To date, the effect of planning ability on adaptive functioning has not been extensively examined in children treated for brain tumors. Findings indicate that individuals with brain tumors are more likely to experience poor planning ability (Boyd & Sautter, 1993) and that children with even mild neurological complications demonstrate impairments in adaptive functioning (Fletcher et al., 1990). The purpose of this study is to assess spatial planning and to examine its utility in predicting adaptive and cognitive functional impairment in children diagnosed and treated for brain tumors. Forty children diagnosed with a brain tumor (mean age at diagnosis 8.6 years) were administered the Rey-Osterrieth Complex Figure (ROCF) task, the Vineland Adaptive Behavior Scale (VABS), and the Stanford-Binet Intelligence Scale: Fourth Edition (SB:IV) at an average of one year post diagnosis (post acute) and again at two years post diagnosis (long term). The results of this investigation did not support the use of spatial planning skills as a predictor of adaptive functioning at one year or two years post diagnosis. However, spatial planning skill was an important predictor of cognitive functioning, accounting for a significant amount of variance at both one year and two years post diagnosis. These results were not expected and therefore further analyses were performed in order to better understand the data and results. Additional analyses suggest that it is spatial skill and not spatial planning that predicts adaptive functioning. Further research should continue to ask questions that will impact how we understand executive, adaptive, and cognitive functioning outcomes in children diagnosed with brain tumors.

ABSTRACT Exploitation of older people can result in devastating emotional and financial consequences. Researchers and policy makers have widely recognised the deleterious effects of exploitation on older adults, particularly cognitively impaired older people. Studies to date have provided basic information about the demographic and health characteristics that contribute to exploitation in later life, namely extreme dependence, frailty, social isolation, severe physical illness, and cognitive impairment. However, an overarching explanatory framework of vulnerability, and clinical instruments to aid with identifying those individuals at elevated risk of exploitation a priori have been lacking. Furthermore, the specific cognitive and social factors at the level of the individual which promote vulnerability to exploitation remain largely unexplored. The present research was directed towards addressing these issues. For definitional purposes, the term social vulnerability is used throughout in reference to an individual’s degree of susceptibility to exploitation. Exploitation of older people can take many forms including social and sexual exploitation, mistreatment, and deprivation of rights. Financial exploitation in particular is a relatively widespread phenomenon among older people, and may be a salient marker of social vulnerability in later life. In Chapter 1 of this dissertation, literature relevant to financial exploitation and social vulnerability more generally among older people is reviewed, and a conceptual framework for describing and explaining heightened vulnerability is presented. Central to this framework are various factors of personal competence at the level of the individual (i.e., intelligence, cognitive functioning, social intelligence, social skill, personality traits) which, in theoretical terms, contribute to, or protect against, exploitation. Chapter 2 details the development and psychometric evaluation of a standardised scale for assessing social vulnerability among older adults (termed the SVS15). Given that financial exploitation may be a pertinent marker of social vulnerability in older people, item content for the scale includes items of a financial nature. The results of two studies provided support for the reliability (internal consistency) and validity (known-groups) of the SVS15. Results of a factor analysis revealed a two-factor solution, with the emerging factors labelled gullibility and credulity. Stability in factor structure of the SVS15 was established in an independent sample using structural equation modelling. Chapters 3 and 4 of the dissertation detail the methodology employed in, and results of, a series of three studies systematically investigating the relationships between personal competence factors and social vulnerability in older people. Using multiple regression analyses, non-significant associations between basic demographic characteristics and social vulnerability were found in a nonclinical older sample, indicating that heightened vulnerability to exploitation is not readily explained by age, gender, or education. Rather, general cognitive functioning emerged as the most significant correlate of SVS15 scores in a combined clinical and nonclinical sample of older adults such that poorer cognitive functioning was associated with greater vulnerability to exploitation. Executive functioning in particular showed significant overlap with SVS15 scores after controlling for differences in memory and age. These results support the inclusion of standardised neuropsychological tests of memory and executive functioning (tests which are routinely used) when issues of social vulnerability arise. After general cognitive functioning, social measures of self-awareness and social skill were also important correlates of social vulnerability scores, indicating that social measures could also contribute useful information when assessing social vulnerability in older people. From an applied perspective, Chapter 5 of the thesis presents normative data for the SVS15, and an examination of the Tclinical utility of the scale using individual case studies of older adults diagnosed with a dementia syndrome. In Chapter 6, an amalgamation of the results from the project is presented, and the theoretical and clinical contributions of the findings are highlighted. TThe findings contribute to the extant literature in two ways: (1) through the development of aT potentially useful and psychometrically sound instrument which targets symptoms of social Tvulnerability more directly than existing neuropsychological measures and (2) by enhancing the current understanding of the cognitive and social personal competence factors associated with heightened vulnerability in later life.

