Test-retest reliability of the halstead-reitan battery and the WAIS in a neuropsychiatric population

Neuropsychological and Symptom Predictors of Diagnostic Persistence in ADHD: A 25-Year Follow-up Study

BACKGROUND

This study extends long-term predictive research on ADHD by including both neuropsychological and symptom measures at baseline in adolescence as predictors of diagnostic persistence 25 years later.

METHODS

Nineteen males with ADHD and 26 healthy controls (HC; M/F = 13/13), were assessed in adolescence and 25 years later. Measurements at baseline included a comprehensive test battery measuring eight neuropsychological domains, an IQ estimate, the Child Behavior Checklist (CBCL), and the Global Assessment Scale of Symptoms. Differences between ADHD Retainers, Remitters, and HC were calculated with ANOVAs, and potential predictions of differences in the ADHD group by linear regression analyses.

RESULTS

Eleven (58%) participants retained their ADHD diagnoses at follow-up. Motor Coordination and Visual perception at baseline predicted diagnosis at follow-up. CBCL Attention problems at baseline in the ADHD group predicted variance in diagnostic status.

CONCLUSION

Lower-order neuropsychological functions related to motor function and perception are important long-time predictors of persistence of ADHD.

Effects of therapeutic instrumental music performance and motor imagery on chronic post-stroke cognition and affect: A randomized controlled trial

BACKGROUND

The burden of post-stroke cognitive impairment, as well as affective disorders, remains persistently high. With improved stroke survival rates and increasing life expectancy, there is a need for effective interventions to facilitate remediation of neurocognitive impairments and post-stroke mood disorders.

OBJECTIVE

To investigate the effects of Therapeutic Instrumental Music Performance (TIMP) training with and without Motor Imagery on cognitive functioning and affective responding in chronic post-stroke individuals.

METHODS

Thirty chronic post-stroke, community-dwelling participants were randomized to one of three experimental arms: (1) 45 minutes of active TIMP, (2) 30 minutes of active TIMP followed by 15 minutes of metronome-cued motor imagery (TIMP+cMI), (3) 30 minutes of active TIMP followed by 15 minutes of motor imagery without cues (TIMP+MI). Training took place three times a week for three weeks, using a selection of acoustic and electronic instruments. Assessments, administered at two baselines and post-training, included the Trail Making Test (TMT) - Part B to assess mental flexibility, the Digit Span Test (DST) to determine short-term memory capacity, the Multiple Affect Adjective Checklist - Revised (MAACL-R) to ascertain current affective state, and the General Self-Efficacy Scale (GSE) to assess perceived self-efficacy. The Self-Assessment Maniqin (SAM) was also administered prior to and following each training session.

RESULTS

Thirty participants completed the protocol, ten per arm [14 women; mean age = 55.9; mean time post-stroke = 66.9 months]. There were no statistically significant differences between pooled group baseline measures. The TIMP+MI group showed a statistically significant decrease in time from pre-test 2 to post-test on the TMT. The TIMP group showed a significant increase on MAACL sensation seeking scores, as well as on the Valence and Dominance portions of the SAM; TIMP+cMI showed respective increases and decreases in positive and negative affect on the MAACL, and increases on the Valence, Dominance, and Arousal portions of the SAM. No statistically significant association between cognitive and affective measures was obtained.

CONCLUSIONS

The mental flexibility aspect of executive functioning appears to be enhanced by therapeutic instrumental music training in conjunction with motor imagery, possibly due to multisensory integration and consolidation of representations through motor imagery rehearsal following active practice. Active training using musical instruments appears to have a positive impact on affective responding; however, these changes occurred independently of improvements to cognition.

Using Serial Trichotomization with Neuropsychological Measures to Inform Clinical Decisions on Fitness-to-Drive among Older Adults with Cognitive Impairment

Decisions related to driving safety and when to cease driving are complex and costly. There is an interest in developing an off-road driving test utilizing neuropsychological tests that could help assess fitness-to-drive. Serial trichotomization has demonstrated potential as it yields 100% sensitivity and specificity in retrospective test samples. The purpose of this study was to test serial trichotomization using four common neuropsychological tests (Trail Making Test Part A and B, Clock Drawing Test, and Modified Mini-Mental State Examination). Test scores from 105 patients who were seen in a memory clinic were abstracted. After applying the model, participants were classified as unfit, fit, or requiring further testing, 38.1%, 25.8%, and 36.1%, respectively. This study provides further evidence that trichotomization can facilitate the assessment of fitness-to-drive.

Evaluating the Measurement Properties of the ScanCourse, a Dual-Task Assessment of Visual Scanning

IMPORTANCE

The ScanCourse is used by occupational therapists to evaluate visual scanning ability during locomotion. Its measurement properties have not been examined.

