The short review of this new book is that it is a necessary resource for your clinical practice and should be up on the reference shelf with your general assessment and neuroanatomy books. Forensic neuropsychology is changing rapidly and this new edition will allow you to catch up on the new issues and clinical practices. The chapters in the book are a great resource, especially when you get one of those unusual forensic referrals.
In the first chapter, Larrabee refers to a scientific and empirical approach to clinical assessment and reasoning that is similar to the actuarial approach originally presented by Meehl (1956). Over the years, cognitive psychologists have contributed a number of new ideas in the study of human reasoning heuristics that apply to clinical reasoning (Wedding & Faust, 1989). Neuropsychologists have always been closer to the numbers than most others involved in clinical assessment, so this chapter will probably be met by nodding heads among the neuropsychologists.
The first section of chapter 2 by Greiffenstein and Kaufman was unclear. Each paragraph introduced a testing controversy, such as the role of blind interpretation, without sufficient discussion. They present five “principles” that probably do not cover all the relevant guidelines. The authors do exceptionally well when they describe the steps involved in conducting a case. They did a great job discussing the issues of access to raw data, third-party recordings and observations and Daubert challenges. They did this without expressing a bias or particular preferences. Something that might make the chapter better would be the presentation of a case or two. They also need to discuss the role of the judge. Judges have saved the testimony of many experts when things get confusing. When I get professorial and start lecturing the jury, it is usually the judge who brings me back to the case at hand. Judges also ask direct questions, especially in criminal cases. I got a lot out of the chapter and I will probably re-read it for my next case.
The third chapter by Kaufman reviews the history and major controversies that surround the use of neuropsychology assessment and testimony. It was fascinating to read a summary of the major cases and personalities involved. Many of the controversies in our field that are not often debated by us, such as the fixed versus flexible test batteries, were debated in court and a judge decided the issue. In this case, flexible testing was initially excluded and then the decision was overturned on appeal. It would be nice if the courts would decide all of our theoretical controversies. It was equally fascinating to read the history of legal cases regarding malingering detection and symptom validity tests (SVTs). Although we discuss the scientific development of malingering detection methods, the courts have had a difficult time dealing with this and generally see it as an infringement of many legal processes. We are attempting the scientific study of deception; this is something the courts usually cover with their time-honored methods and jury deliberation. Kaufman covers the legal basis for competency determinations and criminal responsibility. He also updates the reader on the legal status of new methods, such as functional magnetic resonance imaging and electroencephalogram applications.
Grote and Pyykkonen (chapter 4) review competency to practice, release of raw data, the relationship of the Health Insurance Portability and Accountability Act to legal proceedings, competency of patients to consent to the assessment, and a variety of other ethical dilemmas. In contrast to many chapters like this, the authors do not take a side and admonish the reader to conform to their opinions. The authors discuss the issues on each side and recognize that each clinician's experience with each of these issues may be very idiosyncratic and may only be resolved by an appeal to general principles.
In chapter 5, Larrabee reviews the earlier history of malingering determination and focuses on Symptom Validity Testing. This was reviewed in extremely thorough detail. Malingering assessment is one of the most active research areas in clinical neuropsychology and keeping current is difficult. This chapter will bring your knowledge base up to this year.
The chapter by Ricker (chapter 6) is a well-written, general review of neuroimaging. Neuropsychologists who do not usually work with these imaging techniques will find the chapter useful. It would benefit from more forensic applications. In particular, imaging studies of frontal lobe syndrome cases and psychopaths were not reviewed. There are major imaging centers involved in the study of prisoners of all types. Clinical neuropsychologists may not conduct many criminal cases, but these are increasing as the frontal lobe hypothesis becomes popular.
The next chapters (Taylor, chapter 7 and Donders, chapter 8) provide an excellent review of perinatal disorders and pediatric traumatic brain injury that may result in a forensic evaluation. They also review a general assessment approach and the unique situation of making retrospective judgments of the cause of cognitive impairment among children who may have sustained their injuries years before testing. These are good chapters for challenging your domain of competence. The assessment in this area is so specialized that most neuropsychologists are not competent to conduct these assessments without specialized training. Again, these reviews could be enlivened with more case reports and direct references to forensic issues.
Larrabee (chapter 9) and Roebuck-Spencer and Sherer (chapter 10) both could be combined as a review of the traumatic brain injury outcome studies. There is a major problem in defining severity of injury that is independent of outcomes. To a great extent all the estimates of severity, including coma, refer to behavioral consequences. These chapters are an excellent review of traumatic brain injury outcome studies, but they did not include many forensic references.
Chapter 11 by Bolla covered neurotoxic injury. The review of neurotoxicology principles and the forensic aspects were excellent. Since neurotoxicology cases are infrequent in clinical practice, re-reading this chapter will be a good preparation for the next neurotoxicology referral. This is a specialized domain that most neuropsychologists never encounter and this chapter would benefit from some case reports in this area that include the forensic aspects. It would be helpful to give examples of how some of the solvents actually injure the central nervous system and some general references for the neuropathology of these agents. The neurotoxic agents all appear to produce the same effects. Do any of them have unique consequences?
