Pediatric Neuropsychology: Toward Subspecialty Designation

Abstract

Clinical neuropsychology is a rapidly expanding field of study in the psychological sciences whose practitioners are expert in the assessment, treatment, and research of individuals with known or suspected central nervous system disease or disorder. Pediatric neuropsychology has emerged as a distinct subspecialty area with related education, training, and clinical expertise for a growing number of neuropsychologists. This paper details the numerous steps taken by two affiliated organizations, the American Board of Clinical Neuropsychology and its membership organization, the American Academy of Clinical Neuropsychology, in the interest of the larger pediatric neuropsychology community and in pediatric neuropsychology subspecialty development.

Keywords:

• Pediatric neuropsychology
• Board certification
• Credentials
• Lifespan

Introduction

Clinical neuropsychology is a rapidly expanding field of study in the psychological sciences whose practitioners are expert in the assessment, treatment, and research of individuals with known or suspected central nervous system disease or disorder. While adult neuropsychological principles and constructs were emphasized early in the evolution of the field, pediatric neuropsychology has emerged as a distinct subspecialty area with related education, training, and clinical expertise for a growing number of neuropsychologists who share a desire to contribute to the understanding of brain–behavior relationships from infancy, through childhood, and into adolescence (Baron, 2008; Yeates, Ris, Taylor, & Pennington, 2010). Consequently, actions taken to protect the public and assure quality of training and clinical services have moved to the forefront as the specialty of clinical neuropsychology has matured and expanded its reach. This paper is intended to highlight efforts made over many years to address the interests of the growing pediatric neuropsychology community under the auspices of two affiliated organizations: the American Board of Clinical Neuropsychology (ABCN) (www.theabcn.org) and its membership organization, the American Academy of Clinical Neuropsychology (AACN) (www.theaacn.org). These entities fall under the overarching American Board of Professional Psychology (ABPP) which was incorporated in 1947, supported by the American Psychological Association (APA). ABPP's mission is to enhance consumer protection through the examination and certification of psychologists who demonstrate competence in approved specialty areas in professional psychology (www.abpp.org). Specialty is a defined area in the practice of psychology that connotes special competency acquired through an organized sequence of formal education, training, and experience. To be affiliated with ABPP a specialty must be represented by an examining board that is stable, national in scope, and reflects the current development of that specialty.

Over the past 50 years, as the number of clinical neuropsychologists increased, several professional organizations with distinct yet complementary roles were established to further science and practice in the field. The International Neuropsychological Society (INS) was established in 1967, the National Academy of Neuropsychology (NAN) followed in 1975, the APA's Division of Clinical Neuropsychology (Division 40) was formed in 1979, the American Board of Clinical Neuropsychology was incorporated in August 1981, and the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) was created in 1992 and incorporated in 1994. In 1996 clinical neuropsychology was formally recognized by APA as a specialty of professional psychology through the Commission for Recognition of Specialties and Proficiencies in Professional Psychology (CRSPPP). Consequently still more graduate and postdoctoral training programs in neuropsychology were initiated, and established psychology programs added courses and tracks with neuropsychological content. These were among many influences that helped shape the forward direction and continued growth in clinical neuropsychology, providing structure and definition for clinicians, and setting standards of quality and professionalism to guide and protect members of the public who accessed clinical neuropsychology services.

As the neuropsychology knowledge base broadened and professional identity solidified, an increasing number of psychologists in training or practice declared an interest in the field. This, in turn, led to the emergence of subspecialty emphases that were clearly rooted in the larger field of neuropsychology. Several developments helped to solidify pediatric/developmental neuropsychology as an emerging subspecialty. Rapidly growing knowledge in the developmental neurosciences, driven partly by such new technologies as structural and functional imaging, increased clinicians’ awareness of the biological bases of normal and abnormal behavior, and of the complex interplay of biomedical and environmental factors affecting maturation and brain plasticity. Education and training programs that historically had focused on child development or pediatric psychology introduced coursework and practica in developmental neuropsychology and neuropathology. Converging with these new tracks, training programs previously focused on adult patients embraced a developmental emphasis. The tremendous burgeoning of interest in pediatric neuropsychology was further reflected in the inclusion of pediatric neuropsychology topics in general neuropsychological volumes, the publication of pediatric-specific textbooks, and an emphasis on the development and norming of both general and child-specific neuropsychological measures. By 1995 professional interest was sufficiently high that a child-focused journal, Child Neuropsychology, was founded with the goal of providing a venue to publish research specifically related to neuropsychological aspects of abnormal development in childhood and adolescence. Publications that documented the developmental trajectory of congenital or acquired brain dysfunction in childhood appeared in multiple journals, including those focusing on how to best assess and treat children with neuropsychological dysfunction. An increased focus on better conceptualizing brain–behavior relationships and exploring developmental models also occurred in context with greater documentation of the neuropsychological course in typically developing children. See Figure 1.

