Journal of clinical and experimental neuropsychology最新文献

{"title":"Diagnosing specific learning disorder in adults Part II: bias, base rates, and a path forward.","authors":"Allyson G Harrison, Richard Sparks","doi":"10.1080/13803395.2026.2654023","DOIUrl":"10.1080/13803395.2026.2654023","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnosis of specific learning disorders (SLDs) in adults has increased substantially over the past two decades, particularly within selective postsecondary and professional training settings. Part II of this paper examines why adult SLD diagnosis is especially vulnerable to error and bias, despite diagnostic criteria requiring substantial, developmentally grounded academic impairment.</p><p><strong>Methods: </strong>We synthesize empirical research from neuropsychology, education, and psychometrics to identify systematic sources of diagnostic distortion in adult SLD assessment. Particular emphasis is placed on statistical artifacts (e.g. restriction of range), base-rate neglect, contextual performance effects, performance validity, reliance on self-report, and the misapplication of sociostructural frameworks to clinical decision-making.</p><p><strong>Results: </strong>To combat overdiagnosis and ground diagnosis in empirically-supported practices, we propose a four-step diagnostic framework for first time diagnosis of SLD in adults: 1) Documented academic achievement below at least the 16^th percentile relative to the general population norms; 2) Clear evidence of onset in early school years, including impairment when scaffolding and supports are removed; 3) Evidence that academic difficulties persisted despite adequate educational opportunity and, when available, targeted intervention; and 4) Exclusion of contextual, motivational, neurological/medical, language, or instructional explanations.</p><p><strong>Conclusions: </strong>Accurate diagnosis of SLD in adulthood requires population-referenced criteria, corroborated evidence of childhood onset, objective demonstration of current academic impairment, systematic exclusion of alternative explanations, and assessment of performance credibility. Adoption of a structured, evidence-based diagnostic framework is essential to preserving the scientific validity, ethical application, and equitable use of SLD diagnoses in adult educational and professional settings.</p>","PeriodicalId":15382,"journal":{"name":"Journal of clinical and experimental neuropsychology","volume":" ","pages":"955-969"},"PeriodicalIF":2.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosing dyslexia in adults: what is going wrong and how can we fix it?","authors":"Julian G Elliott, Johny Daniel","doi":"10.1080/13803395.2026.2665373","DOIUrl":"10.1080/13803395.2026.2665373","url":null,"abstract":"<p><p>This paper examines how the concept of dyslexia, a problem that was once considered to be both rare and highly salient, has now been broadened to such an extent that many adults with successful educational histories, and without any history of significant reading difficulty, receive a dyslexia diagnosis only after having progressed to higher education, training, or employment. It is argued that the basis of the problem lies largely in conceptual and scientific misunderstandings. While there is a wide consensus that dyslexia represents a severe, complex, and persistent difficulty in learning to decode text, many have placed undue emphasis upon a wide variety of cognitive processes as diagnostic indicators. The primary error stems from conflating the greater likelihood of finding such difficulties in groups of struggling readers with the belief that these can be adjudged to be markers of dyslexia in the case of a given individual. This misconception has been exacerbated by a growing emphasis upon self-reported difficulties and the use of lived experience as primary means of understanding the nature of the condition. The dangers that result for scientific advance and for evidence-led educational policy and practice are highlighted. It is contended that the expansion of the dyslexia construct, and the misuse of assessment data, particularly when employed with adults, has in part been fueled, not by scientific research, but by the misunderstandings, interests, and motivations of those receiving and providing diagnostic services. Illustrative examples from the domains of adult higher education, medical training, and employment tribunals are offered as illustration.</p>","PeriodicalId":15382,"journal":{"name":"Journal of clinical and experimental neuropsychology","volume":" ","pages":"922-942"},"PeriodicalIF":2.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stability and accuracy of specific learning disability diagnoses from childhood to young adulthood.","authors":"Allyson G Harrison, Nathaniel Davin, Emma Jamieson","doi":"10.1080/13803395.2026.2688955","DOIUrl":"10.1080/13803395.2026.2688955","url":null,"abstract":"<p><strong>Objective: </strong>Specific learning disorder (SLD) diagnoses made in childhood are often assumed to be stable across development; however, diagnostic stability has frequently been conflated with diagnostic validity. This study examined (a) the accuracy of childhood SLD diagnoses at the time they were made, relative to objective academic impairment and (b) the stability of SLD diagnoses from childhood to young adulthood.