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Objective The purpose of this study was to evaluate psychological correlates of self-rated resilience, as assessed with the 10-item version of the Connor-Davidson Resilience Scale (CD–RISC–10), in older adults. In particular, we were interested in the degree to which self-rated resilience might be a protective factor against cognitive decline. Method In total, 100 adults aged 60–90 years who had been referred because of subjective cognitive concerns completed self-report measures of resilience, symptoms of anxiety and depression, and satisfaction with life. They also completed a test of learning and memory. Ratings about daily functioning at home and in the community were obtained from both participants and proxy informants. Results Resilience ratings correlated strongly positively with concurrent self-rated symptoms of anxiety and depression, and strongly negatively with self-rated life satisfaction. However, only informant ratings of daily functioning correlated with actual participant performance on a test of learning and memory, with lower ratings being associated with worse test performance. Conclusions Self-rated resilience, as measured by the CD–RISC–10, is primarily related to subjective well-being and does not inform sufficiently about relative risk for cognitive dysfunction in older adults.

This study investigated the performance on, and correlates of, the Brief Visuospatial Memory Test - Revised (BVMT-R) in patients with traumatic brain injury (TBI).Participants included 100 patients with TBI and 100 demographically matched controls. We first used regression analysis to determine predictors of BVMT-R performance in the clinical group. We then used analysis of variance as well as logistic regression to determine how BVMT-R findings differed between the clinical and control groups.Injury severity and visuospatial ability both contributed to the prediction of BVMT-R Total Recall and Delayed Recall scores in the TBI group. Mean differences between the TBI and control groups on these variables were statistically significant, but overall individual classification accuracy was limited at 59%.The BVMT-R has some clinical utility in the evaluation of patients with TBI but should not be used in isolation.

This study explored the relationships between objective measures of cognitive functioning, self and informant reports of cognitive problems in daily life, and depression screening in older adults who had been referred because of reported or suspected cognitive changes. We used archival data from 100, predominantly White (97%), typically educated (

We sought to determine the utility of a new performance validity index that was recently proposed. In particular, we wanted to determine if this index would be associated with a specificity of at least .90, a sensitivity of at least .40, and an Area Under the Curve of at least .70 in a traumatic brain injury (TBI) sample.We used logistic regression to investigate how well this new index could distinguish persons with TBI (The new performance validity index had acceptable specificity (.96) but had suboptimal sensitivity (.35) and Area Under the Curve (.66). It was concerning that almost half (5/12) of the cases that were identified by this index as providing invalid effort were false positives. Although a slightly more liberal cut-off improved sensitivity, the problem with poor positive predictive power remained. The conventional Forced Choice index had relatively better classification accuracy.Differences in base rates between the original sample of Martin et al. and the current one most likely affected positive predictive power of the new index. Although their performance validity has excellent specificity, the current results do not support the application of this index in the clinical evaluation of patients with traumatic brain injury when base rates of invalid performance differ markedly from those in the original study.

Objective The purpose of this study was to evaluate the presence of demographic, injury and neuropsychological correlates of distinct patterns of performance validity test and symptom validity test results in persons with mild traumatic brain injury (mTBI). Method One hundred and seventy-eight persons with mTBI completed the Test of Memory Malingering (TOMM; performance validity) and the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; symptom validity) within 1–12 months postinjury. Four groups were compared: (a) pass both TOMM and MMPI-2-RF validity criteria, (b) pass TOMM and fail MMPI-2-RF, (c) fail TOMM and pass MMPI-2-RF, and (d) fail both TOMM and MMPI-2-RF. Results Compared to Group a, participants in combined Groups b–d were more than twice as likely to be engaged in financial compensation-seeking and about four times less likely to have neuroimaging evidence of an intracranial lesion. The average performance of Group d on an independent test of verbal learning was more than 1.5 standard deviations below that of Group a. Participants in Group b were more likely to have intracranial lesions on neuroimaging than participants in Group c. Conclusion Performance and symptom validity tests provide complementary and non-redundant information in persons with mTBI. Whereas financial compensation-seeking is associated with increased risk of failure of either PVT or SVT, or both, the presence of intracranial findings on neuroimaging is associated with decreased risk of such.

This exploratory study is the first to investigate whether the construct of sluggish-cognitive tempo (SCT) is related to slowed processing speed in children with traumatic brain injury (TBI), while also considering pre-morbid and injury variables. The study evaluated SCT, as measured by the Child Behavior Checklist (CBCL), and processing speed, as assessed with the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV Processing Speed Index), in children who sustained TBI with a wide range of injury severity. Injury variables examined included the length of coma, presence of neuroimaging findings, and time between injury and assessment. Children's cognitive reserve, as estimated by parental level of education, was a non-injury variable. The participants included 50 children, ages 6-16 years, without co-morbid neurological or psychiatric conditions who underwent a neuropsychological evaluation within 1-12 months after injury. Results indicated no significant correlations between SCT and any of the WISC-IV index scores. Children with a moderate-severe TBI did not differ from those with uncomplicated mild TBI on SCT but they had statistically significant lower WISC-IV Processing Speed. Although parents of children with uncomplicated mild TBI had higher levels of education as compared to parents of children with moderate-severe TBI, there was no statistically significant relationship between the level of parental education and either SCT or Processing Speed. This study suggests that SCT, as measured by the CBCL, is not a sensitive measure of sequelae of pediatric TBI.

