NeuroRehabilitation 41 (2017) 527–538 527

DOI:10.3233/NRE-162144
IOS Press

Perception of ethical misconduct by

neuropsychology professionals in Spain
Laiene Olabarrieta-Landaa , Alfonso Caracuel Romerob , Ivan Panyavina
and Juan Carlos Arango-Lasprillac,d,∗
a Department of Psychology and Education, University of Deusto, Bilbao, Spain
b Departamento

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de Psicologı́a Evolutiva y de la Educación, Facultad de Educación,
Universidad de Granada, Granada, Spain
c BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
d IKERBASQUE, Basque Foundation for Science, Bilbao, Spain

Abstract.
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OBJECTIVE: To examine the prevalence of perceived ethical misconduct in clinical practice, teaching, and research in the
OR
field of neuropsychology in Spain.
METHOD: Two hundred and fifteen self-identified mental health professionals who engage in neuropsychology practice in
Spain completed an online survey from July to December of 2013. In the ethics section of the survey, participants were asked
to identify if neuropsychologists they know who work in their country engaged in specific kinds of ethical misconduct.
RESULTS: 41% reported receiving formal training in professional ethics. The clinical findings are as follows. The highest rate
of perceived misconduct was found in the area of professional training and expertise, with an average of 40.7%, followed by
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research/publications (25.6%), clinical care (23.9%), and professional relationships (8.8%). Specifically, regarding training,
over half of respondents (56.7%) know professionals who claim themselves to be neuropsychologists, even though they lack
proper training or expertise and 46.0% know professionals in the field who do not have adequate training for experience to
be working in the field. Regarding research/publications, 41.9% of respondents know professionals who appear as authors
on publications where they have not made a significant contribution. Regarding clinical care, over one third of respondents
endorse knowing professionals who (1) provide results of neuropsychological evaluations in such a way that patients or other
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professionals are not likely to understand (37.2%) and (2) do not have the skills or training to work with patients who are
culturally different from them (34.9%).
CONCLUSIONS: Less than half of survey respondents reported receiving ethics training. It is possible that introducing
more or improved ethics courses into pre-graduate and/or graduate school curriculums, and/or requiring continuing ethics
education certification may reduce perceived ethical misconduct among neuropsychological professionals in Spain.

Keywords: Ethics, Spain, neuropsychology

1. Introduction assessment and intervention based upon the scien-

tific study of human behavior as it relates to normal
Clinical neuropsychology is a specialty in pro- and abnormal functioning of the central nervous sys-
fessional psychology that applies principles of tem. The specialty is dedicated to enhancing the
understanding of brain-behavior relationships and
∗ Address for correspondence: Juan Carlos Arango Lasprilla, the application of such knowledge to human prob-
Ph.D, Grupo de Psicologı́a y Salud, BioCruces Health Research lems (American Psychological Association, 2010).
Institute, Cruces University Hospital, IKERBASQUE, Basque
Foundation for Science, Plaza de Cruces s/n. 48903, Barakaldo,
Neuropsychology professionals utilize their knowl-
Bizkaia, Spain. Tel.: +34 946006000/Ext. 7963; E-mail: edge of the specific patterns of brain functioning
[email protected]. and behavioral responses in clinical contexts, such as

1053-8135/17/$35.00 © 2017 – IOS Press and the authors. All rights reserved
528 L. Olabarrieta-Landa et al. / Ethical misconduct in neuropsychology

those of diagnostic evaluation and assessment, reha- documents, such as the texts titled Professional Ethics
bilitation and treatment, as well as in research and for Psychologists, or the Meta-code of Ethics, have
teaching. been published by the European Federation of Psy-
Important scientific contributions during the 1950s chology Associations (COP España, 2004) in order to
helped to launch clinical neuropsychology on its guide and help with professional decision-making to
path as a specialty field (Boake, 2008), which subse- Spanish psychologists. However, in the official jour-
quently developed its own theories and applications nal of the COP, titled Papeles del Psicólogo, it was
which helped to further distinguish it from other recently stated that “In practice, the deontology of
branches of psychology (Bombı́n & Caracuel, 2008). the psychology profession, at least in Spain, does not
As such, it is a relatively young discipline, with the yet occupy the place it deserves in the training cur-
guidelines for knowledge and skills needed to prac- riculum of psychology students; nor have psychology
tice in this field in the United States established in professionals fully appreciated the need for a set of

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1997 at the Houston Conference on Specialty Edu- mechanisms that will guarantee the continual updat-
cation and Training in Clinical Neuropsychology ing of deontological aspects” (Bermejo-Frijola & Del
(Hannay et al., 1998). In Spain neuropsychology had Rı́o-Sánchez, 2009, p. 182).
undergone a period of growth and development in the Unlike in the United States, where regulations
1980s (Peña Casanova, 1983), though historically it for specific activities or situations involving eth-

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is a much newer field than in other leading countries, ical issues in neuropsychological practice are in
such as the U.S. place, in Spain to date there are only six scientific
Regardless of the context of their practice, neu- publications relating to this subject. These include
ropsychologists are likely to face challenging ethical ethical aspects of diagnosis and legal incapacitation
dilemmas. In clinical settings this may involve, for of individuals with dementia (De Lepeleire et al.,
example, issues of confidentiality of patient infor- 2008; Molinuevo & Rami, 2013; Viloria Jimenez,
mation, or the extent of capacity to consent by Chung Jaen, Vigara Garcia & Barahona-Alvarez,
OR
individuals with dementia. Many of such potential 2013), psychotherapy using virtual reality (Andrews
ethical dilemmas are specific to neuropsychology, et al., 2005), and rehabilitation of brain injury
and a number of documents have been developed to (León-Carrión. Machuca-Murga Murga-Sierra, &
help professionals address these issues. For instance, Dominguez-Morales, 2001; Léon-Jimenez, 1998).
during the conclusion of the Houston Conference a No consensus document by the Spanish professional
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proposal to address training in professional ethics in organizations on the topic of ethical issues in neu-
psychology in general, as well as specifically in the ropsychology exists at the present time.
context of neuropsychology practice, was made for Ethical aspects of neuropsychology practice in
the first time (Hannay et al., 1998). A number of con- Spain fall under the purview of ethics standards of
sensus documents have consequently been developed psychology in general, and are supported by various
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and published by neuropsychology organizations publications which are based on opinions of gen-
in the United States in order to develop profes- eral psychology professionals, and not specifically
sional ethics and provide decision-making guidance neuropsychologists. Empirical and scientific publi-
in those areas where neuropsychologists most fre- cations on the topic of neuropsychology ethics are
quently engage in practice (American Academy of scarce, and are largely based on expert opinion. In
Clinical Neuropsychology, n.d.; National Academy light of this, the purpose of the present study was to
of Neuropsychology, n.d.). determine the perceptions of neuropsychology pro-
In Spain, the organ which is charged with enforc- fessionals in Spain of ethical misconduct in various
ing professional ethics in the practice of psychology aspects of its practice.
is the General Council of Psychology (Colegio Ofi-
cial de Psicólogos, COP), which has published and
periodically updated the Psychology Code of Ethics 2. Method
(COP España, 1993, 2010, 2014) for the purpose of
establishing general ethical principles, norms, and 2.1. Participants
obligations in the areas of professional relations, stan-
dards of training, provision of therapy, treatment and The study was descriptive, transversal, non-
interventions, as well as research, teaching, adver- experimental, and utilized a non-probabilistic sample
tisement, and fees. Besides the Code of Ethics, other of self-identified psychology professionals who work
 L. Olabarrieta-Landa et al. / Ethical misconduct in neuropsychology 529