ABSTRACT Exploitation of older people can result in devastating emotional and financial consequences. Researchers and policy makers have widely recognised the deleterious effects of exploitation on older adults, particularly cognitively impaired older people. Studies to date have provided basic information about the demographic and health characteristics that contribute to exploitation in later life, namely extreme dependence, frailty, social isolation, severe physical illness, and cognitive impairment. However, an overarching explanatory framework of vulnerability, and clinical instruments to aid with identifying those individuals at elevated risk of exploitation a priori have been lacking. Furthermore, the specific cognitive and social factors at the level of the individual which promote vulnerability to exploitation remain largely unexplored. The present research was directed towards addressing these issues. For definitional purposes, the term social vulnerability is used throughout in reference to an individual’s degree of susceptibility to exploitation. Exploitation of older people can take many forms including social and sexual exploitation, mistreatment, and deprivation of rights. Financial exploitation in particular is a relatively widespread phenomenon among older people, and may be a salient marker of social vulnerability in later life. In Chapter 1 of this dissertation, literature relevant to financial exploitation and social vulnerability more generally among older people is reviewed, and a conceptual framework for describing and explaining heightened vulnerability is presented. Central to this framework are various factors of personal competence at the level of the individual (i.e., intelligence, cognitive functioning, social intelligence, social skill, personality traits) which, in theoretical terms, contribute to, or protect against, exploitation. Chapter 2 details the development and psychometric evaluation of a standardised scale for assessing social vulnerability among older adults (termed the SVS15). Given that financial exploitation may be a pertinent marker of social vulnerability in older people, item content for the scale includes items of a financial nature. The results of two studies provided support for the reliability (internal consistency) and validity (known-groups) of the SVS15. Results of a factor analysis revealed a two-factor solution, with the emerging factors labelled gullibility and credulity. Stability in factor structure of the SVS15 was established in an independent sample using structural equation modelling. Chapters 3 and 4 of the dissertation detail the methodology employed in, and results of, a series of three studies systematically investigating the relationships between personal competence factors and social vulnerability in older people. Using multiple regression analyses, non-significant associations between basic demographic characteristics and social vulnerability were found in a nonclinical older sample, indicating that heightened vulnerability to exploitation is not readily explained by age, gender, or education. Rather, general cognitive functioning emerged as the most significant correlate of SVS15 scores in a combined clinical and nonclinical sample of older adults such that poorer cognitive functioning was associated with greater vulnerability to exploitation. Executive functioning in particular showed significant overlap with SVS15 scores after controlling for differences in memory and age. These results support the inclusion of standardised neuropsychological tests of memory and executive functioning (tests which are routinely used) when issues of social vulnerability arise. After general cognitive functioning, social measures of self-awareness and social skill were also important correlates of social vulnerability scores, indicating that social measures could also contribute useful information when assessing social vulnerability in older people. From an applied perspective, Chapter 5 of the thesis presents normative data for the SVS15, and an examination of the Tclinical utility of the scale using individual case studies of older adults diagnosed with a dementia syndrome. In Chapter 6, an amalgamation of the results from the project is presented, and the theoretical and clinical contributions of the findings are highlighted. TThe findings contribute to the extant literature in two ways: (1) through the development of aT potentially useful and psychometrically sound instrument which targets symptoms of social Tvulnerability more directly than existing neuropsychological measures and (2) by enhancing the current understanding of the cognitive and social personal competence factors associated with heightened vulnerability in later life.

