The modest impact of the COVID-19 pandemic on training expectations at internship programs offering specialization in neuropsychology.

Objective: Given the decreased clinical training opportunities during the COVID-19 pandemic, this study aimed to provide insights into how training directors and supervising neuropsychologists from internships offering neuropsychology training adjusted expectations of competitive applicants. Method: Respondents (n = 50) from internships offering at least an "exposure" in neuropsychology completed questions about how training expectations of competitive applicants have changed because of the COVID-19 pandemic. Results: Most respondents reported decreased expectations for clinical hours and research productivity and increased expectations for telehealth experience and involvement in working with culturally diverse populations. Additionally, more than half of respondents from programs at university-affiliated and Veteran Affairs medical centers indicated reduced expectations for average number of integrated reports. Furthermore, compared to respondents at Veteran Affairs medical centers, respondents at university-affiliated medical centers stated decreased expectations for average number of paper presentations. Conclusions: The COVID-19 pandemic has motivated subtle changes in expectations of competitive neuropsychology-oriented internship applicants, specific to clinical experience, research productivity, and prioritization of certain application materials. Qualitative responses suggest that many respondents endeavored to improve applicant screening rather than lower expectations for applicants. As a result, consistent with previous recommendations, the importance of fit between trainee and training program should continue to be emphasized by prospective applicants. These findings have important implications for trainees for the next several years, as graduate students at all stages of training ultimately progress to the internship application stage.

Back from the sideline, but back to baseline? A pediatric case study examining neuropsychological functioning after sustaining multiple sport-related concussions.

Most individuals recover quickly from a concussion; however, youth who sustain multiple concussions may be at risk for long-term cognitive impairments. This case study examines the neuropsychological performance of a 13-year-old malewith five head injuries. After his first concussion during study participation (fourth injury overall), several improvements were observed, likely due to practice effects, yet after sustaining another concussion <2 years later,declines were observed in visuoconstruction, verbal memory, and intellectual functioning. Across serial re-evaluation, his vocabulary knowledge declined, and fewer improvements were observed than anticipated when accounting for serial practice effects, highlighting the possible cumulative impact of multiple concussions.

A Survey of Doctoral Internships Offering Clinical Neuropsychology Training: Updated Expectations for Competitive Applicants.

OBJECTIVE: The specialty of clinical neuropsychology has experienced significant professional growth and increasing standardization of educational and training guidelines over the past 20 years. Previous literature demonstrated the importance of routine distribution of selection criteria used by training directors and supervising neuropsychologists for competitive applicants aiming to specialize in neuropsychology during internship. This study examined supervisors' updated expectations for competitive applicants from a more diverse sample of doctoral internship programs offering neuropsychological training. These data also provide cross-sectional and longitudinal comparisons to help trainees tailor their graduate training experiences. METHOD: The sample included training directors and/or supervising neuropsychologists from 80 internship programs (73.4% of submitted surveys). Spearman correlations, analyses of variance, and chi-square tests of independence were conducted for cross-sectional and longitudinal comparisons. RESULTS: Clinical experience in assessment and the personal interview were consistently the two most prioritized criteria across all groups, whereas prioritization of the additional criteria was variable based on the program's characteristics. Internship programs generally preferred practica experience at university-affiliated medical centers, Veterans Affairs medical centers, and private/community-based hospitals. University-affiliated medical centers and internships offering ≥50% neuropsychology training showed similar preferences for applicants with a depth and breadth of graduate school experience in neuropsychology. Longitudinally, the applicant expectations for programs offering ≥50% neuropsychology training remained largely unchanged between 2000 and 2020. CONCLUSIONS: This study updated expectations for competitive applicants from a diverse sample of neuropsychology training programs, underscored the importance of fit between trainee and program, and demonstrated consistency over time for trainees seeking neuropsychology training during internship.

Childhood Religious Affiliation Type Is Associated with Alcohol, but Not Cannabis Use in Adults.

