Attention impairment is one of the most common complaints following Traumatic Brain Injury (TBI). Multiple studies have shown that performance on neuropsychological tests of attention is affected by many factors, including injury severity and effort. The aim of this study was to determine the effect of injury severity on neuropsychological tests across different domains of attention while controlling for effort. The domains of focused attention, selective attention, divided attention, sustained attention, and working memory were assessed by performance on the Digit Span Forward subtest, the Stroop Color Word Test, the Trail Making Test, the Conners' Continuous Performance Test - II, and Digit Span Backwards subtest, respectively. Effort was determined according to performance on the Portland Digit Recognition Test and the Test of Memory Malingering. Effort was found to have a greater effect on test performance (.79) than injury severity (.47). Clinical implications of the findings are discussed.

Recent publications have urged researchers to address neuropsychological assessment issues among culturally and linguistically diverse individuals for whom current assessment measures are not typically appropriate. This dissertation examined cultural considerations in clinical neuropsychological practice with Cree-speaking Canadians residing in Saskatchewan. Four inter-related studies focused on understanding cultural perceptions of normal aging and dementia within a Canadian Aboriginal population, modifying existing screening and neuropsychological assessment instruments for use in both normal aging research and clinical practice, and investigating the role of culture in cognitive aging with Cree-speaking. Study 1 involved the qualitative analyses of a series of key informant interviews with an Aboriginal Grandmothers Group. Three related themes were identified that highlighted Aboriginal experiences of aging, caregiving, and dementia within the healthcare system. The third theme, the importance of culturally grounded healthcare, directly informed test development for Studies 2 and 3. In Study 2, two screening measures that were adapted for use with seniors from diverse cultural groups were further modified and examined for use with Canadian Aboriginal seniors. Overall, performance was consistent across the two screening measures, and the measures informed clinical diagnosis and were well-received by both the Aboriginal patients and their family members. Study 3 describes the development of the Grasshoppers and Geese Test battery (G&G), created by modifying and integrating existing instruments and paradigms for language and memory assessment for use with culturally diverse seniors. All G&G subtests demonstrated adequate preliminary psychometric properties and generated excellent sensitivity and good specificity in differentiating healthy older adults from adults with Alzheimers disease. Finally, Study 4 examined performance on the G&G and on other neuropsychological measures in groups of young-middle aged and older adults from majority culture and Cree background. Cree participants mean scores were lower on measures of confrontational naming, semantic memory, verbal fluency, prospective memory, and processing speed, and were presumed to be in keeping with the significantly fewer years of education, lower estimated reading ability, and possible health disparities in the participants of Cree background. Findings of the four studies are discussed in the context of implications for current clinical practice and with regard to future research.

Recent publications have urged researchers to address neuropsychological assessment issues among culturally and linguistically diverse individuals for whom current assessment measures are not typically appropriate. This dissertation examined cultural considerations in clinical neuropsychological practice with Cree-speaking Canadians residing in Saskatchewan. Four inter-related studies focused on understanding cultural perceptions of normal aging and dementia within a Canadian Aboriginal population, modifying existing screening and neuropsychological assessment instruments for use in both normal aging research and clinical practice, and investigating the role of culture in cognitive aging with Cree-speaking. Study 1 involved the qualitative analyses of a series of key informant interviews with an Aboriginal Grandmothers Group. Three related themes were identified that highlighted Aboriginal experiences of aging, caregiving, and dementia within the healthcare system. The third theme, the importance of culturally grounded healthcare, directly informed test development for Studies 2 and 3. In Study 2, two screening measures that were adapted for use with seniors from diverse cultural groups were further modified and examined for use with Canadian Aboriginal seniors. Overall, performance was consistent across the two screening measures, and the measures informed clinical diagnosis and were well-received by both the Aboriginal patients and their family members. Study 3 describes the development of the Grasshoppers and Geese Test battery (G&G), created by modifying and integrating existing instruments and paradigms for language and memory assessment for use with culturally diverse seniors. All G&G subtests demonstrated adequate preliminary psychometric properties and generated excellent sensitivity and good specificity in differentiating healthy older adults from adults with Alzheimers disease. Finally, Study 4 examined performance on the G&G and on other neuropsychological measures in groups of young-middle aged and older adults from majority culture and Cree background. Cree participants mean scores were lower on measures of confrontational naming, semantic memory, verbal fluency, prospective memory, and processing speed, and were presumed to be in keeping with the significantly fewer years of education, lower estimated reading ability, and possible health disparities in the participants of Cree background. Findings of the four studies are discussed in the context of implications for current clinical practice and with regard to future research.