To determine if the GAD-7 provides incremental value, predicting a final diagnosis of an anxiety disorder after traumatic brain injury (TBI). Retrospective analysis of archival data of 100 patients with TBI, who underwent neuropsychological evaluation 1-12 months after injury. Receiver Operating Characteristic analysis determined the optimal cutoff point for clinically significant symptoms on the GAD-7. Hierarchical logistic regression analyses determined the relative contributions of premorbid psychiatric history, injury severity, and GAD-7 results in predicting a final diagnosis of anxiety disorder. GAD-7 cutoff point of ≥7 yielded the best combination of sensitivity and specificity regarding a final diagnosis of anxiety disorder. Within hierarchical logistic regression models, injury severity did not statistically significantly add to prior psychiatric history in predicting a final diagnosis of anxiety disorder. When GAD-7 was added, it made a statistically significant contribution in accounting for such a diagnosis and increased sensitivity from 71% to 91%. The GAD-7 holds diagnostic utility as a screening measure for anxiety disorders in patients with TBI. It should not be used in isolation but as part of a more comprehensive interview and history. The GAD-7 can benefit clinicians in assisting with timelier identification and treatment of symptoms of anxiety.

We sought to determine the accuracy of embedded performance measures for the D–KEFS Color Word Interference Test that were recently proposed by Eglit et al. In particular, we wanted to determine if...

Sixty-one children and adolescents with traumatic brain injury completed the Child and Adolescent Memory Profile (ChAMP; Sherman & Brooks, 2015) within 1 to 12 months post injury. Most of the ChAMP index scores demonstrated statistically significant negative correlations with time to follow commands following traumatic brain injury. Compared with demographically matched neurologically healthy controls, selected from the ChAMP standardization sample, participants with traumatic brain injury had statistically significantly lower scores on all ChAMP index scores but sensitivity and specificity were suboptimal. We conclude that the ChAMP has modest clinical utility as part of a more comprehensive evaluation of sequelae of traumatic brain injury in children and adolescents.

Objective To determine the clinical utility of the Patient Health Questionnaire-Adolescent (PHQ-A) in screening for depressive disorders in adolescents following traumatic brain injury (TBI). Design Retrospective analysis of data collected as a part of routine clinical care over a period of 4 years. Setting Regional rehabilitation facility. Participants Adolescents (n = 101) with mild to moderate-severe TBI who were referred for an outpatient neuropsychological evaluation within 1 to 12 months postinjury. Main outcome measures PHQ-A, PHQ-A_2 (2-item version), and Processing Speed Index (PSI) from the Wechsler scales of intelligence. Results Both premorbid depressive disorder and PHQ-A scores predicted a postinjury diagnosis of depressive disorder, with a combined sensitivity of 0.91 and specificity of 0.59. PHQ-A_2 did not reach acceptable levels of sensitivity in predicting suicidal thoughts. PHQ-A scores did not add significantly to the prediction of PSI results after accounting for TBI severity. Conclusions PHQ-A has clinical utility as a screening instrument for depressive disorders in outpatient adolescents with TBI when the cutoff for clinically significant concern is set at more than 4 and premorbid psychiatric history is also taken into account.

We evaluated the classification accuracy of two abbreviated versions of the Test of Memory Malingering (TOMM) in prediction of results on the full-length instrument in a sample of 126 children who were evaluated within 1-12 months after traumatic brain injury. Both a version based on administration of Trial 1 and a version based on administration of only the first 10 items of Trial 1 had acceptable specificity (i.e.,.90) and sensitivity (i.e.,.60) with regard to prediction of pass/fail results on the complete TOMM. Failure on the TOMM suppressed performance on measures of processing speed that were otherwise sensitive to severity of traumatic brain injury. We conclude that these abbreviated versions of the TOMM can be used in clinical practice with children with traumatic brain injury, at the discretion of the neuropsychologist.

Objective we sought to determine the degree to which cognitive reserve, as assessed by the Test of Premorbid Functioning in combination with demographic variables, could act as a buffer against the effect of traumatic brain injury (TBI) on cognitive test performance. Method retrospective analysis of a cohort of 121 persons with TBI who completed the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) within 1-12 months after injury. Results regression analyses indicated that cognitive reserve was a statistically significant predictor of all postinjury WAIS-IV factor index scores, after controlling for various premorbid and comorbid confounding variables. Only for Processing Speed did injury severity make an additional statistically significant contribution to the prediction model. Conclusions cognitive reserve has a protective effect with regard to the impact of TBI on cognitive test performance but this effect is imperfect and does not completely negate the effect of injury severity.

