Identification of individuals with ADHD using the Dean-Woodcock sensory motor battery and a boosted tree algorithm.

The accurate and early identification of individuals with pervasive conditions such as attention deficit hyperactivity disorder (ADHD) is crucial to ensuring that they receive appropriate and timely assistance and treatment. Heretofore, identification of such individuals has proven somewhat difficult, typically involving clinical decision making based on descriptions and observations of behavior, in conjunction with the administration of cognitive assessments. The present study reports on the use of a sensory motor battery in conjunction with a recursive partitioning computer algorithm, boosted trees, to develop a prediction heuristic for identifying individuals with ADHD. Results of the study demonstrate that this method is able to do so with accuracy rates of over 95 %, much higher than the popular logistic regression model against which it was compared. Implications of these results for practice are provided.

Differential diagnosis of depression and Alzheimer's disease using the Cattell-Horn-Carroll theory.

Clinical differentiation between Alzheimer's disease (AD) and depression is often difficult due to symptom overlap and similar clinical presentation. Concise and accurate diagnostic tests have been of interest for many years. Furthermore, with the continued growth of the Cattell-Horn-Carroll (CHC) theory, there has been an emergence of measures such as the Woodcock-Johnson-III Tests of Cognitive Abilities (WJ-III COG), which are being more commonly used in clinical practice yet have not been fully evaluated in terms of their efficacy in various domains of clinical practice. This study investigated the predictive and diagnostic properties of the WJ-III COG as a CHC-based test in differentiating between AD and depression in the elderly population. A discriminative function used in the study was able to correctly classify 89.02% of cases using six areas of the CHC framework. The variables that had the highest predictive weights were: long-term retrieval, fluid reasoning, processing speed, and working memory. The main implication is that a theory-based approach is crucial in the support of differential diagnosis and in decreasing the length of assessment for elderly populations.

Assessing sensory-motor deficits in pediatric traumatic brain injury.

The assessment of sensory-motor functions is a key component of pediatric neuropsychological evaluations following traumatic brain injury (TBI). Sensory-motor processes have recently been shown to be related to larger neural structures and functions, rather than a secondary role played in the past. Recent research has shown sensory-motor functioning serves as a marker for the integrity of the central nervous system. Children's behavior following a TBI has greater variation than seen in adults, which may well relate to greater natural variation and maturational effects. With the recent findings of greater importance of sensory-motor functions, the need for psychometrically sound measures is stressed and various measures are outlined.

The presence and predictive value of astereognosis and agraphesthesia in patients with Alzheimer's disease.

Sensory and motor functions are good markers of neurocognitive decline due to their proximity and hierarchical relationship to high-order processes. The current study investigated if patients with Alzheimer's disease (AD) differed from a healthy control group in two tactile perceptual processes: astereognosis and agraphesthesia. Analyses were also conducted to see if these tactile processes were predictive of higher-order cognitive functioning. Twenty-eight patients with AD (mean age = 75.86) were compared to 28 healthy control subjects (mean age = 76.38) and were administered the Dean-Woodcock Sensory Motor Battery and the Woodcock-Johnson Psychoeducational Battery-Revised. Results suggest the patients with AD demonstrated significantly higher levels of tactile disturbance and astereognosis while agraphesthesia was able to predict a substantial portion of the variance in 3/7 cognitive tests and 4/7 cognitive tests, respectively. This included measures of fluid reasoning, visual processing, crystallized language, short-term memory, and auditory processing. These results suggest that astereognosis and agraphesthesia may be good markers of the extent of cognitive impairment in AD and should be included in neuropsychological evaluations due to their functional importance.

Cortical and subcortical sensory-motor impairment in patients with major depression: a preliminary analysis.

Assessment of patients with depression tends to focus on the psychiatric symptoms of the disorder to quantify distress, potential for suicide, and helps determine the appropriate course of treatment. However, research increasingly reveals comorbid organic and biological deficits in higher order cortical skills and subcortical processes which should be considered when assessing the depressed patient. The current study investigated the presence of cortical and subcortical sensory deficits in a group of 36 patients with Major Depressive Disorder as compared to a group of normal controls. The results of a MANOVA indicated a significant performance difference between depressed and nondepressed participants (Wilks' Lambda = .437, F = 3.68, p > .001). Subsequent univariate tests showed normals performed better on 29 of 35 variables of a sensory-motor battery. Deficits in sensory and motor functioning can have a profound impact on patient functioning and may remit with treatment. Thus, a comprehensive neuropsychological battery for patients with depression should include standardized and psychometrically sound measures of sensory and motor functioning.