Greve, Bianchini, and Ord (chapter 12) provide a very thorough review of the clinical aspects of chronic pain. This is a large area. Anyone working in this domain must get some additional training that neuropsychology education did not provide. The Appendix in this chapter was especially useful.
Binder's chapter (chapter 13) on medically unexplained symptoms was a marvelous one. We need more open theorizing like this in neuropsychology. Many cases of mild traumatic brain injury (mTBI) essentially present with unexplained symptoms and a recent head injury is taken as the causal factor by the patient. The nonspecific neurological disorders, such as multiple sclerosis, are often the neurological diagnosis of last resort. If the patient does not fit into any of the others, they are assigned to multiple sclerosis, Lupus and other disorders associated with diverse, nonspecific symptoms.
I finally found an excellent history of post traumatic stress disorder (PTSD) in chapter 14 by Andrikopoulos and Greiffenstein. The interviewing section is excellent. Developing symptom validity measures must be difficult in this area. Simply generalizing the cognitive SVTs does not seem reasonable. No one appears to be researching the role of post-traumatic amnesia in the possible PTSD of blast injuries and motor vehicle accidents. If the patient cannot remember the event, how can there be a persistent anxiety reaction? This chapter also has some good case report examples.
Marson, Herbert and Solomon (chapter 15) present a generic model of competency assessment along with the report of research using the tools they have developed. Although it is great to have competency instruments like these to start the assessment, competency usually involves a specific set of circumstances. Every competency assessment must be tailored to the living and financial environment of the individual referral. For example, general concepts in financial matters, such as making a correct cash transaction, are usually well learned. The salient issue is whether the patient will make a good judgment in an actual situation. The assessment guidelines were great. These could have been enhanced with a few case reports.
In chapters 16 and 17, Denney presents a review of criminal responsibility, assessment of competency to engage in legal proceedings, and other forensic issues. These areas are outside the domain of typical clinical neuropsychology practice. Although this is an excellent review, I began to appreciate all I would have to study to really feel competent to conduct this type of evaluation. There are some interesting overlapping domains, such as the role of early brain illness predicting competency and criminal responsibility later in life. The presentation of cases enhances the chapter. Case descriptions introduce the full complexity and idiosyncratic nature of the individual situations seen by the courts. The role of amnesia in competency was interesting. As a neuropsychologist, I have a visceral reaction to the frontal lobe hypothesis (David, 1992). Since Phineas Gage never engaged in criminal behavior, using him as a poster child for the role of frontal lobe pathology in criminal behavior is a fundamental error. These reviews could better use Benton's case (Ackerly & Benton, 1948) to make this point. The low incidence of insanity pleas based on brain injury is evidence that brain illness is not associated with serious criminal behavior. The mediation of criminal behavior and moral reasoning is very complex. Malingering and criminal responsibility is apparently very understudied in this area.
Sweet and Meyer (chapter 18) round out the book with a summary of the field and predictions for future studies. If a picture paints a thousand words, then Figure 18.1 paints the unique history of personal injury litigation using neuropsychologists. I wonder how the patterns of utilization of neuropsychology will change with tort reform? Neuroimaging will be part of the standard clinical examination. The polygraph is not used to detect lies; it is used to generate confessions. Neuroimaging may also be used for this purpose and not as a lie detection measure.
In general, the book takes on the forensic applications of neuropsychology from an empirical, scientific point of view and there are great merits to this approach. However, hyper-empiricism tends to reify constructs and neglect theories of causation. This has clearly happened with the Slick criteria (Slick, Sherman, & Iverson, 1999). Simply failing two SVTs satisfies the Slick criteria. Once this is established, the SVTs that make up the criteria are never further examined. The investigators are off pursuing receiver operating characteristic (ROC) curves and discriminant function analyses. No one can generate ROC curves unless the criterion has been reified into perfect validity. We need to examine the role of malingering strategies in producing variance on the SVTs and other tests in the neuropsychological battery. All we have determined is that malingering subjects fail SVTs. We do not know whether this failure generalizes to the neuropsychology tests. Mapping out the manner by which malingering strategies, such as slowness and intentional wrong responding, influence the SVTs and the other neuropsychological tests is a major validity domain that we have barely studied. Larrabee (chapter 5) presents a wonderful description of all the inconsistencies in test performance, injury severity, premorbid status, and behavior that could form a new model of malingering detection that uses the neuropsychological tests. If this was developed, then SVTs would be unnecessary and we could make inferences about malingering from the very tests used to establish disability and impairment (Williams, 2011).
One of the wonderful things about a book like this one is that the authors present controversies. You will find yourself arguing with the authors and contrasting their comments with your own experiences in the forensic environment. This makes the book engaging and actually fun to read. I plan to use many of the chapters as supplementary reading in courses in assessment and professional ethics.