To determine the predictive accuracy of the Patient Health Questionnaire (PHQ)-2 in predicting PHQ-9 findings and to examine demographic, historical, and injury correlates of PHQ-9 ratings.Retrospective analysis of data collected as part of routine clinical outpatient care over a period of 30 months on 168 persons with mild to severe traumatic brain injury, who were referred for neuropsychological evaluation within 1-12 months after injury.PHQ-2 scores ≥2 had a sensitivity of 0.90 in predicting PHQ-9 scores ≥10, and a sensitivity of 0.95 in predicting endorsement of any passive or active suicidal thoughts on the PHQ-9. Premorbid history of having experienced personal abuse was the strongest predictor of post-injury PHQ-9 ratings.The PHQ-2 has adequate sensitivity in predicting PHQ-9 findings and can be used as a screener in clinical practice in persons with traumatic brain injury, as long as formal psychometric assessment is supplemented with a comprehensive review of premorbid history.

This study examined the role of injury-related variables, socioeconomic disadvantage, and preexisting conditions on verbal learning and memory in a sample of children with traumatic brain injury (TBI). We also explored the mediating effect of processing speed and working memory. One hundred children aged 7-16 years (M = 13.46, SD = 2.78) completed a neuropsychological assessment between 1-12 months post injury. Hierarchical multiple regression analyses were conducted on domains comprising the four-factor model of the California Verbal Learning Test-Children's Version (CVLT-C). Results revealed independent associations between injury severity as well as parental education on learning efficiency and delayed recall, while injury severity alone accounted for inaccurate recall. Working memory and prior special education placement were predictive of the attention factor of the CVLT-C. Additionally, Sobel tests showed that working memory mediated the effect of prior special education on learning efficiency (Z = 2.90, p

The present study was composed of two parts examining the clinical utility of the Delis-Kaplan Executive Function System (D-KEFS) Verbal Fluency and Color-Word subtests in traumatic brain injury (TBI). In the first part, the performance of 128 outpatients with mild to severe TBI on the Verbal Fluency and Color-Word subtests was examined in relation to two primary indicators of TBI severity: length of coma and the presence of intracranial lesions on neuroimaging through regression analysis. After controlling for education, ethnicity, and complicating premorbid and comorbid factors, length of coma predicted performance on the Color-Word Inhibition/Switching subtest, whereas the presence of diffuse lesions was related to Verbal Fluency Category Switching performance. In the second part of this study, performance on the Category Switching and Inhibition/Switching subtests was compared between a group of 28 participants with moderate-to-severe TBI and demographically matched groups with mild-uncomplicated TBI (n = 28) and neurologically healthy control participants (n = 56). The moderate-to-severe TBI group performed significantly worse on both subtests than the mild-uncomplicated TBI and control groups, and the latter groups did not differ from each other on these subtests. Logistic regression analysis showed that the combined group classification accuracy of these subtests was 66.07%, with an area under the curve (AUC) of .70 and a likelihood ratio of 1.93. The findings provide modest support for the clinical utility of the Color-Word Inhibition/Switching subtest in the cognitive assessment of TBI, while also replicating prior research suggesting clinical utility of the Category Switching subtest in this population.