Figure 1. The growth of scholarship in pediatric neuropsychology as illustrated by the sharp rise from 1980 to the present in the total number of publications captured by the search term “neuropsychology AND (pediatric OR child OR developmental OR adolescent OR preschool OR school),” as listed in the online National Library of Medicine (PubMed), by decade.

Current Pediatric Neuropsychological Practice

Professional practice in pediatric neuropsychology now encompasses an enormously diverse range of populations and practice settings. The role of a pediatric neuropsychologist has expanded along with more general advances in medicine that have contributed to increased rates of survival and improved outcome for many children with a specific brain insult or disease that years ago would have resulted in their death or severe disability. Pediatric neuropsychologists are expanding their contributions to research, theoretical formulation, assessment, intervention (including educational planning), and outcome evaluation. Additionally, significant technological advances that enhance the ability to correlate structural and functional brain changes in vivo have offered opportunities to pediatric neuropsychologists who practice in various applied settings. All of these developments are supported by related professional organizations. However the foremost organization dedicated to the examination of practitioners who wish to obtain the credential of competence in the specialty of clinical neuropsychology is the American Board of Clinical Neuropsychology.

American Board of Clinical Neuropsychology

ABCN was formed in 1981. It was based on the principles and criteria set forth in recommendations for education, training, and credentialing in clinical neuropsychology that emerged from a Joint Task Force of APA's Division 40 and INS. The origins of ABCN board examination can be traced back to 22 founding adult and pediatric neuropsychology colleagues who had the foresight to recognize that specialty status in neuropsychology was important for the public as well as for members of the then small but growing profession concerned with brain–behavior relationships. These founders incorporated ABCN, and submitted an application requesting recognition as a new ABPP member specialty board. In 1982 ABPP declared Clinical Neuropsychology to be a distinct and legitimate specialty practice area, leading to the incorporation of the new ABPP specialty board, ABCN. In 1983 ABCN officially became affiliated with ABPP and first awarded the board certified credential in 1984. Thus, less than 5 years after leading national organizations had established explicit guidelines for education and training in the newly acknowledged specialty of clinical neuropsychology, ABCN was established and began operating as a credentialing body for neuropsychologists practicing with adults and/or with children and adolescents.

Policies and procedures established by the founders of ABCN for examination in the specialty were formalized in a structure that remains the core basis for today's examination procedures: (1) psychology credential review by ABPP, (2) neuropsychology credential review by ABCN, (3) a standardized written examination, (4) a candidate's practice sample peer-reviewed by board-certified neuropsychologists, and (5) a 3-hour oral examination covering ethics and professional development, the applicant's practice sample, and case fact-finding. This structure was developed with careful consideration of how it might apply to all clinical colleagues, irrespective of their chosen practice setting (e.g., private practice, institutional) or populations served (e.g., adult, pediatric/child). Each founding neuropsychologist was also examined in advance of the first examination open to applicants in 1983 under ABPP supervision. Thus no one was “grandfathered,” there is no “senior” option, and every applicant goes through an equivalent application and examination process to reach the goal of peer recognition of their competence. ABCN then examined and awarded its first board certification credentials in 1984, and pediatric neuropsychologists were among the inaugural group of examinees. As part of the validation process the written examination was administered to every applicant who passed credential review up until 1993, to acquire normative data and to establish passing with oversight by an independent test development agency, a cutoff score that, once passed, enabled the applicant to proceed through the next mandated steps (practice sample review, oral examination) for specialty certification. The procedures put in place in the 1980s were specifically designed to include and serve the pediatric neuropsychology community. In fact the bylaws included a requirement that “The membership of the board shall reflect interests in child and adult clinical neuropsychology.” With this prescient guidance, the number of board certified members increased to over 800 clinicians in early 2011; about 40% of these serve pediatric populations.

