Research indicates that cognitive and neuropsychological functions are adversely affected by symptoms of depression (Teeter & Semrud-Clikeman, 1997). In addition to deficits in attention and memory, depressive symptomatology may impact one’s executive functioning abilities. Over the last several decades, a number of studies have investigated the effects of internalizing symptoms on neurocognitive function in adults (e.g., Beats, Sahakian, & Levy, 1996; Channon & Green, 1999; Fossati, Coyette, Ergis, & Allilaire, 2002). However, little research is available confirming the presence of these adverse patterns in children and adolescents manifesting similar depressive symptoms. Although research suggests that children and adolescents who exhibit symptoms of depression often experience greater school and academic disruption (Mash & Barkley, 1996), it is unclear how symptoms of depression impair executive functioning skills in youth.

Research indicates that cognitive and neuropsychological functions are adversely affected by symptoms of depression (Teeter & Semrud-Clikeman, 1997). In addition to deficits in attention and memory, depressive symptomatology may impact one’s executive functioning abilities. Over the last several decades, a number of studies have investigated the effects of internalizing symptoms on neurocognitive function in adults (e.g., Beats, Sahakian, & Levy, 1996; Channon & Green, 1999; Fossati, Coyette, Ergis, & Allilaire, 2002). However, little research is available confirming the presence of these adverse patterns in children and adolescents manifesting similar depressive symptoms. Although research suggests that children and adolescents who exhibit symptoms of depression often experience greater school and academic disruption (Mash & Barkley, 1996), it is unclear how symptoms of depression impair executive functioning skills in youth.

The Examination for Professional Practice in Psychology (EPPP) is a requirement for licensure as a psychologist across the entire United States as well as in numerous territories and provinces. Despite many longstanding criticisms and findings of bias, the EPPP is being expanded (adding a second, putatively competency-based, portion to the overall exam) and rebranded as the Enhanced EPPP. A review of literature reveals strong skepticism surrounding these developments, particularly with respect to the issue of criterion validity. The current study sought to examine the criterion validity of the EPPP by (1) drawing archival competency assessment data from existing measures (convergent validity) and (2) gathering new neurocognitive and emotional intelligence data, along with demographic data (discriminant validity), with copies of EPPP score reports from individuals who have recently taken the EPPP. Competency ratings did not significantly positively correlate with EPPP scores and, instead, indicated the opposite trend. Analyses also revealed a significant relationship between ethnicity and exam scores, with White individuals scoring higher than other ethnicities. Finally, performance on neurocognitive tests significantly positively correlated with exam scores, indicating that general test taking abilities play a larger role than abilities and competencies unique to the psychology field. Given the gatekeeping role the EPPP plays in the profession of psychology, external validation of the EPPP is of vital importance and was not supported in this study. Implications for the exam and the field are discussed.