OBJECTIVE

To assess the interrater reliability, test-retest reliability, and construct validity of the ScanCourse.

DESIGN

This study involved data collection at two time points. To assess test-retest reliability, the ScanCourse was administered twice within a 2-week period. To assess interrater reliability, a second rater was present for one session. To assess level of agreement, a Bland-Altman plot was created. To assess absolute reliability, the standard error of measurement was calculated. To evaluate construct validity, the results of the ScanCourse were compared with results of the Bells Test and Trail Making Test A and B.

SETTING

Rehabilitation hospital.

PARTICIPANTS

Forty-one patients with neurological impairments.

OUTCOMES AND MEASURES

The ScanCourse (participants identify numbered cards placed on both sides of a hallway at various heights during locomotion).

RESULTS

The ScanCourse was found to have excellent interrater reliability (intraclass correlation coefficient [ICC] [1,1] = .998; 95% confidence interval [CI] [.996-.999]), test-retest reliability (ICC [1,1] = .912; 95% CI [.811-.959]), a high level of agreement, and a low standard error of measurement (.503), and it was found to be significantly correlated with Trails A (r_s = -.436, p = .009) and B (r_s = -.364, p = .029).

CONCLUSIONS AND RELEVANCE

The assessment was found to have strong measurement properties, and it is therefore an appropriate tool for assessing dual-task visual scanning among those with neurological impairments.

WHAT THIS ARTICLE ADDS

This research demonstrates that the ScanCourse is reliable between raters and over time and that scores on the measure vary as anticipated with scores on a related measure, which provides evidence of its validity. These findings support its use in practice.

Musical Attention Control Training for Psychotic Psychiatric Patients: An Experimental Pilot Study in a Forensic Psychiatric Hospital

Poor attention skills constitute a major problem for psychiatric patients with psychotic symptoms, and increase their chances of treatment drop-out. This study investigated possible benefits of musical attention control training (MACT). To examine the effect of MACT on attention skills of psychiatric patients with psychotic features a randomized controlled trial (RCT) was conducted in a forensic psychiatric clinic. Participants (N = 35, age M = 34.7, 69% male) were pair matched (on age, gender, and educational level), and randomly assigned to an experimental and control group. The experimental group received a 30-min MACT training once a week over 6 weeks' time, whereas the controls received treatment as usual without attention training. Single blind pre- and post-neuropsychological assessments were performed to measure different attention levels. The experimental MACT group outperformed the control group in selective, sustained and alternating attention. In addition, overall attendance of MACT participants was high (87.1%). This result suggests that in this experimental pilot study MACT was effective for attention skills of psychiatric patients with psychotic features. To obtain larger intervention effects additional research is necessary, with a larger sample and a more specific MACT intervention.

Evaluating the Measurement Properties of the ScanCourse, a Dual-Task Assessment of Visual Scanning

IMPORTANCE

The ScanCourse is used by occupational therapists to evaluate visual scanning ability during locomotion. Its measurement properties have not been examined.

OBJECTIVE

To assess the interrater reliability, test-retest reliability, and construct validity of the ScanCourse.

DESIGN

This study involved data collection at two time points. To assess test-retest reliability, the ScanCourse was administered twice within a 2-week period. To assess interrater reliability, a second rater was present for one session. To assess level of agreement, a Bland-Altman plot was created. To assess absolute reliability, the standard error of measurement was calculated. To evaluate construct validity, the results of the ScanCourse were compared with results of the Bells Test and Trail Making Test A and B.

SETTING

Rehabilitation hospital.

PARTICIPANTS

Forty-one patients with neurological impairments. Outcomes and Measures: The ScanCourse (participants identify numbered cards placed on both sides of a hallway at various heights during locomotion).

RESULTS

The ScanCourse was found to have excellent interrater reliability (intraclass correlation coefficient [ICC] [1,1] = .998; 95% confidence interval [CI] [.996-.999]), test-retest reliability (ICC [1,1] = .912; 95% CI [.811-.959]), a high level of agreement, and a low standard error of measurement (.503), and it was found to be significantly correlated with Trails A (rs = -.436, p = .009) and B (rs = -.364, p = .029).

CONCLUSIONS AND RELEVANCE

The assessment was found to have strong measurement properties, and it is therefore an appropriate tool for assessing dual-task visual scanning among those with neurological impairments. What This Article Adds: This research demonstrates that the ScanCourse is reliable between raters and over time and that scores on the measure vary as anticipated with scores on a related measure, which provides evidence of its validity. These findings support its use in practice.