With the recent rise in cannabis use and reported association between use and biopsychosocial risk, identifying factors to reduce use is important. This study examined the association between religion and spirituality factors and cannabis initiation and use. An online survey sample (N = 935) provided demographic, childhood religious affiliation (association with a specific religious group), religiosity (e.g., church attendance, prayer), spirituality, and substance use-related information. As hypothesized, participants with higher religiosity scores were less likely to be regular cannabis users (p = .017). However, cannabis use (early initiation, regular use, recent use, problematic use) was not associated with religious affiliation or with religious affiliation type (religions grouped by identifiable characteristics). Nevertheless, religious affiliation type was associated with recent alcohol use (p < .001) and recent intoxication (p = .006) among participants who reported cannabis use at least once, supporting previous research suggesting an inverse relation between religiosity and substance use. Overall, childhood religious affiliation type was not associated with cannabis use milestones as had been previously reported for alcohol use milestones. This suggests important differences between alcohol and cannabis use characteristics (e.g., social acceptability, recreational vs. medicinal substance) that may have implications for future substance use research, prevention, and treatment.

Depression, health comorbidities, cognitive symptoms and their functional impact: Not just a geriatric problem.

OBJECTIVE: To compare the prevalence of cognitive symptoms and their functional impact by age group accounting for depression and number of other health conditions. METHODS: We analyzed data from the 2011 Behavioral Risk Factor Surveillance System, a population-based, cross-sectional telephone survey of US adults. Twenty-one US states asked participants (n = 131, 273) about cognitive symptoms (worsening confusion or memory loss in the past year) and their functional impact (interference with activities and need for assistance). We analyzed the association between age, depression history and cognitive symptoms and their functional impact using logistic regression and adjusted for demographic characteristics and other health condition count. RESULTS: There was a significant interaction between age and depression (p < 0.0001). In adults reporting depression, the adjusted odds of cognitive symptoms in younger age groups (<75 years) were comparable or greater to those in the oldest age group (≥75 years) with a peak in the middle age (45-54 years) group (OR 1.9 (95% Confidence Interval: 1.4-2.5). In adults without depression, adults <75 years had a significantly lower adjusted odds of cognitive symptoms compared to the oldest age group with the exception of the middle-aged group where the difference was not statistically significant. Over half of adults under age 65 with depression reported that cognitive symptoms interfered with life activities compared to 35.7% of adults ≥65 years. CONCLUSIONS: Cognitive symptoms are not universally higher in older adults; middle-aged adults are also particularly vulnerable. Given the adverse functional impact associated with cognitive symptoms in younger adults, clinicians should assess cognitive symptoms and their functional impact in adults of all ages and consider treatments that impact both cognition and functional domains.

Boston Naming Test: Lose the Noose.

OBJECTIVE: Administering the noose item of the Boston Naming Test (BNT) has been questioned given the cultural, historical, and emotional salience of the noose in American culture. In response, some have modified the BNT by skipping/removing this item and giving the point as if the examinee responded correctly. It is unknown, however, whether modifying standardized administration and scoring in this manner affects clinical interpretation. In the present study, we examined the prevalence of noose item failure, whether demographic and clinical characteristics differed between those who responded correctly versus failed the item, and whether giving a point to those who failed affected clinical interpretation. METHOD: Participants included a mixed clinical sample of 762 adults, ages 18-88 years, seen for neuropsychological evaluation at one of five sites within the USA. RESULTS: Those who failed the item (13.78%) were more likely to be female, non-White, and have primary diagnoses of major neurocognitive disorder, epilepsy, or neurodevelopmental disorder. Noose item failure was associated with lower BNT total score, fewer years of education and lower intellectual functioning, expressive vocabulary, and single word reading. Giving a point to those who failed the item resulted in descriptor category change for 17.1%, primarily for patients with poor overall BNT performance. CONCLUSIONS: Only a small percentage of patients fail the noose item, but adding a point for these has an impact on score interpretation. Factors associated with poorer overall performance on the BNT, rather than specific difficulty with the noose item, likely account for the findings.

The 5-HTTLPR long allele predicts two-year longitudinal increases in cortisol and declines in verbal memory in older adults.