Individuals who sustain traumatic brain injury (TBI) may report various cognitive, emotional, and somatic symptoms. To formally assess the possibility of subtypes of symptom profiles following TBI, we examined patterns of Minnesota Multiphasic Personality Inventory-2-Restructured form (MMPI-2-RF) restructured clinical scales in 201 persons with TBI, 1 to 12 months post injury. We also evaluated how these patterns varied according to injury, demographic, and premorbid variables. Cluster analysis identified 4 distinct MMPI-2-RF profiles. Clusters 1 and 4 differed primarily in overall profile elevation, while Clusters 2 and 3 varied in pattern. Although Cluster 1 endorsed the most distress across clinical scales, they were also most likely to have highly elevated Symptom Validity scales. In addition, they had relatively greater prevalence of prior personal and substance abuse histories than Cluster 4. In contrast, Cluster 4 did not endorse any significant elevations on clinical scales, even though it comprised relatively more patients with positive neuroimaging findings. Cluster 2 was predominantly female and endorsed prominent somatization on the MMPI-2-RF, whereas Cluster 3 was predominantly male, and their MMPI-2-RF pattern was characterized by subclinical levels of guardedness and restlessness. Compared with Cluster 2, Cluster 3 had relatively greater proportions of participants with positive neuroimaging findings as well as prior substance abuse histories. The present study is consistent with research that suggests that subjective symptom reporting following TBI is associated to a considerable degree with premorbid factors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objectives:Traumatic brain injury can result in cognitive impairments in children. The objective of this retrospective study was to determine to what extent such outcomes are moderated by cognitive reserve, as indexed by parental education.Methods: Sixty 6- to 16-year-old children completed the Wechsler Intelligence Scale for Children—Fifth Edition (WISC–V) within 30–360 days after having sustained a traumatic brain injury (TBI). Their Full-Scale IQ and factor index scores were compared to those of demographically matched controls. In addition, regression analysis was used to investigate in the TBI group the influence of injury severity in addition to parental education on WISC–V factor index scores.Results: Cognitive reserve moderated the effect of TBI on WISC–V Full Scale IQ, Verbal Comprehension, and Visual Spatial. In the TBI group, it also had a protective effect with regard to performance on the Verbal Comprehension, Visual Spatial, and Fluid Reasoning indices. At the same time, greater injury severity was predictive of lower Visual Spatial and Processing Speed index scores in the TBI group.Conclusions: Cognitive reserve as reflected in parental education has a moderating effect with regard to children’s performance on the WISC–V after TBI, such that higher cognitive reserve is associated with greater preservation of acquired word knowledge and understanding of visual relationships. Measures that emphasize speed of processing remain affected by severity of TBI, even after accounting for the protective effect associated with cognitive reserve. (JINS, 2019,25, 355–361)

Objective: The purpose of this critical review was to evaluate the current state of research regarding the incremental value of neuropsychological assessment in clinical practice, above and beyond what can be accounted for on the basis of demographic, medical, and other diagnostic variables. The focus was on neurological and other medical conditions across the lifespan where there is known risk for presence or future development of cognitive impairment.Method: Eligible investigations were group studies that had been published after 01/01/2000 in English in peer-reviewed journals and that had used standardized neuropsychological measures and reported on objective outcome criterion variables. They were identified through PubMed and PsychInfo electronic databases on the basis of predefined specific selection criteria. Reference lists of identified articles were also reviewed to identify potential additional sources. The Grades of Recommendation, Assessment, Development and Evaluation Working Group's (GRADE) criteria were used to evaluate quality of studies.Results: Fifty-six studies met the final selection criteria, including 2 randomized-controlled trials, 9 prospective cohort studies, 12 retrospective cohort studies, 21 inception cohort studies, 2 case control studies, and 10 case series studies. The preponderance of the evidence was strongly supportive with regard to the incremental value of neuropsychological assessment in the care of persons with mild cognitive impairment/dementia and traumatic brain injury. Evidence was moderately supportive with regard to stroke, epilepsy, multiple sclerosis, and attention-deficit/hyperactivity disorder. Participation in neuropsychological evaluations was also associated with cost savings.Conclusions: Neuropsychological assessment can improve both diagnostic classification and prediction of long-term daily-life outcomes in patients across the lifespan. Future high-quality prospective cohort studies and randomized-controlled trials are necessary to demonstrate more definitively the incremental value of neuropsychological assessment in the management of patients with various neurological and other medical conditions.

This study aimed to evaluate the degree to which the Behavior Rating Inventory of Executive Function (BRIEF) and Child Behavior Checklist (CBCL) measure overlapping vs. distinct constructs in pediatric patients with mild traumatic brain injury (TBI), and to examine the demographic and injury correlates of such constructs as well as those of cognitive test performance. A total of 100 parents completed the BRIEF and the CBCL within 1 to 12 months after the injury of their child. Groups were contrasted based on the presence vs. absence of impairment on, respectively, the BRIEF and the CBCL. Exploratory maximum likelihood factor analysis was used to evaluate latent constructs. Correlates of the various factor scores were evaluated through regression analysis and contrasted with those of a test of verbal learning and memory.The results revealed that the BRIEF and the CBCL disagree about the presence vs. absence of impairment in about one quarter of cases. A prior history of attention deficit/hyperactivity disorder (ADHD) was associated with an increased likelihood of impairment on both the BRIEF and the CBCL, whereas prior outpatient psychiatric treatment was associated with the increased likelihood of selective impairment on the CBCL. Latent constructs manifested themselves along cognitive regulation, emotional adjustment and behavioral regulation factors. Whereas premorbid characteristics were the exclusive correlates of these factors, performance on a test of verbal learning and memory was negatively affected by intracranial lesions on neuroimaging.It is concluded that the BRIEF and the CBCL offer complementary and non-redundant information about daily functioning after pediatric mild TBI. The correlates of cognitive test performance and parental behavior ratings after such injuries are different and reflect a divergence between premorbid and injury-related influences.