The Clinical Utility of the Conners' Continuous Performance Test-II in Traumatic Brain Injury

OBJECTIVE

The Conners' Continuous Performance Test Second Edition (CPT-II) is a measure commonly used in persons with suspected attentional deficits. Our study examined the utility of the CPT-II as a measure of attention in adults with traumatic brain injury (TBI) of varying severity.

METHOD

As part of a larger investigation, several measures of cognitive functioning, including the CPT-II, were administered to 30 healthy control participants (HCP), 30 mild TBI participants (M-TBI), and 30 moderate to severe TBI participants (MS-TBI). Multivariate and correlational analyses compared group performances and examined convergent and divergent relationships between the CPT-II and various measures, including other tests of attention and neuropsychological function.

RESULTS

Group differences were found for four of six CPT-II variables, with the MS-TBI group exhibiting greater impairment, relative to M-TBI and HCP. In addition, the CPT-II commission and detectability variables were found to correlate significantly with TBI severity. The CPT-II variables also demonstrated correlations of varying magnitude between commonly used neuropsychological measures.

CONCLUSIONS

These findings support the utility of the CPT-II for assessing attentional abilities in persons with TBI of varying severity, particularly those with moderate to severe status. Moreover, the current study also demonstrates relationships that are consistent with convergent validity but inconsistent findings with regard to divergent validity. As a result, the CPT-II measures components of attention that is unique to other commonly used neuropsychological measures of attentive functioning. Further research examining CPT-II performance in TBI populations is recommended.

A Patient With Bipolar Illness and Her Neuropsychological Signature

This article describes a case study in which neuropsychological assessment was carried out on a 30-year-old, previously diagnosed, bipolar female to determine existence of specific deficits in cognitive function. The patient, whose mood cycles were 12 hours to 24 hours, was subsequently evaluated 8 hours per day for 5 consecutive days (a complete work week of neuropsychological assessment). Neuropsychological results showed motor slowing, right hemispheric dysfunctioning, and memory problems during depressive periods and attentional and executive problems during hypomanic and manic periods. The most normal performance was found during euthymic periods. In addition, left and right hemi visual neglect, aphasia, and sensorimotor problems were present across all mood states. Treatment implications are subsequently described.

The Cattell–Horn–Carroll Model of Cognition for Clinical Assessment

The Cattell–Horn–Carroll (CHC) model is a comprehensive model of the major dimensions of individual differences that underlie performance on cognitive tests. Studies evaluating the generality of the CHC model across test batteries, age, gender, and culture were reviewed and found to be overwhelmingly supportive. However, less research is available to evaluate the CHC model for clinical assessment. The CHC model was shown to provide good to excellent fit in nine high-quality data sets involving popular neuropsychological tests, across a range of clinically relevant populations. Executive function tests were found to be well represented by the CHC constructs, and a discrete executive function factor was found not to be necessary. The CHC model could not be simplified without significant loss of fit. The CHC model was supported as a paradigm for cognitive assessment, across both healthy and clinical populations and across both nonclinical and neuropsychological tests. The results have important implications for theoretical modeling of cognitive abilities, providing further evidence for the value of the CHC model as a basis for a common taxonomy across test batteries and across areas of assessment.

Executive function is affected in autism spectrum disorder, but does not correlate with intelligence

INTRODUCTION

Studies of executive function in autism spectrum disorder without intellectual disability (ASD-WID) patients are contradictory. We assessed a wide range of executive functioning cognitive domains in a sample of children and adolescents with ASD-WID and compared them with age-, sex-, and intelligence quotient (IQ)-matched healthy controls.

METHODS

Twenty-four ASD-WID patients (mean age 12.8±2.5 years; 23 males; mean IQ 99.20±18.81) and 32 healthy controls (mean age 12.9±2.7 years; 30 males; mean IQ 106.81±11.02) were recruited.

RESULTS

Statistically significant differences were found in all cognitive domains assessed, with better performance by the healthy control group: attention (U=185.0; P=.0005; D=0.90), working memory (T51.48=2.597; P=.006; D=0.72), mental flexibility (U=236.0; P=.007; D=0.67), inhibitory control (U=210.0; P=.002; D=0.71), and problem solving (U=261.0; P=0.021; D=0.62). These statistically significant differences were also found after controlling for IQ.

CONCLUSION

Children and adolescents with ASD-WID have difficulties transforming and mentally manipulating verbal information, longer response latency, attention problems (difficulty set shifting), trouble with automatic response inhibition and problem solving, despite having normal IQ. Considering the low executive functioning profile found in those patients, we recommend a comprehensive intervention including work on non-social problems related to executive cognitive difficulties.

Factors associated with community ambulation in chronic stroke

PURPOSE

Loss of independent community ambulation is one of the most disabling consequences of stroke. The aim of this study was to investigate the association of multiple personal and post-stroke factors with community ambulation in persons between 1- and 3-year post-stroke.