Once board certified, pediatric neuropsychologists are eligible, and encouraged, to (1) take an active role in peer review of pediatric practice samples, (2) become trained members of the Examiner Cadre and serve on the examination team for their pediatric colleagues, (3) become pediatric members of the item-writing workshops for regularly scheduled exam revisions, and (4) hold office and advocate for their colleagues as active members of the ABCN Board of Directors. They also are eligible for membership in the American Academy of Clinical Neuropsychology.

American Academy of Clinical Neuropsychology

ABCN and AACN each have distinct missions. ABCN's mission, as noted above, is solely one of examination and it is not a membership organization, whereas AACN is a membership organization for those who are board certified. It was created under ABPP auspices to support continued maintenance of standards in clinical neuropsychology. It has its own Board of Directors to oversee membership activities. For example, it provides continuing educational opportunities for both members and non-members at an annual continuing education meeting that offers courses for candidates about the examination process and for those who wish to maintain specialty knowledge, and supports professional publications that serve the public and professionals. The Clinical Neuropsychologist is the official journal of AACN and provides a forum for policy papers and other pertinent documents related to the specialty. Active AACN members have free access to another journal, Child Neuropsychology. AACN sponsors two professional book series in association with Oxford University Press and Psychology Press. The AACN website serves as a forum for practice guidelines, policy papers, and other pertinent task force documents. Additionally, affiliate and student memberships are encouraged for those interested in participating in non-voting activities of the Academy. Most recently, in 2008 the AACN Foundation was established as a charitable entity to award funding for outcome research that demonstrates the utility of neuropsychological services.

ABCN had anticipated the likelihood that subspecialty considerations would arise since clear and well-defined practice differences exist among its members. However, the membership remained satisfied that the existing examination structure, with its broad written exam, paired with targeted practice samples, review of professional credentials, and oral examination, allowed for a fair and thorough assessment of each candidate regardless of their practice setting.

Within this context the advantages of organizing and working together as clinical neuropsychologists, above and beyond any consideration of particular subspecialty practice, have become increasingly clear as the field of neuropsychology is challenged by professional, political, and economic crises. On the professional front, in addition to establishing a thriving continuing education and publications program, AACN task forces are working with other national organizations to refine guidelines for graduate and post-graduate education and training. On the political front, AACN members and Board of Directors are addressing state and national legislation that would inappropriately define or restrict “best practice” of neuropsychology. On the economic front, AACN is negotiating with public and private insurers to establish scientifically based criteria for determining reasonable and necessary coverage of neuropsychological services. In all these endeavors members of AACN have learned that our common cause not only outweighs any differences, but that our different perspectives also inform and enrich every effort—whether that involves writing practice guidelines that apply to the diversity of our field, or drafting “determination of coverage” models that will cover a 10-year-old patient with sickle cell infarct as well as an 85-year-old with Alzheimer's disease. While recognizing the value and power of a unified board—that is, a board that is not segregated by age or subspecialty practice—there is also realization that an explicit subspecialty designation, indicating an individual's specific focus within the field of clinical neuropsychology, will be useful to those who refer clients for neuropsychological services, and to the clients themselves.

While ABCN was recognizing these practice trends, others were also identifying and highlighting the unique characteristics of a pediatric neuropsychology practice. In 2006 an application for a separate specialty board in Pediatric Neuropsychology was made to ABPP by a free-standing group, the American Board of Pediatric Neuropsychology (ABPdN). The application was based, in part, on the premise that ABCN examination procedures did not specifically certify competence in pediatric neuropsychology, so that the public could not determine whether or not an ABCN diplomate was qualified to treat children and adolescents. This was a misunderstanding of the ABCN board certification process. Understandably, others may be unaware of procedural steps instituted over the decades to carefully assess pediatric qualifications of ABCN diplomates, steps that include formal pediatric mentorship, personal choice for the practice sample product (two clinical cases), an option to request two pediatric examiners on the three-member oral examination team (while at least one pediatric specialist is appointed to every team), a guaranteed pediatric fact-finding case option, and a formal and objective appeals process at both ABCN and ABPP levels should a candidate feel that their interests were not well represented at the examination. The success of these efforts are supported by the fact that the number of ABCN diplomates whose practice includes or is exclusive to children and adolescents is greater than 40% of all those boarded by ABCN (Sweet, Meyer, Nelson, & Moberg, 2011). After careful and thorough deliberation the ABPdN application to ABPP for specialty status was denied in early 2007. The decision was complex, but essentially recognized two key arguments: First, pediatric neuropsychology was not sufficiently distinct from the practice of clinical neuropsychology to warrant recognition as a specialty in its own right; and second, that existing ABCN procedures already provided a mechanism for assessing competence in pediatric neuropsychology, even though pediatric qualification was not yet being explicitly “labeled” among ABCN diplomates.