in the field of neuropsychology in Spain. Inclusion Subsequently, these survey questions were given for
criteria included: 1) be over 18 years of age; 2) have at review to a panel of experts in neuropsychology from
least a Bachelor’s degree in psychology; 3) currently Spain (e.g., faculty members from the University of
reside in Spain; and 4) either a) engage in the spe- Deusto, University of Granada, University of Sala-
cialty practice of neuropsychology (i.e., be involved manca) in order to assess their linguistic, cultural,
in neuropsychological assessment, evaluation, treat- and professional appropriateness, applicability and
ment, or intervention work most of the time), or b) call value.
themselves “neuropsychologist” or otherwise desig- After incorporating the panel’s feedback, the final
nate themselves as engaging in the specialty practice corpus of questions, as well as a brief demographic
of neuropsychology. questionnaire, was entered into an online survey plat-
A total of 242 individuals met the inclusion criteria form surveymonkey.com. A brief pilot study was
and responded to the initial question of whether or not carried out to assure accuracy and feasibility of the

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they have received formal training on the topic of pro- survey, as well as data analysis. Participation was
fessional ethics. Of these, 215 respondents proceeded voluntary and anonymous, and no remuneration was
to provide responses to all 20 of the ethical survey provided.
questions (completion rate of 88.8%). This yielded
a complete dataset with no missing data which was
2.3. Procedure

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used for the analyses.
The final sample was comprised of 215 self-
The recruitment, survey dissemination, and data
identified psychologists (78.1% female) with at least
collection took place from July to December of 2013.
a bachelor’s degree. The mean age of the partici-
With the goal of maximizing recruitment, survey
pants was 34.8 years (range 22–73 y.o., mode = 30
dissemination was conducted by sending an email
years). In terms of setting where these profession-
correspondence inviting the participation of neu-
als exercise their work, 26% (n = 56) indicated that
OR
ropsychology professionals to a number of local,
majority of their neuropsychological work takes
national, and regional psychological and neuropsy-
place in the hospital setting, 15.8% (n = 34 each) at
chological professional Associations in Spain (e.g.,
University or non-profit rehabilitation center, 12.6%
Spanish Federation of Neuropsychology Societies
(n = 27) at private clinics, 8.4% (n = 18) in private
[FANPSE], Neuropsychology Society of Valencia,
practice, 7% (n = 15) in for-profit rehabilitation cen-
etc.). Additionally, leaders in the area of neu-
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ters, 4.7% (n = 10) in community medical centers,

ropsychology in the country (e.g., directors of
and 6.5% (n = 14) in other types of settings. The
neuropsychology university training programs, clin-
respondents’ average number of years of experience
ics, rehabilitation centers, etc.) were contacted via
in neuropsychology was 7.8 (range 1–25, mode = 3
email with the study details, the hyperlink to the
years).
online survey, and a request for their assistance in
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recruiting neuropsychology professionals as partici-

2.2. Instruments
pants. Upon the conclusion of data collection period,
participant data was downloaded from the secure sur-
The survey of perceptions of ethical miscon-
veymonkey server directly into an SPSS file, which
duct was developed in collaboration by the research
prevented data entry errors.
teams at the University of Deusto (Spain) and Vir-
ginia Commonwealth University (USA). As the first
step in survey development, the researchers con- 2.4. Statistical analysis
ducted a comprehensive literature review on the
topic of professional ethics in psychology, and iden- Analyses were conducted using SPSS 20.0 (IBM
tified particular areas of interest in the practice of Corp., Armonk, NY). Responses to the survey ques-
neuropsychology. A brief survey instrument was tions were expressed as percentages. Chi-square (χ2 )
created in Spanish language, which consisted of and t-test analyses were used, as appropriate, to
questions which assessed the respondents’ percep- identify potential differences in demographic and
tion of ethical misconduct by their colleagues in neuropsychology practice variables between those
the areas of training, skills, and expertise, clinical who completed the survey and those who dropped
care, research/publications, and professional rela- out. A significance level of 5% (␣ < 0.05) was used
tionships (with patients, students, and colleagues). for the analyses.
530 L. Olabarrieta-Landa et al. / Ethical misconduct in neuropsychology

3. Results Table 1
Ethical misconduct regarding proper training and expertise:
Percentage and number of self-identified psychologists who
Chi-square and t-tests were carried out in order reported knowing others in the field who engage in these acts
to examine the differences between participants who
Perceptions of ethical misconduct in % n
completed the survey (n = 215) and those who pro- training/skills/expertise:
vided incomplete data (n = 27), for gender, age, and Advertise and present themselves as 56.7 122
number of years in neuropsychology practice. Par- neuropsychologists but have not actually
ticipants showed no difference in number of years had the proper training or expertise
Do not possess adequate training and 46.0 99
of experience, t(230) = –0.929, p = 0.354, or gender,
experience to be working as
χ2 (1, n = 242) = 0.824, p = 0.341, but were signif- neuropsychologists
icantly different in terms of age, t(240) = –2.260, Testify in court when they do not have the 19.5 42
p < 0.05, with those participants who dropped out dur- appropriate expertise to do so
Average 40.7

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ing the survey being older (M = 38.44, SE = 1.465)
than those who completed the survey (M = 34.80,
SE = 0.542). training or experience, and nearly one in five (19.5%)
Participants were asked whether or not other confirmed knowing someone who testified in court
neuropsychologists they know who works in their without the appropriate expertise.