METHODS

This was a cross-sectional study of 40 community-dwelling stroke patients, >18 years, between 1- and 3-year post-stroke. The main outcome measures used were self-report community ambulation questionnaire, demographic information, 10-M Walk Test, Timed Up and Go test, Activities-Specific Balance Confidence Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Trail-Making Test-Part B, Single Letter Cancellation Test.

RESULTS

Age, number of medications and use of a walking aid were found to be significantly associated with community ambulation (p ≤ 0.05). Gait speed, walking balance and balance self-efficacy were also found to be significantly associated with community ambulation (p ≤ 0.05). Balance self-efficacy was the only factor independently associated with community ambulation post-stroke (p ≤ 0.05).

CONCLUSION

Balance self-efficacy may be a significant determinant in the attainment of independent community ambulation post-stroke. This suggests that physical aspects such as gait speed and walking balance should not be considered in isolation when addressing community ambulation post-stroke.

IMPLICATIONS FOR REHABILITATION

Balance self-efficacy may play a significant role in the attainment of independent community ambulation in a chronic stroke population. Physiotherapy interventions addressing community ambulation post-stroke should consider methods for improving balance self-efficacy in chronic stroke, such as self management programmes.

A longitudinal study on the relationship between duration of untreated psychosis and executive function in early-onset first-episode psychosis

BACKGROUND

The relationship between duration of untreated psychosis (DUP) and executive function (EF) in patients with first-episode psychosis (FEP) is controversial. We aim to assess the influence of DUP on changes in EF over a 2-year period in subjects with early-onset FEP (first psychotic symptom before age 18) and less than 6 months of positive symptoms.

METHODS

A total of 66 subjects were included in the study (19 females [28.8%], mean age 16.2 ± 1.6 years). The influence of DUP on changes in EF over the 2-year follow-up (expressed as a composite score of 5 cognitive abilities: attention, working memory, cognitive flexibility, response inhibition, and problem solving) was estimated using a multivariate linear regression model after removing the effect of intelligence quotient and controlling for age, gender, diagnosis, premorbid adjustment, severity of positive and negative symptoms at baseline, global functioning at baseline, and mean daily antipsychotic dosage during follow-up.

RESULTS

Mean DUP was 65.0 ± 6.9 days (95% confidence interval [CI], 51.2, 78.8). Median DUP was 47.5 days (range 2-180 days). Negative symptoms at baseline was the only variable significantly associated with EF at baseline (10.9% of explained variance [e.v. 10.9%], p=0.007). Only shorter DUP (e.v. 8.7%, p=0.013) and greater severity of baseline negative symptoms (e.v. 10.0%, p=0.008) were significantly associated with greater improvement in EF.

CONCLUSIONS

In early-onset FEP, shorter DUP was associated with greater improvement in EF over a 2-year follow-up period.

Temporal stability and moderating effects of age and sex on CNTRaCS task performance

Research in schizophrenia has increasingly focused on incorporating measures from cognitive neuroscience, but little is known about their psychometric characteristics. Here, we extend prior research by reporting on temporal stability, as well as age and sex effects, for cognitive neuroscience paradigms optimized as part of the Cognitive Neuroscience Test Reliability and Clinical applications for Schizophrenia consortium. Ninety-nine outpatients with schizophrenia and 131 healthy controls performed 5 tasks assessing 4 constructs at 3 sessions. The constructs were (1) Goal maintenance (Dot Probe Expectancy [DPX] and AX continuous performance tasks [AX-CPT]); (2) Episodic memory (Relational and Item-Specific Encoding and Retrieval task [RiSE]); (3) Visual integration (Jittered Orientation Visual Integration task [JOVI]); and (4) Perceptual gain control (Contrast-Contrast Effect Task [CCE]). Patients performed worse than controls on all but the CCE, and the magnitude of these group differences was stable across sessions, with no sex differences observed. Improvements over sessions were seen for the AX-CPT, the DPX, and the JOVI though practice effects for the AX-CPT and the DPX were primarily present in older participants. For the AX-CPT and the JOVI, practice effects were larger for T1 to T2 than for T2 to T3. Age was associated with poor associative recognition on the RiSE and accuracy on the JOVI. Test-rest reliability ranged from poor for the JOVI threshold score to adequate to good for the DPX, AX-CPT, and JOVI accuracy measures, with RiSE and CCE measures in the moderate range. These results suggest that group differences in DPX, AX-CPT, RiSE, and JOVI are robust and consistent across repeated testing.

Heart rate variability biofeedback, executive functioning and chronic brain injury

PRIMARY OBJECTIVE

To determine if individuals with brain injury can modify heart rate variability (HRV) through biofeedback and, if so, enhance its pattern to improve emotional regulation and problem-solving ability.