To expand on the first point, pediatric neuropsychology as a specialty practice area requires a broad base of knowledge in neuropsychology, with added qualifications in developmental neurobiology, cognitive development, and pediatric disorders. The core knowledge base in clinical neuropsychology as outlined in the Houston Conference on Specialty Education and Training in Clinical Neuropsychology guidelines provided the basis for practice, and has guided eligibility and examination in the specialty of Clinical Neuropsychology since January 1, 2005 (Hannay et al., 1998). To use a medical analogy, separating pediatric neuropsychology from the broader field of clinical neuropsychology would be akin to a neurosurgeon who did not first complete training in general surgery. Second, the ABPP Board of trustees recognized that ABCN, a member of ABPP since 1983, already had an examination process to recognize competence in pediatric neuropsychology, as outlined above. The ABPP Board of Trustees decision also supported the position that Pediatric Neuropsychology should be considered a subspecialty of clinical neuropsychology, and encouraged ABCN to explore issues related to subspecialty recognition.

Subspecialty Study Committee

Following the decision of the ABPP Board of Trustees, in 2007 Michael Westerveld, Ph.D., then ABCN President, formed a “Committee to Study Subspecialization.” This committee, chaired by Ida Sue Baron, Ph.D., an ABCN past-president, was charged with consideration of the pros and cons of subspecialty designation in order to make a recommendation regarding the feasibility of such designation for ABCN. Although subspecialization in pediatric neuropsychology was recognized as an important topic for consideration, no particular subspecialty designation was specified as the intended outcome. Rather, subspecialty endorsement in general needed to be clearly defined and explicated, as the process would have direct implications for the larger ABPP governance and other member Specialty Boards. Therefore committee members were selected who broadly represented professional interests in various practice areas considered possible subspecialties, including pediatric, geriatric, forensic, and rehabilitation neuropsychology.1 The goal was to assure that diverse clinical and research interests across the membership are represented; this composition provides a rich source of discussion regarding subspecialization. The committee first engaged in discussion and research that included review of reputable boards in medicine and open-ended discussion, in person and via conference calls, to consider what subspecialty designation might mean at a generic level, and what value it would have specifically for AACN membership. The committee members concluded that there was relevant precedent from medical board policies honed over decades to guide ABPP member board policy.

A central tenet gleaned from this research and subsequently endorsed by the committee was that development of a subspecialty requires a primary identification with and commitment to the overarching ABPP-defined specialty area. Consequently, this should be concretely demonstrated by undergoing the board-certification examination process of the broader ABPP specialty. These committee meetings further elucidated a number of critical points that warranted further study. Emerging from these discussion were some fundamental principles, applicable to any potential subspecialty area designation, that were endorsed and presented to ABPP in 2008, paraphrased as follows:

(A) For subspecialty designation, the needs and interests and/or practice of any single ABPP Board must be compatible with the needs and interests and/or practice of the members of all other ABPP boards.

(B) Subspecialty areas must be uniquely positioned within their specific specialty area. No ABPP specialty board should develop subspecialty designation when subspecialty interests are already represented by an existing ABPP specialty board. Diplomates should continue to be encouraged to consider dual certification as the primary mechanism for subspecialization across specialties.

(a) Joint recognition of subspecialty areas is necessary by all ABPP specialties and all should have an opportunity to comment on potential subspecialties proposed by another board, and a right to appeal a perceived transgression across specialties to avoid encroachment by existing specialty boards whose interests overlap.

(b) In the majority of cases the pre-eminent core competency required for subspecialization will reside within a single specialty area, i.e., subspecialty designation should originate from within the professionally appropriate ABPP Specialty board. In rare cases when a subspecialty domain substantially cuts across respective core competencies, a “multiple door” model could be considered. For ABCN, the unique education, training, and practice competencies required for neuropsychology subspecialization make only a single door possible.

(C) All boards should expect reciprocity and respect for their subspecialty areas. For example, a subspecialty in any area of “neuropsychology” should originate from ABCN.

(D) A decision to create a subspecialty should be based on upholding the education and practice of the discipline of professional psychology represented by a specific Specialty board, and should not be decided by majority vote of all ABPP boards. Any board has the right to deny another board subspecialty designation that is justified by their own specialty status.