Objective To evaluate the sensitivity of The Child and Adolescent Memory Profile (ChAMP), a relatively new test of learning and memory, to traumatic brain injury (TBI). Method The ChAMP was administered to 61 6–16 year-old children with TBI within 1–12 months post injury. The sample was 64% male and 75% Caucasian, with a median parental level of education of 13 years. Twenty-nine children had uncomplicated mild TBI whereas 32 children had either intracranial lesions on neuroimaging or coma of at least 24 hrs, or both. The findings from the complete TBI group were compared to those from a demographically matched control group, obtained from the ChAMP standardization sample. Results Within the TBI group, the Visual Memory, Immediate Memory, Total Memory and Screening Index scores all demonstrated statistically significant correlations with length of coma. After applying a Benjamini-Hochberg adjustment to correct for the effect of multiple comparisons, the performance of the matched control group was still statistically significantly better than that of the children with TBI on all of the ChAMP Index scores. Effect sizes ranged from small to medium. At the subtest level, Places and Places Delayed showed the greatest group differences. Conclusion These findings supported the clinical utility of the ChAMP in the evaluation of learning and memory in children with TBI.

OBJECTIVE:: To determine correlates of self- and informant reports on a standardized rating of executive functioning in persons with mild traumatic brain injury. SETTING:: Outpatient clinic at a rehabilitation hospital. PARTICIPANTS:: One hundred referred persons who met criteria for mild traumatic brain injury (ie, time to follow commands 12). DESIGN:: Retrospective case series review. MAIN MEASURES:: Participants and informants completed the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) during outpatient neuropsychological evaluations within 30 to 360 days postinjury. RESULTS:: Participant and informant BRIEF-A ratings were strongly correlated, but participants rated themselves as worse than informants did. Regression analysis revealed that higher levels of education and presence of intracranial neuroimaging findings were associated with better BRIEF-A ratings whereas worse BRIEF-A ratings were associated with longer time since injury and prior psychiatric treatment. BRIEF-A ratings were not correlated with laboratory measures of executive functioning. CONCLUSIONS:: Subjective perceptions of executive dysfunction during the first year after mild TBI are driven primarily by premorbid factors and do not reflect acquired cerebral impairment. Language: en

One hundred persons with mild traumatic brain injury (TBI) and their informants completed the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) within 1-12 months after injury. Exploratory maximum-likelihood factor analysis with oblique rotation revealed that although a traditional 2-factor model fit the informant-report data well, a 3-factor solution fit the self-report data relatively best. These factors were labeled Metacognition, Behavioral Regulation, and Emotional Regulation. The presence of a premorbid history of outpatient psychiatric treatment was strongly predictive of higher scores (reflecting more perceived problems) on each of these 3 factors. Lower educational attainment was associated with higher scores on the Behavioral Regulation factor, whereas absence of intracranial findings on neuroimaging was associated with higher scores on the Emotional Regulation factor. It is concluded that, after mild TBI, self-report data on the BRIEF-A can be interpreted along a 3-factorial model and that high elevations on this instrument are strongly affected by premorbid complications.

OBJECTIVE To investigate the clinical utility of a brief cognitive screening instrument, the Lebby-Asbell Neurocognitive Screening Examination for Adolescents (LANSE-A) in 12-17 year-old adolescents with traumatic brain injury in an inpatient rehabilitation setting. METHOD Retrospective study of 56 referred patients, evaluated at a median of 32 days postinjury. Regression analysis was used to determine the contribution of the LANSE-A to prediction of discharge status, as assessed with the Functional Independence Measure for Children (WeeFIM). RESULTS After controlling for premorbid complicating factors, parental education, duration to follow commands, and WeeFIM Cognition score obtained upon admission, the LANSE-A Visual Memory and Verbal Association subtests accounted for a statistically significant amount of unique variance in the WeeFIM Cognition score obtained at discharge. CONCLUSIONS/IMPLICATIONS The LANSE-A improves prediction of acute rehabilitation outcomes of adolescents with traumatic brain injury.

Objective To determine the predictive validity of the Patient Health Questionnaire-9 (PHQ-9) when screening for symptoms of depression after traumatic brain injury. Design Retrospective analysis of data collected as part of routine clinical outpatient care over a period of 30 months. Setting Regional rehabilitation facility. Participants Persons (N=137) with mild to severe traumatic brain injury who were referred for neuropsychological evaluation within 1 to 12 months. Interventions Not applicable. Main Outcome Measures PHQ-9 and Minnesota Multiphasic Personality Inventory-2-Restructured Form. Results PHQ-9 scores ≥10 had a sensitivity of 91.7 and a specificity of 60.2 for predicting a diagnosis of major depression. Correlations between scores of PHQ-9 and Minnesota Multiphasic Personality Inventory-2-Restructured Form Demoralization (.64) and Low Positive Emotions (.48) scales ranged from large to medium. Premorbid outpatient psychiatric treatment was the most consistent predictor of PHQ-9 elevations as well as final diagnoses of major depression. Conclusions The PHQ-9 has adequate clinical utility as a screening instrument for depression in outpatients with traumatic brain injury. Elevations on this instrument cannot, however, be automatically attributed to neuropathology, especially not in the context of premorbid psychiatric dysfunction. Clinicians should conduct more thorough follow-up assessment in those with highly elevated PHQ-9 scores.

