HIV associated neurocognitive disorder screening and diagnosis pathways in Australia: a scoping review and international implications.

Symptomatic HIV-associated neurocognitive disorder (HAND) is a complication of HIV (cognitive impairment, difficulties with everyday functioning). If detected early, interventions assist with optimizing care, avoiding rapid decline and enhancing coping. There remains inconsistency surrounding screening/diagnosis information within Australian healthcare professionals and community settings. A scoping review of academic literature, government policies and non-government organisations (NGOs) was conducted to map existing screening/diagnosis information using the guidelines of Joanna Briggs Institute. A literature search of EBSCOhost and Medline (dates: 2015-2021), the Australian government NGO web domains, Google and unpublished academic works was conducted (July 2021) and updated (December 2022) to identify Australian items (past 5 years). Seventeen items met the inclusion criteria. No government guidelines were identified. Various HIV-related organisations proposed different diagnostic guidelines. Most HAND research originated in Sydney. The most accessible information was from Dementia Australia, with some inaccuracies noted. There is scant Australian research/information on HAND screening/diagnosis. HAND translational research and screening/diagnosis standards are urgently needed to inform best practices. The Australian context is used to discuss international implications regarding higher-income countries with similar patterns/healthcare.

A randomised controlled trial of a web-based multi-modal therapy program to improve executive functioning in children and adolescents with acquired brain injury.

OBJECTIVE: To examine the efficacy of a multi-modal web-based therapy program, Move it to improve it (Mitii™) delivered at home to improve Executive Functioning (EF) in children with an acquired brain injury (ABI). DESIGN: Randomised Waitlist controlled trial. SETTING: Home environment. PARTICIPANTS: Sixty children with an ABI were matched in pairs by age and intelligence quotient then randomised to either 20-weeks of Mitii™ training or 20 weeks of Care As Usual (waitlist control; n=30; 17 males; mean age=11y, 11m (±2y, 6m); Full Scale IQ=76.24±17.84). Fifty-eight children completed baseline assessments (32 males; mean age=11.87±2.47; Full Scale IQ=75.21±16.76). MAIN MEASURES: Executive functioning was assessed on four domains: attentional control, cognitive flexibility, goal setting, and information processing using subtests from the Wechsler Intelligence Scale for Children (WISC-IV), Delis-Kaplan Executive Functioning System (D-KEFS), Comprehensive Trail Making Test (CTMT), Tower of London (TOL), and Test of Everyday Attention for Children (Tea-Ch). Executive functioning performance in everyday life was assessed via parent questionnaire (Behaviour Rating Inventory of Executive Functioning; BRIEF). RESULTS: No differences were observed at baseline measures. Groups were compared at 20-weeks using linear regression with no significant differences found between groups on all measures of EF. Out of a potential total dose of 60 hours, children in the Mitii™ group completed a mean of 17 hours of Mitii™ intervention. CONCLUSION: Results indicate no additional benefit to receiving Mitii™ compared to standard care. Mitii™, in its current form, was not shown to improve EF in children with ABI.

Mitii™ ABI: study protocol of a randomised controlled trial of a web-based multi-modal training program for children and adolescents with an Acquired Brain Injury (ABI).

BACKGROUND: Acquired brain injury (ABI) refers to multiple disabilities arising from damage to the brain acquired after birth. Children with an ABI may experience physical, cognitive, social and emotional-behavioural impairments which can impact their ability to participate in activities of daily living (ADL). Recent developments in technology have led to the emergence of internet-delivered therapy programs. "Move it to improve it" (Mitii™) is a web-based multi-modal therapy that comprises upper limb (UL) and cognitive training within the context of meaningful physical activity. The proposed study aims to compare the efficacy of Mitii™ to usual care to improve ADL motor and processing skills, gross motor capacity, UL and executive functioning in a randomised waitlist controlled trial. METHODS/DESIGN: Sixty independently ambulant children (30 in each group) at least 12 months post ABI will be recruited to participate in this trial. Children will be matched in pairs at baseline and randomly allocated to receive either 20 weeks of Mitii™ training (30 min per day, six days a week, with a potential total dose of 60 h) immediately, or be waitlisted for 20 weeks. Outcomes will be assessed at baseline, immediately post-intervention and at 20 weeks post-intervention. The primary outcomes will be the Assessment of Motor and Process Skills and 30 s repetition maximum of functional strength exercises (sit-to-stand, step-ups and half kneel to stand). Measures of body structure and functions, activity, participation and quality of life will assess the efficacy of Mitii™ across all domains of the International Classification of Functioning, Disability and Health framework. A subset of children will undertake three tesla (3T) magnetic resonance imaging scans to evaluate functional neurovascular changes, structural imaging, diffusion imaging and resting state functional connectivity before and after intervention. DISCUSSION: Mitii™ provides an alternative approach to deliver intensive therapy for children with an ABI in the convenience of the home environment. If Mitii™ is found to be effective, it may offer an accessible and inexpensive intervention option to increase therapy dose. TRIAL REGISTRATION: ANZCTR12613000403730.

