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Hadas I, Hadar A, Lazarovits A, Daskalakis ZJ, Zangen A. Right prefrontal activation predicts ADHD and its severity: A TMS-EEG study in young adults. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110340. [PMID: 33957168 DOI: 10.1016/j.pnpbp.2021.110340] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Here we bring a neurophysiological diagnostic tool, based on pathophysiologically-relevant brain region, that is critical for reducing the variability between clinicians, and necessary for quantitative measures of ADHD severity. METHODS 54 healthy and 57 ADHD adults participated in the study. Electroencephalography (EEG) was recorded when combined with transcranial magnetic stimulation (TMS) over the right prefrontal cortex and also recorded during the Stop Signal task. RESULTS TMS evoked potentials (TEPs) and the event related potential (ERP) components in the Stop Signal task were found to be significantly reduced in ADHD relative to the matched healthy controls. Stop signal reaction time (SSRT) and stopping accuracy was found to correlate with the ERP signal, and ADHD severity correlated with the TEP signal. Cortical activity (early TEP and Stop Signal ERP) diagnostic model yielded accuracy of 72%. CONCLUSION TEPs and ERPs reveal that right PFC excitability was associated with ADHD severity, and with behavioral impulsivity - as a hallmark of ADHD pathology. This electrophysiological biomarker supports the potential of objective diagnosis for ADHD. SIGNIFICANCE Such tools would allow better assessment of treatment efficacy and prognosis, may advance understanding of the pathophysiology of the disease and better the public's attitudes and stigma towards ADHD. TRIAL REGISTRATION Trial to Evaluate the Efficacy of the HLPFC Coil Deep Transcranial Magnetic Stimulation System in Treating Attention Deficit and Hyperactivity Disorder (ADHD) in Adults, https://clinicaltrials.gov/ct2/show/NCT01737476, ClinicalTrials.govnumberNCT01737476.
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Affiliation(s)
- Itay Hadas
- Department of Psychiatry, Faculty of Health, University of California San Diego, La Jolla, CA 92093-0603, USA; Life Science Department and the Zlotowski Center for Neuroscience, Ben Gurion University in the Negev, Beer Sheva, Israel.
| | - Aviad Hadar
- Shalvata Mental Health Center, Hod-Hasharon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Lazarovits
- Life Science Department and the Zlotowski Center for Neuroscience, Ben Gurion University in the Negev, Beer Sheva, Israel
| | - Zafiris J Daskalakis
- Department of Psychiatry, Faculty of Health, University of California San Diego, La Jolla, CA 92093-0603, USA
| | - Abraham Zangen
- Life Science Department and the Zlotowski Center for Neuroscience, Ben Gurion University in the Negev, Beer Sheva, Israel
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Sweet JJ, Heilbronner RL, Morgan JE, Larrabee GJ, Rohling ML, Boone KB, Kirkwood MW, Schroeder RW, Suhr JA. American Academy of Clinical Neuropsychology (AACN) 2021 consensus statement on validity assessment: Update of the 2009 AACN consensus conference statement on neuropsychological assessment of effort, response bias, and malingering. Clin Neuropsychol 2021; 35:1053-1106. [PMID: 33823750 DOI: 10.1080/13854046.2021.1896036] [Citation(s) in RCA: 145] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: Citation and download data pertaining to the 2009 AACN consensus statement on validity assessment indicated that the topic maintained high interest in subsequent years, during which key terminology evolved and relevant empirical research proliferated. With a general goal of providing current guidance to the clinical neuropsychology community regarding this important topic, the specific update goals were to: identify current key definitions of terms relevant to validity assessment; learn what experts believe should be reaffirmed from the original consensus paper, as well as new consensus points; and incorporate the latest recommendations regarding the use of validity testing, as well as current application of the term 'malingering.' Methods: In the spring of 2019, four of the original 2009 work group chairs and additional experts for each work group were impaneled. A total of 20 individuals shared ideas and writing drafts until reaching consensus on January 21, 2021. Results: Consensus was reached regarding affirmation of prior salient points that continue to garner clinical and scientific support, as well as creation of new points. The resulting consensus statement addresses definitions and differential diagnosis, performance and symptom validity assessment, and research design and statistical issues. Conclusions/Importance: In order to provide bases for diagnoses and interpretations, the current consensus is that all clinical and forensic evaluations must proactively address the degree to which results of neuropsychological and psychological testing are valid. There is a strong and continually-growing evidence-based literature on which practitioners can confidently base their judgments regarding the selection and interpretation of validity measures.