Phonological awareness is known to be associated with reading disorder. Intervention for specific reading disorder that focuses on training to improve phonological processing abilities has been found an effective means of addressing reading difficulties experienced by children. However, little is known as to what happens to other neurocognitive abilities associated with the process of reading but that are not causally linked to it. Some of these cognitions include attention, executive functions and verbal and visual memory. A series of three studies explored the relation between neuropsychological skills and phonological abilities in children with specific reading disorder. The first step in the studies involved establishing deficits in associated cognitive abilities in children with specific reading disorder. Children attending the Literacy Clinic, Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand, are screened for the presence of specific reading disorder. They are routinely assessed on reading and phonological processing measures before an intervention programme is initiated. Four such children who were assessed and identified as having specific reading disorder without speech language difficulties were chosen for the study. These children, who ranged in age from 7 to 15 years, referred to as the RD group, were assessed during the week before the onset of the intervention for the neuropsychological functions of attention, executive functions, verbal and visual learning, and memory. After the assessment (termed pre-intervention assessment), they were provided with phonological processing intervention. The intervention programme was carried out by trained speech-language therapists and lasted for 10 weeks. Two sessions a week were conducted, giving a total of 20 sessions. The week after completion of the intervention, the children were assessed once again on the same neuropsychological, reading and phonological awareness tests used before the intervention (termed post-intervention assessment). The results of the pre-intervention assessment were compared with the assessment of a group of typically developing group of children without reading disorder (N = 4; age range 8 to 10 years; referred to as the NRD group). Results indicated that, at pre-intervention assessment, the specific reading disorder (RD) group had deficits in verbal fluency and inhibitory control whereas the typically developing (NRD) group did not. The RD group also differed significantly from the NRD group in reading accuracy and comprehension. After the intervention, the RD group was assessed on reading, phonological processing, and neuropsychological tests. The group showed an improvement in reading accuracy and phonological processing. Of all the neuropsychological functions, only set shifting and visuo-spatial working memory scores showed a significant change in response to intervention. Deficits in executive functions and reading comprehension difficulties persisted. It was hypothesised that the RD group improved in reading accuracy in response to the phonological awareness intervention. However, the persistent reading comprehension difficulties were hypothesised as attributable to the presence of the executive function deficits noticed in the RD group. The exploratory study helped identify the presence of neuropsychological deficits in children with specific reading disorder in addition to their reading and phonological deficits. The study also established that phonological awareness intervention brought about a change in some neuropsychological function while other deficits persisted. The phonological awareness intervention used in the first study was developed for children in New Zealand. The second study hypothesised that, if effective, this intervention would help address reading deficits found in other populations. Children from a culture outside New Zealand accordingly the same intervention as the New Zealand children received in the first study. Children in Bangalore, India, 10 to 12 year of age and under-performing in their class, were screened for the presence of specific reading disorder. From this screening, 20 children with specific reading disorder (the RD group), with average to above average intelligence and without co-morbid psychiatric conditions were chosen to participate. Twenty children were randomly allotted to one of two treatment conditions. The first group of 10 children (the PA group) received phonological awareness intervention. The second group of 10 children (the NP group) received neuropsychological intervention. All 20 children were assessed on reading, phonological awareness tests and neuropsychological tests before and after intervention. Phonological measures included, Queensland University Inventory of Literacy (QUIL, ) Sthal and Murray, Phonological awareness probes of tracking speech sounds and non-word reading tests. Neuropsychological measures included Controlled Word Association test (COWA), Digit Span, Spatial Span, Stroop Colour-Word Test Coulor trails (A & B), Ray Auditory verbal learning test, Rey Osterriech Complex figure test and block design. The scores from the pre-intervention assessment were compared to the assessment data for 20 typically developing, non-reading-disabled children (referred to as the control group). The control group was assessed once on neuropsychological tests and reading and phonological awareness measures (QUIL only). The results indicated that the 20 children with reading disorder (the RD group) differed significantly from the control group on reading abilities. In addition, the two groups differed significantly on neuropsychological measures of attention (Colour Trail, Form A), set-shifting (Colour Trail, Form B), word reading and interference control (Stroop Colour-Word Test) and phonological awareness measures of non-word reading, syllable identification, visual rhyme, spoonerism, phoneme detection and phoneme deletion. After intervention, the RD group was again assessed on reading, phonological awareness and neuropsychological measures. Both the intervention groups (PA and NP) showed improvements on reading. Both groups also made significant gains on neuropsychological measures and phonological awareness measures. The PA group showed significant changes in verbal fluency, visual scanning and attention (Colour Trails, Form A), word reading (Stroop Colour-Word Test, verbal memory (Auditory Verbal Learning Test), immediate visual memory (Complex Figure Test) and visuo-construction abilities (Block Design Test). Phonological measures that showed significant increase in response to intervention in this group included non-word reading, phoneme detection, phoneme segmentation, phoneme deletion and tracking of syllable sound changes via use of coloured blocks and letter tiles. The NP group showed significant change in neuropsychological functions such as verbal fluency, word reading and interference control (Stroop Colour-Word Test), verbal learning (Auditory Verbal Learning Test), immediate visual memory (Complex Figure Test) and visuo-construction ability (Block Design Test). The NP group also improved significantly on phonological awareness measures such as syllable identification, spoken and visual rhyme, spoonerism, phoneme detection, phoneme deletion and tracking of syllable sound changes via use of coloured blocks. This second study established that the two interventions helped improve reading abilities equally. However, the interventions differentially affected neuropsychological and phonological awareness functioning in the participants. The third study explored the changes seen in the second study’s two treatment groups (Group PA and Group NP) three months after the conclusion of the intervention programme. During the three-month period between the post-intervention assessment and the follow-up assessment, all 20 children attended regular school. They received no special help or input for their reading and spelling difficulties during this period. The follow-up assessment consisted of the same tests of reading and neuropsychological measures used at the pre- and post-intervention assessments. The results showed that the groups had maintained the gains evident at the time of the post-intervention assessment on reading measures. The PA group’s performance on the neuropsychological measures and phonological measures showed significant changes in digit span and interference control. In addition, a significant increase from the pre-intervention measures, not observed at the post-treatment assessment, was observed for set-shifting, verbal learning and memory and now-word reading. Visuo-spatial working memory showed a trend towards significance for the NP group on the follow-up assessment. Most other neuropsychological functions did not differ significantly from those evident at the time of the post-intervention assessment. The NP group, like the PA group, showed a significant increase between pre-assessment and follow-up assessment on non-word reading, visual scanning, verbal learning and visual perception. The increase noticed in these measures at the time of the post-treatment assessment, however, was not significant. Comparisons between the PA and NP group at follow-up revealed that the PA group’s performance was significantly better than the NP group’s on digit backward and interference control, while the NP group performance was significantly better than the PA group’s on verbal fluency. The two groups were comparable on all other neuropsychological, phonological awareness and reading measures. The improvements noticed in both groups immediately after the intervention and then three months after intervention were hypothesised to have occurred because the interventions addressed reading along with other cognitive abilities (e.g., executive functions, attention, verbal learning and memory, visual learning and memory) addressed in the study. The improvements noticed in both groups after three months after intervention was hypothesised to be the outcome of improvements in the neuropsychological functions. The series of three studies conducted as part of this research work has helped identify neuropsychological deficits in children with reading disorder that persisted after phonological awareness intervention. The provision of two different interventions to children with reading difficulties showed that these had positive outcomes not only for reading and phonological awareness but also for neuropsychological functioning. The most important conclusion drawn from the findings of the three studies that form this doctoral research is that intervention for reading disorder is most likely to be effective when it addresses the reading and other associated cognitive skills that underlie the reading process. The two interventions used in the study had a similar effect on reading. Both helped the participating children improve their reading scores and both helped maintain those improvements over time. It is hypothesised that the improvement observed was probably sustained over time because both interventions could have addressed the associated deficits (in addition to reading difficulties) known to occur in children with reading disorder. The efficacy of the phonological awareness intervention documented in the studies is strengthened by the finding that it was effective in treating reading disorders in children from different cultural and educational settings (New Zealand and India).

