2.0 CE Credits: JINS Special Issue: INS 50th Anniversary - Pediatric Disorders (JINS 23:9-10, 2017): CE Bundle 4

apa-logo_white_screenThe International Neuropsychological Society is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Neuropsychological Society maintains responsibility for this program and its content.
Educational Objectives
  1. Describe the major defining features of Autism Spectrum Disorder (ASD) and discuss major obstacles to ASD research
  2. Explain influential theories of behavior and neuropsychological function related to ADHD
  3. Discuss contemporary approaches to neuropsychological assessment and intervention of learning disabilities

Course Information
Target Audience:Intermediate
Availability:Date Available: 2018-03-19
You may obtain CE for this JINS package at any time.
Offered for CEYes
CostMembers $20
Non-Members $30
Refund PolicyThis JINS package is not eligible for refunds
CE Credits2.0


The International Neuropsychological Society is celebrating its 50th anniversary (1967-2017). Over the course of these 50 years, members of the society have made great strides in advancing our knowledge of the workings of the human brain both in health and in disease. For the past 2 decades, many of these advances have appeared in the society’s flagship scientific outlet, the Journal of the International Neuropsychological Society. To commemorate the INS 50th anniversary, the two previous JINS editors, Igor Grant and Kathleen Haaland, joined the current editor, Stephen Rao, in organizing this special double issue of JINS. We have invited some of our leading senior investigators, most of whom have served in leadership positions in the INS, to write reviews in their areas of expertise. These reviews are designed to highlight scientific discoveries that have contributed to progress in the field of neuropsychology over the past 50 years. The authors were instructed to selectively discuss landmark discoveries that have had a lasting impact in advancing scientific knowledge rather than to provide comprehensive literature reviews. In addition, the authors were asked to provide their predictions regarding scientific directions of their field over the coming decade.

The papers reflect in a remarkable way the evolution of neuropsychology over the past 5 decades. There is a movement from viewing neurocognitive change from a static anatomic perspective to one that embraces the notion of functional connectivity within neural circuits, and considers how imbalances in circuitry crosstalk may be reflected in the kinds of processes that we neuropsychologists study, for example, executive function, components of memory and attention, and so forth. The field of neuropsychology now interacts with technological advances in structural and functional brain imaging, electrophysiological methods, fluid biomarkers (e.g., cerebral spinal fluid), and genetics, to name a few. The increased emphasis on observational longitudinal designs has provided a more comprehensive understanding of the evolution of neuropsychological disorders. Finally, while neuropsychology has traditionally focused on assessment, each of these reviews also highlight advances made in the treatment of neuropsychological disorders.

We have organized this special issue into four sections: Brain Systems and Assessment, Neurological Disorders, Neuropsychiatric Disorders, and Pediatric Disorders. In the following sections of this introduction, we highlight some of the key take-home messages from these scholarly reviews. It is important to note that all of these invited reviews were peer reviewed and required multiple revisions before acceptance. Another caveat is that we do not pretend to have covered the entire scope of the scientific underpinnings of neuropsychology and we are sure that we have omitted several key research areas in our diverse field. Likewise, we recognize that only a small percentage of our thought leaders in neuropsychology were able to be invited to contribute to this special issue.

Brain Systems And Assessment

In this section, Corballis emphasizes that hemispheric asymmetry exists in great apes as well as humans (although to a lesser extent in the former), is characterized by significant individual variability and complex genetic influences, and encompasses a broader range of functions and associated neural networks than initially thought before more recent neuroimaging studies.

McDonald emphasizes significant developments in our understanding of emotion, including delineation of the neuroanatomical substrates for different aspects of emotion, the influence of emotion on cognitive processes, and the clinical implications of emotion, which necessitate the need to directly examine emotion clinically using newly developed normative procedures.

Verfaellie and Keane discuss a shift toward a more nuanced understanding of the medial temporal lobes (MTL) in human memory and amnesia over the past 30 years. On the one hand, this body of evidence has highlighted that not all types of memory are impaired in patients with MTL lesions. On the other hand, this research has made apparent that the role of the MTL extends beyond the domain of long-term memory, to include working memory, perception, and future thinking.

Dronkers and Baldo emphasize that the study of language has had a major impact on our understanding of brain-behavior relationships. This paper highlights well-known historical case studies with updates using structural MRI and functional imaging in group studies which show that language, like other complex cognitive processes, is dependent upon neural systems rather than single cortical loci.