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country engage in a number of behaviors. Respon- In regards to ethical domain of clinical care
dents reported knowing others in the field of (Table 2), the average percentage was 23.9%. Most
neuropsychology who engage in ethical misconduct prevalent perceptions, confirmed by more than one in
in regards to having proper training and expertise in three respondents, dealt with provision of feedback
their work as neuropsychologists, providing adequate of neuropsychological evaluations in a way that is
clinical care, research activities, and their relation- difficult to understand, lacking skills to work with cul-
ships with patients, students, and colleagues. In
OR
turally diverse clients, and violating confidentiality
general, 59% of participants reported not receiving (37.2%, 34.9%, and 31.6%, respectively).
formal training on the topic of professional ethics. The area of perceptions of unethical conduct in
Perceptions of ethical misconduct in these areas research and publication (Table 3) was assessed with
ranged from none (in a question about sexual relations three questions, with average percentage of 25.6%.
with patients) to 56.7% (related to other professionals Alarmingly, more than one in ten participants (11.2%)
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advertising or presenting themselves as neuropsy- indicated knowing of others who misrepresented or

chologists without the requisite training). faked research data. Nearly one in four (23.7%) knew
In the area of professional training and expertise of others who appropriated their students’ research
(Table 1), the overall average percentage of percep- work as their own, and 41.9% indicated knowing
tion of ethical misconduct was 40.7%, with over half others who were credited with authorship without
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of respondents (56.7%) having indicated that they making a significant contribution.

know of others who advertise or present themselves Finally, in the area of professional relationships
as neuropsychologists without having the necessary (Table 4), the average percentage was 8.8%. The
training or expertise. A little less than half (46%) most commonly reported perception, endorsed by
indicated knowing others who lack the adequate 15.3% of respondents, was that of dual relationships
Table 2
Ethical misconduct regarding clinical care and practice: Percentage and number of self-identified psychologists who reported knowing
others in the field who engage in these acts
Perceptions of ethical misconduct in clinical care: % n
Provide results of neuropsychological evaluations in such a way that patients or other professionals 37.2 80
are not likely to understand
Do not have the skills or training to work with patients who are culturally different from them 34.9 75
Discuss information about their patients with people outside of their professional practice who are 31.6 68
not involved in treating the patient.
Base diagnostic conclusions on inadequate data or ignore important sources of data 27.0 58
Provide interventions with questionable effectiveness or that may even be harmful to patients 14.4 31
Withhold services from or provide substandard services to patients who are unable to pay for services 12.6 27
Keep silent or not refer appropriately when important medical or psychological issues arise 9.8 21
Average 23.9
 L. Olabarrieta-Landa et al. / Ethical misconduct in neuropsychology 531

Table 3 4.1. Training, skills, and expertise

Ethical misconduct regarding research and publication:
Percentage and number of self-identified psychologists who
reported knowing others in the field who engage in these acts Neuropsychology training in Spain was not reg-
ulated until relatively recently. Training in this
Perceptions of ethical misconduct in % n
research/publications: specialty field before the Europe-wide “Bologna Pro-
Appear as authors on publications where 41.9 90 cess” consisted of an undergraduate degree lasting
they have not made a significant five years; after its completion any person could prac-
contribution tice as a neuropsychologist. After the introduction of
Present as their own research done by their 23.7 51
the Bologna Process, which aimed to create compat-
students
Misrepresent the results of their research or 11.2 24 ible standards of training in higher education across
create fake data in order to publish articles various countries of the European Union, the dura-
or give professional presentations. tion of undergraduate training was reduced to four
Average 25.6

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years. However, Master’s level training was made
mandatory if one desired to practice professional psy-
chology (including neuropsychology). While neither
with the patients, namely of knowing or interacting the Ministry of Education nor Health in Spain cur-
with them outside of professional relationship. This rently provide accreditation to neuropsychologists,
was followed by a slightly lower number of respon-

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the professional organization called Federation of
dents who indicated knowing someone who took Neuropsychology Associations of Spain (FANPSE)
deliberate actions to damage their colleagues’ repu- recently approved its own version of clinical
tation (14.9%), and who was negligent/disrespectful neuropsychology accreditation (ComAcre-FANPSE,
towards their students (13%). In questions that dealt 2009). In order to be recognized as a clinical neu-
with perception of inappropriate relationships with ropsychologist according to its standards, a profes-
patients and students, none and 2.8% of participants sional must have completed 4000 hours of supervised
OR
indicated knowing of someone who engaged in sexual clinical practice in the area of neuropsychology, as
relationship with them, respectively. well as 500 hours of theoretical training (such as that
offered by Master’s programs). Additionally, those
practicing professionals who have an equivalent of
4. Discussion six years of full time experience in clinical neuropsy-
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chology are also eligible to petition for accreditation.

The results of the present study demonstrated that Given all this, it is perhaps not surprising that the
neuropsychology professionals in Spain perceived area of professional training and expertise emerged
ethical misconducts in all areas addressed by the sur- as having the highest percentage of perceived ethical
vey instrument. More specifically, the highest rate of misconduct. More specifically, 56.7% of the sample
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perceived misconduct was found in the area of pro- reported knowing someone who advertise or present
fessional training and expertise, with an average of themselves as neuropsychologists without actually
40.7%, followed by research/publications (25.6%), having the proper expertise or training, 46% who
clinical care (23.9%), and professional relationships knew others who did not possess adequate training
(8.8%). Equally importantly, over half of all partic- or experience in the area, and finally 19.5% indi-
ipants indicated that they have not received formal cated knowing someone who testified in court without
training on the topic of professional ethics. having the appropriate expertise.

