Forensic neuropsychologists face a daunting task in the courtroom. They are forced to reconcile the dichotomous decisions of the court with the dimensionality and probabilistic conclusions of psychology. They are asked to be objective and impartial evaluators instead of advocating for their clients. They must learn to play by the rules of the court even when these rules conflict with the ethics of psychology. Unlike in clinical situations, for the forensic neuropsychologist, the “overriding duties and responsibilities are to the courts, not the individual being assessed” (p. 327). Making these fundamental shifts in perspective requires a great deal of forethought as well as extensive training and knowledge. Several edited texts on the practice of forensic neuropsychology have been written to assist clinicians in this process. However, the voluminous research findings and nuanced laws cited in these books can be overwhelming to the inexperienced clinician. Drs. Young, Kopelman, and Gudjonsson recognize that, foremost, psychologists need to learn the best practices in the field and the core ethical and clinical issues that they are most likely to encounter. For these editors, this book “was born from our recognition that what was needed was a practical resource for practitioners and trainees that provided down-to-earth, pragmatic information and guidance” (p. 3). True to their aspirations, the editors have assembled a text that does exactly that.
The book is divided into 13 chapters. With the exception of the final four chapters which focus on general professional issues, each chapter addresses a separate clinical disorder or syndrome. The chapters follow approximately the same format. They begin with a summary of the characteristics of the disorder and a review of the diagnostic, neuropsychological, and judicial issues most relevant to the forensic neuropsychologist. After establishing this framework, the authors address practical issues through case studies and provide direct recommendations for report-writing, assessment practices, and testimony. Non-British readers should be forewarned that the book is written with reference to British law; however, the legal concepts they reference are broadly applicable across all common law judicial systems.
The book begins with four chapters that are more atypical to the forensic neuropsychology field. These include the neuropsychology of aggression and violence, intellectual disability, and autism spectrum conditions. In Chapter 4, Young outlines the best practices in the interview and testing process for neuropsychologists working with individuals with Attention-Deficit/Hyperactivity Disorder (ADHD). She describes the characteristics of ADHD that increase risk for criminal behavior, including sensation-seeking behavior, poor emotional control, and impulsivity. She emphasizes that this population has specific vulnerabilities in the legal process, such as responding impulsively during the police interview and misconstruing multi-step questions during trials, and advises clinicians on how to advocate for their clients.
The following four chapters focus on issues that are more commonly addressed in the forensic neuropsychology literature, including amnesia, epilepsy, alcohol and drug misuse, and traumatic brain injury. In Chapter 7, Bird, Newson, and Dembny broach the philosophical dilemmas elicited by a defense of automatism, which is defined as behavior that lacks voluntariness, such as a seizure. The authors note that, “The concept of automatism raises profound questions of moral and legal responsibility and challenges the ability of the neurosciences to provide worthwhile “real life” answers to these problems” (p. 165). When defendants claim they are not responsible for a crime because they were under the influence of an automatism, the court must assess the level of awareness of the defendant, whether the automatism was endogenous (e.g., internally caused by a tumor) or exogenous (e.g., externally caused by injecting too much insulin), and whether the defendant is “sane” or “insane.” The authors discuss each of the three neuropsychiatric conditions associated with a defense of automatism, which are epilepsy, sleepwalking, and dissociative states. They review the concepts of actus reus, mens rea, specific defenses such as diminished responsibility and insanity, and relevant case law. Additionally, they provide practical advice to clinicians who are supporting a defense of automatism.
The final chapters address professional issues in forensic neuropsychology. In Chapter 10, Powell walks the reader through each detail of the expert witness process, beginning with the response to the solicitor’s letter of inquiry and ending with the process of obtaining post-trial feedback. He addresses specific issues including videotaping the assessment, collaborating with the opposing neuropsychologist, and composing a “statement of truth” to conclude a report. Most helpfully, Powell prepares sample responses to typical cross-examination questions to help clinicians avoid traps in the courtroom. In Chapter 11, Gudjonsson and Young discuss conceptual issues related to malingering and suboptimal effort and outline strategies and specific tests used to detect malingering. Through case studies, they illustrate how psychologists identify patterns in test data and inconsistencies in behavior to support or refute the determination of suboptimal effort. In Chapter 12, Wheatcroft, Gudjonsson, and Young review the duties and responsibilities of the expert witness and examine the ethical and professional dilemmas that the psychologist can encounter. They note that, “Legal work presents dynamic situations that are not clearly defined, which leave the practitioner with decisions to make that might be based on competing demands or goals” (pp. 301–302). For example, forensic neuropsychologists need to make decisions about when to acquiesce to attorneys’ requests to modify reports, to release test results, and to be present during assessment sessions.
Overall, this practical book is well-organized and clearly written. The authors support their clinical recommendations with robust empirical research without losing the reader in the minutiae of specific studies. Each chapter is self-contained, and so Forensic Neuropsychology in Practice: A Guide to Assessment and Legal Processes serves as an excellent reference text that can be used to research specific topics. Admittedly, this text might be too cursory for the seasoned practitioner with courtroom and research experience. The depth of knowledge imparted is necessarily limited by the broad scope of the topics and the relatively restricted page space. It should also be mentioned that this text is more informative for the neuropsychologist learning forensics than for the forensic psychologist learning neuropsychology. That said, this book serves as an excellent starting point for those brave psychologists preparing to walk the forensic walk.