Many studies have shown that adopted children show higher levels of psychological adjustment than children living in institutions. However, there is little research comparing the behaviour and cognitive abilities of adopted and institution-reared children in Latin America, despite the large number of children living in institutional care. The aim of this thesis was to examine differences in the socio-emotional and cognitive functioning of adopted and institution-reared children in Chile, and to identify factors associated with the psychological adjustment and cognitive ability of adopted children. Data were obtained from 52 adopted children and their parents, and a comparison group of 50 children living in institutions. All adoptions were national and the children were aged between 4-9 years. Children’s psychological problems and attachment difficulties were assessed using the Strengths and Difficulties Questionnaire and the Relationship Problems Questionnaire, respectively, completed by adoptive parents or caregivers and teachers. Cognitive functioning was assessed using the Wechsler Intelligence Scale for Children-Third Edition (WISC-III). The Structured Child Assessment of Relationships in Families was used to assess children’s perceptions of family relationships. Adoptive mothers and fathers were individually administered a standardised interview designed to assess parenting quality and questionnaire assessments of anxiety, depression, marital quality and parenting stress. Observational assessments of mother-child interaction were also carried out. Adopted children showed significantly higher levels of socio-emotional and cognitive functioning than institution-reared children, with the majority of adopted children scoring within the normal range and the majority of institutionalised children showed clinical levels of emotional and behavioural problems. The mean IQ score of adopted children was 23 points higher than that of the institutionalised group. Factors associated with more positive outcomes among the adopted children were a younger age at adoption and lower levels of maternal and paternal stress. Although a selection effect cannot be ruled out, with higher functioning children more likely to be adopted, the results point to a beneficial effect of adoption on the psychological development and wellbeing of institutionalised children in Chile.

La tesi si è focalizzata sullo studio del comportamento violento in pazienti con una diagnosi di Disturbo dello Spettro Schizofrenico (DSS) e una storia di violenza, appaiati a dei controlli. Il protocollo ha incluso anche un periodo di osservazione di un anno. Il progetto di ricerca è stato condotto in alcune strutture residenziali (studio 1) e presso alcuni Centri di Salute Mentale (studio 2) del nord Italia, con gli obiettivi di: (i) analizzare le caratteristiche socio-demografiche, cliniche e neuropsicologiche di pazienti con DSS e una storia di violenza comparati a pazienti con DSS, senza tale storia, appaiati per genere ed età; (ii) quantificare i comportamenti violenti esibiti dai pazienti con DSS durante un anno di osservazione, e identificarne i possibili fattori protettivi e di rischio; (iii) caratterizzare i pazienti con DSS che hanno esibito condotte particolarmente violente durante l’anno di osservazione. I risultati mostrano specifiche condizioni cliniche e di funzionamento cognitivo caratterizzanti i pazienti con storia di violenza, ed evidenziano diversi fattori associati all’esibizione di comportamenti violenti nei due servizi. / This thesis addresses the phenomenon of violence by patients with Schizophrenia Spectrum Disorders (SSDs) who had a history of violence, compared to matched controls. The research protocol also included a 1-year observation period. The research project has been carried out in ordinary psychiatric residential facilities (study 1) and in Community Mental Health Centres (study 2) in northern Italy. The aims were: (i) to investigate the demographic, clinical, and neurocognitive features of patients with SSDs who had a history of violence, matched by age, gender and diagnosis to controls; (ii) to quantify violence exhibited by patients with SSDs during 1 year, and to identify protective and risk factors for such violence; (iii) to characterize patients exhibiting considerable violence during the study period. The results of the project show different clinical and cognitive characteristics for patients with a history of violence and for controls, and different factors associated with violence exhibited in the two care settings.