Table 4
Ethical misconduct regarding professional relationships: Percentage and number of self-identified psychologists
who reported knowing others in the field who engage in these acts
Perceptions of ethical misconduct in professional relationships: % n
Know/interact with their patients outside of their professional relationship with the patient. 15.3 33
Take deliberate actions to damage the reputation of their colleagues 14.9 32
Are negligent and/or disrespectful to their students 13.0 28
Accept forms of payment other than money for their services from patients 6.5 14
Engage in sexual relationships with their students 2.8 6
Engage in sexual relationships with their patients 0.0 0
Average 8.8
532 L. Olabarrieta-Landa et al. / Ethical misconduct in neuropsychology

These results are similar to those reported in Latin on knowledge and skills obtained in undergraduate
American countries, such as Mexico or Colombia. In studies in general psychology. However, experts note
both of these countries the highest reported percep- that the content in ethics training are lacking both
tion of unethical conduct was in the area of training at the undergraduate and graduate levels (Bermejo-
and expertise, with 47.9% in Mexico (Fonseca et Frijola & Del Rı́o-Sánchez, 2009).
al., 2016) and 48.1% in Colombia (Panyavin et al., Additionally, since the profession of neuropsy-
2015a). Further, the order of perceived misconduct chology lacks regulation, it is highly likely that
in this area was the same as what was encountered those professionals who lack the necessary train-
in Spain, with higher perception of other profession- ing and experience in this field present themselves
als who engage in advertisement and presentation of as neuropsychologists and engage in its practice.
themselves as neuropsychologists without having the The recently passed accreditation procedure by the
requisite training, followed by those who lack ade- FANPSE is expected to curb such undesirable and

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quate training to be working in the field, and finally by potentially harmful behavior, and calls for further
those who engage in testifying during legal proceed- accreditation and regulation of the profession on the
ings without the necessary training. Interestingly, the Ministerial level.
percentages reported for these questions in both Mex- Finally, the growing field of forensic neuropsy-
ico (63.2%, 60.5%, and 20.2%, respectively; Fonseca chology created the need for establishing standards

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et al., 2016) and Colombia 63.4%, 56.2%, and 24.7%, of ethical practice in this area (Bush, 2005b; Hart-
respectively; Panyavin et al., 2015a) were higher than lage & Horton, 2010), since it frequently deals with
those found in Spain in the present study. In an such important topics as establishing the degree of
equal measure, a large-scale study conducted on this disability, or assessment of competence of individ-
topic across a number of countries in Latin America uals with neurological disorders. Although there is
also reported the highest percentage of perception of no universal consensus on the best ethical practices
unethical conduct in the area of professional train- in forensic neuropsychology (Bush, 2005b), exist-
OR
ing, with 46.7%, and followed the same distribution ing body of literature can help professionals avoid
across the three questions in this domain as in Spain unethical conduct and provide guidance in solving
(60.4%, 56.8%, and 22.8%, respectively) (Panyavin potential dilemmas (Horton & Hartlage, 2003). Some
et al., 2015). individuals evaluated in forensic/legal contexts may
The results of this section could be explained by experience temptations, motivations, and external
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several reasons. First, it must be kept in mind that pressures to manipulate the results of the evaluation
until a few years ago there were hardly any possibil- of their cognitive status by malingering, exaggerat-
ities for specialization in clinical neuropsychology ing symptoms, or providing deliberately low effort
in Spain. Currently, the opportunities for obtaining (Iverson, 2006). Instances of such behaviors must be
neuropsychology training are greater, but this growth detected and dealt with by expert neuropsychology
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in academic programs has not been accompanied professionals (Green, 2003). For these reasons, high
by regulation or establishment of guidelines of even professional competence and ethical conscientious-
the minimal training requirements. Most programs ness should be required of all professionals involved
at the Master’s level have duration of only one year, in the field of forensic neuropsychological assess-
which greatly limits the amount of theoretical content ment. The rise of this professional field within Spain
included in their curricula, especially that pertaining is reflected in the increasing number of scientific
to ethical aspects of neuropsychology practice. publications on ethics by Spanish authors, which
It is likely that students obtain experience and highlight various legal-forensic issues in acquired
skills of how to approach and resolve professional brain injury (Léon-Jimenez, 1998) and dementia (De
ethical issues during supervised clinical practice. Lepeleire et al., 2008; Molinuevo & Rami, 2013;
Periods of such practice, however, are generally of Viloria Jiménez et al., 2013).
relatively short duration, on the order of weeks or
months, so the lack of a regulated and established 4.2. Clinical care
specialization may be limiting the acquisition of the
necessary professional competence to meet the spe- Spanish neuropsychologists play an important role
cific ethical challenges in neuropsychology. If the in providing professional services in the context of
skills to handle ethical conflicts are not acquired dur- clinical practice. The results of a recently conducted
ing Master’s-level training, professionals must rely nationwide survey of Spanish neuropsychology
 L. Olabarrieta-Landa et al. / Ethical misconduct in neuropsychology 533

professionals reported that 88.5% reported engaging that the biggest problems with their assessment
in assessment/evaluations, and 58.7% in neurore- instruments were cost (58%) and lack of normative
habilitation, and worked with neurological patients data for Spain (49%) (Olabarrieta-Landa et al., 2016).
including those with dementia, stroke, and brain Similarly, the lack of adaptation to culture (18%) and
injury (Olabarrieta-Landa et al., 2016). lack of translated instruments (17%) were also iden-
The results of the current study revealed that the tified. Therefore, neuropsychologists in Spain must
highest perceptions of unethical conduct in the con- rely on instruments developed in different cultural
text of clinical care had to do with provision of contexts, and which are also linguistically distinct.
assessment/evaluations results in a way that was diffi- The results of neuropsychological tests are espe-
cult to understand (37.2%), not having skills/training cially susceptible to bias due to effects of culture,
to work with culturally diverse patients (34.9%), gender, age, or low education/illiteracy (Thomas-
and discussing patient information with others who Antérion & Barbeau, 2012; Wong, 2006). The 10

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are not involved in their treatment (31.6%). These most frequently used instruments in the field of clin-
results were followed by over a quarter of the sample ical psychology in Spain are adaptations, especially
who reported knowing someone who based diagnos- of testing instruments developed in the United States
tic conclusions on inadequate data/ignored important (Elosua, 2012). However, many of these adaptations
sources of data (27%), provided questionable or even lack sufficient empirical underpinning to provide