DESIGN

A quasi-experimental design with repeated measures was employed. Thirteen individuals aged 23-63 years with severe brain injury (13-40 years post-onset) participating in a community-based programme were enrolled.

MAIN OUTCOMES

Response-to-treatment was measured with HRV indices, Behavior Rating Inventory of Executive Function (BRIEF-A-Informant) and attention/problem-solving tests.

RESULTS

At post-treatment, HRV indices (Low Frequency/High Frequency [LF/HF] and coherence ratio) increased significantly. Increased LF/HF values during the second-half of a 10-minute session were associated with higher attention scores. Participants who scored better (by scoring lower) in informant ratings at pre-treatment had highest HRV scores at post-treatment. Accordingly, at post-treatment, families' ratings of participants' emotional control correlated with HRV indices; staffs' ratings of participants' working memory correlated with participants' HRV indices. Self-ratings of the BRIEF-A Task Monitoring scale at post-treatment correlated with family ratings at pre-treatment and post-treatment.

CONCLUSIONS

Results demonstrate an association between regulation of emotions/cognition and HRV training. Individuals with severe, chronic brain injury can modify HRV through biofeedback. Future research should evaluate the efficacy of this approach for modifying behavioural problems.

The robust reliability of neuropsychological measures: meta-analyses of test-retest correlations

Test-retest reliability is an important psychometric property relevant to assessment instruments typically used in neuropsychological assessment. This review presents a quantitative summary of test-retest reliability coefficients for a variety of widely used neuropsychological measures. In general, the meta-analytic test-retest reliabilities of the test scores ranged from adequate to high (i.e., r=.7 and higher). Furthermore, the reliability values were largely robust across factors such as age, clinical diagnosis, and the use of alternate forms. The values for some of the memory and executive functioning scores were lower (i.e., less than r=.7). Some of the possible reasons for these lower values include ceiling effects, practice effects, and across time variability in cognitive abilities measured by those tests. In general, neuropsychologists who use these measures in their assessments can be encouraged by the magnitude of the majority of the meta-analytic test-retest correlations obtained.

Recommendations for the use of common outcome measures in traumatic brain injury research

This article summarizes the selection of outcome measures by the interagency Traumatic Brain Injury (TBI) Outcomes Workgroup to address primary clinical research objectives, including documentation of the natural course of recovery from TBI, prediction of later outcome, measurement of treatment effects, and comparison of outcomes across studies. Consistent with other Common Data Elements Workgroups, the TBI Outcomes Workgroup adopted the standard 3-tier system in its selection of measures. In the first tier, core measures included valid, robust, and widely applicable outcome measures with proven utility in TBI from each identified domain, including global level of function, neuropsychological impairment, psychological status, TBI-related symptoms, executive functions, cognitive and physical activity limitations, social role participation, and perceived health-related quality of life. In the second tier, supplemental measures were recommended for consideration in TBI research focusing on specific topics or populations. In the third tier, emerging measures included important instruments currently under development, in the process of validation, or nearing the point of published findings that have significant potential to be superior to some older ("legacy") measures in the core and supplemental lists and may eventually replace them as evidence for their utility emerges.

Etiology and neuropsychology of comorbidity between RD and ADHD: the case for multiple-deficit models

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) and reading disability (RD) are complex childhood disorders that frequently co-occur, but the etiology of this comorbidity remains unknown.

METHOD

Participants were 457 twin pairs from the Colorado Learning Disabilities Research Center (CLDRC) twin study, an ongoing study of the etiology of RD, ADHD, and related disorders. Phenotypic analyses compared groups with and without RD and ADHD on composite measures of six cognitive domains. Twin analyses were then used to test the etiology of the relations between the disorders and any cognitive weaknesses.

RESULTS

Phenotypic analyses supported the hypothesis that both RD and ADHD arise from multiple cognitive deficits rather than a single primary cognitive deficit. RD was associated independently with weaknesses on measures of phoneme awareness, verbal reasoning, and working memory, whereas ADHD was independently associated with a heritable weakness in inhibitory control. RD and ADHD share a common cognitive deficit in processing speed, and twin analyses indicated that this shared weakness is primarily due to common genetic influences that increase susceptibility to both disorders.

CONCLUSIONS

Individual differences in processing speed are influenced by genes that also increase risk for RD, ADHD, and their comorbidity. These results suggest that processing speed measures may be useful for future molecular genetic studies of the etiology of comorbidity between RD and ADHD.

Neurobehavioral Outcomes After Early Versus Late Childhood Traumatic Brain Injury

OBJECTIVES

To examine differences in outcomes at transition age (17-21 years) between individuals who sustained complicated mild-to-severe traumatic brain injury (TBI) in early or middle childhood and those who were injured in late adolescence.