OBJECTIVES: The short form or s-allele variant of the serotonin transporter polymorphism (5-HTTLPR), as compared with the long-form or l-allele variant, has been associated with the presence of cognitive dysfunction, and particularly memory impairment in older adults. This body of cross-sectional work has culminated in the hypothesis that presence of the s-allele predicts greater memory decline in older adults. Yet, to date, there are no longitudinal studies that have investigated this issue. METHODS/DESIGN: Here, we examine 109 community-dwelling older adults (mean and SD of age = 70.7 ± 8.7 years) who underwent blood draw for genotyping, cognitive, and psychological testing at baseline, 12-, and 24-monthfollow-ups. RESULTS: Multilevel modeling found that s-allele carriers (ss or ls) performed worse than ll homozygotes at baseline on delayed verbal recall. Yet, s-allele carriers' memory performance was stable over the two-yearfollow-up period, while l-allele homozygotes experienced significant memory decline. l-allele homozygote status was associated with both increased cortisol and decreased memory over time, resulting in attenuated verbal memory performance differences compared to s-allele carriers with age. CONCLUSIONS: Overall, our findings do not support the hypothesis that presence of the 5-HTTLPRs-allele is a marker for memory decline in older adults. J Am Geriatr Soc 68:-, 2020.

Commonality in Abnormality: "Abnormal" Neuropsychological Scores Are Common in Baseline Testing of Youth Athletes.

OBJECTIVE: Although research shows that abnormal scores are common in adults, fewer studies examine the frequency of abnormal scores within children. The present study assessed how specific tests, cognitive domains, and patient factors affect the likelihood of abnormally low scores among healthy youth athletes. METHODS: Youth athletes (n = 85, Mage = 11.72, SD = 2.23) completed a comprehensive neuropsychological battery (N = 23 tests) during baseline testing for a sport-related concussion clinical research program. "Abnormal" scores were defined using cutoffs at 1, 1.5, and 2 standard deviations (SDs) below the population mean. Univariate and multivariate Poisson regression models examined abnormal test scores as a function of age, sex, ethnicity, and Full-Scale Intelligence Quotient (FSIQ). RESULTS: Using cutoffs of 1, 1.5, and 2 SDs, the percent of healthy participants with at least one abnormal test score was 61.2, 36.5, and 22.4%, respectively, indicating a high proportion of healthy participants with abnormal scores and low specificity for tests using these cutoffs. In univariate Poisson regression analyses, FSIQ and abnormal score were negatively correlated (p < .001), wherein lower FSIQ was associated with more abnormal scores. In multivariate regression analyses, lower performance on executive function, memory, and processing speed tests was significantly associated with an increased frequency of abnormal scores. CONCLUSIONS: Abnormally low scores in healthy youth occur frequently and do not necessarily represent functional deficits. Cutoffs of 2 SDs should be considered for many tests to increase specificity and reduce the risk of false positive errors that could lead to negative clinical outcomes.

Rey 15 item test plus recognition trial and TOMM in a community pediatric sample.

In pediatric evaluations, performance validity test (PVT) selection is often constrained by reading level, developmental appropriateness of stimuli, and administration time. The Rey 15 Item Test (FIT) addresses these constraints, and ranks among the most frequently used PVTs. Unfortunately, research indicates poor sensitivity of the FIT recall trial. Boone et al. developed a FIT recognition trial and demonstrated in an adult sample that its use increased sensitivity while maintaining high specificity. These results are promising, but, to the authors' knowledge, have only been replicated once in a pediatric sample. The present study examined the FIT plus recognition trial in a sample of 72 young athletes ages 8-16 years. All data for the present study were collected during baseline cognitive evaluations. The Test of Memory Malingering (TOMM) was used as the comparison criterion. Receiver operating characteristic curve analyses showed the addition of the recognition trial did not substantially improve sensitivity of the FIT. There was a surprising lack of concordance between TOMM and FIT scores, and, whereas the FIT correlated with multiple cognitive measures, the TOMM did not correlate with any other measures. Results suggest the FIT is not appropriate for pediatric clinical care, even with the additional recognition trial.