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harmful interventions (14.4%), providing substan- appropriate psychometric indices of validity and reli-
dard or even no services to those unable to pay for ability (Elosua, 2012). Consistent with the results in
them (12.6%), and keeping silent or failing to refer the present study, Spanish professionals who apply
patients when other important issues arose (9.8%). and interpret cognitive tests reportedly recognize the
These results are also consistent with those frequently lacking validity of the assessment (Muñiz
reported by previously conducted studies across & Fernández-Hermida, 2010).
Colombia, Mexico, and Latin America as a whole. In On the other hand, the lack of neuropsychological
OR
the case of Colombia (32%, Panyavin et al., 2015b) instruments which are adapted to Spanish popula-
and Latin America in general (31.3%, Panyavin et tion, or which in some cases do not have normative
al., 2015a), of the four surveyed areas clinical care data may drive some clinicians to base their diag-
emerged as having the second highest average of nostic impressions on raw data or to use the norms
perceived unethical conduct, after professional train- developed in other countries, which was recently
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ing/skills/expertise. In Mexico the area of provision reported in a study by Olabarrieta-Landa and col-
of clinical care had the third highest average percent- leagues (2016). They found that the most frequently
age, at 33.5%, after professional training/expertise used scoring procedure among neuropsychologists
and research/publications (Fonseca et al., 2016). involved using normative data from Spain (76%);
Despite this apparent similarity, some interesting however, 29% of respondents also reported using
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differences were revealed on the level of specific normative data from other countries. Further, these
questions. Across Latin America, Colombia, and authors found that 9.6% reported using raw scores
Mexico, lack of skills or training to work with patients as the basis for scoring, and 20% used personal-
who are culturally different was consistently the high- ized scoring procedures developed in clinical practice
est reported conduct (Fonseca et al., 2016, Panyavin (Olabarrieta-Landa et al., 2016).
et al., 2015a; Panyavin et al., 2015b), while in Spain it In the context of clinical care, present study
was found to be in the second place. This could poten- found that the highest percentage of perceived eth-
tially be due to the fact that relative to Spain, in Latin ical misconduct occurred in the provision of results
America there is greater ethnic diversity across and of neuropsychological assessments. It is possible that
within countries (Ardila, 1986; Navarrete Linares, many individuals who engage in the practice of neu-
2008), making this a more salient issue for practicing ropsychology in Spain know how to apply tests and
neuropsychologists in this global area. instruments, but not how to write reports and present
There are several reasons that may explain these their findings in a way that is clear and understand-
findings. First, during the neuropsychological evalu- able to patients, family members, or other health
ation it is important to consider the cultural, ethnic care professionals. This, in turn could potentially
and linguistic diversity in the administered tests and be explained by a perceived lack of clinical train-
their interpretation (Brickman, Cabo, & Manly, 2006; ing opportunities in Spain (47.5%), as well as the
Wong, 2006). Spanish neuropsychologists reported lack of academic training programs in the country
534 L. Olabarrieta-Landa et al. / Ethical misconduct in neuropsychology

(34.8%) (Olabarrieta-Landa et al., 2016), since these without having made a significant contribution (i.e.,
two important training contexts generally provide “honorary authorship”), such as when a department
practical skills in effective written communication supervisor grants access to data collection opportu-
skills, such as those involved with preparing assess- nities. In fact, of the three other published studies
ment reports which are easily comprehensible by both on the topic, Spain emerged as second only to Mex-
professionals and lay persons alike. ico in terms of perceptions of unmerited authorship
Another important finding in the area of clinical by neuropsychologists, 48.2% vs. 41.9% (Fonseca et
care was that nearly a third (31.6%) of respon- al., 2016), compared also to Colombia (27.3%) and
dents reported knowing someone who discussed Latin America in general (35.9%) (Panyavin et al.,
patient information with individuals not involved 2015a, 2015b). This suggests a possible systematic
with their treatment. This potentially unethical con- issue, which must be addressed on a number of levels.
duct of not respecting patient confidentiality could be Colleagues and collaborators engaged in neu-

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attributable to those cases where neuropsychologists, ropsychology must be made aware of the authorship
especially those who engage in private practice, may standards currently in place (like those published by
lack colleagues who they can rely on for professional the International Committee Medical Journal Editors
supervision and advice when with, for instance, an and others). On the other hand, scientific publica-
especially challenging clinical case. In such situa- tions ought to request from authors a list of their

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tions, they may engage in behaviors such as speaking specific contributions and responsibilities in the sub-
about the case and possibly revealing patient details to mitted research manuscript in order to document and
other psychologists, health care professionals, indi- compile written evidence of individual authors’ con-
viduals or even friends who are not involved with tributions, make the authorship assignation process
providing treatment. The topic of patient confidential- more transparent, discourage gifted and honorary
ity must be addressed in ethics training and academic authorship, and potentially highlight their instances.
curricula, and neuropsychology professionals ought Finally, organizations and institutions which host
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to exercise care and caution to refrain from reveal- research projects should discourage such practices
ing personal details and identifying information when by providing disincentives (e.g., disciplinary action,
discussing clinical cases and patient details. etc.) to those who are found to engage in them.
Conversely, they could also actively support and
4.3. Research and publications reward those research neuropsychologists who, for
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example, provide opportunities for their students to

The next area assessed by the current survey highlight their work (via congress presentations, pub-
dealt with research and publications in the neu- lications, etc.), provide earned authorship credit, and
ropsychology practice, and emerged as having the maintain transparent databases and statistical anal-
second highest average percentage (25.6%) of per- yses and serve as role models for good research
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ceived ethical misconduct. This area was assessed practices.

using three topical questions, and inappropriate or
unearned authorship, followed by misappropriation 4.4. Professional relationships
of students’ work as own, 41.9% and 23.7%, respec-
tively, were endorsed as the most frequent behaviors The domain of professional relationships asked
by other neuropsychologists in Spain. Additionally, the participants a number of questions in regards to
one in ten (11.2%) of participants indicated knowing their perceptions of ethical misconduct in dealing
someone who faked or misrepresented research data with patients, students, and colleagues. The most fre-
in order to advance their career. quently endorsed behavior in the context of patient
Many of neuropsychologists who engage in contact was that of interacting with patients out-
research in Spain work in Universities and hospital side of professional relationship (15.3%), followed
centers, and experience a great deal of pressure to by accepting forms of payment other than money for
produce high quantity of scientific output in order neuropsychological services (6.5%); none of the par-
to meet academic research standards (“sexenios”), or ticipants indicated knowing another professional who
advance their career. This may result in situations engaged in sexual relationships with their patients. In
in which individuals are tempted to take advantage regards to relationships with students and trainees,
of their students’ productivity, or engage in conduct 13% indicated knowing someone who acts negli-
which results in their name appearing on a manuscript gently and/or disrespectfully towards them. Perhaps a
 L. Olabarrieta-Landa et al. / Ethical misconduct in neuropsychology 535