Recent progress in science and medicine is that regions such as the United States, Canada, Australia, and Western Europe have witnessed dramatic declines in infant morbidity and mortality. The most significant of these declines has occurred among infants born prematurely and low birth weight (LBW)--the cohort that represents the highest proportion of illness and death among infants Despite these medical advances, recent longitudinal studies have provided clear evidence of physical health problems; cognitive and neuropsychological dysfunction; and other social, emotional, and behavioral problems among children born prematurely. A number of studies have indicated that premature and LBW infants are still at risk for psychosocial, physical, and mental problems despite the immediate contributions of post-natal interventions to their increased chance for survival The extant research has demonstrated that children born prematurely and LBW are at risk for problems in health, neuropsychological functioning, learning, academic achievement, behavior, and psychosocial adjustment. Research has further demonstrated that a variety of physical and psychological conditions are associated with poorer QOL among children. However, few studies have examined pediatric QOL among preterm school-aged children. Moreover, existing studies have not explored the relationship between cognitive, academic, and social/emotional functioning and QOL. The current study compared child and parent ratings of health-related quality of life among school-aged children born preterm (n = 26) and full-term (n = 28). Given the increased rates of physical, psychological, and cognitive problems among the preterm population, it was hypothesized that children born prematurely would have significantly poorer proxy-reported and self-reported QOL than children born preterm.