Factors Associated with Supportive Care Service Use Among California Alzheimer's Disease Patients and Their Caregivers.

BACKGROUND: Existing literature on factors associated with supportive care service (SCS) use is limited. A better understanding of these factors could help tailor SCS to the needs of frequent users, as well as facilitate targeted outreach to populations that underutilize available services. OBJECTIVE: To investigate the prevalence of SCS use and to identify factors associated with, and barriers to, service use. METHODS: California Alzheimer's Disease Center patients with AD (n = 220) participated in the study from 2006-2009. Patients and their caregivers completed assessments to determine SCS use. Cognitive, functional, and behavioral status of the patients were also assessed. A two-part hurdle analysis identified 1) factors associated with any service use and 2) service use frequency among users. RESULTS: Forty percent of participants reported using at least one SCS. Patients with more impaired cognition and activities of daily living and more of the following: total number of medications, comorbid medical conditions, and years of education were more likely to use any SCS (p < 0.05). Factors associated with more frequent SCS use included younger age, more years of education, older age of AD onset, female gender, and having a spouse or relative for a caregiver (p < 0.05). Caregivers frequently indicated insufficient time as a reason for not receiving enough services. CONCLUSION: Factors associated with any SCS use mostly differed from those associated with SCS frequency, suggesting different characteristics between those who initiate versus those who continue SCS use. Our findings highlight the importance of targeted education on services and identifying barriers to long-term SCS use.

Embedded performance validity indicator for children: California Verbal Learning Test - Children's Edition, forced choice.

Performance validity testing in children undergoing neuropsychological testing is a growing research area. Accurate identification of performance validity is necessary to avoid invalid assessment conclusions. In the present research, a forced choice (FC) trial was created for the California Verbal Learning Test - Children's Edition (CVLT-C), modeled after the established California Verbal Learning Test - Second Edition (CVLT-II) FC trial. Distractor words were taken directly from the CVLT-II FC Standard Form, with about half being concrete (n = 8) and half abstract (n = 7). The order of the items was organized similarly to the CVLT-II FC to ensure that items from within the same category were not sequential. The Test of Memory Malingering was administered for comparison, and three embedded measures that have previously been validated in adults were also calculated. The CVLT-C FC trial was administered to 40 children, aged 6-16 (M = 12.08, SD = 3.13). Average full scale IQ was 97.3 (SD = 12.41, range = 71-123). Ninety-three percent of examinees performed perfectly on the CVLT-C FC, suggesting high specificity, which is similar to findings for the CVLT-II FC normative group (90%). Results from other embedded measures are also presented.

Perceptions of the cognitive effects of cannabis use: A survey of neuropsychologists' beliefs.

Introduction: Research evaluating the neuropsychological effects of cannabis has yielded mixed findings, with some studies finding cognitive deficits in cannabis users (primarily in learning and memory) and others finding no significant effects. It is important to understand how clinicians perceive this discrepancy in the empirical literature. However, no studies have assessed neuropsychologists' beliefs regarding the effects of cannabis on cognitive functioning. Thus, this study sought to evaluate how patient and cannabis-use factors influence neuropsychologists' perceptions of cannabis's cognitive effects. Method: Neuropsychologists (N = 261) read eight vignettes, each depicting cannabis users varying in age, gender, and cannabis-use history (frequency, duration, and recreational/medicinal use). Respondents rated the anticipated effects of cannabis in each vignette on nine cognitive domains. Mixed effects linear regression modeled the ratings of cognitive abilities as a function of neuropsychologist, neuropsychologists' training, vignette, patient age, gender, and frequency/duration/type of cannabis use, and treated neuropsychologist and vignette as random effects. Results: Duration of use had the most notable effect on neuropsychologists' ratings, with a small (0.1 to 0.2 SDs) yet statistically significant (p < .001) negative effect on each cognitive domain. Male gender and medicinal use also predicted lower cognitive ratings. Differences in ratings between neuropsychologists accounted for 73% of the total variability in each domain, whereas variability due to vignette alone was negligible (<1%). Conclusions: Results suggest that neuropsychologists believe that cannabis use results in broad but mild cognitive deficits, consistent with meta-analytic findings of active chronic cannabis users, particularly for males and for individuals using cannabis for medicinal purposes. Interestingly, neuropsychologists expected fewer cognitive effects in recreational cannabis users. Further, duration of use (rather than frequency) was believed to be the primary factor contributing to cognitive deficits.

