ANST Blog

Research Roundup: The RDoC Project

12/17/2013

The Research Domain Criteria (RDoC) Project

The Research Domain Criteria (RDoC) project, initiated by the U.S. National Institute of Mental Health (NIMH), has the potential to substantially change the way we conceptualize psychiatric disorders, psychopathology, and cognitive symptoms and the methods used to research them. The following are resources to help you learn about this initiative and how it may affect you.

DISCUSSION

DSM-5 and RDoC: progress in psychiatry research?
Neuroscience studies into psychiatric disorders generally rely on disease definitions that are based on the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), the fifth edition of which (DSM-5) was released earlier this year. Designed as a purely diagnostic tool, the DSM considers different disorders as distinct entities. However, boundaries between disorders are often not as strict as the DSM suggests. To provide an alternative framework forresearch into psychiatric disorders, the US National Institute of Mental Health (NIMH) has recently introduced its ResearchDomain Criteria (RDoC) project. In the RDoC, five 'domains' each reflect a brain system in which functioning is impaired, to different degrees, in different psychiatric conditions. Nature Reviews Neuroscience asked six leading investigators for their thoughts on how DSM-5 and the RDoC will influence neuroscience research into psychiatric disorders. [Casey et al. (2013) Nature Reviews Neuroscience, 14:810-814.]

ABSTRACT

Constructing constructs for psychopathology: the NIMH research domain criteria.As a commentary for the special section on Reconceptualizing the Classification of Mental Disorders, this article begins with a description of the impetus for the U.S. National Institute of Mental Health's (NIMH) Research Domain Criteria (RDoC) initiative and provides an update of progress on that initiative to date. The commentary then engages the articles in this special section, beginning with a response to Berenbaum's concern that the RDoC approach to sorting constructs across multiple units of analysis espouses a de facto biological fundamentalism. This leads us to delineate the relationship between RDoC and the NIMH priorities relevant to this initiative. The commentary then considers how Patrick's iterative "construct-network" method can be applied to RDoC construct validation, highlighting several aspects that are particularly useful. One aspect of this work involves determining subject inclusion and exclusion criteria that provide an appropriate range of variance. Finally, this commentary considers the Bilder group's article, explicating the ways in which multilevel models can foster development of hypotheses and informatics approaches needed for further RDoC progress. [Cuthbert & Kozak (2013). J Abnorm Psychol, 122(3): 928-937.]

FURTHER READING

Description of RDoC project at NIMH website Developing Research Domain Criteria (RDoC) to improve diagnosis and treatment of social deficits in psychiatric disorders: The Mirror Neuron System as a model. [Singh & Feifel (2013). Schizophr Res, Epub ahead of print]
Disruptive Behavior Disorders: Taking an RDoC(ish) Approach. [Blair, et al. (2013). Curr Top Behav Neurosci, Epub ahead of print]

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ANST Director's Meeting: Medical College of Wisconsin

12/14/2013

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Amy Heffelfinger, PhD, ABPP-CN

Medical College of Wisconsin (Milwaukee, WI)

Introduction

The Division of Neuropsychology in the Department of Neurology at the Medical College of Wisconsin (MCW) in Milwaukee, Wisconsin offers APA-accredited postdoctoral fellowship options in either Adult Neuropsychology or Pediatric Neuropsychology. The program is a member of the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) and participates in the National Match Program for residencies in clinical neuropsychology. The MCW postdoctoral fellowship also is accredited by the American Psychological Association (APA) Committee on Accreditation in the Specialty of Clinical Neuropsychology and adheres to the Houston Conference standards and model.

The program, which recruits three to four fellows per year, offers many unique training opportunities for both adult and pediatric fellows including rotations in the following:

Adult Track Major Rotations:

Epilepsy Surgery
Memory Disorders
General Medical/Psychiatry
Forensic/Traumatic Brain Injury

Adult Multidisciplinary Specialty Clinics: Brain Tumor, Normal Pressure Hydrocephalus Amyotrophic Lateral Sclerosis (ALS), Deep Brain Stimulation (DBS)

Pediatric Track Major Rotations:

Epilepsy Surgery
Preschool and Infant Neuropsychological Testing (PINT)
Neurological and Medical Disorders
Developmental Disorders/Forensic Evaluations

Pediatric Track Specialty Clinics: Autism Screening, Brain Tumor, Sickle Cell, Sports Concussion and Traumatic Brain Injury, Genetics

Using an apprentice model for training in clinical, research, teaching and supervision, they place a strong emphasis on career mentoring. MCW provides comprehensive didactics and training with competency-based assessment of knowledge and skill to prepare each fellow for board certification with AACN/ABPP.

Amy Heffelfinger, PhD, ABPP-CN, directs the Neuropsychology Postdoctoral Training Program at MCW. She is board certified in clinical neuropsychology and holds the academic rank of Associate Professor of Neurology, Neurosurgery, and Pediatrics. She serves on the Board of Directors for the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN). She specializes in pediatric neuropsychology, with her current research interests involving attention and executive functioning in preschoolers, neuropsychological functioning in children with Phenylketonuria (PKU), neuropsychological outcomes following pediatric brain tumors, and autism.