more troubling was the finding that 2.8% of respon- Finally, the finding that some neuropsychology
dents indicated knowing someone who engaged in professionals act negligently and disrespectfully to
sexual relationships with their students. About one their students, as well as engage in inappropriate rela-
in seven respondents (14.9%) indicating knowing tionships with them, is also troubling. Institutions of
of someone who engaged in actions to damage the higher learning in Spain are beginning to introduce
reputation of their colleagues. and promote the role of ombudsman, or impartial
The overall average percentage of perceived mis- review and defense of students’ rights. However,
conduct for this domain was 8.8%, and was the many Universities and training centers still do not
lowest compared to the findings from Latin America, have such a program in place, which may leave many
Colombia, and Mexico, 14.6%, 14.4%, and 19.7%, students without recourse if they experience lack of
respectively (Fonseca et al., 2016; Panyavin et al., professionalism or poor treatment from their faculty
2015a, 2015b). A more detailed look at these findings supervisors. It may be important to make students

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revealed that this discrepancy is due to the partic- aware of their rights, and create protections for their
ipants in Colombia, for instance, reporting nearly academic and personal welfare on an institutional
twice as frequently that they knew someone who level.
accepted alternative forms of payment (12.9% vs.
6.5% in Spain) or those in Mexico who deliberately 4.5. Implications

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damaged colleague’s reputation (28.9%, vs 14.9% in
Spain), and nearly three times as frequently reported The results of the current study have a number of
awareness of neglectful or disrespectful behavior important implications. Firstly, they suggest a need
towards students (36% vs. 13% in Spain) (Fonseca to include more theoretical and practical content on
et al., 2016; Panyavin et al., 2015b). professional ethics on undergraduate and graduate
While a relatively high percentage of respondents level of education in order to provide effective train-
indicated knowing someone who knows or interacts ing of young psychology professionals in ethical
OR
with their patients outside of professional relation- decision-making, regardless of their field of special-
ship, it must be noted that such behavior in and of ization. This has also been previously suggested in
itself does not necessarily constitute ethical miscon- Spain (Bermejo-Frijola & Del Rı́o-Sanchez, 2009)
duct. Many neuropsychology professionals in Spain as well as in other countries (Bush, 2005a). Training
reside and practice in relatively small towns and programs should place special emphasis on provid-
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villages, or maintain their practice or professional ing future neuropsychologists with specific skills to
employment within close proximity to their residence enable them to detect and resolve ethically chal-
in a particular neighborhood in a large city. Addition- lenging scenarios and issues in a variety of practice
ally, the culture prevalent in the country encourages settings.
close interpersonal contact and informal relations, The next line of action suggested by the cur-
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which could contribute to the perception of accept- rent results is that of professional accreditation of
ing alternative payments for services rendered and neuropsychology professionals (Meier, 1992). Such
interacting with patients. accreditation ensures compliance with the minimum
On the other hand, a comparable percentage of par- requirements to engage in the practice of clini-
ticipants responded affirmatively that they knew of cal neuropsychology, including upholding its ethical
someone who deliberately damaged the reputation of standards. Professional and scientific neuropsycho-
their colleagues, which is a greater cause for concern. logical societies in Spain have recently issued a
Highly competitive professional environment and consensus document on accreditation of a “Profes-
interpersonal conflict between professionals could sional Expert in Clinical Neuropsychology” (COP,
contribute to this behavior, which is further made 2015), which established the basic criteria in order
more accessible by social media and networks which to be considered an expert in this specialty of pro-
could be accessed anonymously and go unpunished. fessional psychology. This accreditation process is
While in many ways such conduct is difficult to pros- being gradually implemented throughout the country
ecute, those individuals who engage in it ought to via the COP, and is a prerequisite for the regulation
be referred to professional organizations for repri- of the official specialization training programs, as
mand and possible sanctioning, if found that their had occurred in the United States (“Reports of the
actions impacted or damaged the career of another INS – division 40 task force on education, accredita-
neuropsychologist. tion, and credentialing,” 1987).
536 L. Olabarrieta-Landa et al. / Ethical misconduct in neuropsychology

Providing and improving continuing education professional trajectory, as well as at students and
opportunities for neuropsychology professionals in trainees. Additionally, the results were not analyzed
Spain could be a third avenue of action (Meier, by region, which prevented the possibility of compar-
1992). In the United States, clinical neuropsychol- ing various Autonomous Communities in Spain as a
ogy professionals have ample access to programs function of perception of ethical misconduct. Geo-
which provide case study and practical analysis of graphic location of professional training and practice
moral decision making (Banja, Adler, & Stringer, could be included in the analyses in future studies.
1996; Binder & Johnson-Greene, 1995; Bush, 2007; Another important limitation is contained in the
Bush & Drexler, 2002; Bush, 2005a), as well as way the questions were structured and worded, which
recommendations to guide them in interpretation of allowed to gather responses about the perception
the code of ethics standards (Binder & Thompson, of ethical misconduct, but not their incidence or
1995; Hartlage & Horton, 2010) after completing number of occurrences. Further, it is possible that

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their formal training. However, in Spain currently different participants interpreted the phrasing of the
there are virtually no such programs, and very few questions differently. For example, the word “inter-
publications have addressed these issues. The ethics act” in “. . . interact with their patients outside of
committees of the COP and its regional offices their professional relationship” could have meant
could contribute more effectively in the develop- simply greeting a patient on the street to one partic-

