The current wars in Iraq and Afghanistan represent the longest continuous combat engagement for the USA, and myriad changes have unfolded within the military and among veterans who have served in Operation Enduring Freedom and Operation Iraqi Freedom. Stresses associated with multiple deployments, harsh and unfamiliar environments and new warfare involving exposure to blasts from various sources are considerable. In The Rand Center report, The Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery (2008), it is noted that 19.5% of service members reported experiencing a TBI during deployment, a percentage that translates to upward of 360,000 individuals who may have sustained brain injuries. In addition, 18.5% of U.S. service members who have returned from Iraq and Afghanistan currently have PTSD or depression. Historically, the fields of psychology in general and neuropsychology in particular owe much of their foundations to attempts to be of service to the military while at war. It is to be hoped that lessons from the current conflicts will increase our understanding of the human psyche and brain function as present-day neuropsychologists seek to offer services to our nation's service men and women.
In Military Neuropsychology, Carrie Kennedy and Jeffrey Moore offer a unique volume on the current state of research and practice in this specialized field. The editors have assembled a group of experts who clearly and capably cover pertinent topics and include useful resources within their chapters. The book encompasses a comprehensive range of neuropsychological topics and provides an excellent reference source for concepts and applications essential to clinical practice among military service personnel and veterans.
Military acronyms, processes, and language that frequently befuddle the uninitiated are decoded. Sensitive clinical issues, potential ethical dilemmas, test forms in the public domain, normative data, reference materials, patient educational materials, and numerous case examples are provided to enhance clinical practice. Queries that frequently are raised among peers for guidance and consultation, such as the format of a fitness-for-duty exam, assessment of return to flight status, waiver procedures, retention and management of HIV-positive service members, confidentiality issues, and the medical boarding process, are explained thoroughly. An informative discussion of the military regulations that are germane to these issues is provided as well. Questions at the heart of daily practice within military and veterans settings are addressed and informed by presentation of current research. These include developmental conditions among military service personnel and veterans, issues unique to the assessment of service personnel from several different eras, noncredible neuropsychological presentations, cognitive and neurobehavioral effects of concussive blast injury, neuropsychological correlates of PTSD, and cognitive sequelae of sustained operations (e.g., conditions of sleep deprivation and sleep disruption).
Although there is considerable breadth and diversity to this text, several of the chapters warrant specific mention. The chapter on Fitness for Duty evaluations demystifies this multistep process and explains the role of neuropsychological assessment for service members with known or suspected brain disorders. In a similar manner, the chapter on Attention Deficit/Hyperactivity Disorder and Learning Disorders discusses these conditions within the context of military regulations and military clinic evaluations and explains in detail the waiver procedure. The chapter on acute assessment of concussion/mild TBI and return to duty in theatre is informative for those providing care on the battlefield or those following-up care afterward. The authors provide instructive algorithms and narratives; discuss measures used in theater, including the prescribed screening tool, the Military Acute Concussion Evaluation (MACE) (DVBIC, 2007) (a copy of which is included), and the selected neurocognitive assessment tool, the Automated Neuropsychological Assessment Metrics (ANAM) (Reeves et al., 2002); and explore ways to assess effort. An entire chapter is also devoted to the often thorny issue of noncredible neuropsychological performance. In a chapter on the neuropsychology of PTSD, the authors tackle one of the most challenging areas of current clinical practice with considerable organization and clarity. For those who work with active duty personnel, the chapters on cognitive sequelae of sustained operations (dealing with the contribution of sleep to operational effectiveness) and cognition and decision-making in extreme environments (introducing the concept of operational demand-related cognitive decline or ODRCD) will be particularly helpful.
Weaknesses of the text are few. Inevitably, an edited volume is composed by different voices, and in this particular case, the chapters are written in varying styles and formats. Although each contribution is self-contained, the flow and transition from one to the next is at times uneven. Topics are well-chosen, but one or two are absent that would have added to the book's usefulness for neuropsychologists who treat both veterans and active duty personnel. A chapter devoted to Gulf War syndrome and its neuropsychological correlates would have been particularly welcome. Finally, in serving as a guide to best practice, the text avoids presenting alternate opinions and discussing current controversies within the field. Some readers may find they view certain issues differently and bring other nuances to bear in their practical work with patients. Such alternative views will hopefully stimulate additional research and further the lessons we all learn.
In summary, this is a highly useful reference book for clinicians providing evaluation and care to military service personnel and veterans. It builds nicely upon Carrie Kennedy's previous book with co-editor Eric Zillmer, Military Psychology: Clinical and Operational Applications. The present text focuses the lens with an even more specialized eye and will serve to facilitate the provision of thoughtful, ethical care.