</p><p><strong>Method: </strong>Archival data were analyzed from 325 postsecondary students who underwent comprehensive adult psychoeducational assessment and for whom childhood assessment documentation was available. Childhood reports were coded for assessment content, diagnostic clarity, and evidence of objective academic impairment. Diagnostic stability was evaluated by comparing childhood and adult SLD diagnoses across reading, written expression, and mathematics.</p><p><strong>Results: </strong>Most childhood assessments included standardized measures of cognitive, academic, and behavioral functioning; however, fewer than half included measures of phonological processing, and only 52.3% contained a clear diagnostic statement. Across domains, 82-89% of childhood SLD diagnoses were supported by objective academic impairment at the time of assessment. Despite this, diagnostic stability from childhood to adulthood was moderate, with approximately 59% of childhood diagnoses retained across reading, writing, and mathematics, and roughly 40% not confirmed at adult reassessment.</p><p><strong>Conclusions: </strong>Findings indicate that while many childhood SLD diagnoses are supported by contemporaneous academic impairment, that impairment does not always persist into adulthood. These results underscore the importance of distinguishing diagnostic accuracy from diagnostic stability and highlight the need for careful reassessment of learning difficulties in postsecondary contexts rather than reliance on childhood diagnoses alone.</p>","PeriodicalId":15382,"journal":{"name":"Journal of clinical and experimental neuropsychology","volume":" ","pages":"907-921"},"PeriodicalIF":2.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 50-year personal odyssey through the story of learning disabilities: from primary school to adult LD diagnoses.","authors":"Richard L Sparks","doi":"10.1080/13803395.2026.2678870","DOIUrl":"10.1080/13803395.2026.2678870","url":null,"abstract":"<p><p>The problems with LD diagnosis are the logical consequence of a concept that, after 63 years, has never had a universally accepted definition or empirically validated diagnostic criteria. This essay is a personal odyssey over 50 years that explores the many problems with the LD concept and LD diagnosis that have affected my research, teaching, and clinical practice with children and adults. It is a critical, historical, and analytic journey about the LD story grounded in first-person clinical experience and explicit engagement with diagnostic theory that has implications for first-time adult LD diagnosis. The essay advances several claims about the evolution and current state of the LD concept and LD diagnosis across the lifespan with adult diagnosis as its destination: (1) intra- and inter-individual differences in achievement and cognition are normal and expected, yet were reframed as abnormal through the construct of \"unexpected underachievement\"; (2) even as the LD field promoted unexpected underachievement, it selectively treated only some individuals' underachievement as \"unexpected,\" creating internal inconsistency; (3) reliance on discrepancy from presumed \"potential\" (IQ) made diagnosis unnecessarily complex and introduced inequities by excluding lower-achieving individuals; (4) these practices persisted despite substantial empirical evidence challenging their validity; (5) DSM-IV's retention of discrepancy-based approaches contributed to ongoing problems in adult diagnosis and pathologizing of normal variability and average performance; (6) disability standards emphasizing substantial limitation relative to the average person were overridden by continued reliance on discrepancy; and (7) discrepancy, potential, and unexpected underachievement were normalized as enduring conceptual and cultural assumptions. Together, these claims reframe LD as a construct shaped by a story, not science, and call for renewed attention to its theoretical foundations and practical consequences, especially for adult diagnosis.</p>","PeriodicalId":15382,"journal":{"name":"Journal of clinical and experimental neuropsychology","volume":" ","pages":"970-983"},"PeriodicalIF":2.