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ment, regulation, and supervision of the ethical ipant, or engaging in a friendly or even professional
aspects of professional psychology practice. One relationship outside of clinical setting to another.
of the recommended steps is that committees are Finally, future studies could address a number of
formed by experts who can act as advisers (Bush, other ethically questionable behaviors in the field
Grote, Johnson-Greene, & Macartney-Filgate, 2008). of professional neuropsychology that are known to
Another measure could involve continuing education be commonplace in Spain, but were not included in
courses which present real and hypothetical ethi- the present survey. These could include undeclared
OR
cally challenging examples and scenarios, so that conflicts of interest, procedures regarding obtaining
neuropsychologists can strengthen their efficacy in ethics committee approval for research studies, dec-
resolving dilemmas which they may face during laration of ethics committee approval for a published
their daily practice. Such courses could include train- research study when no such approval was received,
ing modules grounded in evidence-based decision selective peer review processes for grant applications
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making models (Bush & Martin, 2006). and journal articles in favor of certain researchers,
power of editors to publish their own work, copyright
4.6. Limitations and future directions violations via the internet/social media applications
(e.g., instruments, articles, chapters, books), mistreat-
The present study contains a number of limita- ment of colleagues via social networks, domains
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tions which must be taken into consideration when of legal/forensic practice such as providing favor-
interpreting its findings. First, the results have been able evidence to support disability claims, and other
obtained through an online survey. Therefore, the frequent ethical challenges encountered by profes-
sample was limited to those professionals who were sionals. Additional research to investigate these areas
contacted by internet, and who followed the provided are warranted.
survey hyperlink and provided their responses via the
survey website, signifying that these participants had 4.7. Conclusion
familiarity with online survey format and had suffi-
cient motivation in order to complete it. Future studies The practice of neuropsychology in Spain has
should use other means of contacting participants experienced a lot of growth in recent years. However,
and providing alternative survey formats in order to its training programs are not sufficiently developed or
maximize the pool of potential participants. regulated as to ensure high quality specialized pro-
The participants were required to have at least fessional preparation. The professionals who work
one year of experience in neuropsychology, which in the field perceived unethical behavior in the
may limit the applicability of the findings to those contexts of neuropsychology training and exper-
professionals who have less professional experience. tise, clinical practice, research, and professional
Subsequent studies could include questions directed relationships. Professional societies and government
at young neuropsychologist with a relatively short agencies should improve existing measures and
 L. Olabarrieta-Landa et al. / Ethical misconduct in neuropsychology 537

implement new strategies in the different stages of Bush, S. S., Grote, C. L., Johnson-Greene, D. E., & Macartney-
training to ensure the quality of programs and pro- Filgate, M. (2008). A panel interview on the ethical practice of
fessional services, with special attention to training neuropsychology. Clinical Neuropsychologist, 22(2), 321-344.
http://doi.org/10.1080/13854040601139187
in professional ethics. Bush, S., & Drexler, M. (2002). Ethical Issues in Clinical Neu-
ropsychology. CRC Press.
ComAcre-FANPSE. (2012). Documento de Acreditación del
Conflict of interest Profesional Experto en Neuropsicologı́a Clı́nica. Federación
de Asociaciones de Neuropsicologı́a Españolas FANPSE.
None to report. Retrieved from http://www.sanp.es/docs/acreditacionexperto
fanpse2012.pdf
COP España - Principios Éticos de la Evaluación Psi-
cológica. (n.d.). Retrieved January 11, 2015, from http://www.
References cop.es/index.php?page=principios-eticos
COP España. (1993). Código Deontológico. Madrid: COP España.

PY
American Academy of Clinical Neuropsychology. (n.d.). AACN COP España. (2004). Ética y Deontologı́a para Psicólogos.
Position Papers, Policies, and Research. Retrieved April 25, Madrid: COP España.
2015, from https://www.theaacn.org/positionpapers.aspx COP España. (2010). Código Deontológico. Madrid: COP España.
American Psychological Association. (2010). Clinical Neuropsy- COP España. (2014). Código Deontológico. COP España.
chology. Retrieved from http://www.apa.org/ed/graduate/ Retrieved from http://www.cop.es/index.php?page=codigo

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specialize/neuro.aspx deontologico
Andrews, T., Bañgs, R. M., Botella, C., Emmelkamp, P. M. G., COP España. (2015). Acreditación del Profesional Experto
Gamberini, L., Spagnolli, A., & Rothbaum, B. O. (2005). en Neuropsicologı́a Clı́nica. Consejo de la Psicologı́a
Commentary on Riva, G., virtual reality in psychotherapy: de España COP. Retrieved from http://www.sanp.es/docs/
Review. Cyberpsychology and Behavior, 8(3), 231-240. http:// acreditacionexperto cop2015.pdf
doi.org/10.1089/cpb.2005.8.231 De Lepeleire, J., Wind, A. W., Iliffe, S., Moniz-Cook, E. D.,
APA Ethics Office. (n.d.). Retrieved January 11, 2015, from Wilcock, J., Gonzalez, V. M., . . . & Vernooij-Dassen, M.
http://www.apa.org/ethics/index.aspx (2008). The primary care diagnosis of dementia in Europe: An
OR
Ardila, R. (1986). El pasado y futuro de la psicologı́a en Colombia. analysis using multidisciplinary, multinational expert groups.
Revista de Historia de las Psicologı́a, 6(2), 9-17. Aging and Mental Health, 12(5), 568-576. http://doi.org/
Banja, J. D., Adler, R. K., & Stringer, A. Y. (1996). Ethical dimen- 10.1080/13607860802343043
sions of caring for defiant patients: A case study. The Journal Elosua, P. (2012). Tests published in Spain: Uses, customs and
of Head Trauma Rehabilitation, 11(6), 93-97. pending matters. Papeles Del Psicólogo, 33(1), 12-21.
Bermejo-Frijola, V., & Del Rı́o-Sánchez, C. (2009). Professional Fonseca, P., Olabarrieta-Landa, L., Panyavin, I., Ortiz Jiménez, X.
ethics and deontology. Papeles Del Psicólogo, 30(3), 182-183. A., Aguayo Arelis, A., Rabago Barajas, B. V., . . . & Arango
TH

