Handbook of Forensic Neuropsychology, 2nd Edition

The editors organized this revision and expansion of their book's first edition¹ into four broad domains: foundations of neuropsychology, legal and ethics-related concerns, topics related to practice, and special areas and populations. The stated intent is to address the broadest range of professional interest in forensics for clinicians, adjudicators, educators, and police officers. There are 42 contributors in addition to the two editors, all psychologists or attorneys, who represent various types of forensic practice. The chapters are written to stand alone.

Section 1, “Foundations of Neuropsychology,” consists of seven chapters and begins with an overview of forensic neuropsychology that attempts to distinguish cerebral dysfunction from brain damage based on neuroimaging results. Curiously, there is no mention of neuropsychiatry. The authors of a chapter titled “Principles of Brain Structure and Function” contend that the neuropsychologist recommends physical treatments and medications, without discussing relevant scope of practice. In addition, the material presented is overly simplistic, incomplete, and potentially misleading for clinical correlation purposes. An illuminating chapter examines the history of the uphill battle to have neuropsychologists proffer expert testimony regarding causation and prognosis in organic brain syndrome-related litigation. Case law and legislative interventions are cited to illuminate the discipline's success in this regard. The degree of training, knowledge, and experience, rather than the professional title and degree, is rightly emphasized.

A well-written chapter on the neuropsychology of intelligence with a fine review of Luria's brain-behavior model declares that hemisphericity now supersedes cerebral dominance as a concept. The Halstead-Reitan battery is redefined as more of a flexible system than it generally is. A review of normative data and scaling with useful examples devoid of statistical challenges follows and elucidates pitfalls in test interpretation.

Useful tables and figures accompany the chapter on detecting poor test effort and malingering. The authors believe that clear evidence of poor effort on any test makes the entire set of results questionable and that screens and tests for this should always be included in the forensic evaluation. Specific tests and indices are discussed in detail, and the authors emphasize the need for further research.

The book's first section closes with a review of the literature on the neuroimaging of aggression and mental disorders, traumatic brain injury, and epilepsy. Various neuroimaging methods are accurately described and cautions related to introducing neuroscience evidence in legal proceedings are nicely outlined.

Section 2 concentrates on legal issues and ethics, beginning with maximizing test security. There are detailed instructions on how to manage discovery demands for test materials and raw data and a discussion about conflicts regarding releasing the information. The authors of a discussion about the security of test data rely on Watts v. United States,² when they state their beliefs that psychiatrists are not qualified to receive psychological materials and data, although release to the opposing side's neuropsychologist, who can inform the attorney, is acceptable. Chapter authors opine that the neuropsychologist has legal and ethics-based obligations to oppose fervently the release of raw test data, based on Federal Rules of Evidence Rule 26, nondisclosure laws that exist in 18 states, contractual agreements with test publishers and distributors, copyright laws, the American Psychological Association ethics codes, the principle of nonmaleficence, and the need to reduce the risk of attorneys coaching litigants.

An odd definition of testamentary capacity appears in the discussion of civil competency in Chapter 10. This is one of the few chapters that mentions physicians and psychiatrists and contains fleeting references to the MacArthur projects. The clinical and forensic aspects of the nested concepts of privacy, confidentiality, and privilege are examined in another chapter; the authors recommend an ethical decision-making model. There is a detailed discussion of conflicts of interest and other expert witness practices and pitfalls, along with hints for self-preservation. A variety of fee arrangements are substantively explored.

Commonly encountered practice issues appear in Section 3. Chapters address making depositions, preparing for courtroom testimony, dealing with minority groups, measuring change in test scores, and estimating premorbid intelligence. Included is a discussion of the ecological validity of neuropsychological testing in traumatic brain injury cases. The assertion that the neuropsychological examination provides the most comprehensive and accurate data concerning central nervous system insults sounds authoritative, although it is debatable. Some authors attempt to mount counterarguments to the general proscription against the treating clinician's serving in a dual role as the expert witness.

A brief review is provided of the effect of third-party observers on test performance and case law permitting such observers or the recording of testing. The authors opine that “diffuse [sic] tensor imaging” MRI and fMRI may supplant neuropsychological testing in the diagnosis of traumatic brain injury and enthusiastically recommend the use of visual aids to assist testimony. Bayesian methods of determining meaningful change in test results garner enthusiastic support, accompanied by good references and software resources. Can neuropsychological testing stand alone in diagnosing traumatic brain injury in the forensic setting and determine functional impairment? Authors answer with a resounding “No” with good case examples.

Section 4, “Special Areas and Populations,” reviews the admissibility of neuropsychological evidence, disability evaluations, age-specific examinations, autism spectrum disorder, substance use disorders, and neurotoxicology. These chapters have a broad range of readability, quality, and formatting but should not be skipped over. Readers will find clinical pearls, such as the critical importance of interpreting test scores, along with behavioral observations during the testing and the neuroimaging overlap of traumatic brain injury with normal and abnormal aging and the difficulties in determining capacity for specific tasks. There is a discussion of mirror neurons and the theory of mind related to autism spectrum disorders, which may be mistaken for antisocial personality disorder because of the absence of empathy and true remorse. These defendants may be easily manipulated to participate in a crime and to confess under interrogation. Generous case examples accompany these chapters.

A discussion of the future of forensic neuropsychology explores training and credentialing, the importance of board certification, the need for research into ecological validity of test results, and Internet threats including “beat the test” sites.

The text contains several strengths, including references through 2009, very fine reviews on privilege, estimating premorbid IQ, minority group testing and interpretations, and only rare proofreading errors. However, this book suffers from its attempt to address an excessively broad audience. Also, there is a lack of medical input in chapters obviously requiring such expertise, insufficient editing, and categorical statements that are debatable or only weakly supported.

• © 2011 American Academy of Psychiatry and the Law