Empathy Measurement in Autistic and Nonautistic Adults: A COSMIN Systematic Literature Review.

Empathy is essential for social functioning and is relevant to a host of clinical conditions. This COSMIN review evaluated the empirical support for empathy self-report measures used with autistic and nonautistic adults. Given autism is characterized by social differences, it is the subject of a substantial proportion of empathy research. Therefore, this review uses autism as a lens through which to scrutinize the psychometric quality of empathy measures. Of the 19 measures identified, five demonstrated "High-Quality" evidence for "Insufficient" properties and cannot be recommended. The remaining 14 had noteworthy gaps in evidence and require further evaluation before use with either group. Without tests of measurement invariance or differential item functioning, the extent to which observed group differences represent actual trait differences remains unknown. Using autism as a test case highlights an alarming tendency for empathy measures to be used to characterize, and potentially malign vulnerable populations before sufficient validation.

The Development of a Motor-Free Short-Form of the Wechsler Intelligence Scale for Children-Fifth Edition.

Purpose. This study aimed to develop a motor-free short-form of the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) that allows clinicians to estimate the Full Scale Intelligence Quotients of youths with motor impairments. Method. Using the reliabilities and intercorrelations of six WISC-V motor-free subtests, psychometric methodologies were applied to develop look-up tables for four Motor-free Short-form indices: Verbal Comprehension Short-form, Perceptual Reasoning Short-form, Working Memory Short-form, and a Motor-free Intelligence Quotient. Index-level discrepancy tables were developed using the same methods to allow clinicians to statistically compare visual, verbal, and working memory abilities. Results. The short-form indices had excellent reliabilities (r = .92-.97) comparable to the original WISC-V. Conclusion. This motor-free short-form of the WISC-V is a reliable alternative for the assessment of intellectual functioning in youths with motor impairments. Clinicians are provided with user-friendly look-up tables, index level discrepancy tables, and base rates, displayed similar to those in the WISC-V manuals to enable interpretation of assessment results.

How Small Is Big: Sample Size and Skewness.

Sample sizes of 50 have been cited as sufficient to obtain stable means and standard deviations in normative test data. The influence of skewness on this minimum number, however, has not been evaluated. Normative test data with varying levels of skewness were compiled for 12 measures from 7 tests collected as part of ongoing normative studies in Brisbane, Australia. Means and standard deviations were computed from sample sizes of 10 to 100 drawn with replacement from larger samples of 272 to 973 cases. The minimum sample size was determined by the number at which both mean and standard deviation estimates remained within the 90% confidence intervals surrounding the population estimates. Sample sizes of greater than 85 were found to generate stable means and standard deviations regardless of the level of skewness, with smaller samples required in skewed distributions. A formula was derived to compute recommended sample size at differing levels of skewness.

Discrepancy analysis and Australian norms for the Trail Making Test.

OBJECTIVE: Discrepancy analyses refer to comparison methods that evaluate the relationship or differences between two measures in the same individual. A common type of discrepancy analysis involves the comparison of two trials within a measure, such as, Trails A and B of the Trail Making Test (TMT). The TMT is well-suited to this role as the two measures are highly correlated, assess similar underlying constructs, and most importantly demonstrate differential vulnerability to the impact of pathology. While the inclusion of these types of data in the form of difference scores or ratios has become more frequent, this information has been presented only for demographically adjusted subgroups and has not taken into account the level of performance of the comparison trial, Trails A. METHOD: The role and advantages of discrepancy analysis with the TMT stratified by level of Trails A performance were demonstrated with an Australian normative sample of 647 participants and a heterogeneous clinical sample consisting of 2,292 Australian and U.S. RESULTS: The ability to differentiate between the influence of slowed visual scanning and/or graphomotor speed, and reduced mental flexibility was demonstrated by applying the normative data to clinical case discrepancies. The importance of accounting for the variability in discrepancy scores associated with the level of performance of Trails A was also highlighted. CONCLUSION: A simple, efficient, and effective approach to examining the basis for differences between TMT-A and TMT-B performances is provided to examine the relative contributions of perceptual/motor abilities, and mental flexibility.

Randomized controlled trial of a web-based multi-modal therapy program for executive functioning in children and adolescents with unilateral cerebral palsy.

