Brain, Vol. 123, No. 12, 2568-2569,
December 2000
© 2000 Oxford University Press
Book reviews |
FORENSIC NEUROPSYCHOLOGY: FUNDAMENTALS AND PRACTICE.
.
School of Psychology, Cardiff University, Cardiff, UK
This is a very good book, covering all aspects of neuropsychological practice from basic psychometrics to the neuropsychologist as expert witness. The book is aimed at practising clinical neuropsychologists who wish to venture into the territory of the expert witness. That said, the book will also be of relevance to academic psychologists and professionals of related disciplines.
Perhaps the biggest drawback of the book for a British audience is its title. In the UK, `forensic' infers that it has something to do with the criminal justice system or offending. This is not the case with this book. Here `forensic' refers to the broad definition, meaning `public'. Hence the authors go beyond neuropsychology as it applies to civil and criminal legal cases, and include all potential activities of the neuropsychologist relating to public discussion and debate. This includes `worker's compensation, disability determination, education, personal injury, criminal, child custody, impaired professional and "fitness for duty" competency'. This is an advantage of the book, as it gives the reader a broad overview of how and where neuropsychological principles can be applied, and in what domains. However, I suspect that the title will attract forensic psychologists who are seeking something more specifically related to the criminal arena (who will be disappointed) and may also simultaneously repel neuropsychologists working in the civil, educational and child custody domains, who would perhaps most benefit from its content. Another downside of the book, which stems directly from the fact that it was written in the US, is that it refers to American legislation and case law, which does not necessarily apply to the British judicial system. Readers therefore need to take care not to interpret the legal arguments directly and, if necessary, will need to investigate differences in legislation and case law between the US and UK before reaching any firm legal conclusions. This difficulty with the book does not, however, detract from the highly useful clinical arguments, which safely cross international boundaries.
The book will perhaps be most useful as a reference source and it includes chapters from US experts in neuropsychology, usefully segmented into: `Fundamentals' (including essential psychometrics, base rates and clinical decision making, premorbid functioning); `Practice expertise' (including personality and emotional functioning, executive function, ecological validity and malingering); `Relevant populations' (mild traumatic brain injury, neurotoxic effects, paediatrics); and `Parameters of the forensic arena' (the legal environment and the neuropsychologist as expert witness). It is an easy book to `dip into' and clarify a point of practice or theory and it is very well indexed.
The chapter on `Baserates and clinical decision making in neuropsychology' by W. Drew Gouvier is excellent and, in my opinion, should be recommended reading to all medical students and clinical psychology trainees who are seeking to learn about clinical diagnostics. The question that this chapter seeks to address is simple, but commonly misunderstood: how do baserates influence the diagnostic accuracy of any test or symptom? The author argues that most of us ignore the importance of baserates in our everyday practice, even though the significance of baserates on our diagnostic accuracy may be much larger than that of any positive test result. Many good examples, and even a cartoon, are used to illustrate this argument.
There is also a very good chapter on different methods of assessing premorbid function and a review of the pros and cons of each. What is particularly interesting about this chapter is that it goes beyond the usual focus on premorbid intellectual ability, and extends itself to premorbid personality. This involves a fascinating discussion of how premorbid personality traits may be associated with post-traumatic symptom expression and emotional adaptation. All of the chapters contained within the sections on `Practice expertise' and `Relevant populations' are insightful, well written and interesting. I particularly enjoyed the chapter on `Interpreting apparent neuropsychological deficits: what is really wrong?' by Thomas Kay, who argues that the real value of the neuropsychologist is to provide an overall complex formulation of a patient and an understanding of the behaviour shown, as opposed to merely interpreting test scores within a vacuum.
Although the final two chapters of the book are not directly relevant to a UK audience, dealing as they do with American legislation and case law, they are still of interest. This is mainly because of the insights they provide regarding what we should expect in terms of future developments in neuropsychological practice as applied to the legal domain. The recognition of clinical neuropsychologists as expert witnesses has developed much faster in the US than in the UK, and we can learn many lessons from the American experience. One chapter I found particularly fascinating was `The neuropsychologist as expert witness: towards credible science in the courtroom' by Paul Lees-Haley and Larry Cohen. This chapter describes some of the fundamental guidelines and tensions of being an expert witness. Of particular interest was the distinction made between scientific and pseudo-scientific experts in `forensic' neuropsychology. Any competent neuropsychologist who has had the experience of being an expert witness will recognize the many pitfalls into which we (and our colleagues!) can so easily fall (e.g. attempting to suppress data and details of specific methodology to anyone outside the discipline; not viewing neuropsychology as a young discipline with many issues yet to be resolved). Anyone who has yet to function as an expert witness will be able to learn many points of presentation and content.
A downside to the book is that, because different chapters are written by different authors, it has a tendency to be slightly repetitive. Thus, central issues such as sensitivity and specificity are covered in many different places throughout the book. However, I do not feel that this is a major criticism, and could actually prove to be rather helpful for the reader using the book as a text source as it means that it is not necessary to flip backwards and forwards through chapters to ensure that one has understood the basics. Nevertheless, for those of us who read the book cover to cover this can prove to be rather irritating. Regardless, this is small price to pay for such a wealth of practical neuropsychological information being contained within one source. It is a rare book that covers the full range of topics pertinent to neuropsychological practice: from the basic premises and psychometric principles; to points of practice, methodology, and interpretation; and ending with how these can and should be applied within legal and adversarial domains. As such, I recommend it highly.
Notes
Edited by Jerry J. Sweet. 1999. Lisse: Swets & Zeitlinger. Price $119. Pp. 536. ISBN 90-265-1544-8.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||