PARTICIPANTS

Fifteen persons who sustained TBI between the ages of 6 and 12 years (early-onset) and 30 persons who sustained TBI between the ages of 16 and 20 years (late-onset).

MEASURES

Peabody Picture Vocabulary Test-Third Edition, Trail-Making Test, Buschke Selective Reminding Test, Benton Visual Retention Test, Dysexecutive Questionnaire, Community Integration Questionnaire, Satisfaction with Life Scale.

RESULTS

The groups did not differ in overall cognitive ability level, postinjury education or vocational accomplishments, or current living situation. However the early-onset group demonstrated worse outcomes in higher-level cognitive skills, social integration, driving, and legal guardianship.

CONCLUSIONS

Complicated mild-to-severe TBI earlier in childhood is associated with worse long-term neurocognitive and psychosocial outcomes than injury sustained in late adolescence. Findings provide further support for theories that early brain injury onset interferes with development of immature or rapidly developing skills, and may be associated with further magnification of deficits during the course of later development.

A pilot investigation of the effects of stress on neuropsychological performance in Asian-Indians in the United States

The present study evaluated the effects of stress and the ethnicity of the examiner on neuropsychological performance in a sample of Asian-Indian males in the United States. Participants were 60 Asian-Indian college students randomly assigned to one of four conditions in a 2 x 2 factorial design. The first factor was level of stress induction and the second was ethnicity of examiners. Results suggested that both stress inducing instructions and examiner ethnicity impacted highly demanding tasks, while moderately difficult tasks were less sensitive to ethnicity of the examiner. Results also indicate that examiners should recognize the potential impact of ethnicity and heightened level of stress when administering and interpreting neuropsychological measures.

Cross-Validation of Measures Used for Computer-Based Assessment of Concussion

The purpose of this study was to cross-validate subscales of computerized test batteries developed for the assessment and management of sports-related concussion, as well as to validate these subscales against select long-standing paper-based measures. In order to examine concurrent validity, we administered 3 such computerized measures, CogSport, ImPACT, and HeadMinder along with more established paper-based measures, the Trail Making Tests and the Digit Symbol subtest of the Wechsler scale. Analysis of processing speed indices revealed significant but modest correlations between Trails B and the computer-based measures, ranging from -.51 (ImPACT) to .60 (HeadMinder), and for Digit Symbol ranging from -.37 (Headminder) to .53 (ImPACT). Analysis of complex reaction time (CRT) data revealed significant but modest correlations between ImPACT and CogSport (.65), and between ImPACT and HeadMinder (.41), but not between CogSport and HeadMinder. No intercorrelations were found between the memory indices from the 3 programs. Our results suggest that these tests share some common variance on constructs such as processing speed and reaction time, but not within the domain of memory. Clinicians obtaining baseline evaluations using 1 measure should not use the baseline as a basis for post-concussion assessment using another measure.

A longitudinal analysis of memory in patients with schizophrenia

Memory deficits are widely reported in patients with schizophrenia, but uncertainties remain about the extent and the longitudinal course of these deficits. Twenty-eight patients with a DSM-IV diagnosis of schizophrenia were tested on multiple aspects of memory at baseline, 9- and 18-month follow-up. Measures included: digit span, the Rivermead Behavioural Memory test (RBMT) battery, the Graded Naming Test (GNT) and several computerized memory tests from the Cambridge Automated Neuropsychological Testing Battery (CANTAB). A group of healthy controls (N=17) was tested on the CANTAB battery at baseline and 9-month follow up. The patients performed significantly poorer than controls on all CANTAB measures; however, there was no difference in change between groups over a 9-month period. Within-group patient comparisons revealed that symptoms reduced significantly over the study period, but had no association with memory. Significant improvements were observed for patients on two verbal memory tasks: the GNT and digit span, but not on any other measure. Interestingly, these were the only two tests on which patients were within normal limits at baseline. This study shows that patients with schizophrenia have deficits in multiple aspects of memory which remain stable over long periods of time. In addition, patients showed a tendency to improve on memory tasks which contained a verbal component.