Your postdoctoral program provides many impressive training options and gives Adult and Pediatric Neuropsychology fellows the opportunity to work side by side. What opportunities are there at MCW to learn about neuropsychological assessment across the lifespan?

The key to “lifespan neuropsychology” is remembering that all of our patients are/were children and hopefully will develop into adults. Fellows only work with adult or pediatric patients, but much discussion occurs regarding development across the lifespan for individuals with epilepsy, brain tumors, traumatic brain injury, stroke, developmental disorders and genetic disorders. Many of our pediatric patients grow up and are transitioned to the adult side for continued neuropsychological care.

For example, we regularly follow our children with brain tumors over time, and, when they are 18, we ask the adult team to see them. Because we know the child and family, we can help the adult side understand the psychosocial, developmental, and cognitive issues of the individual. Conversely, the adult side regularly provides informal consults on assessment and interpretation of classic “adult” neuropsychological syndromes like aphasia and apraxia, and help with conceptualizing potential prognoses. All of our faculty and fellows are housed together, so, discussion about these patients is natural and seamless. Additionally, our didactics strongly focus on topics that are relevant across the lifespan including early neural development, neuroanatomy, and neuropsychological syndromes.

What, in your opinion, are other strengths about your program?

You were perceptive to identify that our lifespan approach is one of our proudest strengths, and we have several other strengths as well.

1)     We provide outstanding depth and breadth in patient populations. It is not unusual for a fellow to work with several different types of medical/neurological/genetic disorders in one week! Additionally, every fellow receives sufficient training to develop expertise in specific disorders such as epilepsy, TBI, brain tumor, dementia, and developmental disorders such as autism.

2)     Fellows have opportunity to work in multidisciplinary clinic settings, including those that serve patients with epilepsy, brain tumors, and mild TBI. It is not unusual for our fellows to directly interact with faculty and residents in neurology, neurosurgery, physical medicine and rehabilitation, and neuroradiology.

3)     We emphasize a flexible approach to answering referral questions. We do in-patient or in-clinic consults providing education on the impact of treatments on cognition or assessing decisionality, and brief evaluations to answer specific questions, and comprehensive evaluations. It is so important for fellows to learn how to provide cost-effective, referral driven evaluations.

4)     We really have a lot of fun here! Fellows, faculty, and staff work closely together and enjoy each other. We emphasize a culture of kindness, cooperative collaboration, and humor. In the department, we are known as the life of any party. First to come and last to leave!

MCW is a known leader in neuroimaging research and is the birthplace of AFNI (Analysis of Functional Neuroimages), a widely-used image analysis package. Do fellows at MCW have the opportunity to participate in neuroimaging research?

With others tools as well, AFNI is a component of neuroanatomy education. Residents can become involved in neuroimaging research in several areas both inside the division of Neuropsychology and in other research labs at the Medical College of Wisconsin.

What other research opportunities are available?

Our division in engaged in research in the following areas:

Autism
Brain tumor
Development of attention
Dyslexia
Epilepsy
Genetic disorders
Language
Memory
Movement disorders

MCW is one of a select number of institutions to use both Wada testing and fMRI in evaluation of pre-surgical epilepsy candidates. How does the addition of fMRI enhance the overall clinical picture traditionally obtained through neuropsychological evaluation and Wada testing for epilepsy surgical candidates?

Published research conducted at MCW has demonstrated that language fMRI with a Semantic Monitoring task is a better predictor of both language and verbal memory outcome after left anterior temporal lobectomy than Wada testing. Moreover, fMRI is noninvasive with lower risk of complications. FMRI laterality scores, when combined with pre-operative cognitive test scores, are an excellent predictor of cognitive morbidity which can be used in surgical decision making. Our residents are involved in both Wada and FMRI procedures. When fellows leave the program they are competent in state of the art presurgical epilepsy evaluation.

A postdoctoral fellowship is the last opportunity for a neuropsychology trainee to prepare for those anxiety-provoking job applications. What do you think fellows should prioritize to make themselves attractive job candidates?

Fellows should always be encouraged to 1) carefully define their ideal position, and 2) maximize opportunities on fellowship that prepare them optimally for that type of position. Neuropsychology offers many career options, and fellows really need to become concrete about what is most important to them regarding this big career step. Do they want to primarily do research, clinical work, or teaching? While neuropsychologists can still do the “trifecta,” they typically have to prioritize one. Fellows can request additional supervised opportunities to help them focus on their choices. They can ask for focused time with patient populations of interest. We encourage all of our fellows to publish one paper and if they want research to be central to their career, we encourage them to publish more than that. Learning to supervise students is also very important, and fellows can request supervision opportunities, if they are not built into the program. Importantly, they should make sure they receive supervision for their supervision.

