B.S., psychology; Ph.D., clinical
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Neuroscience is a field dedicated to learning about the brain and nervous system, which can help us understand, prevent, and treat diseases and disorders such as Alzheimer’s, depression, and addiction. The vast scope of questions neuroscience is trying to answer draws interest from many disciplines, including psychology. Clinical neuropsychologists, such as Deborah Attix, help people who appear to have cognitive or behavioral problems. Using scientific tests to assess what parts of the brain might be linked to certain problems, Attix gets an overall picture of someone’s cognitive function. With this information, she can diagnose a disorder and provide targeted treatment to help that person recover or cope.
Describe this field.
Clinical neuropsychologists are psychologists who specialize in assessment and treatment of memory and behavior in relationship to central nervous system functioning. Assessment includes an array of objective paper-and-pencil, computerized, and interview-style psychological tests, which measure behavior, memory, and thinking skills known to be linked to particular brain structures or pathways. These tests evaluate whether or not someone is having cognitive problems, the affected area (e.g., memory, language, attention, visual-spatial analysis), and the severity of the deficits. Factors shown to affect performance, such as age and educational background, are taken into account. The test results are not definitive but rather are tools that give us an overall picture of someone’s cognitive function. Based on the findings, we make diagnostic inferences about what systems of the brain might be affected and what illnesses might be operating. With a diagnosis, we recommend treatment that can help people recover from or adapt to their dysfunction.
A typical day?
A typical day at work involves patient evaluations, feedback, intervention, research, and teaching. Evaluations are done by a team and can take several hours. Patients are often referred by other physicians, so we begin by reviewing medical information to determine the reason for referral, such as differentiating between depression and neurologically based memory problems or identifying if the patient has a cortically based memory disorder (e.g., Alzheimer’s disease). We then interview the patient to determine relevant medical history, including symptom onset, the course of the illness, and its effects on functioning. Next, a psychometrician (data technician) administers and scores neuropsychological tests, which I later interpret. These tests look at skills such as the patient’s memory, higher-level reasoning, sequencing, language, visual-spatial, fine motor, mood, and attention.
While the psychometrician administers tests, I might give another patient feedback from an examination or provide intervention sessions. Interventions are designed to help people compensate for and adjust to the changes they experience as a result of their diagnosis. For some patients, this involves cognitive training—e.g., targeting improvement of memory and processing skills—while for others intervention entails psychotherapy. In addition to helping patients, I also work with clinical research teams on cognitive aspects of studies and teach clinical neuropsychology graduate students, interns, and postdoctoral fellows.
Advice for students?
The education required is a bachelor’s degree, typically in psychology, followed by a doctorate in clinical psychology with a neuroscience focus (e.g., courses in neuroanatomy and neurobiology). Essential specialty training in clinical neuropsychology occurs during the predoctoral internship and postdoctoral fellowship. Because a fellowship is usually a two-year training experience, the entire journey from high school to independent practice takes approximately 10 years. Students should not be discouraged—many occupations require extensive study and preparation (e.g., physicians, attorneys, scientific researchers). Further, the journey is typically fascinating and rewarding. Students also should note that neuroscience in general is an exciting and continually evolving field. There are many career opportunities in allied disciplines, including education, basic research, neuroimaging, and even computer science.
High school students interested in learning more should shadow a clinical neuropsychologist in their community and become familiar with various practice arenas. From private practice to major medical centers, there is considerable variance in focus, clinical work, research, and teaching. Interested students can also learn a lot online and by reading some basic neuropsychology texts, such as Lezak’s Neuropsychological Assessment or Kolb and Wishaw’s Fundamentals of Clinical Neuropsychology.
Why do you like your career?
In my first year of graduate school, I took a class in the biological bases of behavior and was fascinated. Almost 20 years later, I find myself still captivated and excited about my field. Many specialty areas of practice in medicine have a well-defined system for evaluation and treatment. The brain, however, is amazing in its complexity and our knowledge remains in its infancy despite constant progress. There is always new research and new understanding, and there are always more questions. It is a field that will keep one challenged, learning, and humble. The opportunity to participate in the rewarding process of moving forward is immense and a privilege, both at the level of the individual patient and the level of the field.