Stuss and Burgess review how our knowledge of prefrontal functions in the context of neuropsychological assessment has been transformed over the past 50 years with key themes, including development of theoretical frameworks that address the role of prefrontal systems in the organization of human cognition, the importance of naturalistic tests, the emerging integration of functional imaging into clinical practice, and how we might develop new ways to measure executive function to fill existing gaps.

Haaland, Dum, Mutha, Strick, and Troster, a multidisciplinary group of experts in movement and movement disorders, summarize the influence of animal and human studies in showing that the corticospinal tract includes projections from multiple premotor regions as well as the motor cortex, that cognition strongly impacts even what appear to be simple motor skills, and that differential connectivity among cortical, cerebellar, and striatal regions influences normal movement and impairment with movement disorders and cortical lesions.

Casaletto and Heaton identify historical pioneers and their approaches to neuropsychological assessment as well as factors that have influenced neuropsychological interpretation (e.g., normative standards, cultural considerations, quantifying longitudinal change). They also emphasize the importance of enhancing ecological validity and ways that technological advances have impacted assessment.

Neurological Disorders

Hermann, Loring, and Wilson discuss five major paradigm shifts that have occurred within the neuropsychology of epilepsy, including departure from syndrome-specific pathophysiology, bidirectional comorbidities, quality of life, surgical outcomes, and iatrogenic treatment effects. Unlike most other disorders evaluated by neuropsychologists, surgical interventions have played an important role. This review focuses on the neuropsychological consequences of different surgical interventions and the re-emergence of electroencephalography as an important research tool for probing cognitive dysfunction.

Yeates, Levin, and Ponsford highlight progress made through studies of traumatic brain injury in adults and children. The study focuses on contributions of advances in neuroimaging in characterizing the pathophysiology of traumatic brain injury, the impact of non-injury factors on outcomes (pre-morbid factors), and medical and non-medical interventions to improve outcomes.

Bondi, Edmonds, and Salmon survey historical advances in Alzheimer’s disease, beginning with studies profiling the neuropsychological deficits associated with AD and its differentiation from other dementias, identification of specific cognitive mechanisms affected by neuropathological substrates, the shift in focus to the study of prodromal stages of neurodegenerative disease (mild cognitive impairment), and the rise of imaging and other biomarkers to characterize preclinical disease before the development of significant cognitive decline.

Benedict, DeLuca, Enzinger, Geurts, Krupp, and Rao highlight advances made in the areas of neuropathology, neuroimaging, diagnosis, and treatment that pertain to the neuropsychological aspects of multiple sclerosis (MS). This review focuses on the discovery that MS produces pathological lesions of gray matter that have consequences for cognitive functions, the use of multimodal imaging that integrates structural and functional imaging methods to better understand cognitive test performance and functional reserve, screening and comprehensive assessment of cognitive disorders including pediatric MS, and outcome studies in cognitive rehabilitation.

Neuropsychiatric Disorders

Sullivan shows us how early careful observations of neuropsychological patterns in alcoholism led to modern neuroimaging confirmations and deepening understanding not only of the structural neuroanatomy underlying alcoholism, but also to new appreciation of functional connectivity disruptions. Ongoing studies now hope to relate such functional connectivity changes not only to specific cognitive profiles but also to related deficits in self-regulation, impulse control, and reward processing that are linked to such neurocognitive deficits.

Saloner and Cysique summarize the progress from earliest reports of neurocognitive changes, first reported in 1987, to the delineation of the specific syndromes of HIV-associated neurocognitive disorders (HAND). The authors demonstrate that neuropsychology has led the way in appreciating that the brain continues to be affected by the HIV process despite good control of virus by modern antiretroviral treatments; and they note that the consequences of these persisting mild cognitive disorders include disturbance in quality of life and everyday functioning in those affected by HIV.

Waters and Mayberg present depression as a failure in the coordination of distributed frontal networks, and discuss how differential functional brain responses to different therapies, for example, pharamacotherapy versus cognitive behavioral therapy (CBT), provide for a better understanding of the component elements of depression. They suggest that increases in adaptive functionality of dorsal frontal networks controlling attention and executive function may be specifically targeted by CBT, whereas antidepressant drugs may reduce the hyper-reactivity of ventral corticolimbic structures.