Binder, L. M., & Johnson-greene, D. (1995). Observer Lasprilla, J. C. (2016). Perceived ethical misconduct: A sur-
effects on neuropsychological performance: A case report. vey of neuropsychology professionals in Mexico. International
The Clinical Neuropsychologist, 9(1), 74-78. http://doi.org/ Journal of Psychological Research, 9(1), 64-71.
10.1080/13854049508402061 Green, P. (2003). Welcoming a paradigm shift in neuropsychol-
Binder, L. M., & Thompson, L. L. (1995). The ethics code and ogy. Archives of Clinical Neuropsychology, 18(6), 625-627.
http://doi.org/10.1016/S0887-6177(03)00094-5
AU

neuropsychological assessment practices. Archives of Clinical

Neuropsychology, 10(1), 27-46. http://doi.org/10.1016/0887- Hannay, H. J., Bieliauskas, L., Crosson, B. A., Hammeke, T.
6177(93)E0004-U A., Hamsher, K. D., & Koffler, S. (1998). Special issue:
Boake, C. (2008). Clinical neuropsychology. Professional Psy- Proceedings of the Houston Conference on specialty edu-
chology: Research and Practice, 39(2), 234. cation and training in clinical neuropsychology. Archives of
Bombı́n, I., & Caracuel, A. (2008). Specialization in neuropsychol- Clinical Neuropsychology, 13(2), 157-250. http://doi.org/10.
ogy: From clinical necessity to strategic convenience. Papeles 1016/S0887-6177(98)00036-5
Del Psicologo, 29(3), 291-300. Hartlage, L. C., & Horton, A. M. (Eds.). (2010). Handbook
Brickman, A. M., Cabo, R., & Manly, J. J. (2006). Ethical Issues in of Forensic Neuropsychology (2nd ed.). Springer Publishing
Cross-Cultural Neuropsychology. Applied Neuropsychology, Company.
13(2), 91-100. http://doi.org/10.1207/s15324826an1302 4 Horton, A. M., & Hartlage, L. C. (Eds.). (2003). Hand-
Bush, S. (2007). Ethical Decision Making in Clinical Neuropsy- book of forensic neuropsychology. New York, NY: Springer
chology. Oxford University Press. Pub. Co.
Bush, S. S. (2005b). Introduction. Journal of Forensic Neuropsy- Iverson, G. L. (2006). Ethical Issues Associated With the
chology, 4(3), 1-9. http://doi.org/10.1300/J151v04n03 01 Assessment of Exaggeration, Poor Effort, and Malinger-
Bush, S. S. (Ed.). (2005a). A Casebook of Ethical Challenges in ing. Applied Neuropsychology, 13(2), 77-90. http://doi.org/
Neuropsychology (1 edition). London; New York: Taylor & 10.1207/s15324826an1302 3
Francis. León-Carrión, J., Machuca-Murga, F., Murga-Sierra, M., &
Bush, S. S., & Martin, T. A. (2006). Introduction: Applied Domı́nguez-Morales, R. (2001). Outcome after an intensive,
Neuropsychology: Special Issue Ethical Controversies in holistic and multidisciplinar rehabilitation program after trau-
Neuropsychology. Applied Neuropsychology, 13(2), 63-67. matic brain injury. Medico-legal values. Revista de Neurologia,
http://doi.org/10.1207/s15324826an1302 1 33(4), 377-383.
538 L. Olabarrieta-Landa et al. / Ethical misconduct in neuropsychology

Léon-Jimenez, F. (1998). Ethical and legal issues in brain and neuropsychology in Colombia: Survey results]. In J. C.
injury rehabilitation. NeuroRehabilitation, 11(2), 119-127. Arango-Lasprilla, D. Rivera, and J. M. Medina Salcedo (Eds.),
http://doi.org/10.1016/S1053-8135(98)00016-X Neuropsicologı́a en Colombia: Datos Normativos, Estado
Meier, M. J. (1992). Modern clinical neuropsychology in historical Actual y Retos a Futuro [Chapter 13: Neuropsychology in
perspective. American Psychologist, 47(4), 550-558. Colombia: Normative Data, State of the Art, and Future Direc-
Molinuevo, J. L., & Rami, L. (2013). Applying the IWG tions]. Manizales, Colombia: Editorial Universidad Autónoma
Research Criteria in Clinical Practice. Feasibility and Ethi- de Manizales.
cal Issues. Medical Clinics of North America, 97(3), 477-484. Panyavin, I., Goldberg-Looney, L. D., Rivera, D., Perrin,
http://doi.org/10.1016/j.mcna.2012.12.018 P. B., & Arango-Lasprilla, J. C. (2015b). Perception of
Muñiz, J., & Fernández-Hermida, J. R. (2010). The opinion ethical misconduct by neuropsychology professionals in
of Spanish psychologists on the use of tests. Papeles Del Latin America. Archives of Clinical Neuropsychology, 30(5),
Psicólogo, 31(1), 108-121. 413-423.
National Academy of Neuropsychology. (n.d.). NAN Posi- Peña Casanova, J. (1983). Neuropsicologı́a. Barcelona: Toray.
tion Papers. Retrieved April 25, 2015, from https://www. Reports of the INS - division 40 task force on education, accredi-
nanonline.org/nan/Professional Resources/Position Papers/N tation, and credentialing. (1987). Clinical Neuropsychologist,

PY
AN/ Research Publications/Position Papers.aspx?hkey=7160 1(1), 29-34. http://doi.org/10.1080/13854048708520033
2191-716a-4375-8eb8-4b4e6a071e3a Thomas-Antérion, C., & Barbeau, E. (2012). Ethics and
Navarrete Linares, F. (2008). Los pueblos indı́genas de México: neuropsychological assessment. Geriatrie et Psycholo-
Pueblos Indı́genas del México Contemporáneo. México: gie Neuropsychiatrie du Vieillissement, 10(4), 445-452.
Comisión Nacional para el Desarrollo de los Pueblos http://doi.org/10.1684/pnv.2012.0372

CO
Indı́genas. Viloria Jiménez, M. A., Chung Jaén, M., Vigara Garcı́a, M., &
Olabarrieta-Landa, L., Caracuel, A., Pérez-Garcı́a, M., Panyavin, Barahona-Alvarez, H. (2013). Decision-making in older peo-
I., Morlett-Paredes, A., & Arango-Lasprilla, J. C. (2016). The ple with dementia. Reviews in Clinical Gerontology, 23(4),
profession of neuropsychology in Spain: Results of a national 307-316. http://doi.org/10.1017/S0959259813000178
survey. The Clinical Neuropsychologist, 30(8), 1335-1355. Wong, T. M. (2006). Ethical controversies in neuropsy-
Panyavin, I., Fonseca, Aguilar, P., Olabarrieta Landa, L., Rivera, chological test selection, administration, and interpreta-
D., Quijano, M. C., Olivera Plaza, S. L., Calderón Chagualá, tion. Applied Neuropsychology, 13(2), 68-76. http://doi.
J. A., & Arango-Lasprilla, J. C. (2015a). Ética y Neurop- org/10.1207/s15324826an1302 2
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sicologı́a en Colombia: Resultados de una encuesta [Ethics
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