Articles

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.