Objective. This thesis examines the invariance of a battery of neuropsychological tests to known education-associated differences in strategy implementation and neural resource allocation underlying cognitive task performance in older adults without cognitive impairment. Methods. Confirmatory factor analysis was used to evaluate the fit of a three-factor measurement model (Verbal Ability, Visuospatial Ability, Long-term Retention; Tuokko et al., 2009) to scores from the neuropsychological battery of the Canadian Study of Health and Aging (CSHA) for the purpose of confirming the latent constructs measured by its 11 tests. Measurement equivalence of the model across lower- (LE; ≤8 years) and higher-educated (HE; ≥9 years) participants was then evaluated using invariance testing. Results. The measurement model demonstrated adequate fit across LE and HE samples but the loadings of the 11 tests (indicators) onto the three factors could not be constrained equal across groups. Two non-invariant tests of verbal ability (Animal fluency, token test) were identified that, when freed from constraints, produced an invariant model. Constraint of factor covariances did not compromise the partial invariance of this model. Because demographic characteristics of the LE and HE samples differed significantly, findings were replicated on age-and sex-matched subsamples. Conclusions. Two measures of verbal ability were not invariant across HE and LE samples of older adults, suggesting that the cognitive processes underlying performance on these tests may vary as a function of educational attainment. / Graduate

The current study examined the WAIS-IV and how the changes to the test may impact the measure's usefulness in neuropsychological evaluations. It was hypothesized that the WAIS-IV would be a significantly better predictor of performance on the neuropsychological measures of the Category Test, Finger Tapping Test, Trail Making Test, and Wisconsin Card Sorting Test over the WAIS-III. The mixed clinical sample came from an archival database of volunteer research participants and individuals clinically referred to a university outpatient facility. A total of 91 participants were administered the WAIS-III and WAIS-IV as part of a larger neuropsychological battery. The results of the current study found that both the WAIS-III and the WAIS-IV were able to account for a significant amount of the variance in performance on the neuropsychological measures, with the exception of the FTT dominant and non-dominant hands, where only the WAIS-IV was able to significantly account for the variance in performance on the measures. Using the Alf and Graf (1999) model, there were no significant R2 differences between the WAIS-III subtests and WAIS-IV at the .01 significance level. Thus, the WAIS-IV did not provide a better model for predicting performance on any of the neuropsychological measures. It should be noted that the small sample size of the current study may have inflated the R2, particularly in the WAIS-III models, which could have masked greater R2 differences between the two models. While the publishers endeavored to make the WAIS-IV a better measure of processing speed, working memory, and fluid reasoning, these goals were largely unmet. The analyses of the WAIS-IV working memory subtests, showed that the sequencing component added to the Digit Span subtest did not add to the relationship with neuropsychological measures with working memory components. The analyses of the WAIS-IV processing speed subtests showed that the Coding subtest of the WAIS-IV was a better measure of processing speed than the WAIS-III version, but this was not found for the PSI as a whole. Changes to Symbol Search did not show any improvement in the relationship to neuropsychological measures. One interesting finding was that the new subtest of Visual Puzzles does appear to add to the relationship with neuropsychological measures over the other subtests of the WAIS-IV. Visual Puzzles was consistently the highest correlated PRI subtest with the neuropsychological measures, with the exception of the WCST. The subtest appears to assess a wide range of abilities outside of the spatial reasoning skills purported by the test publishers. Specifically, the subtest was correlated with measures of processing speed, executive skills, and motor speed/reaction time. Thus, clinicians should use caution and examine all possible options when evaluating poor performance on this new subtest. Since none of the WAIS-IV models were able to significantly predict performance on any of the neuropsychological measures over the WAIS-III models, it would appear that the WAIS-IV as a whole is not a better neuropsychological measure than its predecessor. Despite being the gold standard for intellectual assessment, the WAIS-IV appears to add little to clinical utility over the WAIS-III outside of shorter administrative time. Clinicians are advised to continue using neuropsychological measures to assess processing speed, working memory, and higher order cognitive skills in conjunction with the WAIS.

No description available.