Foremost, fellows should be assertive at defining what is personally important for them and their family from the beginning. Do they need to work in a certain location? You would be amazed at how often supervisors can help fellows create an ideal position in that location, but that takes time. Do they need a position with flexible time requirements? Then some places and types of jobs will be better.

At MCW, fellows are assigned a professional mentor. That mentoring relationship is designed to help them define their goals and obtain experiences to achieve them. This works! It is very rare for one of our fellows to not obtain the type of job that they want.

The field of neuropsychology continues to grow and adapt to new changes in technology and healthcare. Where do you see the field of neuropsychology in 10 years?

What an intriguing and tough question! Like all providers, we are going to have to be able to change our practices with a changing health care system. Changes in research and training naturally have to lead the way for neuropsychology to determine what we need to successfully make these changes. What really works in neuropsychology? How do our evaluations actually help improve the health of our patients? Fellows from our program are acutely aware of how neuropsychology “fits” into the healthcare system primarily through functioning on multidisciplinary teams. As a field we need to understand how we are most helpful to our referral sources and we need to be very focused on how we can promote functional, positive outcomes in our research and patient care.

Although I believe there will always be a place for traditional assessments for traditional problems that really depend on long, comprehensive evaluations, we have to tailor our evaluations for the specific individual and referral question with consideration of the medical costs to the patient, society, and the neuropsychologist.

Neuropsychology will learn to embrace technological solutions to measure our effectiveness, monitor our business practice, and administer and score our tests. Telemedicine is a catching term and it is a necessary reality. Neuropsychology has to evolve to use technology to provide better care. We will find ways to meet the needs of individuals in remote locations and impoverished countries, for example.

All of that said, I really hope that neuropsychology can remain a stable discipline, but stability is not a given. Our recent history includes the establishment of neuropsychology as a distinct sub-specialty of clinical psychology, and our roots are not deep enough. Students really need to understand the history of neuropsychology and the current events in the political and professional aspects of neuropsychology. Issues regarding reimbursements and billing procedures, unified training programs, “the match” and board certification are really important issues. They might determine whether neuropsychology remains a recognized subspecialty of psychology. Education and involvement in organizations that make decisions regarding these issues can solidify our stability as a field.

Would you like to add anything else about your program?
I asked for help reviewing my answers, because my editing skills are notably subpar! I was so touched by the fellow’s last comment.

“I think that one of the best parts of this program is that these great training opportunities are provided in a very supportive and nurturing environment. I don’t think that doing great work and being challenged is always synonymous with being happy.”

That really sums up how I feel too! I am proud to train such a talented and fun group of individuals.

To learn more, please visit:

APPCN website (www.appcn.org )
MCW and the Department of Neurology at: http://www.mcw.edu/neurology/divisions/neuropsych.htm

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Research Roundup: Tip-of-the-tongue

12/14/2013

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Tip-of-the-tongue

The “tip-of-the-tongue” state/experience/phenomenon occurs when a person cannot immediately retrieve the precise name of a person, object, or word, but has the feeling that retrieval is imminent.

PODCAST:
Language Construction, Tip of the Tongue, and Speech Errors
This is a very short clip from “Moment of Science” produced by Indiana Public Media that describes a basic two step retrieval process that may help explain tip-of-the-tongue experiences. Author: Barbara Bolz

ABSTRACT:

Do Age-Related Increases in Tip-of-the-Tongue Experiences Signify Episodic Memory Impairments?
Tip-of-the-tongue experiences (TOTs), in which a name is known but cannot be immediately retrieved from memory, can be a cause of concern if these experiences are viewed as a sign of memory decline. The current study was conducted to investigate the relation between age and TOT frequency, and the influence of episodic memory, which is the type of memory most often assessed to detect memory problems, on that relation. In a sample of adults, increased age was found to be associated with more TOTs across different types of materials, and additional analyses suggested that these relations between age and TOT frequency were not attributable to the use of different response criteria or to different amounts of knowledge. Because statistical control of a measure of episodic memory had little effect on the relation between age and TOT frequency, age-related increases in TOTs and age-related decreases in episodic memory appear to be at least partially independent phenomena. [Salthouse & Mandell (2013). Psychological Science, Epub ahead of print.]

FURTHER READING

The “tip of the tongue” phenomenon [Brown & McNeill (1966) Journal of Verbal Learning and Verbal Behavior, 5(4): 325-337.]
Subjective states associated with retrieval failures in Parkinson’s disease [Souchay & Smith (2013) Consciousness and Cognition, 22(3): 795-805.]
Tip-of-the-tongue (TOT) states: retrieval, behavior, and experience [Schwartz & Metcalfe (2011) Memory & Cognition, 39(5): 737-749.]

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Research Roundup: The RDoC Project

The Research Domain Criteria (RDoC) Project

ANST Director's Meeting: Medical College of Wisconsin

Research Roundup: Tip-of-the-tongue

Tip-of-the-tongue

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