The performance of 100 patients with traumatic brain injury (TBI) on the Wechsler Adult Intelligence Scale–Fourth Edition (WAIS-IV) was compared with that of 100 demographically matched neurologically healthy controls. Processing Speed was the only WAIS-IV factor index that was able to discriminate between persons with moderate-severe TBI on the one hand and persons with either less severe TBI or neurologically healthy controls on the other hand. The Processing Speed index also had acceptable sensitivity and specificity when differentiating between patients with TBI who either did or did not have scores in the clinically significant range on the Trail Making Test. It is concluded that WAIS-IV Processing Speed has acceptable clinical utility in the evaluation of patients with moderate-severe TBI but that it should be supplemented with other measures to assure sufficient accuracy in the diagnostic process.

This study evaluated the degree to which an 8-subtest short form of the Wechsler Intelligence Scale for Children--Fourth Edition would yield acceptable estimates of the long-form Full-Scale IQ index while clarifying the underlying factor structure in a sample of 100 children and adolescents with traumatic brain injury. The short-form Full-Scale IQ had sufficient (i.e., at least two thirds) nonerror covariance with its full-length counterpart. In addition, a sufficient proportion (i.e., > 80%) of these short-form estimates fell within the 90% confidence interval of the respective full-length scores. Importantly, the elimination of 2 subtests, and in particular the Picture Concepts subtest, resulted in a factor structure where each remaining subtest was fairly specifically associated with its intended scale. It is concluded that this short form can be used clinically in children with traumatic brain injury without sacrificing reliability and with more straightforward interpretability at the level of the factor index scores.

Objective To evaluate the factor structure and correlates of the Behavior Rating Inventory of Executive Function-Self-Report (BRIEF-SR) in 118 adolescents with traumatic brain injury (TBI). Method Cross-sectional study. Maximum-likelihood exploratory, as well as confirmatory, factor analysis. External correlates of factor scores were evaluated. Results Two latent constructs were identified, with notable variation in scale loading pattern compared with standardization sample findings of the BRIEF-SR. These factors covaried inversely with severity of TBI; more severe injuries were associated with lower self-ratings of executive dysfunction, indicating a possible lack of deficit awareness in those with relatively severe injuries. Premorbid ADHD affected both factors, resulting in higher self-ratings of executive dysfunction, suggesting preserved awareness of preexisting difficulties in those with uncomplicated mild injuries. In addition, males reported less executive dysfunction than females. Conclusions/implications Findings suggest that the BRIEF-SR measures somewhat different latent constructs after TBI than in typically developing adolescents, and that BRIEF-SR scores need to be considered in concert with objective measures of injury severity and premorbid demographic and historical variables. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

This study investigated whether the Multiple Choice, Paired Associates, Free Recall, and Long Delayed Free Recall subtests of Green's Word Memory Test (WMT) were sensitive to memory impairment after traumatic brain injury (TBI) in 107 persons who passed performance validity criteria on the same instrument. Whereas several of the California Verbal Learning Test-Second Edition indices demonstrated a statistically significant correlation with coma duration, and also showed statistically significant mean differences between TBI severity groups, none of the four WMT memory subtests did so. It is concluded that, although the WMT is an excellent performance validity test, it is not sensitive to memory impairment after TBI.

Objective: The purpose of this paper is to review various aspects of decision-making capacities in children and adolescents with a history of central nervous system compromise over the course of development and into transition to adulthood. Method: The literature on consent capacity in various domains is reviewed, with reference to state-specific legal definitions and requirements, and illustrated with a case example. Conclusions: Neuropsychologists who use an evidence-based assessment approach, and who can clearly communicate their findings in reference to specific probate court standards, can make a unique contribution to the legal system while serving their clients who are transitioning from adolescence into adulthood.

