I I FROM: Harrdbook of Chi-Id Clinical PsYchologY Edited by CecJ.I R. Reynolds arrd Elairre nleLc he r- Janzert New York: Plerrum Press (1989) Historical Perspectives in the Development of Neuropsychology as a Professional Psychological specialty ANTONIO E. PUENTE The growth of ncuropsychology, and clinicat neur> discussion of thc growth of publications, organiza- psychology in particular, has been rapid though tions, and conlinuing educadbn acriviries in ilinical poorly documented. Alrhough clinical neuropsychol- neuro,psychology. Recent trends in professional ogy tcxts provide overviews on theorics of brain practicc, certification, and credentialing arc also ad- onlya few review how !ry{o1, rhe field developed. etfl. The chapar concludes wirh suggcsrions for* This lack of informarion is nor typical of related disci- maximizing rhe growth and efficacy of rf,e fietd. plincs (e.g., neurology) or of orhcr specialries wirhin psycholog-y (e.g., clinical psychology). Clinical psy- chology, for example, has experienicd rapid growth Historical Perspectives ovcr the past 25-40 years and its in the dcvelopment is well Development documenrcd (Fox, 1982; Fox, Barclay, & Rogers, of Neuropsychology 1982). Documenration is helpful for a variery of rea_ Localization of brain function has becn the focus philosophers, sons. First, studens must be provided with a comprc_ of physiologisrs, and psychol- hensive analysis of rhe discipline's devcloprnent. ogists for many centuries. Around 4O0 BC, Hippoc- Historical perspectives should scrye as foundation rarcs anempted to corrclate his behavioral observa- for a more comprehensive appreciation of currcnt tions with what hc knew about anarcmical trends and limindons. Simitarly, hea.lrh profes_ localization; this was conjecture becausc he was le- gatly sionals not directly involved in rhe held should have a and socially prohibited from dissecring the clearer understanding ofour rcchniques and rrcnds, if human body, especially rhe cranium. later, Ariirode n9t rhe professional (not Plato) sumrised that the -for welfare of Cthicat neuopsy- heart was rhe seat of the chology, at leasl for the welfare of consumers ser- mind. Almo$ 600 years after Hippocrares, Galen viced. by rhe. discipline. shifted tbe sire of rhe Finally, and becoming in- mind o rhe brain. Clarificarion r crcasingly important, documcntation of overall mind function was larer offered murt be by De- , available to individuals ourside of health care who are scartcs who suggested thar the soul was tocalized in r in a posirion to affecr thc discipline rhrough funding thc pineal gland. In 1810, Call described corrical and lcgislarion. localization function of through the concepr of j This_chaprcr chronicles phrenology. and cririques rhe devel_ I opment of clinical neuropsychology asa professional Flourens and Broca introduced morc accurate pracririoner or specialry in psychology. A brief hisro_ observations of brain funcrion during rhe mid lgrh ry ot c€ntury, rcsearch and clinical developments precedes a forcing physiologists ro rescarch localiza- tion of function morc systematically and wid more precir measurement tools. This rescarch was in- AMONTO E. PUENTE Dcprurrcru of hychology, Uoi- by carly recordings of brain funcrion or dys_ rcniry of Nonh Crrolina, Wilmingoo, function which .26403-329?. '1 No.rh Crroliru can be traced to at least the lTth cen- \ tury (Gibson, 1962) whcn scveral cascs describing ri C}IAPTER T traurnatic brain injury werc documented. Prrecisc ex- normative approach." Such an approach builds on pcrimental, rather than observational, analysis began the uniqueness of the individual and on the complex- with the electrical stimulation work of Frirsch and iries of syndromes by tailoring the assessment. How- Hietzig in 1790. New scientific lechniques were in- ever, unlike the Russian methods, the British ap' troduced m the study of brain function by one of proach does rely on psychometric tests. An Catell's sntdenrs, Sheperd Franz, during the early evaluation may begin with the Wechsler Adult Intel- part of this cenory. While in Washingron, D.C., ligence Scale and proceed to the Wisconsin Card Franz taught Karl S. f ashley who, in turn, advanced Sorting Test, Halstead Category Test, or Trail Mak- the understanding of brain-behavior rclarionships as ing Test, depending on the functions that are to be yell as thc theory of equipotenrialiry. During the mid examined. Gaps in the asscssrnent are filled with 20th cenmry, Nobel laurcarc Roger Sperry and col- more cxperimental (i.e., poorly sundardized) and leagues extended rhis earlier work by developing pro- individual tasks. A hnal yet imponant aspcct of the cedurcs for experimentally examining disconnection British appmach is the shift from strict localization