Few would argue that when it comes to neuropsychological assessment the real intellectual chore is not the administration or scoring of our measures, but rather the accurate interpretation of our data. Of critical importance in that process is the consideration of secondary factors and the degree to which they impact test validity. For those who resonate more with statistical concepts, this book focuses on the amount of variance (i.e., deviance from normative standards) in test scores accounted for by secondary factors. The importance of such a book should be immediately apparent. While many neuropsychological texts touch upon this topic with a single token chapter, this is the first attempt of which I am aware to devote an entire book to the subject. Dr. Arnett's decision to develop Secondary Influences on Neuropsychological Test Performance is not misguided. This book represents the latest in a series of evidenced-based practice books by the National Academy of Neuropsychology. The series editor purports that the goal was to produce a “pull off the shelf” resource for clinicians with an adherence to evidence-based information, and my perusal of the book suggests that overall they have been successful in reaching this goal.

The volume is divided into two sections. A brief editorial introduction introduces the reader to the book and the importance of secondary factors in neuropsychological test interpretation (Chapter 1). Section 1, Relationship of affective disorders, anxiety disorders, fatigue, motor impairments, diagnosis threat, and effort to cognitive functioning, highlights the influence of the most common secondary factors that neuropsychologists deal with in their practices and has eight chapters. These are Symptom invalidity in neuropsychological testing (Chapter 2); Neuropsychological deficits in major depressive disorder: Correlates and conundrums (Chapter 3); The allure of emotion: How affective stimuli impact cognitive processing among patients with mood disorders (Chapter 4); The impact of anxiety on cognitive task performance (Chapter 5); Fatigue: Its influence on cognition and assessment (Chapter 6); The impact of pain and pain-related factors on cognitive functioning (Chapter 7); The influence of motor impairments in cognitive functioning (Chapter 8); and Response expectancies and their potential influence in neuropsychological evaluation (Chapter 9). Section 2, Complexities in assessing secondary influences in specific neurologic conditions, includes seven chapters and focuses on secondary factors common to specific neurological disorders including: Secondary influences on cognition in multiple sclerosis (Chapter 10); The role of secondary factors in HIV-associated neurocognitive disorders (Chapter 11); Parkinson's disease: Secondary influences on cognition (Chapter 12); Traumatic brain injury and the impact of secondary influences (Chapter 13); Secondary factors in Alzheimer's disease, mild cognitive impairment, and stroke (Chapter 14); Secondary influences on neuropsychological test performance in epilepsy (Chapter 15); and Assessing secondary influences and their impact on neuropsychological test performance: Summing things up and where we need to go from here (Chapter 16). The diverse group of authors are among the most well-known neuropsychologists in the field, and their names are in many cases are synonymous with the focus of their chapters (e.g., Boone and malingering, Deluca, and fatigue).

There are a number of aspects of the chapters that are laudable. Unlike some texts that inundate readers with superfluous information these chapters are noteworthy for being written in a more parsimonious and clear style. Additionally, references are recent and utilized well. The empirical focus of the book is evident and enticing case examples are available for nearly all chapters. However, there are a few distractions. There is a lack of consistency between the formats for each chapter. Some chapters offer guidelines for practice, others offer a brief summary or closing comments, and still others offer a section on clinical relevance. Secondly, for a book on secondary influences, this reviewer is surprised at the absence of several common factors, including the iatrogenic impact of medications and other substances such as alcohol and illicit drugs, premorbid functioning and intellectual capacity, medical comorbidities, and intra-testing factors such as the presence of third-party observers. These omissions are all the more surprising in the presence of chapters that seem to lack strong clinical relevance, such as Chapter 8 on affective stimuli and cognitive processing.

Should you buy this book? The price of nearly $100 seems excessive for this text despite its many exceptional chapters. Though expertly written and authoritative, there are some distractions, and omissions of topics that would have been of interest to prospective readers. Nonetheless, the average neuropsychologist will find some truly excellent gems in this text that have direct relevance to their practice. Overall, Secondary Influences on Neuropsychological Test Performance is a welcome addition to the neuropsychology literature written by some of neuropsychology's best and brightest.