(a) To accomplish this collaborative arrangement and to reinforce collegiality between ABPP boards, ABPP should have a central mechanism to review subspecialization proposals and to facilitate cross-board communication.

(b) Representation by each member board is one mechanism to maintain structure, function, and collegiality of ABPP member boards

(c) A mechanism for cross-board communication needs to be established.

Thus recommended education and training models should precede subspecialty designation. How eligibility and competency would be defined remained to be determined; specific criteria for determining eligibility within various subspecialties are currently under development in committee, and have not yet been formally proposed to the ABCN or ABPP boards for adoption.

Pediatric Neuropsychology Subspecialty

Once the basic foundation was laid to guide the development of subspecialties within ABPP at large, the committee turned its focus to topics specific to neuropsychology. To further the committee's discussion on key points, pediatric neuropsychology was chosen as the presumptive first subspecialty. This choice was based on the large percentage of ABCN diplomates that serve a pediatric clientele. According to the 2010 TCN/AACN Salary Survey, 40.7% of ABCN diplomate respondents serve pediatric patients in their practice (15.2% solely pediatric; 25.5% pediatric and adult). Consistent with these percentages, of neuropsychology residents who responded, 37.5% identified as pediatric, either solely pediatric (23.4%) or as both pediatric and adult (14.1%) (Sweet et al., 2011).

Obstacles were apparent and continue to be a focus of the Committee, as the work moves forward. As noted above, there was no impetus for subspecialty status originating within the membership, no mechanism to identify the subspecialty status of existing diplomates was yet in place in the ABPP structure, and accepted standards for definition, education, and training in a subspecialty do not yet exist, although these are essential before examination for competency in a subspecialty can proceed. Moreover, a significant proportion of ABCN members see patients across the entire lifespan, leaving at issue how these individuals could justifiably declare in one subspecialty without minimizing their qualifications in areas that are not (yet) subspecialty designated. The merits of subspecialization designation were appreciated but these and other critical issues remained to be considered carefully to avoid unintended consequences including potential harm to well-qualified clinicians and to the public.

At its formation, ABCN recognized that pediatric neuropsychology requires some unique knowledge and skills that are different from those required in neuropsychological practice with adults. However, recognition that a practice requires an additional knowledge base and skill set does not necessarily indicate that such practice is sufficiently distinct to qualify as a specialty; not all niche areas of practice warrant recognition as a specialty in their own right. The position of ABCN is that, as currently defined, pediatric neuropsychology is a subspecialty within the broader specialty of clinical neuropsychology. The core foundation of knowledge and methods of practice in pediatric neuropsychology are shared with clinical neuropsychology and are more similar than distinct. However, specialties emerge and grow over time following a progression that is similar to the evolution of neuropsychology as a specialty built on the foundations of the broader field of psychology. This opinion is rooted in the definition of a specialty practice, which also helps to shape the future path for pediatric neuropsychology to continue evolving into a more mature field that one day may become a specialty.

CRSPPP identified 12 principles for the definition of a specialty (American Psychological Association, 2008). Several key criteria are briefly reviewed below for the purpose of developing recommendations for further discussions regarding designation as a specialty. Among these, Criterion I (“Administrative Organizations”) describes the need for a consortium of organizations to provide a system of oversight to guide the development of the specialty, including the development of standards for education and training. Establishing such an organization can be a difficult step, and requires enlisting self-identified “experts” in the proposed specialty area. While representation of diverse opinions about what is necessary to prepare for practice can be a healthy stimulant for discussion it can also make consensus difficult to achieve. Criterion III refers to distinctiveness of the specialty with regard to scientific knowledge and application in practice. This criterion also recognizes that there may be overlap with other existing specialties, but the differences should be great enough to distinguish a specialty from these other specialties. Currently, foundations in clinical neuropsychology include principles of lifespan development including but not limited to child development. However, principles of normal and pathological development is also an area for increasingly specialized knowledge at both extremes of the lifespan. Identification of a point at which there is a critical mass of specialized knowledge to require a separate specialty is a difficult task at best, but one that requires an administrative organization as outlined in Criterion I in order to determine what areas of knowledge are important for practice. This is also addressed in Criterion V, which establishes the need for an advanced, specialty-specific scientific and theoretical knowledge base that extends beyond the core foundations of related specialties.

