain injury (TBI) represents a critical intersection between neuropsychological function and emotional regulation. Although TBI is often framed through its cognitive and physical effects, growing evidence highlights the significant and frequently overlooked...

Evaluating the long-term impacts of birth-related trauma—such as prolonged labor, eclampsia, and neonatal brain hemorrhages—on children's emotional, behavioral, developmental, and social outcomes is a complex and nuanced endeavor. Establishing a direct...

When I first met James, he was six months post-Traumatic Brain Injury (TBI), sitting across from me in my office, exuding a resilience that masked the trauma he had endured. James, a 34-year-old electrician, had suffered a moderate traumatic brain injury...

For decades, neuropsychological testing has been a cornerstone in evaluating cognitive functioning. These assessments have helped us measure critical domains such as memory, attention, and executive functioning. However, as the field evolves ...

Forensic neuropsychology is a field fraught with complexities, where the stakes are high, and the consequences of assessments can profoundly affect legal outcomes. One particularly contentious tool in this domain is ...

Postural Tachycardia Syndrome (POTS) is a medical condition increasingly recognized for its significant impact on those who experience it. Still, it is also frequently present in forensic neuropsychology evaluations. It is a form of ...

In the past year, during my forensic work, I have had the opportunity to evaluate several children, ranging in age from 2 to 10, who have experienced a broad spectrum of outcomes following ...

Neuropsychological evaluations are comprehensive and nuanced assessments designed to measure cognitive functions, including but not limited to intellect, achievement, memory, executive, behavior and emotions. They are frequently misunderstood by legal ...

I have been asked numerous times to testify about the significant differences and advantages of kinship care compared to traditional foster placement in child welfare cases. In this month's Forensic Update, I summarize the foundation ...

The principle that "no one is above the law" has long been heralded as a cornerstone of democratic societies, epitomizing fairness and justice. This hypothesis suggests that everyone, irrespective of their status, wealth, or influence, is subject to ...

John, a 35-year-old construction worker, has been healthy and hardworking throughout his life. However, his life took an unexpected turn one fateful afternoon when he fell from a scaffold, striking his head against a steel beam. He was rushed to the hospital ...

Intelligence, a complex and often misunderstood aspect of human cognition, has captivated scholars for centuries. It encompasses a wide range of cognitive abilities, including reasoning, problem-solving, and adapting to new ...

Brain injuries at birth, often categorized under the term neonatal brain damage, can significantly affect a child's development and quality of life. These injuries can result...

This month’s article provides a brief exploration of the ongoing research into post-concussion syndrome (PCS), particularly the persistent form that affects a small subset of...

The intricate landscape of forensic neuropsychological assessment, especially in the context of traumatic brain injury (TBI), presents numerous challenges and complexities. Among these, one of the most daunting tasks for professionals ...

I often face the daunting challenge of discerning how pre-existing cognitive, psychiatric, and physical challenges influence the nature of accidental injuries, impairments, and outcomes in the complex realm of forensic matters, particularly in cases related to Traumatic Brain Injury (TBI). This intricate task ...

As a neuropsychologist, my concern about headaches, particularly following traumatic brain injuries (TBIs), is rooted in the profound impact these headaches can have on the brain's functioning and the overall recovery process. Headaches are not merely ...

Attorneys face several challenges when retaining experts for legal matters. One primary issue is finding an expert with the requisite specialized knowledge and experience pertinent to the case. The expert must not only be ...

Jurors, as ordinary individuals, bring a rich tapestry of human qualities to their deliberations, which profoundly influence the manner in which they ...

A number of weeks ago I had the opportunity to testify as a forensic neuropsychology expert on behalf of a plaintiff whose treating providers had diagnosed, and for a number of years ...

Forensic neuropsychological evaluations are a critical component in many legal proceedings. They can assist the trier of fact and offer valuable insights into an individual’s cognitive and psychological functioning within the context ...

In this forensic update I will address one of the central issues in forensic neuropsychological evaluation, identifying and apportioning contributing etiologies to an individual’s deficits, impairment, needed treatment and prognosis. The COVID-19 pandemic, specifically our efforts to ...

I recently had the opportunity to review an evaluation authored by a fellow neuropsychologist in a forensic matter in order to author a rebuttal report. The opposing neuropsychologist argued that the reason the middle-aged gentleman he evaluated, a man a year post a moderate traumatic brain injury (TBI) with significant...