Purpose state: Determine the efficacy of Move-it-to-improve-it (Mitii™), a multi-modal web-based program, in improving Executive Function (EF) in children with unilateral cerebral palsy (UCP). METHOD: Participants (n = 102) were matched in pairs then randomized to: intervention (Mitii™ for 20 weeks; n = 51; 26 males; mean age = 11 years 8 months (SD = 2 years 4 months); Full Scale IQ = 84.65 (SD = 15.19); 28 left UCP; GMFCS-E&R (I = 20, II = 31) or waitlist control (n = 50; 25 males; mean age = 11 years 10 months (SD = 2 years 5 months); Full Scale IQ = 80.75 (SD = 19.81); 20 left UCP; GMFCS-E&R (I = 25, II = 25). Mitii™ targeted working memory (WM), visual processing (VP), upper limb co-ordination and physical activity. EF capacity was assessed: attentional control (DSB; WISC-IV); cognitive flexibility (inhibition and number-letter sequencing DKEFS); goal setting (D-KEFs Tower Test); and information processing (WISC-IV Symbol Search and Coding). EF performance was assessed via parent report (BRIEF). Groups were compared at 20 weeks using linear regression (SPSS 21). RESULTS: There were no significant between group differences in attentional control (DSB; p = 0.20;CI= -0.40,1.87); cognitive flexibility (Inhibition, p = 0.34; CI= -0.73,2.11; number/letter sequencing, p = 0.17; CI= -0.55,2.94); problem solving (Tower; p = 0.28; CI= -0.61,2.09), information processing (Symbol; p = 0.08; CI= -0.16, 2.75; Coding; p = 0.07; CI= -0.12,2.52) or EF performance (p = 0.13; CI= -10.04,1.38). CONCLUSION: In a large RCT, MitiiTM did not lead to significant improvements on measures of EF or parent ratings of EF performance in children with UCP. Implications for rehabilitation A large RCT of the multi-modal web based training; Move It to Improve It (MitiiTM) improves motor processing, visual perception, and physical capacity but does demonstrate statistically significant improvements or clinical significance in executive function in children with mild to moderate unilateral cerebral palsy (UCP). MitiiTM training completed by an intervention group was highly variable with few children reaching the target dosage of 60 h. Technical issues including server and internet connectively problems lead to disengagement with the program. Web-based training delivered in the home has the potential to increase therapy dose and accessibility, however, MitiiTM needs to be tailored to include tasks involving goal-setting, more complex problem solving using multi-dimensional strategies, mental flexibility, switching between two cognitively demanding tasks, and greater novelty in order to increase the cognitive component and challenge required to drive changes in EF.

Adult Verbal Abstract Reasoning Assessment Instruments and their Clinimetric Properties.

OBJECTIVE: This systematic review aims to identify, examine, and compare tests used to measure and assess verbal abstract reasoning (VAR). METHOD: Seven tests were identified through a systematic search of electronic databases, neuropsychological textbooks, and online catalogs. Clinical utility, normative data, and psychometric properties (internal consistency, test-retest reliability, and construct validity) of current test versions were evaluated using recent studies. A modified version of the CanChild Outcome Measures Rating Form, and structured quality assessment criteria were used in the evaluation process. RESULTS: The WAIS-IV Similarities subtest was ranked the highest, followed by the Shipley-2 Abstraction test and Gorham's Proverbs test. These three tests had sufficient validity to recommend their use, however some caution is advised for the latter two in terms of construct purity, and age of normative data, respectively. Other tests reviewed were the Delis-Kaplan Executive Functioning System Proverbs subtest, the Stanford-Binet Intelligence Scale fifth edition Verbal Analogies subtests, the Conceptual Level Analogy Test, and the Verbal Concept Attainment Test. For the majority of tests, construct validity was lacking while reliabilities were sufficient. CONCLUSIONS: Lack of sound psychometric evidence limits the range of options for the practitioner to choose a test with confidence to assess VAR. While there is merit in the clinical utility of the majority of assessment instruments evaluated in this review, caution is recommended before deciding to use a test that does not carry sufficient psychometric evidence to support its use. Further research is recommended to improve the library of tests available to clinicians and researchers.

Stability of executive functioning measures in 8-17-year-old children with unilateral cerebral palsy.

The study investigated the stability of executive functioning (EF) measures in children and adolescents aged 8-17 years with unilateral cerebral palsy (CP). Here 44 participants with unilateral CP (mean age = 11 years, 11 months; Manual Abilities Classification Scale Level I = 6 and Level II = 37; Gross Motor Function Classification Scale Level I = 22 and Level II = 22) were randomized into the wait-list control group of a large randomized controlled trial. Participants had baseline testing with Wechsler Intelligence Scale for Children--Fourth Edition Short Form (WISC-IV-SF) and Delis-Kaplan Executive Function System (D-KEFS) subtests. Parents completed the Behavior Rating Inventory of Executive Functioning (BRIEF). Participants were re-assessed 20 ±2 weeks later with a shortened test battery including the D-KEFS subtests; Digit Span, Coding and Symbol Search (WISC-IV); and BRIEF. Pearson's test-retest reliabilities and Reliable change scores were calculated. Results indicated excellent to fair test-retest reliabilities (r = 0.91-0.74) for all measures except Digit Span Backwards (r = 0.62), Inhibition (r = 0.69), and Initiate (r = 0.68). Reliable change scores applying 90% confidence intervals for estimating reliable change while accounting for practice effects were provided for all measures. The data support the stability of EF measures in this population.