The establishment of a foundation of knowledge necessary for competent practice would ideally lead to the development of models to teach and apply knowledge in clinical practice. Criterion VII states that a specialty should have a defined sequence of training that includes curriculum, research, and supervision. At present, and of particular import, there are no separately defined graduate programs in pediatric neuropsychology that exist outside of major areas of study. Concentration in a pediatric track typically takes place during graduate school, and continues at the internship and post-doctoral level. However, the content and nature of preparation varies considerably, and consensus on what constitutes an appropriate basis for practice is lacking. Finally, a mature specialty should be able to define competence and establish guidelines for practice. It is important to have a means to measure and evaluate competence, and identify competent practitioners to fulfill the obligation to protect the public interest. Examination by peers leading to the awarding of board certification through a reputable organization is considered the clearest means of demonstrating professional competence.

When pediatric neuropsychology is viewed through the lens of the CRSPPP criteria, the ABCN viewpoint regarding status as a subspecialty becomes clear. However, there is also a need to recognize and evaluate competence in pediatric neuropsychology. As mentioned, pediatric/child neuropsychological practice is not the same as practice with adults, and ABCN bylaws explicitly state that the interests of both be considered. Establishing a procedure for examining added qualifications in pediatric neuropsychology should no longer be considered premature given the evolution of a more distinct identity development. However, the current model of a written examination to assess broad foundational knowledge across the lifespan is based on the understanding that before one can demonstrate competence in a subspecialty, the broader principles of the specialty need to be mastered. Competence applying that knowledge to practice with children is evaluated more directly by peer review of practice samples and direct examination of clinical knowledge in pediatric neuropsychology during oral examination.

Pediatric neuropsychology is a rapidly developing field from a scientific perspective and in the breadth of clinical applications. As the number of neuropsychologists specializing in pediatrics increases it is likely that a more distinct specialty will emerge. However, development of a specialty is a lengthy and considered process. Careful deliberation and consensus building regarding basic issues must precede more advanced steps, such as defining competence. Professional organizations in neuropsychology will need to develop an administrative structure and organization as outlined in Criterion I of the CRSPPP principles. A consensus conference with representatives from relevant organizations discussing foundational knowledge and training models will be a critical next step if pediatric neuropsychology is to continue to evolve and become a specialty.

Pediatric Subspecialty Interest Group

To begin the process, the Subspecialty Committee recommended in early 2009 that a Pediatric Subspecialty Interest Group be endorsed as an interim step. This group was charged with several initiatives as part of its mission, e.g., membership, mentoring, continuing education, and contribution to subspecialty development. The transition from interest group to subspecialty would require definition of training and education standards, competence definition and measurement, and clarity about what is being measured with this additional certification. The first annual meeting of the PSIG was held at the June 2009 AACN Annual Conference and Workshops Excellence in Clinical Practice meeting, and yearly meetings are scheduled in association with this meeting. What is emerging is a preliminary outline of the education and training requirements that will lay a foundation for competence in pediatric neuropsychology. ABCN, endorsing the Houston conference guidelines as the foundation, recognizes the breadth of training provided by this model as critical for competence in any neuropsychological subspecialty. While specific recommendations are still under study, general guidelines for added qualifications in pediatric neuropsychology include specific knowledge of developmental principles and brain development in childhood. Knowledge of pediatric neurological conditions and of the developmental impact of neurologic insult at different ages is critical. Broad knowledge of developmental conditions that are specific to childhood, as well as understanding of childhood onset of illness/injury that can occur at any age (e.g., stroke) are also important, as is the application of interventions and special education law for this population.

In conclusion, pediatric neuropsychology is a rapidly growing practice area that is recognized as a subspecialty within the broader field of clinical neuropsychology. ABCN, which has always had in place procedures for the evaluation and certification of competence of pediatric practitioners, is moving towards a model of greater distinction that will allow specialists to select one or more subspecialty areas as added qualifications. At the same time it is recognized that developmental issues are critical for both pediatric and adult practitioners since congenital conditions, as well as neurological injury or disease acquired in childhood or adolescence, will continue to directly impact function throughout the individual's lifespan. The most effective approaches to understanding brain–behavior relationships depend on that recognition.

Notes

¹ Drs. Kira Armstrong, Deborah Attix, Ida Sue Baron (Chair), Dean Beebe, Linas Bieliauskas, Kerry Hamsher, Michael Kirkwood, Greg Lee, John Lucas, Michael McCrea, Celiane Rey-Casserly, Jerry Sweet, Brenda Spiegler, Michael Westerveld, Karen Wills.