Predicting global and specific neurological impairment with sensory-motor functioning.

The present study assessed the ability of the Dean-Woodcock Sensory-Motor Battery (DWSMB) to distinguish between normal subjects and neurologically impaired individuals. Scores from the subtests of the DWSMB for 250 normal and 250 neurologically impaired individuals were randomly assigned to two equal groups to allow for cross-validation. The DWSMB was able to correctly identify 92.8% of the cases, identifying 94.4% of the normal population and 91.2% of the neurologically impaired subjects. The cross-validation correctly identified 87.2% of the total cases, identifying 91.2% of the normal subjects and 83.2% of the neurologically impaired subjects. An additional discriminant analysis indicated that the DWSMB correctly identified the following cases: 44.9% cardio-vascular accidents, 66.7% multiple sclerosis, 40% seizures, 42% traumatic brain injuries, 62.7% dementia, and 54.5% Parkinson's disease. The results add to the validity of the DWSMB by providing evidence of its ability to differentiate between neurologically impaired and normal individuals.

Neurocognitive Problems in Children and Adolescents With Depression Using the CHC Theory and the WJ-III.

Depression has been commonly associated with both subjective complaints and objectively measured problems in cognition. Most commonly discussed in relation to the adult population, growing evidence has supported the idea that children and adolescents experience cognitive problems in relation to depression. The purpose of this study was to further examine the negative influence of depression on the cognitive functioning of children and adolescents. Additionally, the present study evaluated the sensitivity of the Woodcock-Johnson III Test of Cognitive Abilities (WJ-III-COG) and, in turn, the Cattell-Horn-Carroll (CHC) theory in measuring cognitive problems related to depression in children and adolescents. Participants included 420 children and adolescents aged 8 to 18 years old (M = 13.09, SD = 2.95) with a clinical diagnosis of depression. Comparisons were made against the normative mean. All participants completed 11 subtests of the WJ-III-COG including Visual-Auditory Learning, Spatial Relations, Sound Blending, Concept Formations, Visual Matching, Numbers Reversed, Auditory-Working Memory, Picture Recognition, Analysis Synthesis, Decision Speed, and Memory for Words. Children and adolescents with depression demonstrated significantly lower performance on subtests related to learning and memory (long-term retrieval), attentional capacity, working memory, reasoning, and processing speed. No problems were noted on subtests related to visual-spatial thinking and auditory processing. Findings suggested sensitivity of the WJ-III-COG and CHC theory in identifying cognitive problems associated with depression in children and adolescents.

Finger agnosia and cognitive deficits in patients with Alzheimer's disease.

The purpose of this study was to examine the presence of finger agnosia in patients with Alzheimer's disease (AD) and to determine if level of finger agnosia was related to cognitive impairment. Finger agnosia is a sensitive measure of cerebral impairment and is associated with neurofunctional areas implicated in AD. Using a standardized and norm-referenced approach, results indicated that patients with AD evidenced significantly decreased performance on tests of bilateral finger agnosia compared with healthy age-matched controls. Finger agnosia was predictive of cognitive dysfunction on four of seven domains, including: Crystallized Language, Fluid Processing, Associative Learning, and Processing Speed. Results suggest that measures of finger agnosia, a short and simple test, may be useful in the early detection of AD.

The canonical relationship between sensory-motor functioning and cognitive processing in children with attention-deficit/hyperactivity disorder.

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) typically exhibits a pattern of behavioral deficits, impairment in academic achievement, and cognitive processing, and presents with sensory-motor deficits. This study examined the relationships between sensory-motor tasks, cognitive processing, and academic achievement for a group of 67 children with ADHD. Strong canonical correlations emerged between sensory-motor functioning and academic achievement (.93) and sensory-motor functioning and cognitive processing (.98). An analysis of the redundancy coefficient showed that sensory-motor skills accounted for 65% of the variance in the achievement variables and 31% of the variance in the cognitive processing variables. The strong relationship between sensory-motor skills and higher order cognitive processes indicates that early assessment of sensory-motor skills may be useful in the identification of subsequent deficits in academic performance. Neuropsychologists should carefully consider the contribution of sensory-motor functioning to the more widely studied and assessed constructs of academic, behavioral, and emotional problems in children with ADHD.