Bell Ringers: Factors Related to Concussive Events in Children Playing Tackle Football.

INTRODUCTION: Sports-related concussion is a significant pediatric health risk, given the number of children involved in sports and the vulnerability of developing brains. Although most research has focused on high school/college athletes, these findings may not be applicable to younger athletes. METHOD: A mixed-methods analysis examined concussion incidence and sequelae in a cohort of 8- to 13-year-old males (N = 31) playing youth football and their parents. Parents provided background information and completed mood/behavioral questionnaires, and each athlete completed a neuropsychological battery. RESULTS: Eight athletes (26%) had a history of concussion before assessment. Concussion risk was related to lack of medical evaluation in prior concussions, tackling exposure (in both offensive and defensive positions), and multisport participation. There were no cognitive or psychological differences based on concussion history. DISCUSSION: Findings identify factors that may contribute to concussion risk in children and show the need for further research in this understudied population.

The "Jay-Dar" Phenomenon: Individuals Discriminate Cannabis Users from Nonusers Based Upon a Photograph.

OBJECTIVE: With increasing legalization of medicinal and recreational cannabis, use is on the rise. Research suggests individuals may be able to guess cannabis user status based upon appearance; however, these findings utilized a small sample of photographs that was not balanced on user status or gender. Further, no studies examined whether raters with cannabis experience are better at judging others' cannabis use, or what physical features they use to make these judgments. This study explored these factors using a larger, balanced photograph database. METHOD: An American sample (n = 249, 48.6% female, mean age = 35.19 years) rated 36 photographs (18 cannabis users, 18 nonusers) balanced on gender and age on the likelihood that the photographed individuals use cannabis, producing 8964 ratings. Respondents also reported physical features considered in their ratings, as well as their own cannabis use history. RESULTS: As hypothesized, photographs of users received higher ratings on the Marijuana Use Likelihood Index relative to nonusers. Further, results revealed a gender by rater user status interaction, indicating that raters with no previous cannabis experience rated males higher than females, while raters with cannabis experience did not demonstrate this rating discrepancy. Cannabis use explained over 9% of the variance in ratings across all photographs. CONCLUSIONS: Results suggest individuals do rate cannabis users as more likely to be users, relative to nonusers, based upon appearance alone. These findings have important implications, not only for research on chronic cannabis use effects, but also for social and achievement factors such as potential stigma.

The D-KEFS Trails as performance validity tests.

This study was designed to examine the potential of the Delis-Kaplan Executive System (D-KEFS) version of the Trail Making Test (TMT) as a performance validity test (PVT). Data were collected from a mixed clinical sample of 157 consecutively referred outpatients (49% male, MAge = 47.1, MEducation = 13.6) undergoing neuropsychological assessment at an academic medical center in the northeastern United States. Sensitivity and specificity of the D-KEFS Trails to psychometrically defined invalid responding was calculated across various cutoffs and criterion PVTs. The D-KEFS Trails produced classification accuracy comparable to the original version of the TMT, hovering around the "Larrabee limit" (.50 sensitivity at .90 specificity). Different cutoffs (age-corrected scaled score ≤5 on Trails 1-3, ≤4 on Trails 4 and ≤8 on Trails 5) were needed to achieve the same classification accuracy across the five trials. Combining multiple cutoffs improved the signal detection performance. The study provides preliminary evidence of the utility of D-KEFS Trails as a PVT. Embedded PVTs are valuable, because they make a multivariate approach to validity assessment feasible. Combining validity indicators is superior to relying on single cutoffs. (PsycINFO Database Record

Cream of the Crop: Clinical Representativeness of Eligible and Ineligible Cannabis Users in Research.