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Affiliation(s)
- Jerry J Sweet
- Department of Psychiatry & Behavioral Sciences, NorthShore University HealthSystem, Evanston, IL, USA
| | | | | | | | - Martin L Rohling
- Psychology Department, University of South Alabama, Mobile, AL, USA
| | - Kyle B Boone
- California School of Forensic Studies, Alliant International University, Los Angeles, CA, USA
| | - Michael W Kirkwood
- Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Ryan W Schroeder
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, KS, USA
| | - Julie A Suhr
- Psychology Department, Ohio University, Athens, OH, USA
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Smith JN, Suhr JA. Sluggish Cognitive Tempo Factors in Emerging Adults:Symptomatic and Neuropsychological Correlates. Dev Neuropsychol 2021; 46:169-183. [PMID: 33730951 DOI: 10.1080/87565641.2021.1902528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We examined whether there are factors of SCT in nonclinical young adults and whether SCT factors show differential relationships with depression, anxiety, ADHD, and executive functioning as assessed by self-report (EF-SR) or neuropsychological performance (EF-NP). Factor analysis revealed Daydreaming/Bored (D/B), Lethargy (L), and Cognitive Complaints (CC) factors. CC was associated with anxiety and D/B with depression. CC and D/B were associated with inattentive ADHD, while D/B was associated with hyperactive/impulsive ADHD. While all factors were associated with EF-SR, there were few relationships with EF-NP. Higher CC was associated with lower intellect, and higher D/B was related to better working memory.
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Affiliation(s)
- Jessica N Smith
- Department of Psychology , Ohio University, Athens, Ohio, USA
| | - Julie A Suhr
- Department of Psychology , Ohio University, Athens, Ohio, USA
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Wilson K, Lesica S. Performance on the Memory Validity Profile in a mixed clinic-referred pediatric sample. Child Neuropsychol 2021; 27:516-531. [PMID: 33504273 DOI: 10.1080/09297049.2020.1870676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The primary purpose of this study was to evaluate performance on the Memory Validity Profile (MVP) in a mixed pediatric clinical population. Goal 1, assessing MVP pass rates, yielded a slightly higher pass rate (98.58%) compared to research on other performance validity tests (PVTs) in youth when using manual-based cutoffs and a slightly lower pass rate (84.40%) using an experimental cutoffs (PASS Total ≥31) similar to others' research. Goal 2, determining if MVP performance was contingent on variables other than effort, yielded significant differences in age, sex, and intelligence (p < 0.05); but not parental education or occurrence/nonoccurrence of previous neurological issues, ADHD, or psychiatric disorders. Goal 3, investigating the agreement of an embedded PVT (Children and Adolescent Memory Profile [ChAMP] List Recognition [LR] subtest) with the MVP in classification of adequate vs. suboptimal effort, showed that the highest levels of consistency (81%) were achieved when experimental MVP and LR ss ≤5 cutoffs were utilized. In conclusion, the MVP is a useful tool in detecting suboptimal effort in children in a broad clinical sample and the ChAMP LR subtest adds to identification of suboptimal effort as an ePVT with the MVP. The established cutoffs stated in the MVP manual should be used, as these better identify suboptimal effort in children by age than experimental cutoffs (i.e., 31 and 32 PASS). The ChAMP LR cutoff should be ss ≤5, with MVP manual-based (75%) or experimental cutoffs (81%).
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Affiliation(s)
- Kate Wilson
- Psychology Department, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
| | - Sofia Lesica
- Psychology Department, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
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Harrison AG, Armstrong I. The license plate test performance in Canadian adolescents with learning disabilities: A preliminary study. APPLIED NEUROPSYCHOLOGY. CHILD 2020; 9:360-366. [PMID: 32286886 DOI: 10.1080/21622965.2020.1750111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Accurate identification of symptom exaggeration is essential when determining whether data obtained in pediatric evaluations are valid or interpretable. Performance validity measures identify performance patterns that are implausible if the test taker is investing full effort; however, it is unclear whether or not persons with preexisting cognitive difficulties such as Specific Learning Disabilities (SLD) might be falsely accused of poor test motivation due to actual but impaired reading, processing or memory skills. The purpose of this study was to evaluate the newly developed License Plate Test (LPT) performance in students with identified SLD providing good effort, to examine the influence of severe reading or learning problems on LPT performance. Participants were 29 students with SLDs aged 11-14 years (M = 12.1), who completed psycho-educational assessments as part of a transition program to secondary school. Results indicate that recognition memory measures on the LPT were insensitive to cognitive impairments in these children; all students achieved scores of 80% or higher on these tasks. Performance was more variable as test demands of the LPT increased, and the difference between performance on easy and hard subtests was related to greater difficulties with working memory. These results provide preliminary data regarding how children with SLD perform on the LPT, allowing for development of appropriate cut scores to maximize sensitivity and specificity of this test for use with child and adolescent populations.
