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Evidence for the validity of the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy,Kenworthy, 2000) based on internal structure was examined in a sample of children with mixed clinical diagnoses via maximum likelihood confirmatory factor analysis. Four alternative factor models of children's executive function, based on current theories that posit a unidimensional versus fractionated model (Rabbitt, 1997; ShalliceBurgess, 1991), using the revised 9-scale BRIEF configuration that separates two components of the Monitor scale, were examined for model fit. A 3-factor structure best modeled the data when compared directly with 1-, 2-, and 4-factor models. The 3-factor model was defined by a Behavior Regulation factor consisting of the BRIEF Inhibit and Self-Monitor scales, an Emotional Regulation factor consisting of the Emotional Control and Shift scales, and a Metacognition factor composed of the Working Memory, Initiate, Plan/Organize, Organization of Materials, and Task-Monitor scales. The findings support a fractionated, multi-component view of executive function as measured by the BRIEF.

This Chapter is intended to provide a framework for the neurobehavioral investigation and assessment of infants and young children (i.e., those under 5 years of age), and to discuss the relevance of those assessments to clinical interventions with at-risk children. A selected survey of the increasing knowledge base regarding brain-behavior relationships that is especially pertinent in this age range is included. We also emphasize three functional domains of particular interest in this age range: attention, memory, and executive function. Our goal is to challenge clinicians to develop concepts about brain-behavior relationships in this age group, and to provide a basis for clinicians to generate hypotheses in their own clinical evaluations and effect appropriate interventions. Our objective is not to provide an exhaustive listing of tests and measures, but instead to consider the functional domains for which a judicious selection of tests can be made. We hope to convince the reader that neuropsychological services provided in early childhood do not depend merely on the administration of test measures but instead on the knowledge of unique brain-behavior relationships that are applicable within this age range, their direct application to these early periods of development, and their relevance beyond these early years.

Objective Demonstrate classification statistics (OR, Likelihood Ratios) of a pediatric multi-component battery of neurocognitive tests, child and parent symptom report to identify the presence or absence of concussion. Design Prospective cohort design. Setting Outpatient clinic, teaching hospital. Participants Two groups of children, ages 5–7 years (n=22 per group) and ages 8–12 years (n=67 per group) (≤7 days post-concussion) were compared to gender/age-matched groups of non-injured children. Interventions Predictor variables: Response Speed Composite, Child and Parent Post-Concussion Symptom Inventory (PCSI) symptom scores. Main Outcome Measurements Group membership—concussion, control. Results MANOVAs revealed significant group differences for the Response Speed Composite, Child and Parent PCSI symptom scores for both age groups. Discriminant function analyses conducted on the Child and Parent PCSI scores and Neurocognitive Composite scores independently and in combination indicate parent and child PCSI symptoms and Response Speed demonstrate adequate classification independently; in combination offered greatest rates. For the 5–7 year age group, 73% were correctly classified by the three combined scores (Positive Likelihood Ratio=3.5, Negative Likelihood Ratio=0.58, OR=6.0, 80% Area Under Curve (AUC)). 84% of 8–12 age group were identified correctly by the three combined scores (LR+=47.0, LR−=.30, OR=155, 94% AUC). Relative differences between scores will be demonstrated. Conclusion The multi-component pediatric battery demonstrates appropriate capability to classify children referred for a suspected concussion. Increased parent and child PCSI symptom ratings and decreased neurocognitive performance (Response Speed) increases diagnostic accuracy, assisting the clinician in their clinical decision-making. Competing interests Drs Gioia, Isquith and Vaughan are co-authors of Pediatric ImPACT battery.

Objective Identify risk for adverse outcomes in school performance and attendance following concussion. Design Correlational. Setting Outpatient clinic, teaching hospital. Participants 216 children ages 12–18 (mean (SD)=15.1 (1.6); 70% male) seen within 2 months of sport-related concussion (mean days since injury=21.2 (12.6)). Interventions Predictors: Pre-injury risk/post-concussion symptoms, injury characteristics. Main Outcome Measurements Reported drop in grades, days of school absence. Results Correlation and crosstabs revealed no association between a drop in grades and a personal or family history of developmental delays, pre-injury school performance, developmental disabilities, or previous concussions. Higher maternal education and retrospective pre-injury symptoms were significantly associated with lower grades. Total post-injury symptom burden (parent and child reported) and physical exertional symptoms were not related, although presence of amnesia/loss of consciousness and cognitive exertional effects (symptom exacerbation) were significantly associated with lower grades. No pre-injury risk factors were correlated with school absence, but symptom burden at time of injury and subsequent parent/child symptom report at time of evaluation were positively associated with number of days absent from school. Conclusions Varying post-concussion factors are related to school outcomes. Pre-injury risk factors (higher baseline symptoms, maternal education) and post-injury factors (LOC/amnesia, cognitive exertional effects) related to drop in grades. In contrast, symptom burden at injury and later severity was related to days absent from school. These findings provide the clinician with useful indicators of possible risk factors for adverse outcomes in school performance, an important issue in concussion management for children. Competing interests None.

An exploratory investigation of the effects of incidental and intentional learning instructions upon the free recall of a categorized list of naturalistic sounds was conducted. Subjects who performed a “physical” orienting task (judging whether a sound was louder in the left or right ear) recalled significantly less than subjects who performed a “semantic” task (judging the pleasantness or unpleasantness of the referents of the sounds) and subjects who were directly asked to learn the sounds. All groups showed significant categorical clustering, but there were no differences among the groups. These results further attest to the generality of Craik and Lockhart’s (1972) levels of processing framework, and suggest that the retention of sounds varies with the degree of semantic involvement.