Placing neuropsychology in context.

The tenure of a journal editor is one in which the voyage is understood only after it is over. There is little resemblance now to my goals and plans as originally conceived. This journal is different from the one I began to edit 3 years ago, and as a result, so am I. I can report that neuropsychology, as a discipline and as an interdisciplinary field of study, is vibrant and growing. Over the past 3 years, our special issues in rehabilitation, ADHD, imaging, substance abuse, epilepsy, dementia prodromes, cultural issues and autism bear witness to the breadth of inquiry and sophistication of analyses that are being pursued. Free-standing papers on executive function, cerebrovascular disease, congenital syndromes, pain, memory, systemic lupus, and cancer demonstrate the diversity of interests. It is frankly quite humbling to step beyond one’s field and come to realize how much there is to know. I believed at the outset that being an editor would be an opportunity to help shape neuropsychology. In the end, however, it was the extraordinary nature of the field that shaped my thinking. Not only am I considering new ideas, but I have learned how much other areas of pursuit can offer regarding unanswered questions in my own work. I am grateful for having had the opportunity to grow in this fashion. It is important to acknowledge the dedication, hard work and thoughtfulness of an outstanding group of Associate Editors, and the efforts of a talented and diverse group of reviewers who reflect the richness of the field. They have all served as wonderful partners in this process. I believe strongly that with the appointment of Edith Sullivan at Stanford as the new editor-in-chief, this journal has been placed in extraordinary hands. There are some important challenges that remain for us. With all that neuropsychology has accomplished, we should not lose sight of the larger picture of how our knowledge will ultimately translate to the clinical setting. For the ostensible gains in visibility to the greater healthcare community, NIH, government regulators, and industry, our work has not been embraced to the extent that it deserves. It seems to me that we actually bear some responsibility for our current status, not for lack of effort but rather for how we approach some of the clinical problems we are trying to solve. The result has been somewhat of a public-relations problem. One of the strengths of neuropsychology is the exquisite measurement of cognitive function and other aspects of human behavior. Our tools are unsurpassed in this regard. What remains unclear to those outside of our pursuits is the extent to which our findings are clinically relevant. To conclude that a change is not the result of chance does not make it meaningful to patients, caretakers or the healthcare system. We cannot infer clinical importance on the basis of statistical difference alone. This matter often arises when we are measuring continuous outcomes, including treatment effects; this issue also relates to dichotomous outcomes, such as a treatment goal or an adverse event. In a clinical trial of medical therapy, for example, what is the actual benefit to patients when the difference in neuropsychological outcome between two treatment groups is at the 0.01 significance level? How relevant is a 0.5 treatment effect in a meta-analysis? What are the criteria for deciding whether a loss of cognitive function should be 1.0, 1.5 or Neuropsychol Rev (2008) 18:269–270 DOI 10.1007/s11065-008-9071-0