In my last forensic update, I offered an overview of what we know scientifically about patients with persistent Post Concussive Disorder. On June 2, 2019, the Journal of ...

One of the most common, acute outcomes of mild to low moderate TBI are a set of physical, emotional and cognitive symptoms currently forming a syndrome known as Post Concussive Disorder. Typically, this condition includes physical or somatic symptoms such as ...

Perhaps no greater challenge faces the forensic neuropsychologist today than the differential diagnosis of impairment secondary to emotional and mental health disorders versus chronic pain and/or traumatic brain injury. This challenge...

It is an accepted phenomena in medicine and neuropsychology that traumatic injury to the brain (TBI) can and does cause lasting, adverse changes in the functioning of the mind and subsequently reduced efficiency in every day life. There has been an increasing interest in understanding and evaluating post TBI impairment relative to neuropsychological test scores, symptom reports, symptom severity and diagnoses.

It is functional impairment that should be the true target of our evaluations. From my perspective as a forensic neuropsychological evaluator, my primary goal is to collect data allowing me to provide an explanation of an individual’s daily functional impairments.

In July of 2000, the National Academy of Neuropsychology provided an official statement in its membership journal, The Archives of Clinical Neuropsychology, concerning the presence of third party observers during neuropsychological testing.

In this issue I review Post Traumatic Stress Disorder specifically focusing on the chronic nature of this condition and whether long term treatment can cure PTSD. I also briefly review a recent article raising important questions about frequently reported sleep problems in patients following traumatic brain injury.

Forensic evaluators typically confront multiple risk factors that contribute to impairment in every day functioning, as well as poor or inconsistent performance on neuropsychological test batteries.

It is the rule rather than the exception that individuals recovering from Traumatic Brain Injury experience psychiatric problems. These problems often result from two causes.

In a number of past legal updates, the effect of multiple forces such as pain, life stress and specific psychiatric problems upon neuropsychological testing and every day functioning were mentioned.

There has been a dramatic improvement in the care and treatment of individuals with brain injury in the past twenty years.

In the seventh issue of this legal update, I provided an overview of Post-concussion Syndrome (PCS). This is a collection of symptoms, including problems with thinking, physical impairments involving fatigue, dizziness, headache and sensory sensitivity as well as mood changes.

Perhaps no topic in forensic neuropsychology is as heatedly debated as the cause and effect relationship between Traumatic Brain Injury and an individual’s pre-trauma history, severity of and immediate response to trauma, physical findings, long-term sequelae and neuropsychological test data.

In recent NLBC Legal Updates, I reviewed a number of studies suggesting that multiple factors impact cognitive efficiency and general functioning beyond the limitations created by physical conditions.

These three issues relate to third party observers during neuropsychological testing, the use of neuropsychology test technicians, and test security will be reviewed in this Legal Update.

Neuropsychologists routinely rely on patient self-report to obtain a pre-trauma history even though researchers have long known that memory is often an unreliable and inaccurate source of information. Further, patients are often highly confident about their recollections even in the face of evidence to the contrary.

Post Concussion Syndrome (PCS) is a collection of symptoms that include cognitive complaints such as inattention, concentration and memory difficulty; physical complaints such as headache, fatigue, dizziness and sensory sensitivity; and psychosocial complaints such as irritability, depression, anxiety and personality change.

Forensic mental health experts are increasingly required to assess emotional damages, particularly Post Traumatic Stress Disorder claimed by plaintiffs as well as defendants in a variety of non-criminal and criminal matters.

Although the majority of individuals experiencing mild head injury have been found to remit in their symptoms and improve to near or at pre-trauma level within a year’s time, it has always been recognized that a small group of individuals appear to not recover.

A recent issue of the British Medical Journal examined the incidence of Post Traumatic Stress Disorder among children involved in automobile accidents. Increasing data demonstrating that emotional symptoms caused by experiencing trauma or the impact of living with physical problems secondary to trauma complicates neuropsychological assessment and often exerts a negative impact on daily functioning is being generated.

The following four articles address a number of the most pressing issues in the neuropsychological/legal arena. These studies represent but a few of the increasing number of questions being asked and addressed in research settings concerning the validity of neuropsychological tests, accuracy of patient reports, impact of other life factors upon symptom complaints and the issue of emotional change independent of cognitive differences secondary to brain injury.

Neuropsychologists have traditionally focused on the impact of developmental difference, trauma, medical and mental illness upon neuropsychological test performance.