Evidence of construct similarity in Executive Functions and Fluid Reasoning abilities.

Executive Functions and Fluid Reasoning are both considered to be core aspects of intelligence and mediated by frontal lobe functioning. However, both constructs considerably overlap, and the distinction between the two constructs is unclear. For this study, three measures of Executive Functions and three measures of Fluid Reasoning were administered to a group of participants. Significant correlations were found establishing an empirical association between these two constructs. Factor analysis and confirmatory factor analysis also provide evidence for construct similarity. Future research in defining these constructs for measurement purposes and using tests of these constructs in clinical practice is discussed.

Classification and regression tree analysis of a neurologically impaired and normal sample using sensory-motor tasks.

The ability to differentiate between neurologically impaired and normal individuals is an important component in a valid neuropsychological battery. However, limited research exists regarding the ability of sensory-motor batteries to differentiate between the two groups. This study used Classification and Regression Tree Analysis (CART) to identify which measures of sensory-motor functioning from the Dean-Woodcock Sensory Motor Battery (DWSMB) would best differentiate between neurologically impaired and normal individuals, as well as identify which subtests would provide the best pathognomic power. The results revealed that a number of clinically useful nodes emerged that enabled the differentiation between groups with a small number of tasks. The primary separation variable was the Gait and Station subtest, a measure of subcortical motor functioning. Auditory Acuity and Clock Construction also provide important pathognomic information. A cross validation was conducted to determine the integrity of the generated decision tree, and results revealed that the generated model correctly predicted 84.5% of the normal group and 71.4% of the neurologically impaired sample. The results from the present analysis provides further evidence for the construct validity of the DWSMB.

Cortical and subcortical constructs of the dean-woodcock sensory motor battery: a construct validity study.

The factor structure of the Dean-Woodcock Sensory Motor Battery was examined using exploratory factor analysis with promax rotation. Participants (n = 1,651) were composed of 701 neurologically impaired individuals and 950 normal individuals. Three factors, accounting for almost 58.2% of the total test variation, emerged from the data and were labeled Simple Sensory Skills, Motor and Complex Sensory Skills, and Subcortical Motor Skills and Auditory/Visual Acuity. Hypothesized cross loadings were present, especially between the first two factors, which highlighted the parallel nature of sensory-motor skills. The third factor demonstrated the least amount of cross loadings, which reinforced the demarcation of cortical and subcortical motor skills measured by the DWSMB. The results also indicated that the factors were separated by the complexity of the cortical sensory-motor tasks. The factor structure, combined with an analysis of the interfactor correlations, provides evidence for construct validity of the DWSMB.

Neuropsychological measures and single photon emission computed tomography in the differentiation and classification of cerebral perfusion deficits in Alzheimer's dementia.

The accurate diagnosis of Dementia of the Alzheimer's Type (DAT) continues to be an area of difficulty for the fields of neuropsychology and neurology. The introduction of new medications that appear to mediate the insidious progression of the disorder increases the need for timely differentiation of DAT from other dementia-related disorders. The present study examined the relationship between hemispheric differences in regional cerebral blood flow with corresponding lateral neuropsychological processing deficits in patients with DAT. Eighty patients with a diagnosis of DAT were administered Single Photon Emission Computerized Tomography (SPECT) scans and a battery of left and right hemisphere neuropsychological-based tasks. The results of ANOVA indicated that patients with DAT who were not suffering from perfusion deficits exhibited significantly fewer neuropsychological deficits than did patients with DAT who had perfusion deficits. The neuropsychological tests that measured verbal ability, logical memory, word-pair learning, reading, arithmetic, and visual-perceptual organization were all significantly lower in the group with perfusion deficits. Further analysis indicated that patients with left hemisphere perfusion deficits tended to have poorer neuropsychological skills than did individuals with right hemisphere perfusion deficits, diffuse perfusion deficits, and no perfusion deficits. A Stepwise Discriminant Analysis was unable to use the neuropsychological variables to classify patients accurately into perfusion deficit groups.

The efficacy of neuropsychological symptom inventory in the differential diagnosis of medical, psychiatric, and malingering patients.

