Neuropsychological assessment with lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals: Practice, education, and training survey

Abstract

Objective: We sought to describe the LGBTQ + related education, training, and clinical practice of independently licensed neuropsychologists in the United States and to identify factors that predict affirmative neuropsychological practices. We hypothesized that LGBTQ + identity, female gender, more recent training, and extent of LGBTQ + education/training would predict use of LGBTQ + practice guidelines. Method: A workgroup of clinical psychologists with experience in LGBTQ + psychology and neuropsychology developed a survey to identify personal and professional factors that predict affirmative neuropsychological testing practices. The survey was distributed through professional organizations and listservs between August and September 2021 with 118 responses meeting inclusionary criteria. Results: The majority of participants identified as heterosexual (70.3%) and cisgender (97.5%), and most (48-63%) received LGBTQ + training post-licensure. Between 19% and 32% of participants reported never completing LGBTQ + specific education. Consistent with our hypotheses, factors predicting affirmative clinical practice behaviors were LGBTQ + education/training, and personal background (sexual minority status, female/feminine gender, and years since degree). Other significant factors included prior experience with LGBTQ + patients and primary patient population (child vs. adult). Qualitative responses indicated varying values, attitudes, and knowledge regarding collection of LGBTQ + information and modification of clinical practice. Conclusions: Neuropsychologists underutilize affirming practices as evidenced by low rates of querying pronouns, knowing whether LGBTQ + health information is available at their institutions, and adjusting evaluation and feedback approaches. We provide specific training and education recommendations to increase knowledge and skills and to address beliefs about LGBTQ + health that can serve to promote affirmative neuropsychological practice.

Keywords:

• LGBTQ+
• sexual and gender minority
• training and education
• affirming practice
• cultural humility

Acknowledgments

We thank the research participants for responding to our survey so thoughtfully and diligently. ANC thanks Dr. Colleen Jackson for support in joining his interests in clinical neuropsychology and the minority stress model as well as Dr. Kaitlin McCloskey for consultation on early iterations of this project. Finally, we would like to thank Dr. Neil Alexander for his practical support in the Institutional Review Board process and Sayre Corbin for her administrative assistance with study protocols.

Disclosure statement

Two coauthors (ANC and ET) are Executive Board members of the Queer Neuropsychological Society, but they received no financial support related to this manuscript. No potential conflict of interest was reported by the other authors. The views and opinions expressed herein are not meant to be taken as official policy of any of the authors’ affiliated institutions, including the Department of Veteran Affairs.

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes

1 The initialism LGBTQ+ is inclusive of queer, questioning, and additional identities and experiences (Kronk & Dexheimer, 2020; Kronk et al., 2019). We use that initialism when broadly discussing sexual and gender minority communities. Otherwise, our language mirrors the literature we are citing.

2 Heterosexuality is a sexual orientation in which a person is sexually and romantically attracted to individuals of a gender that is different from their own gender (Kronk & Dexheimer, 2020; Kronk et al., 2019).

3 Cisgender is a gender in which a person’s gender identity is congruent with the sex they were assigned at birth; sex assigned at birth is a sex that people or institutions prescribe to a neonate based on observable sex and/or reproductive organs (Kronk & Dexheimer, 2020; Kronk et al., 2019).