A anorexia nervosa caracteriza-se pela recusa em manter um peso corporal na faixa mínima, um temor intenso de engordar, acompanhado por grave distorção da imagem corporal. Nas avaliações neuropsicológicas em pacientes com AN, além das complicações clínicas, também são identificadas alterações neurocomportamentais, déficits cognitivos, distorções da imagem corporal e por vezes alterações cognitivas leves. Este trabalho teve como objetivo geral, identificar as funções cognitivas de atenção, linguagem, habilidade visuo espacial e viso construtiva, funções executivas e memória, por meio da avaliação neuropsicológica, de pacientes com Anorexia Nervosa internadas, no início e após alta hospitalar. Teve como objetivos específicos, relacionar o perfil neuropsicológico aos aspectos sócio demográficos, número de internações prévias, aspectos diagnósticos de índice de massa corporal - IMC, distorção de imagem corporal, comorbidades, o tempo de doença, e traços de personalidade, de pacientes internadas, avaliando a evolução e/ou declínio no funcionamento cognitivo ao final da internação de pacientes com Anorexia Nervosa. Foram avaliadas 17 pacientes internadas, no início e na alta hospitalar, com protocolo de avaliação neuropsicológica, sintomas de depressão e ansiedade, e traços de personalidade. As pacientes não apresentaram melhora no desempenho na memória visual tardia, na atenção, nas habilidades visuo espaciais, visuo construtivas, e nas funções executivas, na flexibilidade cognitiva, controle inibitório, raciocínio verbal, formação de conceitos e planejamento, após a alta hospitalar. Os resultados apresentados nesta pesquisa, sugerem que pacientes com AN apresentam vários déficits neuropsicológicos na internação, e mesmo recebendo tratamento de forma intensiva para o transtorno alimentar e suas comorbidades, ainda apresentam déficits cognitivos, após a alta hospitalar. Sugere-se que esses déficits cognitivos possam fazer parte de um padrão de funcionamento associado aos sintomas psicopatológicos da doença, possam ser traços pré mórbidos, ou seja, existentes anterior à doença, bem como por se tratarem de pacientes graves, com um tempo de doença significativo. Propõe-se, portanto, a realização de reabilitação neuropsicológica a fim de compensar ou reduzir os déficits cognitivos, visando trazer uma melhora funcional que auxilie não só no funcionamento cognitivo, buscando remodelar a capacidade cerebral, reformulando suas conexões em função das necessidades, como nos aspectos emocionais, interação social, comportamento e aprendizagem / Anorexia nervosa is characterized by refusal to maintain a body weight at minimum range, an intense fear of gaining weight, accompanied by severe distortion of body image. In neuropsychological evaluations in patients with AN, in addition to clinical complications, are also identified neurobehavioral alterations, cognitive deficits, distortions of body image and sometimes mild cognitive impairment. This study aimed to identify the cognitive functions of attention, language, spatial ability and visuo constructive vision, executive function and memory, through neuropsychological assessment of patients with Anorexia Nervosa hospitalized at the beginning and after discharge. Its specific objectives relate profile neuropsychological socio demographics, number of previous admissions, diagnostic aspects of body mass index - BMI, body image distortion, comorbidities, disease duration, and personality traits of hospitalized patients, assessing the progress and / or decline in cognitive functioning at the end of hospitalization of patients with Anorexia Nervosa. 17 hospitalized patients were evaluated at baseline and at discharge, with neuropsychological evaluation protocol, symptoms of depression and anxiety, and personality traits. Patients showed no improvement in performance on delayed visual memory, attention, visuo in spatial skills, visuo constructive and executive functions, cognitive flexibility, inhibitory control, verbal reasoning, concept formation and planning, after hospital discharge. The results presented in this study suggest that patients with AN have several neuropsychological deficits on admission, and even being treated intensively for the eating disorder and its comorbidities, still have cognitive deficits after hospital discharge. It is suggested that these cognitive deficits may be part of an operation pattern associated with psychopathological symptoms of the disease may be pre morbid traits, or existing before the disease, and because they are seriously ill patients with a disease duration significant. Therefore, it is proposed to carry out neuropsychological rehabilitation in order to compensate or reduce cognitive deficits, aiming to bring a functional improvement that helps not only in cognitive functioning, seeking to reshape the brain capacity, revamping its connections to the needs, as in emotional, social interaction, behavior and learning