As the global burden of dementia continues to plague our healthcare system, efficient, objective, and sensitive tools to characterize cognition and detect underlying neurodegenerative disease increasingly are needed. Digital phenotyping relies on passive, continuous collection of smartphone sensor data during everyday life to measure activities, behaviors, and mood. The present study explored the feasibility, acceptability, and validity of a digital phenotyping protocol as a novel method for characterizing cognition and function among a heterogeneous group of older adults. Validation analyses were based on a recently proposed conceptual model explaining activity level and variability as a function of cognitive ability level. Exploratory analyses aimed to examine and account for a range of participant and environmental factors that may be associated with digital phenotyping data. A total of 22 participants ages 65 - 81 years with either healthy cognition or mild cognitive impairment (MCI) used their own personal smartphones naturally during a four-week study period while a secure software application unobtrusively and continuously obtained Global Positioning System (GPS)-based movement trajectories. Participants completed gold-standard neuropsychological measures and questionnaires of everyday function, mood, and mobility habits at a baseline visit intended to evaluate construct validity. In-depth informed consent and a comprehension of consent quiz also were administered at baseline to inform feasibility of explaining digital phenotyping study procedures to older adults. Debriefing questionnaires were completed at the end of the study period, including questions pertaining to acceptability. Correlation analyses showed that measures of GPS activity and variability were positively associated with validators of cognition, everyday function, mood, and mobility habits. Potential confounding factors included season of study participation, unexpected health changes, and highest lifetime household annual income, whereas participant demographics such as education, sex, and race were not significantly associated with GPS features. Metrics on study withdrawal, comprehension of consent, and satisfaction ratings at study completion revealed good feasibility and acceptability. In sum, digital phenotyping shows promise as a feasible, acceptable, and potentially valid method to efficiently and objectively assess cognition, function, and mood in a cohort of older adults. Future studies will benefit from incorporating these preliminary findings and testing predictions in larger, more diverse cohorts both cross-sectionally and over time in longitudinal designs. / Psychology

Research has paid little attention to clients’ experience of the psychological assessment process, particularly in regard to the experiences of children and their parents. Advocates of collaborative assessment have long espoused the therapeutic benefits of providing feedback that can help clients better understand themselves and improve their lives (Finn & Tonsager, 1992; Fischer, 1970, 1985/1994). Finn, Tharinger, and colleagues (2007; 2009) have extended a semi-structured form of collaborative assessment, Therapeutic Assessment (TA), with children. One important aspect of their method, drawn from Fischer’s (1985/1994) example, is the creation of individualized fables that incorporate assessment findings into a child-friendly format. The fables are then shared with the child and parents as assessment feedback. This study evaluated whether receiving this type of individualized, developmentally appropriate feedback would affect how children and their parents report experiencing the assessment process. The assessment process, with the exception of child feedback, was standard for the setting. Participants were 32 children who underwent a neuropsychological evaluation at a private outpatient clinic, along with their parents. Multivariate and univariate statistics were used to test differences between two groups: an experimental group that received individualized fables as child-focused feedback and a control group. Children in the experimental group reported a greater sense of learning about themselves, a more positive relationship with their assessor, a greater sense of collaboration with the assessment process, and a sense that their parents learned more about them because of the assessment than did children in the control group. Parents in the experimental group reported a more positive relationship between their child and the assessor, a greater sense of collaboration with the assessment process, and higher satisfaction with clinic services compared to the control group. Limitations to the study, implications for assessment practice with children, and future directions for research are discussed. / text

