Elisabeth M.S. Sherman and Brian L. Brooks
This book is the very first text dedicated specifically to pediatric forensic neuropsychology. The authors whose work you are about to read represent an elite, knowledgeable, and expert group of clinician-researchers who are among the best in the field, and whose work sets the standard for the practice, science, and discipline of neuropsychology. The book was created with the hope that it may become the definitive reference text on the practice and process of forensic neuropsychological assessment of children.
This book was created for several reasons. First and foremost was the simplest: we could not find a book to refer to in our forensic work that covered the practical, clinical, and theoretical topics that are essential to pediatric forensic neuropsychology. Pediatric forensic neuropsychological assessment involves a more complex collection of knowledge than any of its constituent parts. It requires knowledge of forensic, ethical, psychometric, and developmental issues, and blending this knowledge with child clinical neuropsychological assessment skills requires a fair degree of expertise and training. This book seemed like a good place to begin to put these different topics together. Second, there appeared to be larger need for this book beyond our own. Pediatric neuropsychology is one of the fastest-growing branches of neuropsychology, and neuropsychology is one of the fastest growing branches in the entire discipline of clinical psychology (Heben & Milberg, 2002). Likewise, forensic neuropsychology is growing at an exponential rate (see Sweet & Westerveld, Chapter 1 this volume). Yet, references that meld together pediatrics, neuropsychology, and forensics are few and far between. For instance, the entire collection of existing forensic neuropsychology books published during the last decade include only a small fraction of content specific to pediatric forensic neuropsychology. There are case reports (Heilbronner, 2005; Heilbronner, 2008; Morgan & Sweet, 2009), and single chapters on assessing children as part of larger works on forensic assessment (Denney & Sullivan, 2008; Horton & Hartlage, 2003; Larrabee, 2005; Sweet, 1999), but the majority of forensic neuropsychology books do not have coverage of pediatric issues at all. Conversely, general books on forensic assessment of children rarely include coverage of neuropsychological assessment or do not contain sufficient coverage of all of the practical and theoretical issues that are encountered. For instance, one of the best-known reference texts on forensic mental health assessment of children and adolescents contains only a single chapter devoted to pediatric neuropsychological assessment (Sparta & Koocher, 2006).
Pediatric Forensic Neuropsychology is intended primarily to be used by neuropsychologists who engage in forensic work. However, this book does not discriminate: it is intended for all neuropsychologists, regardless of whether they are retained by plaintiff or defense, or in the case of school-mandated evaluations, by attorneys representing parents or schools and school districts. Importantly, the authors in this book represent a large range of practices, experiences, and approaches to forensic neuropsychological assessment. At times, their perspectives and opinions differ from one another, and they may differ from our own. We hope that this diversity of opinion enriches the book considerably, and mirrors to some extent forensic practice, where there are necessary ambiguities and complexities on the way to establishing a legal truth.
Clinical work can become forensic either unexpectedly, or by design. Although we hope that the book will be helpful for the pediatric forensic neuropsychologist who is an expert at his or her craft, the topics in this book should prove useful for those who do not usually engage in forensic work, such as clinicians who find themselves at the end of a subpoena or summons to appear in court relating to a clinical case. This book is intended to set down some guideposts for helping navigate such a situation. Therefore, the information provided in this book may be of utility for any neuropsychological assessment, regardless of whether or not there is a forensic reason for the referral.
The book is divided into three main sections. First, theoretical and conceptual topics in the assessment of children for forensic purposes are covered. This includes legal and process issues pertaining to forensic neuropsychological assessment of children, such as the role of pediatric neuropsychology in the courtroom and practical issues encountered in private forensic practice (Sweet and Westerveld, Chapter 1), as well as the ethical issues that need to be considered (Bush, MacAllister, and Goldberg, Chapter 2). Foundational topics in the psychometrics of forensic neuropsychological assessment are also covered, and these include core topics such as neuropsychological test selection (Reynolds and Horton, Chapter 3), understanding the prevalence of low scores when interpreting performance on pediatric neuropsychological test batteries (Brooks and Iverson, Chapter 4), and interpreting change across repeated assessments (Iverson, Chapter 5). These chapters are particularly important because they form the basis of the interpretation of test findingsa foundation that is necessary for any clinician and critical for forensic work. Of necessity, given the forensic context where cases occur, the book also covers topics germane to exaggeration, malingering, and sub-optimal performance, including conceptual distinctions between poor effort and non-adherence to test instructions (Slick and Sherman, Chapter 6), and a diagnostic framework for the detection and identification of malingering and related conditions in children. The practical implications of these issues for interpreting test scores and a detailed review of techniques for detecting sub-optimal performance are also provided in a chapter by Kirkwood (Chapter 7). Cross-cultural issues are also well addressed in a comprehensive chapter (Landwher and Llorente, Chapter 8), and confounding factors that complicate interpretation of findings such as premorbid functioning and comorbid conditions are covered in another chapter (Donders, Chapter 9).