Objectives: The majority of individuals who sustain a mild traumatic brain injury (mTBI) will experience a full recovery within the first weeks or months post-injury. However, some individuals will experience ongoing difficulties, or persistent post-concussion symptoms (PCS), for years following the injury. To date, most researchers have attributed PCS to either neuropathological factors or to psychogenic factors. Lacking exploration has been the role of psychosocial variables and the consideration of PCS from a more holistic, or 'whole person', perspective. As such, the goal of the current study was to undertake an investigation of persistent PCS using a broad, neuropsychosocial framework. Specifically, this was done by investigating how (a) cognitive functioning, (b) susceptibility to anxiety while in the context of a stressful situation (i.e., anxiety susceptibility), and (c) multiple components of identity (including self-perception, TBI- related self-concept, and TBI-related social identity) influence the severity of persistent PCS. The main underlying assertion to this research is that there are multiple factors that underlie the experience of persistent PCS; a purely neuropathological or psychogenic perspective is not sufficient to understand the complex processes inherent in recovery after mTBI. Method: The sample consisted of 21 adults, between 20 and 65 years of age, who had sustained an mTBI at least one year earlier. Following a telephone interview to determine eligibility (and a separate telephone interview with a source of collateral information) the participants completed a number of standardized neuropsychological measures and self- report questionnaires during an in-person, one-on-one data collection session. Results: The only injury-related or demographic variable that had an influence on PCS was injury etiology, whereby individuals with sports related injuries reported significantly less PCS than did those who sustained non-sports related injuries (e.g., motor vehicle accidents). Cognitive functioning had no influence on PCS severity, nor did anxiety susceptibility. However, one's general propensity to experience anxiety (i.e., trait anxiety) was a significant predictor of PCS. Further, multiple aspects of identity influenced PCS with both current self-perception and TBI-related social identity being significant predictors of self-reported PCS severity. Conclusions: Despite the failure to find any impact of neuropsychological factors on PCS in the current study, other lines of research have demonstrated neuropathological changes associated with mTBI – some of which may be chronic. Therefore, cognitive functioning may not be a sufficiently sensitive indicator of possible neuropathology at more than one year post-injury. On the other hand, the current study demonstrates that psychological and psychosocial factors are highly relevant to recovery and outcome following mTBI, and are significant predictors of PCS severity. Overall, the results support the assertion that recovery after mTBI is complex and that there are multiple factors that underlie persistent PCS. Further, the study demonstrates the importance of conceptualizing the process of recovery from a broad, neuropsychosocial perspective. Implications for treatment interventions and future research are discussed. / Graduate

This study investigated the effect of cognitive factors on competency to stand trial. Previous researchers have investigated how psychological variables --such as psychosis and intelligence--contribute to incompetency. Although several researchers have established that intelligence contributes to incompetency, very few have investigated the role of specific cognitive abilities within the realm of intelligence. This study investigated the performance of 55 defendants referred for competency restoration on neuropsychological measures. Specifically, competent defendants and incompetent defendants were compared on several measures assessing functioning in seven cognitive domains. Competent defendants performed significantly better than incompetent defendants on measures of verbal comprehension, social judgment, verbal memory, and executive functioning. Competent and incompetent defendants did not differ on attention, visual spatial skills, or nonverbal memory.

Cognitive functioning is disrupted during a depressive episode and cognitive dysfunction persists when depression is in remission. A subtype of depressed individuals who exhibit elevated inflammatory biomarkers may be at particular risk for cognitive dysfunction. We examined whether an elevated inflammatory biomarker (C-reactive protein: CRP) in acute and/or remitted depression was associated with specific deficits in executive functioning, episodic memory, and verbal fluency. Data were drawn from a population-based sample of Dutch adolescents (N = 1,066; 46% male) recruited at the age of 11 and followed over the course of eight years. We tested whether adolescents with either, (i) a history of depression (Wave 1 – 3) or (ii) current depression (Wave 4), and elevated levels of C-reactive protein measured in blood at Wave 3 performed worse on cognitive assessments at Wave 4. Eight measures of cognitive functioning were hypothesized to load on to one of three dimensions of cognitive functioning (executive functioning, episodic memory, and verbal fluency) within a structural equation model framework. Higher levels of CRP were associated with worse future executive functioning in adolescents with and without current/prior depression. A current depression diagnosis also was associated with worse future executive functioning. There was consistent evidence linking low socioeconomic status and health-related covariates (high body mass index/sedentary behavior) with worse performance across multiple measures of cognitive functioning and, importantly, the association of depression/CRP and executive functioning was no longer significant when controlling for these covariates. Future studies may benefit from investigating whether specific depressogenic behaviors (e.g., sedentary behavior/substance use) mediate a relationship between depression and worse executive functioning, potentially via a prospective pathway through elevated inflammation. / Psychology

A higher prevalence and incidence of dementia is found in Hispanic/Latino older adults. Therefore, valid instruments are necessary to assess cognitive functioning in this population group. Our aim was to review existing articles that have examined and reported on the validity of cognitive assessment tools in Hispanic/Latino population groups in the United States.