Seidman and Mirsky note that the view of schizophrenia has shifted from one of “functional psychosis” (i.e., with no known brain substrate) to that of a neurodevelopmental disorder. Neuropsychological deficits, once viewed as the result of psychosis, are now thought to be a prodrome of the disorder, since they are found many years before the onset of symptoms and occur in biological relatives who never develop psychosis. They note a steady increase in convergence of neuropsychological, structural, and functional brain mapping toward understanding of the neurodevelopmental events that lead to these symptoms, such as perinatal insults, abnormal neural network organization, faulty pruning, and genetic alterations.

Gonzalez, Pacheco-Colón, Duperrouzel, and Hawes address progress in the field of cannabis use, which was just being born 50 years ago when the INS was founded. The earliest reports were a few experimental cognitive studies and case reports. Now, there is a vast neuropsychological literature and, as with studies on alcoholism and depression, an increased emphasis on structural-functional brain correlates and their relation to neurodevelopmental outcomes. While they note that evidence for persisting adverse effects of moderate marijuana use by adults is inconclusive, there is increasing concern that marijuana may not be so benign in children, adolescents, and extremely heavy cannabis users.

Pediatric Disorders

Fein and Helt indicate that the pace of research in autism has accelerated moving from an initial focus on behavior and cognition to advances associated with the incorporation of imaging and genetics. Despite these recent advances, a coherent picture of the syndrome at either a phenotypic or biological level has not emerged. They provide a roadmap for future progress, in which studies include individuals defined by social impairment without regard to repetitive behaviors to form narrowly defined subtypes, focus on characteristics that are less influenced by environmental factors, study children as early as possible thereby minimizing environmental influence, emphasize the longitudinal course, examine the relationship between specific subtypes and environmental risk factors, distinguish between what participants can do and what they typically do, and aggregate large data sets across sites.

Mahone and Denckla review the key literature pertaining to the neuropsychology of attention-deficit hyperactivity disorder (ADHD) over the past 35 years. These include the evolution of the diagnosis, influential theories, landmark treatment studies, and advances in brain mapping techniques, including anatomic, task activation and resting state fMRI, and diffusion tensor imaging. Challenges associated with studying and treating a heterogeneous neurodevelopmental disorder such as ADHD are described, along with an emphasis on associated disorders and conditions and special populations.

Fletcher and Grigorenko make the case that experimental trials of interventions focused on improving academic skills and addressing comorbid conditions are most effective for diagnosing and treating learning disabilities with a particular focus on reading disability. They conclude that neuropsychological assessment needs to move away from a focus on delineation of cognitive skills toward performance-based assessments of academic achievement and comorbid conditions, along with intervention responses that lead directly to evidence-based treatment plans. Finally, they emphasize that the path to further understanding learning disabilities will be strongly influenced by interdisciplinary research that includes the neuropsychologist and links data from cognitive neuroscience with assessment and treatment of these disorders.

Upon reflection of the articles contained within this special issue, we believe members of the INS will be proud of the many scientific accomplishments that have occurred over the past 50 years of our society’s existence. We are also assured that the future will see even greater scientific innovation in the field of neuropsychology. We think you will agree.

On a closing sad note, Larry Seidman, an Associate Editor of JINS and a co-author of the review on schizophrenia in this special issue, died unexpectedly in September 2017. We will miss this valued friend and colleague, who has made such important discoveries in the neuropsychology of mental health research.

Individual Titles, Authors, and Articles:

Facilitating Autism Research
  • Deborah Fein | Departments of Psychological Sciences and Pediatrics, University of Connecticut, Storrs, Connecticut
  • Molly Helt | Departments of Psychology and Neuroscience, Trinity College, Hartford, Connecticut

E-mail address | deborah.fein@uconn.edu

M.H. has no potential COI. D.F. is part owner of the M-CHAT-R, LLC, a screener for autism in toddlers. The LLC collects royalties when the screener is incorporated into a commercial product, but is available for free to pediatricians.