Neuropsychological Analyses of Comorbidity Between Reading Disability and Attention Deficit Hyperactivity Disorder: In Search of the Common Deficit

Measures of component reading and language skills, executive functions, and processing speed were administered to groups of children with attention deficit hyperactivity disorder (ADHD; n = 113), reading disability (RD; n = 109), both RD and ADHD (n = 64), and neither RD nor ADHD (n = 151). Groups with RD exhibited pronounced deficits on all measures of component reading and language skills, as well as significant weaknesses on measures of verbal working memory, processing speed, and response inhibition. Groups with ADHD exhibited weaknesses on all response-inhibition and processing speed tasks and were impaired on some measures of component reading skills and verbal working memory. The group with comorbid RD and ADHD exhibited the combination of the deficits in the RD-only and ADHD-only groups, providing evidence against the phenocopy and cognitive subtype hypotheses as explanations for the co-occurrence of RD and ADHD. Slow and variable processing speed was characteristic of all 3 clinical groups, suggesting that measures of this domain may be useful for future studies that search for the common genes that increase susceptibility to RD and ADHD.

Test-retest stability of neuropsychological testing and individual differences in variability in schizophrenia outpatients

The accurate measurement of neurocognitive function requires stable and reliable instruments. These assessments are critically important as correlates, predictors, and outcome measures of psychopathology, neuropathology, and treatment. Particularly, in studies that evaluate the impact of treatments on neurocognitive function, it is essential that their reliability as repeated measures be quantified. In an attempt to measure within- and between-subject variance on a battery of neuropsychological tests commonly used in schizophrenia research, baseline measures were administered twice, approximately 10 weeks apart, to 54 stable outpatients with schizophrenia or schizoaffective disorder. Instruments were judged for their stability, and individuals were assessed for individual differences in test-retest variability. The majority of the instruments administered were highly stable. Group means for several tests showed improvement on retest, which may indicate a practice effect, although many tests did not reach our criteria for "change." Of 962 test scores, 21 (2%) showed significant change. Most subjects were stable, with only 7% of subjects accounting for 38% of significant test-retest changes. Results indicate that the instruments assessed have sufficient reliability and stability to be used as repeated measures in clinical trials and that a small number of patients may have instability of performance as an individual characteristic.

Neuropsychologists diagnose traumatic brain injury

The case of John versus Im (2002) stands for the proposition that clinical neuropsychologists are not qualified to diagnose traumatic brain injury. This ruling by the Supreme Court of Virginia prohibits neuropsychologists from testifying about these professional conclusions in the courtroom. However, in clinical practice neuropsychologists are often asked to disentangle the relative contribution of brain dysfunction and psychological factors to presenting symptomology. In the proposed submission, the authors provide an analysis of the neuropsychological testimony at issue in John versus Im using the admissibility standards for expert testimony that were established and refined by a trilogy of cases from the Supreme Court of the United States. The paper provides support for the notion that neuropsychological method has an established scientific base of knowledge, standards for clinical competence, and evidence of peer-reviewed acceptance by medical related disciplines. No other scientific discipline has employed a more rigorous methodology for assessing cognitive function and disentangling the relative contributions of brain dysfunction and psychological factors to presenting symptomology. By limiting the testimony of neuropsychologists as to cause of an individual's cognitive impairment, courts will exclude opinions based on scientific research and specialized knowledge that would assist in the trier of fact.

Effects of low-dose risperidone and low-dose zuclopenthixol on cognitive functions in first-episode drug-naive schizophrenic patients

BACKGROUND

Studies on the effects of antipsychotics on cognitive deficits in schizophrenia mostly suggest a superior effect of atypical over typical compounds, although findings are inconsistent and effect sizes small. Several methodological issues, such as heterogeneous patient samples, incomparable drug doses, effects of prior medication, construct validity, and retest effects on neuropsychological tasks, confound most results and the comparability between studies. Consequently, the conclusion concerning effects of antipsychotics on cognition is still equivocal.

OBJECTIVE

The present randomized clinical trial examined the effects on cognition of comparatively low doses of a typical antipsychotic (zuclopenthixol) and an atypical antipsychotic (risperidone) in a homogeneous group of drug-naive first-episode schizophrenic patients in a longitudinal setting.

METHODS

First-episode schizophrenic patients who had never previously been exposed to antipsychotic treatment (N=25) were randomly allocated to treatment with flexible doses of zuclopenthixol or risperidone in an open-label design. Cognitive functions were examined both when patients were drug-naive, and after 13 weeks of treatment. A comprehensive neuropsychological battery was used in order to optimize construct validity, and principal components of cognitive functions were extrapolated in order to reduce type I errors. A healthy control group was tested at baseline and after 13 weeks, in order to examine retest effects. The cognitive domains studied were executive functions, selective attention, and reaction time.

RESULTS

The patients showed considerable cognitive deficits when drug-naive. There were few differential effects of risperidone and zuclopenthixol on cognitive deficits, except for a differential significance, respectively, tendency towards improved reaction and movement times in the risperidone group, and a lack of such in the zuclopenthixol group. These differences were no longer significant after covarying for extrapyramidal side effects and anticholinergic medication that were more prevalent in the zuclopenthixol group and the increases after medication were comparable with retest effects in controls.