This study aimed to evaluate the degree to which the Behavior Rating Inventory of Executive Function (BRIEF) and Child Behavior Checklist (CBCL) measure overlapping vs. distinct constructs in pediatric patients with mild traumatic brain injury (TBI), and to examine the demographic and injury correlates of such constructs as well as those of cognitive test performance. A total of 100 parents completed the BRIEF and the CBCL within 1 to 12 months after the injury of their child. Groups were contrasted based on the presence vs. absence of impairment on, respectively, the BRIEF and the CBCL. Exploratory maximum likelihood factor analysis was used to evaluate latent constructs. Correlates of the various factor scores were evaluated through regression analysis and contrasted with those of a test of verbal learning and memory.The results revealed that the BRIEF and the CBCL disagree about the presence vs. absence of impairment in about one quarter of cases. A prior history of attention deficit/hyperactivity disorder (ADHD) was associated with an increased likelihood of impairment on both the BRIEF and the CBCL, whereas prior outpatient psychiatric treatment was associated with the increased likelihood of selective impairment on the CBCL. Latent constructs manifested themselves along cognitive regulation, emotional adjustment and behavioral regulation factors. Whereas premorbid characteristics were the exclusive correlates of these factors, performance on a test of verbal learning and memory was negatively affected by intracranial lesions on neuroimaging.It is concluded that the BRIEF and the CBCL offer complementary and non-redundant information about daily functioning after pediatric mild TBI. The correlates of cognitive test performance and parental behavior ratings after such injuries are different and reflect a divergence between premorbid and injury-related influences.

To determine factors related to three-month follow-up outcomes for individuals participating in an outpatient rehabilitative treatment program for mild traumatic brain injury (TBI).Fifty participants underwent neuropsychological screening prior to treatment initiation and completed the Mayo-Portland Adaptability Inventory-4 (MPAI-4) at treatment initiation, discharge from treatment, and three months following discharge.Regression models indicated that information garnered from the neuropsychological screening prior to treatment initiation (e.g., mood symptoms and prior psychiatric history) accounted for unique variance in three-month post-discharge outcomes on several MPAI-4 subscales. Specifically, after controlling for baseline MPAI-4 ratings, higher Beck Depression Inventory-second edition (BDI-II) scores were associated with worse MPAI-4 Ability scores at three-month follow-up, and the presence of a psychiatric history was associated with worse MPAI-4 Adjustment scores at three-month follow-up.Neuropsychological screening prior to the initiation of treatment for mild TBI can help to identify patients who may be at greater risk for poorer rehabilitation outcomes, thus allowing for the implementation of specific interventions to address these risk factors.

The Tower of London - Drexel University, Second Edition (TOL(DX)) was investigated in order to determine the efficacy of using this instrument in evaluating the impact of traumatic brain injury on cognitive functioning in adults. Performance on the TOL(DX) was compared among 56 individuals with complicated mild to severe traumatic brain injury ("sTBI"), 68 individuals with uncomplicated, mild traumatic brain injury ("mTBI"), and 124 demographically matched, healthy controls. Both TBI groups performed worse than controls on TOL(DX) measures of executive time (ET) and number of moves used (TMS), but only patients with sTBI were more likely to be impaired on TMS (i.e., performing at least 1.5 SD below the mean). Poorer performance on TMS was associated with increasing length of coma. Although poor sensitivity of this measure limits its use in isolation, the TOL(DX) may provide a complementary measurement of aspects of problem-solving deficit in TBI that may not be captured by other tests.

This study examined the psychometric properties of test presentation and response formats that were modified to be accessible with the use of assistive technology (AT). First, the stability of psychometric properties was examined in 60 children, ages 6 to 12, with no significant physical or communicative impairments. Population-specific differences were then examined with samples that included 24 children with cerebral palsy and matched control peers. Children were administered standard and modified versions of tests. The type of AT access did not have a statistically significant effect on modified test scores. Measurement stability between the standard and modified versions of quadrant forced-choice format tests was sufficient. The findings support the potential use of AT and accessible procedures for some test instruments in the assessment of children with cerebral palsy.

Retrospective review of a consecutive patient series (n = 115) referred for neuropsychological examinations for traumatic brain injury was undertaken to evaluate an embedded measure of symptom validity for the Continuous Visual Memory Test (CVMT). Performance on the Test of Memory Malingering (TOMM) and Word Memory Test (WMT) was used for classification. Individuals who failed the TOMM or WMT were almost six times more likely to fail the CVMT validity criteria than those who passed the TOMM or WMT. The addition of compensation seeking increased this odds ratio to 9.80. The area under the curve for the latter classification was 0.74. Maximum likelihood ratio optimization of the CVMT validity test cutoff score indicated sensitivity of 0.25 and specificity of 0.99 at a revised cutoff of

The construct and criterion validities of the parent version of the Behaviour Rating Inventory of Executive Function (BRIEF) were evaluated in a sample of 100 6- to 16-year-old children with traumatic brain injury (TBI). Maximum-likelihood factor analysis identified two latent constructs that largely replicated the factor structure reported for the standardization sample, with the notable exception that the Inhibit scale covaried primarily with the metacognition factor and not with behavioural regulation factor. Only the former factor demonstrated evidence for sensitivity to the severity of TBI. Results on both factors were affected by a premorbid history of attention-deficit/hyperactivity disorder or other out-patient psychiatric treatment. It is concluded that the BRIEF has construct and criterion validity in the evaluation of children with TBI but that findings on this instrument can only be interpreted within the context of review of the child's premorbid history.