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Affiliation(s)
- Allyson G Harrison
- Regional Assessment and Resource Centre, Queen's University, Kingston, Ontario, Canada
| | - Irene Armstrong
- Regional Assessment and Resource Centre, Queen's University, Kingston, Ontario, Canada
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Suhr JA, Lee GJ, Harrison AG. Susceptibility of functional impairment ratings to noncredible reporting in postsecondary students undergoing screening for ADHD. Clin Neuropsychol 2020; 36:1493-1505. [DOI: 10.1080/13854046.2020.1817564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Julie A. Suhr
- Department of Psychology, Ohio University, Athens, OH, USA
| | - Grace J. Lee
- Department of Psychology, Ohio University, Athens, OH, USA
| | - Allyson G. Harrison
- Regional Assessment and Resource Centre, Queen’s University, Kingston, Ontario, Canada
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Kirk JW, Baker DA, Kirk JJ, MacAllister WS. A review of performance and symptom validity testing with pediatric populations. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 9:292-306. [DOI: 10.1080/21622965.2020.1750118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- John W. Kirk
- Kirk Neurobehavioral Health, Louisville, CO, USA
| | - David A. Baker
- Department of Physical Medicine & Rehabilitation, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - William S. MacAllister
- Alberta Children’s Hospital Research Institute and Alberta Health Sciences, Alberta, Canada
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Harrison AG, Armstrong IT. Differences in performance on the test of variables of attention between credible vs. noncredible individuals being screened for attention deficit hyperactivity disorder. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 9:314-322. [DOI: 10.1080/21622965.2020.1750115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Allyson G. Harrison
- Regional Assessment and Resource Centre, Queens University, Kingston, Canada
| | - Irene T. Armstrong
- Regional Assessment and Resource Centre, Queens University, Kingston, Canada
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Bosworth C, Dodd JN. Noncredible effort on the Nonverbal-Medical Symptom Validity Test (NV-MSVT): Impact on cognitive performance in pediatric mild traumatic brain injury. APPLIED NEUROPSYCHOLOGY. CHILD 2020; 9:367-374. [PMID: 32223424 DOI: 10.1080/21622965.2020.1742717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined failure rates on the Nonverbal-Medical Symptom Validity Test (NV-MSVT) and its impact on cognitive performance in a sample of youths with mild traumatic brain injury (mTBI). Participants were 184 children and adolescents who presented to a multidisciplinary concussion clinic for a targeted neuropsychological evaluation. Performance Validity Tests (PVTs) were a part of the standard battery, including the NV-MSVT. Twenty-eight participants (15.2%) failed the NV-MSVT, none of whom displayed a genuine memory impairment profile (GMIP). Participants who failed the NV-MSVT performed significantly worse than those who passed the NV-MSVT on measures of IQ, memory, and immediate attention/working memory. There was no significant difference between groups on processing speed, sustained attention, cognitive flexibility, or sight word reading level. Aside from a slight difference in age, NV-MSVT failure was not impacted by demographic variables (sex, race), premorbid risk factors (pre-injury ADHD, learning disabilities, psychiatric diagnoses or treatment, developmental delays, or prior special education), injury-related variables (time since injury, positive neuroimaging findings, post-traumatic amnesia, number of prior mTBIs, etc.) or post-mTBI anxiety/depression. That said, participants who failed NV-MSVT endorsed significantly more severe postconcussive symptoms. These findings support the use of the NV-MSVT in neuropsychological evaluation of children and adolescents with mTBI.
