We had the pleasure of sitting down with Debbie recently to discuss key challenges and opportunities facing the industry today. You can read the full Q&A below.
Trends and developments in Neuropsychology having an impact now:
In my opinion, one of the biggest trends – evidenced in the international research literature which has been conveyed the media - is the impact of concussion injuries. The widespread public education regarding concussion (especially in American football players) has led, in my view, to a greater focus on it – both by clinicians and people who are injured.
Whilst this has meant that more people are seeking treatment and compensation, there is – in my experience – also an increased anxiety. This means that their concern about possible long term cognitive consequences, leads to greater anxiety, which in many ways becomes a self-fulfilling prophesy. That is, the person is worried that they might have cognitive impairment following the concussion, and this anxiety leads them to become very focused on everyday mistakes, and thus their anxiety is increased. This, in turn, leads to greater worry which distracts them from concentrating, causing more mistakes, and compounding their anxiety.
Therefore, careful neuropsychological assessment of cognitive function and psychological state are very important to discern these factors. In terms of treatment, collaborative work with a multidisciplinary team to treat these types of injuries is vital.
What’s a common mistake you see people make related to neuropsychologists working with psychiatrists towards a satisfactory outcome?
Primarily the role of the neuropsychologist is to use objective measures to identify whether there is evidence of cognitive impairment as the result of a brain injury. However, the injured person’s responses to the changes in their life (physical, cognitive or impacting on their ability to work) can lead them to develop psychiatric symptoms at the same time. The symptoms of depression (or anxiety) can impact on cognitive function as well, thus compounding the problem.
A common mistake that I observe is that there is often a tendency to attribute all difficulties to the brain injury. If there is a mood element, this is important to identify and treat, as it can improve outcome. Similarly, if there is significant cognitive impairment that will also impact on the type of therapy they can cope with, so this is important information.
Thus, it is my view that at times our psychiatric colleagues aren’t given clear enough information about the relative contribution of both of these factors, as they are very important to inform treatment.
What’s an advantage or disadvantage of working in the area of neuropsychology and psychiatric injury?
A major advantage of including neuropsychological assessment in these cases is the thorough assessment of both cognitive and psychological function with objective measures. This can provide a greater clarity concerning the factors at play, which can inform treatment.
A disadvantage (although I see it as a challenge) is that the situation is not always clear – that if there are many contributing factors to outcome (for example brain injury/neurological disorder and psychiatric factors) it can be hard to make clear predictions about recovery for example.
Are there any recent developments in Neuropsychology that you think practitioners should keep on their radar?
Historically, neuropsychologists experience great anxiety when medicine develops better imaging and diagnostic techniques, so as these improve we are often worried that we will be out of work! However, our role is to understand the complex interplay between organic and psychological factors, so we are determined to keep using psychological tests and knowledge to contribute unique information. We rely heavily on our psychometric tests, so improvements in that area are always keenly watched. The biggest change in recent years has been the introduction of cognitive testing on iPads – to replace the old book format that has served us well for many decades. The tests themselves have not fundamentally changed, but the way people interact with them has – clients can tap on screens to show their responses for example, making the timing and recording of their responses more accurate. In my experience most people are very receptive to this, and seem to enjoy the assessment a little more. I think in the future there will be greater use of technology in assessments, but the role of analysis and interpretation will stay with us for a little longer!
Debbie initially worked in public hospital settings before moving into full time private work. She evaluates clients both at the referral of treating doctors and as an independent expert in medicolegal cases (personal injuries civil matters and cognitive aspects of capacity to stand trial in criminal matters). She enjoys the challenge of fully evaluating complex cases, and had given evidence in legal proceedings on a number of occasions. She has several publications and conference presentations related to this work, which demonstrate her commitment to evidence-based practise. Debbie is also very active in the Australian Psychological Society, and will again be chairing the College of Clinical Neuropsychologists annual conference later this this year. She is passionate about training the next generation of professionals, so supervises new graduates (registrars) and retains casual appointments at two universities in Brisbane, lecturing the students in clinical neuropsychology and assessment skills. Her most recent project combines self-care for clinicians and professional education, organising overseas retreats for neuropsychologists.