Pediatric Neuropsychology

Relationships Between the BRIEF/BRIEF-SR and Performance-Based Neuropsychological Tests in Adolescents with Mild Traumatic Brain Injury Abstract Clinical neuropsychologists typically use both performance-based tests and behavioral rating scales as part of comprehensive assessment. However, literature has suggested that performance-based tests account for limited variance in behavioral rating scales in healthy and clinical populations. Importantly, little work has investigated the relationships between performance-based tests and behavioral rating scales in adolescent mild traumatic brain injury (mTBI). The present study was retrospective in nature and included 136 adolescents (M age = 14.97; 56% female) in the post-acute phase of recovery from mTBI (M days since injury = 33.4) referred for neuropsychological evaluation. Participants were administered a multi-domain neuropsychological test battery with measures of reaction time, processing speed, sustained attention, impulsivity, working memory, and verbal and visual memory, and the Behavior Rating Inventory of Executive Function (BRIEF) and BRIEF-Self Report (BRIEF-SR). Results revealed mean neuropsychological test performance and parent- and self-reported executive dysfunction within the average range. Hierarchical multiple regressions revealed that performance-based test scores accounted for between 13 and 18% variance in BRIEF scores and between 8 and 14% variance in BRIEF-SR scores after controlling for demographic factors (which accounted for 3% variance in BRIEF scores and 7–10% variance in BRIEF-SR scores). Processing speed emerged as the most consistent significant individual predictor of BRIEF/BRIEF-SR scores across regression analyses. These findings build on previous literature by suggesting relatively limited psychometric overlap between performance-based tests and behavioral rating scales, such that these approaches likely assess distinct and unique psychological constructs. Relationships to previous work, limitations of the current study, and directions for future research are discussed.

Story Learning Test: Decelerated Learning and Accelerated Forgetting in Children with Epilepsy Abstract Introduction Increasing interest is seen for early and late memory consolidation and accelerated forgetting, but little is known about these phenomena in children with epilepsy. The present study analysed the trajectory of learning and retention in typically developing children and children with epilepsy on a story learning test. Methods 285 children, 126 typically developing children and 159 children with epilepsy, in ages between 4 and 10 years and Full-Scale IQs ≥ 75, were given a specifically designed story learning test (iter-sein). The learning phase included Initial reading and a Free Recall trial with 10 Questions, and up to three repetition trials with Questions. Trials of Delayed Free Recall and Questions followed after half an hour, the next day and 1 week later. With several repeated measures analyses of variance, level of performance and gains or losses over time were analysed. Results Age-dependent learning was seen after repetitions. On the Questions, typically developing children outperformed children with epilepsy increasingly, due to smaller gains after the second trial. Learned information was similarly preserved. Free Recall showed similar performance for both groups up to day 2. A week later, a conspicuous loss of information was observed in the children with epilepsy, whilst typically developing children retained the information. On index scores, reliable cognitive loss of information was seen in epilepsy in 24.5% of the children. Semantic neuropsychological tasks and severity measures of epilepsy were associated with level of performance. Discussion The results provided evidence for early decelerated learning and late accelerated forgetting in children with epilepsy.

A Clinician’s Guide to Machine Learning in Neuropsychological Research and Practice Abstract Machine learning (ML) techniques can help harness insights from data that complement and extend those that can be attained by traditional statistical methods. The current article introduces clinicians to concepts underlying ML and explores how it can be applied within the domain of neuropsychology. Specifically, we illustrate an application of ML to a dataset that includes a battery of standardized measures designed to provide diagnostic support for concussions, including standardized neurocognitive (CPT 3) and neurobehavioral (BESS, NIH 4 meter gait) measures, gait sensor data, and a CDC concussion symptom checklist. These variables were used to predict the decision-making of a pediatric neurologist evaluating a group of child/adolescent patients. With a sample of 111 cases, ML (using a general linear model and deep learning as illustrations) achieved accuracies of 91% and 84.8% and AUCs of 1.0 and .947, respectively, when predicting the neurologist’s binomial decision-making (safe/remove). In presenting the data and various considerations for interpretation, we attempt to balance both the promise and perils of ML.

Evaluating the Relation Between CHC Cognitive Factors and Selected Components of Executive Functioning Abstract Executive functioning remains an elusive paradigm in regard to their underlying constructs. The Cattell-Horn-Carroll (CHC) theory of cognitive functions is the predominant theory of the measurement of human intelligence in psychology in regard to test construction and interpretation. The purpose of this study was to evaluate the relations between components of the Tower Test and Color-Word Interference Test from the Delis-Kaplan Executive Function System (D-KEFS) and CHC theory, as measured by the Woodcock-Johnson III Tests of Cognitive Abilities (WJ-III-COG). Participants were 64 undergraduate students (women, n = 38; men, n = 26), with a mean age of 19.88 years. Results of a Structured Equation Model indicated a correlation between the two factors modeled for Intelligence and Executive functioning was estimated to be 0.575 (0.331), and was statistically significant (p < .001), with a 95% credible interval of (0.551, 0.599). Thus, approximately 33% of the variance for measures of Intelligence was accounted for by measures of Executive Functioning; the biggest CHC contributor was Numbers Reversed which argues for the importance of attention and working memory being an important component of executive functioning. The results suggest that despite a relation between some components of executive function and cognitive ability, much variance between the D-KEFS and WJ-III-COG remains unaccounted for. These findings have implications for evaluation and intervention planning within vocational and educational settings.