In the second part of the book, the forensic evaluation of specific pediatric populations is introduced. Here, we focus purposefully on clinical groups seen by neuropsychologists in forensic practice. Many of the clinical chapters include case studies, to help bring the topics to life. Topics include concussions and mild traumatic brain injuries (Gioia, Vaughn, and Isquith, Chapter 10), as well as moderate to severe traumatic brain injuries (Yeates, Chapter 11). In addition, because it is a question that frequently arises in the forensic evaluation of children, secondary ADHD in the context of traumatic brain injury is covered in its own chapter (Max, Schachar, and Ornstein, Chapter 12). Medical malpractice cases (Baron and Morgan, Chapter 13) and independent educational evaluations (Hahn and Morgan, Chapter 14) are also discussed in detail.
The third part of this book contains the pediatric forensic toolbox. This includes a sample consultant-attorney contract (Exhibit A), examples of brief (Exhibit B) and lengthier (Exhibit C) consent forms, samples letters for parents (Exhibit D) and teachers (Exhibit E), a consent form for release of school information (Exhibit F), a clinical interview checklist (Exhibit G), a sample interview form specifically for traumatic brain injury cases (Exhibit H), and a background questionnaire that can be used in forensic assessments (Exhibit I). These sample forms are intended primarily for use by the clinical practitioner but can also be informative for any professional involved in a forensic case that includes neuropsychological assessment. Clinicians are free to use these as a template for creating their own forms, or these documents can also be downloaded directly from the Oxford website (www.oup.com/us/sherman) and modified according to circumstance or jurisdiction.
Importantly, this book is designed to cover topics germane to civil litigation, the legal domain where the majority of pediatric neuropsychologists practice. The book purposefully omits topics relevant to criminal litigation, such as competence to stand trial, competence to waive Miranda rights, determination of legally-defined insanity, topics pertaining to the juvenile justice system, as well as topics related to child custody or child abuse evaluations. Unlike the practice areas included in this book (e.g., the assessment of children with traumatic brain injuries), these areas of practice are usually not the sole domain of the neuropsychologist. Instead, they are relevant to a broader clinical psychology audience. Several excellent books address these topics, and the interested reader is encouraged to refer to general sources for further information (e.g., Grisso, 2005; Sparta & Koocher, 2006; Wynkoop, 2008).
In addition, this book only has limited coverage of assessments with children who are exposed to environmental and industrial contaminants (see Sweet and Westerveld, Chapter 1, this volume). Childhood toxin exposure is a complex, sometimes controversial topic that is well covered elsewhere. In particular, lead exposure in children is covered both within (McCaffrey, Horwitz & Lynch, 2009; Stanford, 2005) and outside (e.g., Bisbing, 2006) the field of neuropsychology. There is also a rapidly expanding literature concerning the effects of childhood exposure to polychlorinated biphenyls (PCBs), lead, mercury, radioactive substances, carbon monoxide, mold, and industrial waste and substances used in manufacturing. At this time, the reader is encouraged to also refer to key sources for information on exposure to toxic substances, including references on forensic neuropsychology and the neurotoxic tort (Bolla, 2005, Berent & Albers, 20052008; Hartman, 1995, Hartman, 1999), and on the many issues that need to be considered, including non-credible claims (Artiola i Fortuny, 2009).
The book should also be a useful resource for attorneys, both to better understand the process of neuropsychological assessment and its considerable assets in the forensic arena, as well as its limitations. As well, some topics will also be of interest to neuropsychologists who conduct forensic evaluations of adults; adult forensic work often involves the consideration of pre-existing or premorbid childhood conditions, and several chapters include this important topic. Other professionals involved in forensic evaluations, such as clinical psychologists, psychiatrists, neurologists, and physiatrists may also find this book useful. Because most neuropsychologists, at one time or another, will engage in forensic work, coverage of forensic neuropsychology as part of clinical neuropsychology training should be a requirement of any good training program, and we hope the book will be used by graduate training programs and postdoctoral programs as part of training future neuropsychologists. As well, this book presents psychometric, diagnostic, and assessment issues that can be generalized to forensic practice in a wide range of countries, with the main focus of legal and process issues specific to the United States and Canada. Importantly, this book is intended as an introduction to basic legal, clinical and forensic aspects of pediatric neuropsychology. Individual readers should consult appropriate legal, clinical, and forensic materials in their jurisdiction.
It is our hope that, thanks to the invaluable contribution of the expert chapter authors, this book represents a first step in establishing a solid foundation of theoretical, practical, and clinical knowledge that reflects the current state of the art in forensic neuropsychological evaluation of children.