Includes bibliographical references / There are still no diagnostic criteria for a spectrum of neurocognitive disorders (ND) secondary to HIV infection for children. The American Academy of Neurology (AAN) proposes guidelines for assessment of HIV associated neurocognitive disorders (HAND) in HIV infected adults. A cross-sectional clinical cohort study was initiated in Cape Town, in which 120 participants, including a HIV negative healthy control group for comparison, completed clinical and neurocognitive assessments. HIV infected children were either stable on antiretroviral treatment (ART) for a minimum of 6 months or ART naïve. Neuroimaging was completed on 105 children in the cohort study. We compared 75 children vertically infected with HIV aged 6 to 16 years, including both children on antiretroviral therapy (ART) and ART-naïve, with 30 matched controls using diffusion tensor imaging (DTI) measures. We then used the detailed neurocognitive battery; an assessment of adaptive functioning and the AAN system for diagnosing ND to establish whether this system could detect a spectrum of ND in HIV infected older children and adolescents. When comparing HIV uninfected children to HIV infected children this DTI study found damaged neuronal microstructure in the HIV infected children. Significant associations were found between failing first line ART regimen, socio-demographic factors, nutritional-hematological status, HIV-relevant clinical variables, cognitive functioning and white matter integrity in children stable on ART. Children with a clinical diagnosis of encephalopathy (HIVE) had greater white matter damage when compared ART treated children without encephalopathy. DTI also found significant myelin loss in ART naïve children when compared with ART treated children. Using the AAN criteria for HAND, we found that 45.35% of the HIV infected children had a ND. ART naïve slow progressors, who receive limited attention from heath care service s, as they are thought to be 'well', were found to have neurocognitive impairment and white matter microstructural damage. HIV infected children were also more likely to have impaired competence in various domains of functioning. The current findings also underline the possible association of first line treatment failure with white matter brain dysfunction in children on ART. Despite the use of ART and improved virological control with immune reconstitution, there were still a significant percentage of children in this study who were found to have ND. Our findings also suggest that children on ART remain at risk for developing CNS disease, and that this risk extends to physically well ARV naïve slow progressors. The AAN HAND criteria designed for adults was able to identify children and adolescents with important functional cognitive impairments who don't fit criteria for HIVE and would therefore not have been identified otherwise.

Background: The ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) neurocognitive testing battery is a popular assessment tool used for concussion management. The stability of the baseline neurocognitive assessment is important for accurate comparisons between postconcussion and baseline neurocognitive performance. Psychometric properties of the recently released online version of ImPACT have yet to be established; therefore, research evaluating the reliability of this measure is warranted.Purpose: The authors investigated the 1-year test-retest reliability of the ImPACT online version in a sample of high school athletes.Study Design: Case series; Level of evidence, 4Methods: A total of 369 varsity high school athletes completed 2 mandatory preseason baseline cognitive assessments approximately 1 year apart as required by their respective athletics program. No diagnosed concussion occurred between assessments.Results: Intraclass correlation coefficients (ICCs) for ImPACT online indicated that motor processing speed (.85) was the most stable composite score, followed by reaction time (.76), visual memory (.70), and verbal memory (.62). Unbiased estimates of reliability were consistent with ICCs: motor processing speed (.85), reaction time (.76), visual memory (.71), and verbal memory (.62).Conclusion: The online ImPACT baseline is a stable measure of neurocognitive performance across a 1-year time period for high school athletes. These reliability data for online ImPACT are higher than the 2-year ICCs previously reported from the desktop version.Clinical Relevance: It is recommended that the ImPACT baseline assessment (both desktop and online) continue to be updated every 2 years. The online version of ImPACT appears to be a stable measure of neurocognitive performance over a 1-year period, and systematic evaluation of its stability over a 2-year period is warranted.