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary from the Education Committee of the Society for Clinical Neuropsychology on: facilitating best practices in practicum training in clinical Neuropsychology: introducing the North American Association of Practicum Sites in Neuropsychology (NAPSN) organizational training guidelines.","authors":"Danielle N Shapiro, Marcy C Adler, Susanne Duvall, Joel Eppig, Rayna B Hirst, Joel Kamper, Lynn A Schaefer, Amanda Winter-Greenberg, Julie Suhr, Brian P Yochim, Amy Jak, Jennifer N Longoria","doi":"10.1080/13803395.2026.2725548","DOIUrl":"10.1080/13803395.2026.2725548","url":null,"abstract":"<p><p>This commentary examines the newly developed guidelines for clinical practicum training from The North American Association of Practicum Sites in Neuropsychology (NAPSN). NAPSN was formed in 2023 in order to support practicum level training in neuropsychology, adding to existing organizations supporting pre-doctoral and doctoral education, internship, and postdoctoral level training. The NAPSN training guidelines represent an important step toward ensuring consistent and high-quality clinical training for neuropsychologists at all professional stages in core areas including clinical training, didactics and educational programming, professionalism, and research. We outline anticipated benefits for trainees, impact on clinical supervisors, practical implications for clinical supervision, and areas for ongoing consideration. In particular, next steps may include delineating training goals and benchmarks for practicum students at different stages in their doctoral training, developing strategies to provide consistency in evaluation and supervision practices across practicum sites and doctoral programs, and including forensic neuropsychology training at the practicum level.</p>","PeriodicalId":15382,"journal":{"name":"Journal of clinical and experimental neuropsychology","volume":" ","pages":"993-996"},"PeriodicalIF":2.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitating best practices in practicum training in clinical neuropsychology: introducing the North American Association of Practicum Sites in Neuropsychology (NAPSN) organizational training guidelines.","authors":"Jason R Soble, Stephanie J Towns, Marc A Silva, Julie B Newman, David Andrés González, Lynette M Abrams-Silva, Christine Koterba, Kelsey D Csumitta, Erin G Holker, Carolyn R Anderson, Ari N Rabkin, Douglas M Whiteside","doi":"10.1080/13803395.2026.2725544","DOIUrl":"10.1080/13803395.2026.2725544","url":null,"abstract":"<p><strong>Introduction: </strong>The North American Association of Practicum Sites in Neuropsychology (NAPSN) was established in 2023 to support external practicum programs in urban, suburban, and rural areas in the United States and Canada by providing resources for member practicum programs and supporting prospective and current neuropsychology practicum students in collaboration with doctoral training programs. This article describes the development of and documents the current NAPSN organizational training guidelines for member programs.</p><p><strong>Method: </strong>A NAPSN training guidelines subcommittee was formed, consisting of six practicing clinical neuropsychologists who supervise practicum students across a variety of patient populations (i.e. adult, pediatric, lifespan), practice settings (e.g. academic medical center, Department of Veterans Affairs, hospital-based, private practice) and types (e.g. clinical, mixed clinical and forensic, mixed clinical and research), and geographic regions (e.g. urban, suburban, rural) to ensure sufficiently broad perspectives were incorporated.</p><p><strong>Results: </strong>Incorporating best practices for supervision in neuropsychology, existing position statements on practicum training in neuropsychology, and recently revised, profession-wide training guidelines, four core content areas were established through consensus discussion: 1) Supervised experience of clinical practice activities; 2) Didactics/educational programming; 3) Professionalization; 4) Research. Guidelines were drafted for each respective content area. Following multiple internal rounds of revision among the subcommittee, these guidelines were presented to the NAPSN Board of Directors and Elected Officers and underwent additional rounds of revision to arrive at the final guidelines.</p><p><strong>Conclusion: </strong>The NAPSN training guidelines were established not as prescriptive rules/standards but rather are designed to function as supportive guidelines for NAPSN member programs to facilitate high-quality and effective training at the practicum level by allowing for maximum flexibility to account for the range of existing practicum training settings and experiences.</p>","PeriodicalId":15382,"journal":{"name":"Journal of clinical and experimental neuropsychology","volume":" ","pages":"984-992"},"PeriodicalIF":2.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosing specific learning disorder in adults Part I: conceptual and methodological challenges.","authors":"Allyson G Harrison, Richard Sparks","doi":"10.1080/13803395.2026.2668454","DOIUrl":"10.1080/13803395.2026.2668454","url":null,"abstract":"<p><strong>Introduction: </strong>Specific learning disorders (SLDs) are widely conceptualized as lifelong neurodevelopmental conditions; however, the validity of first-time diagnosis in adulthood, particularly in postsecondary and professional settings, remains poorly defined. Despite more than six decades of research, the field lacks a stable definition and empirically validated diagnostic criteria capable of reliably distinguishing SLD from normative academic variability or contextual disadvantage.