Beery VMI and Brain Volumetric Relations in Autism Spectrum Disorder Abstract Although diminished proficiency on tasks that require visual-motor integration (VMI) has been reported in individuals with autism spectrum disorder (ASD), very few studies have examined the association between VMI performance and neuroanatomical regions of interest (ROI) involved in motor and perceptual functioning. To address these issues, the current study included an all-male sample of 41 ASD (ages 3–23 years) and 27 typically developing (TD) participants (ages 5–26 years) who completed the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) as part of a comprehensive neuropsychological battery. All participants underwent 3.0 T magnetic resonance imaging (MRI) with image quantification (FreeSurfer software v5.3). The groups were statistically matched on age, handedness, and intracranial volume (ICV). ASD participants performed significantly lower on VMI and IQ measures compared with the TD group. VMI performance was significantly correlated with FSIQ and PIQ in the TD group only. No pre-defined neuroanatomical ROIs were significantly different between groups. Significant correlations were observed in the TD group between VMI and total precentral gyrus gray matter volume (r = .51, p = .006) and total frontal lobe gray matter volume (r = .46, p = .017). There were no significant ROI correlations with Beery VMI performance in ASD participants. At the group level, despite ASD participants exhibiting reduced visuomotor abilities, no systematic relation with motor or sensory-perceptual ROIs was observed. In the TD group, results were consistent with the putative role of the precentral gyrus in motor control along with frontal involvement in planning, organization, and execution monitoring, all essential for VMI performance. Given that similar associations between VMI and ROIs were not observed in those with ASD, neurodevelopment in ASD group participants may not follow homogenous patterns making correlations in these brain regions unlikely to be observed.

Gender Matters in Neuropsychological Assessment of Child and Adolescent Writing Skill Abstract Gender differences in Cattell-Horn-Carroll cognitive explanatory variables of basic writing skills and written expression in children and adolescents in grades 1–12 were explored using multiple-group structural equation modeling with the standardization samples for the Woodcock Johnson IV (N = 3569). Results showed small female advantages in cognitive processing speed and written expression across grade levels. Crystallized ability, fluid reasoning, short-term working memory, processing speed, and auditory processing were significant predictors of basic writing skills with learning efficiency showing stronger effects on basic writing skills for males compared to females in grades 9–12. Additionally, fluid reasoning, short-term working memory, processing speed, learning efficiency, and visual processing were significant predictors of written expression. Processing speed had stronger effects on written expression for males compared to females in grades 9–12, whereas auditory processing had stronger effects on written expression for females compared to males in grades 9–12. Theoretical and practical implications of findings are discussed.

Using the Delis–Kaplan Executive Function System Tower Test to Examine ADHD Sensitivity in Children: Expanding Analysis Beyond the Summary Score Abstract Attention-deficit/hyperactivity disorder (ADHD) affects many children and is commonly regarded as a disorder of executive function (EF; Willcutt et al. Journal of Biological Psychiatry, 57, 1336–1346, 2005). EF is thought to be housed primarily within the brain’s prefrontal cortex (PFC), with different areas of the PFC orchestrating different EF components (Jurado and Rosselli Neuropsychology Review, 17, 213–233, 2007). Key PFC areas for this study included the dorsolateral PFC and orbitofrontal cortex. A measure on the Delis–Kaplan Executive Function System (D-KEFS), the Tower Test, has been infrequently studied with child populations, particularly those with ADHD. The limited research that does exist has primarily focused on the Tower’s summary score, overlooking available optional scores. The current study involved investigation of Tower performance in children ages 8 to 18 with ADHD (n = 252) to look for impaired scores, examine correlations with common ADHD measures, and compare Tower scores to clinical (n = 49) and normative controls (n = 110). Children with ADHD showed deficits on multiple Tower scores. Notably, more than half of the children with ADHD scored more than 1 standard deviation below the norm on the Move Accuracy Ratio (MAR) score, and children younger than 14 completed the Tower less efficiently than older children (i.e., lower MAR). Lower MAR scores were also correlated with higher parent ratings of inhibition on the Behavior Rating Inventory of Executive Function (BRIEF) and more errors of impulsivity on the Conners’ Continuous Performance Test, second edition (CPT II). Normative controls significantly outperformed children with ADHD on five of six Tower measures. The sensitivity of these optional measures was evident even while the total score was not sensitive to group differences, which highlights the importance of analyzing Tower optional scores and underscores the need for future research applying similar methods.

Measuring Visual, Spatial, and Visual Spatial Short-Term Memory in Schoolchildren: Studying the Influence of Demographic Factors and Regression-Based Normative Data Abstract The study aims to establish demographically corrected norms for three computerized tasks measuring different aspects of visual short-term memory (VSTM) in Ukrainian schoolchildren. These tasks measure respectively visual STM (the Pattern Recognition Memory (PRM) test), spatial STM (the Spatial Span (SSP) task), and visual spatial STM (the Paired Associates Learning (PAL) task). All tasks were administered to n = 186 children aged 5.10 years to 14.5 years old to evaluate the influence of demographic variables. Relevant demographic factors that influence task scores (VSTM), i.e., age and level of parental education, are identified and in keeping with the current literature. No sex differences were found. Based on these data, regression-based, demographically corrected norms were established per task. This approach to constructing norms differs from how (worldwide) PRM, SSP, and/or PAL norms have been constructed traditionally. In the latter approach, norms are calculated for each age group separately and without correcting for level of parental education, whereas in the regression-based normative method, multiple regression models are used to compute the expected test scores of an individual (rather than the subgroup means that are used in the traditional approach). Consequently, the regression-based norms for the PRM, SSP, and PAL presented in this paper are individualized, taking into account the unique characteristics of the individual that is tested on these tasks. Last, the confidence intervals of the PRM scores of the Ukrainian schoolchildren and the western norm group largely overlapped, except for the youngest age group, which adds to the literature about cultural effects on cognition.

Review of Neurodevelopmental Disorders in Children and Adolescents

Review of The Complexity of Autism Spectrum Disorders