This chapter will address the issue of risk for HIV-associated neurocognitive disorder (HAND), focusing on HIV-associated dementia (HAD), among persons living with HIV in relationship to the risk for other dementias. Advances in effective antiretroviral therapy (ART) have led to an increase in the prevalence of older persons surviving with HIV – in addition to older persons who become infected by HIV later in life. Hence, HIV is no longer a disease of younger persons, and additional attention has been brought to bear against the plight of older persons living with HIV – not only as it pertains to treatment but also to prevention. The additional risk caused by aging among older persons living with HIV is complex to asses, and HIV infection is a research area that requires a robust approach to multiple other factors causing neurocognitive impairment with older age. The long-term and potentially neurotoxic exposure to ART and the deleterious consequences of chronic infection with HIV and its associated neuro-inflammation have been described for health. This aids in the understanding of dementia risk factors in this patient population, but the comorbidities (HIV- and non-HIV-associated) occurring among older persons living with HIV must also be addressed to properly assess the overall impact on dementia risk in this group. This need also warrants our examination of the risk factors for other dementias (and comorbid dementias) in persons living with HIV versus the general population through the assessment and quantification of modifiable and non-modifiable risk factors identified as major contributors toward dementia.

Doctor of Philosophy (Medicine) / Sleepiness is an important source of morbidity in the community, with potentially catastrophic consequences of occupational or driving injuries or accidents. Although many measures of sleepiness exist, there is no gold standard. The electroencephalograph (EEG) has been studied as an indicator of sleep pressure in the waking organism, or sleep depth. A mathematical model has been developed, relating the observed EEG to interactions between groups of neurons in the cortex and thalamus (Robinson, Rennie, Rowe, O'Connor, & Gordon, 2005; Robinson, Rennie, & Wright, 1997). These interactions are thought to be important in the transition from wake to sleep. Sleepiness is common in obstructive sleep apnea (OSA). The measurement of sleepiness would have great utility in quantifying the disease burden, measuring treatment response, or determining fitness for work or driving. This study will evaluate parameters derived from the EEG mathematical model as a measure of sleepiness. It is divided into the following four parts: 1. Subjects with likely OSA based on symptoms and demographics from an international database were compared with matched non-OSA controls. The OSA group showed deficits in executive function and abnormalities on evoked response potential testing. 2. Outcomes from a cross-sectional study in a sleep-clinic OSA population were aggregated by factor analysis into a five summary variables relevant to sleepiness: subjective sleepiness, mood & anxiety, memory & learning, driving, and executive functioning. 3. EEG mathematical model parameters from wake EEG recordings were related to the five summary outcomes. Executive function correlated with a parameter Z, representing the negative feedback loop between the thalamic reticular nucleus and the thalamocortical relay nuclei. 4. EEG model parameters during first NREM sleep cycle of 8 subjects with regular sleep architecture were studied. Net cortical excitation (parameter X) is predicted to increase across the cycle, while there was, as predicted, a greater inhibitory effect of the thalamic reticular nucleus upon thalamocortical relay cells (parameter Z). In this preliminary assessment, EEG model parameters reflecting thalamocortical interactions are sensitive to prefrontal lobe tasks such as executive function, which are known to be vulnerable to sleep loss and sleepiness, and these parameters also show variation with increasing sleep depth.

Evidence from the pediatric traumatic brain injury and pediatric brain tumor populations suggests that positive family functioning serves as a protective factor for neurocognitive outcomes of children who survive these conditions. However, no research has been found that examines whether positive family functioning similarly moderates the effects of CNS-directed chemotherapy on the neurocognitive functioning of survivors of pediatric ALL. The purpose of this study is to examine the effect of family functioning upon neurocognitive outcome among survivors of pediatric ALL treated with chemotherapy. Based upon a multidimensional model of attention and Anderson’s model of executive function (EF), four subcomponents of attention (selective, divided, sustained, and shifting) and four subcomponents of EF (working memory, planning, inhibition, and processing speed) will be examined. Sequential, or hierarchical, multiple regression analyses will be conducted to examine the relationship between family functioning and neurocognitive functioning among survivors of pediatric ALL as well as a comparison group of healthy children. Data for the ALL group and the comparison group will be examined using separate analyses, with demographic and treatment-related variables entered first, followed by a family functioning variable. For the ALL group, family functioning is expected to explain a significant amount of variance in neurocognitive outcome, even after controlling for demographic and treatment-related variables. It is expected that this relationship will not be found for the comparison group. If so, this would have important implications for the survivors and their families. For example, survivors from families with lower levels of functioning could be identified early through screening measures and their families could receive targeted interventions aimed at improving family functioning and thus survivor outcomes. / text