Abstract A revised Developmental Delay (DD) category became effective in Arizona on September 30, 2009 and allows children who demonstrate significant delays in at least two developmental areas to receive services in special education up to age 10. In order for the educational team to determine that a student meets the criteria for DD, an assessment in all five developmental areas, including cognitive, physical, communication, adaptive, and social/emotional must be completed. However, areas typically included in a neuropsychological assessment, like attention and executive functioning or memory and learning, are typically not part of an educational evaluation and have the potential to adversely affect learning when there are deficits in these areas. DD is a highly prevalent group that has a wide variety of genetic, environmental, and societal risk factors. The definition varies greatly in research, education, medical or health-related fields, as well as by culture. Since the DD category is viable until age 10, outcome studies have been conducted to find out if children with DD continue in special education and if so, under what categories. It has been found that children with DD generally stay in special education and continue receiving services, most often as students with specific learning disability, mild intellectual disability, and speech/language impairment, in addition to other categories. There is limited information in the available literature regarding the neuropsychological strengths and weaknesses for this prevalent group. Moreover, there is limited information available regarding the possible predictors of reading achievement for children with DD. The first aim of the study was to determine how much variability in performance there was for children who met the educational criteria for DD in Arizona as well as to assess strengths and weaknesses compared to normative means. The second aim of this study was to find out if two specific scores from a neuropsychological battery found to be significantly lower in children with a reading disorder were also significant predictors of reading performance in children with DD. A third aim involved an exploratory analysis to determine if there was evidence of a pattern of strengths and weaknesses by delay type. Thirty-three children with DD ages 5 to 9 years were recruited for this study from a single school district in Southern Arizona. Children were administered measures of cognition, attention and executive functioning, memory and learning, sensorimotor skills, and visuospatial processing, and reading. The parent/guardian of the child completed a structured developmental history. For the first aim, the total sample was split into two groups by presence of cognitive delay and analyzed separately. Qualitatively, the data in the form of box-plots was examined. Levene's and Nonparametric Levene's tests were used to quantitatively evaluate variance in score distributions. Single sample t-tests were used to compare group mean scale or subscale scores to the appropriate normative means. The second aim was analyzed using the total sample of children with DD. Stepwise linear regression models were used to determine if Speeded Naming and Inhibition Naming Total Completion Time scores significantly predicted reading performance as measured by the Reading Cluster score from the WJ IV ACH for all children with DD. Two other subtest scores, which were observed to be within normal limits in children with reading disorder on the NEPSY-II special group study, were also analyzed with stepwise linear regression to confirm that they did not predict reading in children with DD, namely Memory for Designs Total Score and Geometric Puzzles. Lastly, for the third aim, those with each delay type were analyzed separately from those without the delay type (e.g., no communication delay and communication delay). Like the first aim, box-plots were generated to visually represent the data. DD group mean scores of each scale or subscale were also compared to the appropriate normative means by single sample t-tests. Results from this study indicated that the variation in the scores was not significantly different between groups, except for a measure of graphomotor speed and precision. Children with DD with a cognitive delay were found to exhibit a wide range of deficits, including deficits in cognition, reading, attention and executive functioning, language, memory and learning, sensorimotor, and visuospatial processing. Children without cognitive impairment did not demonstrate impairments in cognition and reading and demonstrated specific skill deficits for sustained attention, speeded naming with accuracy, immediate and long-term visual memory, memory for organized verbal information, phonological short-term memory, and fine motor speed. When the total sample was analyzed together, three high reading scores were identified as outliers from group reading performance. Both predictor variables were found to be moderately related to reading whether the outliers were in or out. Only one of the two predictors were found to significantly contribute to the predictive model whether the outliers were in or out yet the strength of the prediction was weak, suggesting there are likely better predictors of reading for children with DD. In the analysis of the non-predictors, when the outlier scores were left in, Geometric Puzzles, a measure of visuospatial perception and mental rotation was indicated as a significant predictor of reading. When the outliers were removed, neither score was significantly related with reading. Lastly, meaningful group strengths and weaknesses were seen when the total sample of children with DD was broken into groups by delay, even when the majority performed below normative means. The results of this study indicate that children with DD are at increased risk for significant difficulties in many of the areas included in neuropsychological assessment. This points to the need for many of these areas, namely attention and executive functioning, memory and learning, and visuospatial processing to be included in a comprehensive evaluation in the school setting. Moreover, knowledge of group strengths and weaknesses can aid intervention selection and implementation in addition to appropriate accommodations to facilitate learning. This can inform intervention implementation and design. More research is needed in this area to have a better understanding of how neurocognitive skills relate to reading since the predictors selected for this study were not strong predictors of reading performance for children with DD. Visuospatial perception and mental rotation may be more highly related for children with DD that have higher reading skills.

Apathy, defined as a decrease in purposeful or goal-directed behavior, is common in many neurological disorders. The assessment of apathy in these disorders is important as apathy is associated with differential engagement and response to treatment and future cognitive and functional decline. Although apathy is often described as including three separate symptom dimensions, reflecting diminished interest, action, and emotional expression, investigations of the factor structure of apathy symptoms have been limited by the use of scales which do not comprehensively assess all of three of the proposed dimensions. The current study aimed to develop a novel informant report measure of apathy symptoms, investigate the factor structure of apathy symptoms, and examine the relationship of different types of apathy symptoms to several clinically relevant variables. Participants included 249 informants who reported on an individual with (n=210) or without (n=39) a neurological or psychiatric condition. Results showed the best fitting model of apathy symptoms was a bifactor model in which apathy could be represented as a global dimension with three separate, specific symptom factors reflecting diminished interest and initiative, asociality, and diminished emotional and verbal expression. In general, apathy was associated with poorer cognitive functioning, greater functional impairment, and higher caregiver distress. The specific symptom factors differed somewhat in their association with those same variables, highlighting the utility of measuring different types of symptoms in addition to overall apathy. Future work will refine the apathy measure developed in this study and test the obtained bifactor symptom model in an independent sample.