Early autism research focused on behavior and cognition. In recent decades, the pace of research has accelerated, and advances in imaging and genetics have allowed theaccumulation of biological data. Nevertheless, a coherent picture of the syndrome at either phenotypic or biological level has not emerged. We see two fundamentalobstacles to progress in basic understanding of autism. First, the two defining features (impairment in social interactions and communication, and restricted, repetitivebehaviors and interests) are historically seen as integrally related. Others hold that these two major traits are fractionable and must be studied independently, castingdoubt on autism as a coherent syndrome. Second, despite much recent research on brain structure and function, environmental factors, and genetics/genomics, findingson the biological level have not generally aligned well with those on the phenotypic level. In the first two sections, we explore these challenges, and in the thirdsection, we review approaches that may facilitate progress, such as (1) including in studies all individuals defined by social impairment without regard to repetitivebehaviors, (2) forming narrowly defined subtypes by thorough characterization on specific features, both diagnostic and non-diagnostic, (3) focusing on characteristicsthat may be relatively robust to environmental influence, (4) studying children as early as possible, minimizing environmental influence, and including longitudinalcourse as an important part of the phenotype, (5) subtyping by environmental risk factors, (6) distinguishing between what participants can do and what they typicallydo, and (7) aggregating large data sets across sites. (JINS, 2017, 23, 903–915)

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Attention-Deficit/Hyperactivity Disorder: A Historical Neuropsychological Perspective
  • E. Mark Mahone | Kennedy Krieger Institute, Baltimore, Maryland, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • Martha B. Denckla | Kennedy Krieger Institute, Baltimore, Maryland, Johns Hopkins University School of Medicine, Baltimore, Maryland

E-mail address | mahone@kennedykrieger.org

The authors declare no conflicts of interest.


The behavior patterns of hyperactivity, impulsivity and inattention that would ultimately become recognized as Attention-Deficit Hyperactivity Disorder (ADHD) have beendescribed for centuries. Nevertheless, in the past 35 years, advances in diagnostic methods, identification of biomarkers, and treatments have advanced at an exponentialrate. ADHD is now recognized as the most common behavioral disorder of childhood, with risks extending well into adulthood for both males and females, leading to itsidentification as a significant public health issue. This historical neuropsychological review of ADHD emphasizes scientific highlights in the past 35 years relatedto ADHD, including the evolution of the diagnosis (from Hyperkinetic Reaction of Childhood to ADHD), influential theories (executive functions, cognitive-energetic,delay aversion), landmark treatment studies (Multimodal Treatment of ADHD [MTA] and Preschool ADHD Treatment Study [PATS]), and advances in brain mapping techniques(anatomic, functional, and resting state magnetic resonance imaging, diffusion tensor imaging). The review concludes by highlighting the challenges of studying andtreating a heterogeneous neurodevelopmental disorder like ADHD, with emphasis on associated disorders and conditions (learning disabilities, sluggish cognitive tempo),special populations (girls, preschoolers, adults), and recommendations for scientific inquiry in the next 35 years. Neuropsychologists are well positioned to addressthe clinical and research challenges of the next generation of studies, especially involving advances in understanding the sexual dimor.phism, full developmental course,and dynamic risks associated with ADHD. (JINS, 2017, 23, 916–929)

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Neuropsychology of Learning Disabilities: The Past and the Future
  • Jack M. Fletcher | University of Houston, Houston, Texas
  • Elena L. Grigorenko | St. Petersburg University, St. Petersburg, Russia


The authors declare no conflicts of interest.


Over the past 50 years, research on children and adults with learning disabilities has seen significant advances. Neuropsychological research historically focused on theadministration of tests sensitive to brain dysfunction to identify putative neural mechanisms underlying learning disabilities that would serve as the basis for treatment.Led by research on classifying and identifying learning disabilities, four pivotal changes in research paradigms have produced a contemporary scientific, interdisciplinary,and international understanding of these disabilities. These changes are (1) the emergence of cognitive science, (2) the development of quantitative and moleculargenetics, (3) the advent of noninvasive structural and functional neuroimaging, and (4) experimental trials of interventions focused on improving academic skills andaddressing comorbid conditions. Implications for practice indicate a need to move neuropsychological assessment away from a primary focus on systematic, comprehensiveassessment of cognitive skills toward more targeted performance-based assessments of academic achievement, comorbid conditions, and intervention response that leaddirectly to evidence-based treatment plans. Future research will continue to cross disciplinary boundaries to address questions regarding the interaction of neurobiologicaland contextual variables, the importance of individual differences in treatment response, and an expanded research base on (a) the most severe cases, (b) older peoplewith LDs, and (c) domains of math problem solving, reading comprehension, and written expression. (JINS, 2017, 23,930–940)

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