syndromes. (which is central to Luria's approach) to an under- As noncultural variables have traditionally been standing of behavioral and psychological deficits. anributed little value in neuropsychological informa- Canadian and American or North American ap tion, it is surprising ro noc rhar differcnt approaches proaches to clinical neuropsychology have historical to the applicarion of neuropsychological knowledge roots in the work of Franz and Lashlcy in Wash- have developcd across three major culturcs, i.e., ington, D.C. However, the clinical or applicd study North Amcrica, Russia, and Great Brirain. of brain dysfunction in the Unired Starcs could be The approach to clinical ncuropsychological un- traced back to Kurt Goldstein. Goldstcin's (1939) derstanding in Russia grcw from rhe classical psy- approach to the study of brain dysfunction was sim- chophysiological reflexive studics of pavlov and ilar to that of Luria's in the sensc thar he did not use other Russian physiologisa (Bechrercva, 1978). psychomeric tests and that an extcns-iie clinical case Clearly the best recognized individual to apply this study was favored over shon, stn.rcturcd contacts orientation to clinical assessment of neuropsychol- (Hanfmann, Ricken-Ovsiankina, & Goldstein, ogical dysfunction was A. R. Luria (1902-1977). r944r. According to Luria ( 1970), there are rwo basic princi- Early psychometric approaches to brain assess- ples that guidc assessment of brain dysfunction: lo- ment can be traccd to Babcock ( 1930). Howcver, ir calization ofbrain lesions and analysis ofpsychologi- was Ralph Reitan who launched clinical neuropsy- cal activities associared with brain funcrion. The chology in Nonh America toward the now-accepted Russian appmach to assessment is bascd on a psychometric tradition. ln his seminal paper in 1955, qualiutive, rather than quantitative or psychornetric he indicated that the purposc of a neuropsychological method. Specifically, this approach anemprs ro pr<> evaluation was lo ms$ure deficits accurately in a vide a "clinical description using flexible bur sys- standardized psychometdc fashion. An interesting tcmatic sets of tests" (Luria & Majovski, 1977,- p. comparison of Reitan's and Luria's approach to brain fti2). The foundation for this flexiblc appmach is assessmcnt is found in Diamant ( 198 I ). An extension based on the concept tlrat strong individual dif- of Luria's approach into the psychometric realm of fcrences preclude dcvclopment of accuratc nonns. brain assessment scrved as the foundation for the Empirically derived analyscs cannot rcplacc a com- work of Golden, Hammcke, and Purisch ( 1980) wirh prehcnsivc undentanding of brain or individual pa- thc Luria-Nebraska Neuropsychological Bartcry. tient functioning. Each client prcsens with an indi- Although numerous criticisms have becn leveled at vidual sct of sympoms; thus, individual hyporhescs this banery and approach (Adams, 1980), the batrery and expcrirncnts must bc performed. Obscrvation of continues to be uscd and with increasing regulanty form and contentr rcplication, and flexibiliry of (Serctny, Dean, Gray, & Hartlage, 1986; Lubin, thinking are ccntral to this approach. I-arsen, Matarazzo, & Seevcn, 1986). Although neu- Whcreas thc methods of Luria rcprescnt the his- ropsychology as a field of investigation has a long lorical foundations for rhe clinical application of past, formal efforts in clinical neuropsychology have ncuropsychological principles in Russia, Henry a more recent onsct and more of a divcrgent geo' Head and Hughlings Jackson rEpres€nr the founda- graphical origin. Nevertheless, the discipline has re- tion for British approaches to clinical neuropsychol- cenrly made significant strides toward the under- ogy. According to Beaumonr (1983), Brirish clinical standing of brain function from both rcsearch and ncuropsychologiss favor thc "individual-ccnrcrcd clinical perspectives. ;i HISTORICAL PERSPECTIVES fournal and Book Publications Georgemiller, and Hymen (1982) analyzed the affil- iation, geographic region, and context of manu- The proliferarion of head-injured World War II scrips published berween 1979 and 1983 in these veterans into Veterans Administration domiciliary journals. Whereas the Univeniry of Nebraska repre- scnings occurred with the rapid growrtr of clinical scnted ll.3% of articles in CN, a wide variety of psychology. Such growrh was sready though nor nec- universities (e.g., City College of New york) were essarily rcmarkable rhrough the 1950s and ltX0s. representcd io JCN. Southern and nonh central snres This growth is well chronicled in research and were the geographic origin of articles in CN, whereas clinical srudies published in various journals. For nortbeastern states and Canadian locations 'n were bet- cxarnple,