Although often viewed as a speciality within Clinical Psychology, we continue to feelthat knowledge of neuropsychology (and its applications) is relevant to all areas of clinical work where people (across the age span) might be showing some change in their cognitive functioning. Thus, a working knowledge of neuropsychology and the assessment and management of cognitive impairment may be necessary for the delivery of a competent clinical service by even those practitioners who do not wish to see themselves as experts in the field of clinical neuropsychology, and who may well have had little or no experience of clinical neuropsychology during their training as Clinical Psychologists. Historically, psychometric testing (underpinned by knowledge of psychometric principles) has been a cornerstone of the skills making psychologists unique as a professional group and it remains a core, essential skill of clinical neuropsychologists. In recent years there have been increasing and multiple threats to clinical psychology: from non-psychologist IAPT practitioners providing CBT, other neuro-professionals claiming skills in cognitive assessment and the move from self-management under the British Psychological Society to external regulation by non-psychologists with the Health Professions Council. We, more than ever before, need to protect our expertise and ensure the next generation of psychologists have the same breadth and depth of skills if the profession is to continue to exist and if the public is to be protected. While we would argue that neuropsychological assessment should formpart of the core competencies acquired by all trainee clinical psychologists, our compilation of this second edition is based on the more realistic
appreciation of the training opportunities available to those who are both pre- and post-qualification, an appreciation gained through many years of being actively involved in both pre- and post-qualification training of clinical psychologists at the Institute of Psychiatry and elsewhere.
There are of course different ways in which to present information on clinical neuropsychological knowledge and practice. One is to focus on specific neurological disorders, and their assessment and management. Within the scope of a relatively short book, however, we feel that this may limit the apparent relevance and generalizability of the skills, which we feel it is important for clinicians to possess. Thus, for the current volume we have again chosen to focus on broad areas of cognitive function (including those such as praxis and number processing and calculation which are perhaps less well-developed areas of clinical neuropsychology in the United Kingdom) which may be relevant to assess across a wide range of neurological and psychiatric disorders.We have also chosen to include chapters that deal with important background information relevant to those being assessed (such as the effects of medication and the interaction between neurological and psychiatric presentations) and, because somuch of clinical neuropsychologists’ work does involve test interpretation, an overview of key psychometric concepts underpinning neuropsychological assessment. There is also a consideration of the impact of cognitive deficits on driving skills, an area that has developed considerably since our first edition.
In addition to addressing specific cognitive functions, it is of course obvious that clinical neuropsychology may be somewhat differently applied at different ends of the age spectrum, where different factors may assume particular importance. For this reason, we have chosen to include specific chapters that address the issue of neuropsychological practice with children and older adults as well as a new chapter addressing frontotemporal lobar degeneration. We have also covered the specific difficulties encountered in working with individuals with very severe and profound brain injury, an area brought to the public’s attention through some recent dramatic neuroimaging studies as well as cases questioning the issues of life prolongation in situations reflecting potentially poor quality of life. At any point in the age range, neuropsychologists may be required to have an input into the medicolegal system, and for this reason we have again included a very practical chapter dealing with the way in which such work should be undertaken as well as a chapter on the assessment of mental capacity. The latter area has become increasingly relevant to clinical neuropsychologists with the passing of new legislation.