BACKGROUND: Experts have recommended criteria (Gonzalez et al., 2002) for recruiting pure chronic cannabis users (i.e., those without polysubstance use or psychiatric illness) when evaluating cannabis' non-acute effects on cognition. OBJECTIVES: We sought to demonstrate the implications of using such criteria by examining characteristics of respondents who completed an eligibility screening for a parent study evaluating the cognitive effects of chronic cannabis use. METHODS: Over a 3-year, 8-month period, 612 respondents from the community completed an eligibility screening based on recommendations in the cannabis literature. Using independent samples t-tests and chi-square tests, we examined whether qualified/eligible respondents (n = 219) differed from non-qualified/ineligible respondents (n = 393). RESULTS: Compared to ineligible cannabis users, eligible cannabis-using respondents were significantly younger, used cannabis more frequently, used alcohol less frequently, and were less likely to have a history of other drug use, a psychiatric diagnosis, or to have used psychiatric medication. Conclusions/Importance: Our findings indicate that eligible/pure cannabis users are not representative of typical cannabis users in the general community (i.e., ineligible users with polysubstance use and/or psychiatric diagnoses) who ultimately comprised the majority of our cannabis-using sample (65.2%). Thus, typical cannabis users may be more accurately characterized as polysubstance users, posing a number of challenges related to the generalizability of findings from studies utilizing pure samples of cannabis users. Recruiting samples of typical cannabis users will improve external validity in research. Furthermore, reporting comprehensive characteristics of such samples will enable consumers to gauge the applicability of study findings to populations of interest.

Don't Judge a Book by its Cover: Examiner Expectancy Effects Predict Neuropsychological Performance for Individuals Judged as Chronic Cannabis Users.

OBJECTIVE: The experimenter expectancy effect confound remains largely unexplored in neuropsychological research and has never been investigated among cannabis users. This study investigated whether examiner expectancies of cannabis user status affected examinees' neuropsychological performance. METHOD: Participants included 41 cannabis users and 20 non-users. Before testing, examiners who were blind to participant user status privately rated whether they believed the examinee was a cannabis user or non-user. Examiners then administered a battery of neuropsychological and performance validity measures. Multiple regression analyses compared performance between examinees judged as cannabis users (n = 37) and those judged as non-users (n = 24). RESULTS: Examiners' judgments of cannabis users were 75% accurate; judgments of non-users were at chance. After controlling for age, gender, and actual user status, examiner judgments of cannabis user status predicted performance on two measures (California Verbal Learning Test-II, and Trail Making Test B; p < .05), as individuals judged as cannabis users obtained lower scores than those judged as non-users. CONCLUSIONS: Examiners' judgments of cannabis user status predicted performance even after controlling for actual user status, indicating vulnerability to examiner expectancy effects. These findings have important implications for both research and clinical settings, as scores may partially reflect examiners' expectations regarding cannabis effects rather than participants' cognitive abilities. These results demonstrate the need for expectancy effect research in the neuropsychological assessment of all populations, not just cannabis users.

Anorexia nervosa and bulimia nervosa: A meta-analysis of executive functioning.

OBJECTIVE: Research investigating the link between eating disorder (ED) diagnosis and executive dysfunction has had conflicting results, yet no meta-analyses have examined the overall association of ED pathology with executive functioning (EF). METHOD: Effect sizes were extracted from 32 studies comparing ED groups (27 of anorexia nervosa, 9 of bulimia nervosa) with controls to determine the grand mean effect on EF. Analyses included effects for individual EF measures, as well as an age-based subgroup analysis. RESULTS: There was a medium effect of ED diagnosis on executive functioning, with bulimia nervosa demonstrating a larger effect (Hedges's g=-0.70) than anorexia nervosa (g=-0.41). Within anorexia nervosa studies, subgroup analyses were conducted for age and diagnostic subtype. The effect of anorexia nervosa on EF was largest in adults; however, subgroup differences for age were not significant. CONCLUSIONS: Anorexia and bulimia nervosa are associated with EF deficits, which are particularly notable for individuals with bulimia nervosa. The present analysis includes recommendations for future studies regarding study design and EF measurement.