CONCLUSION

The study underscores the importance of examining impact of factors, such as clinical improvement, extrapyramidal side effects, anticholinergic medication and retest effects in longitudinal efficacy studies. This study does not support efficacy of either risperidone or zuclopenthixol on cognitive functions in drug-naive schizophrenia patients after 3 months of medication, because neither could be distinguished from retest effects of the healthy control group.

Measures of short-term test-retest reliability of computerized neurobehavioral tests

Neurobehavioral test batteries are often administered repeatedly to evaluate changes over time or effects of clinical interventions or neurotoxic exposures. Time intervals between test sessions range from very short (hours) to very long (decades). The aim of this study was to compare the impact of two brief time intervals on the test-retest reliability of frequently used neurobehavioral tests. Fifty healthy adults were recruited through newspaper advertisements in Portland, Oregon. Participants were divided into either a 6h (same-day) or 1-week retest group. All participants completed a battery of tests from the computerized Behavioral Assessment and Research System (BARS). Reliability was assessed by Pearson product-moment correlation and by intraclass correlation coefficient (ICC). The test battery generally showed adequate reliability in the short-term (week) and very short-term (day) and stability in performance over repeated administration when examined by multiple measures. Intraclass correlation coefficient ranged from 0.35 to 0.85. The magnitude of variation of performance in the administered tests was equally distributed around zero (i.e. no difference). The findings suggest that neurobehavioral tests such as BARS may be a useful tool for the assessment of acute exposures and clinical status where short-term evaluation is required (e.g. in the same-day or within 1 week).

A comparison of the cognitive deficits in reading disability and attention-deficit/hyperactivity disorder

This study used a nonreferred sample of twins to contrast the performance of individuals with reading disability (RD; n = 93), attention-deficit/hyperactivity disorder (ADHD; n = 52), RD and ADHD (n = 48), and neither RD nor ADHD (n = 121) on measures of phoneme awareness (PA) and executive functioning (EF). Exploratory factor analysis of the EF measures yielded underlying factors of working memory, inhibition, and set shifting. Results revealed that ADHD was associated with inhibition deficits, whereas RD was associated with significant deficits on measures of PA and verbal working memory. The RD + ADHD group was most impaired on virtually all measures, providing evidence against the phenocopy hypothesis as an explanation for comorbidity between RD and ADHD.

Internal consistency of three tests from the Halstead-Reitan neuropsychological battery for older children

The internal consistency of three neuropsychological tests was examined in a sample of 334 referred children (9-14 years of age). Coefficient alpha was calculated to estimate reliability on the Seashore Rhythm Test (SRT), two forms of the Speech Sounds Perception Test (SSPT), and the Aphasia Screening Test (AST). The standard SSPT appears to have relatively good internal consistency with an average coefficient of.81. The average coefficient for the abbreviated form of the SSPT was considerably lower (i.e.,.73), highlighting the superiority of the standard form in clinical practice. Internal consistency of the SRT was relatively low (i.e.,. 67). This level of reliability may be acceptable in group research and for component tests, but is marginal for independent clinical use. Coefficient alpha for the AST was moderate (i.e.,.77), suggesting adequate reliability for a screening test. These reliability estimates are compared to those obtained in previous studies using these tests in adult samples and with other tests commonly used with children.

Neuropsychological functioning: comparison of mothers at high- and low-risk for child physical abuse

OBJECTIVE

The present study investigated the performance of high- and low-risk (for child physical abuse) mothers on cognitive measures in a cry (crying infant) and no-cry condition. The degree to which observed risk group differences in cognitive abilities were due to group differences in depression and/or anxiety was explored.

METHOD

Forty mothers, 20 high-risk and 20 demographically matched low-risk mothers, participated in the study. All mothers completed neuropsychological measures of conceptual ability, cognitive flexibility, ability to adjust responses, verbal fluency, attention, and susceptibility of interference, and measures of intellectual functioning, depression, and anxiety.

RESULTS

Although initial analyses indicated expected risk group differences on most of the neuropsychological measures, a second set of analyses, that controlled for group differences in IQ, revealed risk group differences only on measures of conceptual ability, cognitive flexibility, and problem-solving skills. In a third set of analyses that controlled for group differences in IQ, depression, and anxiety, no risk group differences on any of the neuropsychological measures were found. In each analysis, expected interactions between risk group and cry condition were not found.

CONCLUSIONS

The findings support clinical reports of cognitive differences in abusive and nonabusive mothers, but indicate that clinically observed cognitive deficits in high-risk and abusive mothers may be associated with lower levels of intellectual ability and with higher levels of depression and anxiety that are commonly reported in high-risk and abusive mothers.