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Affiliation(s)
- Christopher Bosworth
- St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Jonathan N Dodd
- Department of Neuropsychology, WellStar Medical Group-Psychological Services, Marietta, GA, USA
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Abstract
The present study introduces the Verbal Associated Pairs Screen (VAPS) as a new measure for assessing performance validity in pediatric populations. This study presents initial data on psychometric properties and establishes construct validity for the VAPS in a sample of 30 adolescent healthy controls and 206 youths with traumatic brain injury (TBI: moderate/severe, N = 30; mild, N = 176). The control group's age (M = 14.93, SD = 1.8) was significantly higher than the moderate/severe TBI (M = 13.9, SD = 2.8), t(68.508) = -3.038, p = .003, and mild TBI (mTBI) groups (M = 14, SD = 2.8), t(54.147) = 2.038, p = .046. The TBI groups were administered the VAPS in accord with other established performance validity tests (PVTs) and well-established memory tests as part of routine clinical evaluations. The healthy control group was administered the VAPS only. VAPS score distributions for the control group were negatively skewed and highly kurtotic. VAPS scores from the moderate/severe TBI and control groups were indistinguishable for Trial 2 (U = 274, p < .01) and the Delay (U = 396, p = .218). In the mTBI group, convergent and divergent validity was established with other well-validated PVTs and memory tests, respectively. ROC curve analyses identified optimal cutoff scores for the VAPS Total Score, with acceptable sensitivity (55%) and excellent specificity (100%), as well as strong detectability (AUC = .829, 95% CI: 0.731 - 0.928, p < .001). Clinical applications, limitations, and directions for future research with the VAPS are discussed.
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Affiliation(s)
- Jonathan Dodd
- a Department of Psychology , St. Louis Children's Hospital , St. Louis , MO , USA.,b Department of Neurology , Washington University School of Medicine , St. Louis , MO , USA
| | - Samantha Murphy
- c Department of Psychology , University of Missouri - St. Louis , St. Louis , MO , USA
| | - Meghan Doherty
- d Department of Occupational Therapy , St. Louis Children's Hospital , St. Louis , MO , USA
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Emhoff SM, Lynch JK, McCaffrey RJ. Performance and Symptom Validity Testing in Pediatric Assessment: A Review of the Literature. Dev Neuropsychol 2018; 43:671-707. [DOI: 10.1080/87565641.2018.1525612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Stephanie M. Emhoff
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
| | - Julie K. Lynch
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
- Albany Neuropsychological Associates, Albany, New York, USA
| | - Robert J. McCaffrey
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
- Albany Neuropsychological Associates, Albany, New York, USA
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Ryan JJ, Blacksmith JL, Kreiner DS, Glass Umfleet L. Use of the 21-Item Test with children and adolescents 5 to 16 years of age. APPLIED NEUROPSYCHOLOGY. CHILD 2018; 7:354-365. [PMID: 28707956 DOI: 10.1080/21622965.2017.1346507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The goals of the present study were to: (a) collect preliminary normative data on the 21-Item Test in children and adolescents and to determine if cutoffs for biased responding in adults can be generalized to a younger population; (b) determine if Caucasian and Hispanic children perform differently on the test; and (c) ascertain the relationships of age and verbal intelligence with effort test performance. The 21-Item Test was administered to 153 children attending either a public (n = 96) or private (n = 57) school. The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) was also administered to the private school sample. The results indicated that the 21-Item Test has potential as a tool for identifying children who do not put forth maximal effort during formal assessment and that the adult cutoffs appear applicable to children 8 years and older. Caucasian and Hispanic participants performed similarly on the test. Forced-choice scores ≤12 were associated with age and lower levels of performance on the Verbal Comprehension Index of the WISC-IV.
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Affiliation(s)
- Joseph J Ryan
- a Department of Psychological Science , University of Central Missouri , Warrensburg , Missouri
| | - Jennifer L Blacksmith
- a Department of Psychological Science , University of Central Missouri , Warrensburg , Missouri
| | - David S Kreiner
- a Department of Psychological Science , University of Central Missouri , Warrensburg , Missouri
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The Importance of Performance Validity Assessment in Pediatric Neuropsychological Evaluations. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2017. [DOI: 10.1007/s40817-017-0031-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lichtenstein JD, Erdodi LA, Rai JK, Mazur-Mosiewicz A, Flaro L. Wisconsin Card Sorting Test embedded validity indicators developed for adults can be extended to children. Child Neuropsychol 2016; 24:247-260. [DOI: 10.1080/09297049.2016.1259402] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jonathan D. Lichtenstein
- Department of Psychiatry, Neuropsychology Services, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Laszlo A. Erdodi
- Department of Psychology, Neuropsychology Track, University of Windsor, ON, USA
| | - Jaspreet K. Rai
- Department of Psychology, Neuropsychology Track, University of Windsor, ON, USA
| | - Anya Mazur-Mosiewicz
- Department of Psychology, Chicago School of Professional Psychology, IL, USA
- Department of Psychiatry and Behavioral Science, Oklahoma State University, Tulsa, OK, USA
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