</p><p><strong>Methods: </strong>Part I of this paper presents a critical narrative review of the historical development of the SLD construct, population prevalence estimates in adults, and the major diagnostic frameworks that have shaped identification practices. We examine evidence concerning IQ - achievement discrepancy models, Response to Intervention, Processing Strengths and Weaknesses approaches, and DSM-IV, DSM-5, and DSM-5-TR criteria, with attention to psychometric validity and diagnostic utility.</p><p><strong>Results: </strong>The reviewed literature demonstrates persistent definitional instability, continued reliance on empirically unsupported discrepancy-based logic, and extreme heterogeneity in adult and postsecondary SLD samples. Diagnostic practices frequently classify individuals with average or above-average academic achievement as SLD, particularly in selective educational contexts. Evidence further indicates that adult SLD diagnoses and associated accommodations are disproportionately concentrated among socioeconomically advantaged students, raising concerns about construct drift, equity, and validity.</p><p><strong>Conclusions: </strong>Contemporary adult SLD identification remains insufficiently anchored to population-referenced academic impairment, developmental continuity, and objective evidence of functional limitation. These shortcomings undermine confidence in SLD as a neurodevelopmental construct. Part II examines the cognitive, professional, and institutional factors sustaining these practices and proposes a stepped, empirically grounded framework for diagnosing SLD in adolescents and adults.</p>","PeriodicalId":15382,"journal":{"name":"Journal of clinical and experimental neuropsychology","volume":" ","pages":"891-906"},"PeriodicalIF":2.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complementary emphases in doctoral training support trainees and our profession: authors' response to Shapiro et al.'s (2026) and Calamia et al.'s (2026) commentaries on the North American Association of Practicum Sites in Neuropsychology (NAPSN) training guidelines.","authors":"Jason R Soble, Stephanie J Towns, Marc A Silva, Julie B Newman, David Andrés González, Lynette M Abrams-Silva, Christine Koterba, Kelsey D Csumitta, Erin G Holker, Carolyn R Anderson, Ari N Rabkin, Douglas M Whiteside","doi":"10.1080/13803395.2026.2741879","DOIUrl":"10.1080/13803395.2026.2741879","url":null,"abstract":"","PeriodicalId":15382,"journal":{"name":"Journal of clinical and experimental neuropsychology","volume":" ","pages":"1002-1004"},"PeriodicalIF":2.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction to the special issue on first-time diagnosis of young adults with specific learning disorders.","authors":"Julie A Suhr, Allyson Harrison","doi":"10.1080/13803395.2026.2703681","DOIUrl":"10.1080/13803395.2026.2703681","url":null,"abstract":"","PeriodicalId":15382,"journal":{"name":"Journal of clinical and experimental neuropsychology","volume":" ","pages":"889-890"},"PeriodicalIF":2.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Base rates of low achievement scores in young adults: implications for specific learning disability assessment.","authors":"Benjamin J Lovett, Theresa M Schaberg","doi":"10.1080/13803395.2026.2654019","DOIUrl":"10.1080/13803395.2026.2654019","url":null,"abstract":"<p><strong>Background: </strong>Specific learning disability (SLD) is a high-incidence diagnosis, with academic skill deficits at its core. Diagnostic models for SLD vary but they generally require data from norm-referenced achievement tests. Multivariate base rates for low scores on such tests have not been examined in young adults.</p><p><strong>Methods: </strong>The young adult (ages 18-29) group from the Woodcock-Johnson IV (WJ-IV; 2014) normative sample (<i>N</i> = 1330) was used. We calculated base rates for low scores on the 11 subtests of the Standard Battery of the WJ-IV Tests of Achievement. We also calculated base rates for discrepancies between participants' General Intellectual Ability scores and their achievement subtests.</p><p><strong>Results: </strong>Low achievement subtest scores were very common; most participants had at least one standard score below 90, and almost half had at least one score below 85. Achievement scores that were discrepant from ability scores were also common; most participants had at least one score that was at least 1.0 SD below their ability estimate, and among high-ability subgroups, discrepant achievement scores were extremely common.</p><p><strong>Conclusions: </strong>Normative and relative low achievement subtest scores are common in the general population of young adults. SLD diagnosis in young adults should require objective evidence of other criteria being met, such as trouble initially acquiring academic skills in childhood, current functional impairment in educational or occupational settings, and rule-outs of other possible causes of low achievement test scores.</p>","PeriodicalId":15382,"journal":{"name":"Journal of clinical and experimental neuropsychology","volume":" ","pages":"943-954"},"PeriodicalIF":2.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}