A specialty like clinical neuropsychology is shaped by its selection of trainees, educational standards, expected competencies, and the structure of its training programs. The development of individual competency in this specialty is dependent to a considerable degree on the provision of competent supervision to its trainees. In clinical neuropsychology, as in other areas of professional health-service psychology, supervision is the most frequently used method for teaching a variety of skills, including assessment, report writing, differential diagnosis, and treatment. Although much has been written about the provision of quality supervision in clinical and counseling psychology, very little published guidance is available regarding the teaching and provision of supervision in clinical neuropsychology. The primary focus of this article is to provide a framework and guidance for the development of suggested competency standards for training of neuropsychological supervisors, particularly at the residency level. In this paper we outline important components of supervision for neuropsychology trainees and suggest ways in which clinicians can prepare for supervisory roles. Similar to Falender and Shafranske (2004), we propose a competency-based approach to supervision that advocates for a science-informed, formalized, and objective process that clearly delineates the competencies required for good supervisory practice. As much as possible, supervisory competencies are related to foundational and functional competencies in professional psychology, as well as recent legislative initiatives mandating training in supervision. It is our hope that this article will foster further discussion regarding this complex topic, and eventually enhance training in clinical neuropsychology.

This study investigated cognitive, metacognitive, and psychosocial aspects of neurobehavioral functioning in 22 boys with Duchenne muscular dystrophy (DMD) and 18 unaffected siblings, all between the ages of 6 and 16 years. Probands and siblings completed the Wechsler Abbreviated Scale of Intelligence, as well as selected subtests from the Children's Memory Scale and from the Delis-Kaplan Executive Function System, while parents completed the Child Behavior Checklist and the Behavior Rating Inventory of Executive Function. Compared to siblings, probands demonstrated relative weaknesses on both verbal and nonverbal measures of delayed recall and response generation and were rated by parents as having more difficulties with social interaction, initiation, and adaptation. It is concluded that DMD is associated with mild but potentially significant difficulties in a range of neurobehavioral areas, likely related to deficient dystrophin levels in an integrated brain circuit that includes the cerebellum, hippocampus, and association neocortex.

We report the case of a 14-year-old boy with bilateral congenital perisylvian syndrome as evidenced by polymicrogyria in the left and right frontotemporal regions, pseudobulbar paresis, seizures, and spastic diplegia. This is the first description of comprehensive neuropsychological assessment in a child with this syndrome. The results reflect significant impairments in auditory processing and independent learning and retention, but relatively preserved cognitive performance on interactive tasks involving frequent feedback and redirection. The findings are interpreted in the context of the neuropathology of this syndrome, with an emphasis on pragmatic implications for rehabilitation.

The criterion validity of the Continuous Visual Memory Test (CVMT) was investigated using a sample of 53 patients with moderate-severe traumatic brain injury (TBI) and a demographically matched control group from the standardization sample. There was a statistically significant main effect of groups for both CVMT Total and Delayed Recognition scores ( p < .0001). Hierarchical linear regression analyses suggested that, in the clinical group, the effect of injury severity on the CVMT Total score was mediated by visuospatial ability. Logistic regression analyses revealed that the CVMT Total score correctly classified about three quarters of the combined participants, with slightly better specificity than sensitivity. It is concluded that the CVMT is a clinically useful instrument with satisfactory criterion validity but that it should not be used in isolation to determine the presence or absence of memory impairment.

The purpose of this study was to determine representative, core profile subtypes of learning and memory, based on four variables representing different latent constructs, in the standardization sample of the California Verbal Learning Test-Second Edition (CVLT-II; Delis, Kramer, Kaplan, & Ober, 2000). Two-stage cluster analysis identified six reliable subtypes. Variability in both level and pattern of performance contributed to the differentiation of these subtypes. Level of education was meaningfully related to variability in overall performance of the subtypes. Implications for the interpretation of CVLT-II findings obtained in clinical practice are discussed.

The performance of 40 children with complicated mild to severe traumatic brain injury on the Wechsler Intelligence Scale for Children–Fourth Edition (WISC–IV; Wechsler, 2003) was compared with that of 40 demographically matched healthy controls. Of the four WISC–IV factor index scores, only Processing Speed yielded a statistically significant group difference (p< .001) as well as a statistically significant negative correlation with length of coma (p< .01). Logistic regression, using Processing Speed to classify individual children, yielded a sensitivity of 72.50% and a specificity of 62.50%, with false positive and false negative rates both exceeding 30%. We conclude that Processing Speed has acceptable criterion validity in the evaluation of children with complicated mild to severe traumatic brain injury but that the WISC–IV should be supplemented with other measures to assure sufficient accuracy in the diagnostic process. (JINS, 2008,14, 651–655.)