The present study was conducted to examine patient responses to the Neuropsychological Symptom Inventory (NSI) and attempted to discriminate among medical, psychiatric, and simulated malingering patients. Results indicated that the NSI was able to significantly discriminate malingered responses from medical and psychiatric patient responses. However, applying a lie scale derived from previous research with the NSI did not allow discrimination between the malingered group and the psychiatric patients. Using the factors of the NSI derived from earlier research offered both greater detection of malingerers and enhanced evaluation of symptom profiles of medical and psychiatric patients. The NSI provides an efficient screen for exaggerated symptoms, as well as an indication of the level of general neuropsychological functioning of the patient when included in a neuropsychological evaluation.

Utility analysis for clinical decision-making in small treatment settings.

Data-driven clinical decision-making can be difficult in settings that service relatively few patients because of the small samples available, the patients' potential dissimilarity from participants in published research, and highly limited resources. This study was designed to demonstrate how utility analyses might assist clinical decision-making in small treatment settings and provide data for promoting programmatic improvements. Data came from a study to identify rural juvenile delinquents suspected to not benefit from residential behavioral treatment. A prospective correlational design was used with data from a midwestern juvenile criminal justice residential unit in which about 30 males were treated annually. Outcomes included treatment performance measures and number of delinquent offenses during the year after treatment. Utility analyses suggested that delinquents who were less likely to benefit from residential treatment could be identified a priori using a modified Psychopathy Checklist, Revised. Cost utility analysis estimated $180,000 less would be spent on residential treatment as a result of selecting residents based on the pretreatment assessment. This money might be reallocated toward alternative intervention for delinquents who are not likely to benefit from the residential treatment. More importantly, results suggested specific alternative interventions for the delinquents who were less likely to benefit from the treatment by providing direct links to existing literature. Advantages of utility analysis research include strong external validity, minimal interference with treatment during data collection, results that estimate clinical and practical significance, and results that are easily communicated to laymen.

Predicting scores of the Halstead Category Test with the WAIS-III.

The Halstead Category Test (HCT) and the Wechsler Adult Intelligence Scale (WAIS) are two of the most widely used neuropsychological tests. Often assessment conclusions are dependent upon the comparison of these measures. Therefore, it is crucial for clinicians to know how they relate to one another. This study examined the relationship between the HCT and the WAIS-III with undergraduate psychology students. Correlational analyses were conducted between HCT scores and WAIS-III subtests, Verbal and Performance IQ, and Full Scale IQ scores. Additionally, the new WAIS-III scales (Letter-Number Sequencing, Matrix Reasoning, and Symbol Search) were further examined. Regression analyses were run to develop predictor equations for the HCT using VIQ, PIQ, and FSIQ. Finally, predictor tables were generated between the HCT and VIQ, PIQ, and FSIQ to provide assessment of brain dysfunction for clinical use.

Attention deficit/hyperactivity disorder and working memory in clinically referred adults.

A current theory of attention deficit/hyperactivity disorder (ADHD) implicates a dysfunction in working memory as a significant factor in ADHD. The Working Memory Indexes of the Wechsler Adult Intelligence Scale--Third Edition (WAIS-III; The Psychological Corporation, 1997a) and the Wechsler Memory Scale--Third Edition (WMS-III; The Psychological Corp -oration, 1997b) were used to evaluate this theory. Seventy adults clinically diagnosed with ADHD (mean age = 25) and who were previously administered the WAIS-III and WMS-III were reviewed to determine the association between working memory and ADHD symptomology. The respondent was asked to estimate the frequency of occurrence of ADHD symptoms by completing the Brown ADD Scales (Brown, 1996). Results indicated no significant relationship between working memory and self-reported symptoms, although the Working Memory Indexes of the WAIS-III and the WMS-III were significantly correlated. Implications for current ADHD theory and suggestions for future research were discussed.

Diagnosing attention disorders with measures of neurocognitive functioning.

The validity of the Differential Ability Scales (DAS; Elliott, 1990) in predicting attention disorders in school-aged children was examined. The participants were 40 children diagnosed with attention deficit/hyperactivity disorder (ADHD) and 40 normal children between 7 and 12 years of age. Comorbidity was controlled by excluding children with ADHD who had a concurrent DSM-IV diagnosis such as reading disability, learning disability, mood disorder, or behavioral disorder. In addition, groups did not differ significantly by sex, age, racial/ethnic identification, or parental educational level. A stepwise discriminant analysis indicated the DAS correctly classified 72.5% of the total sample when either the Sequential and Quantitative Reasoning subtest or the Recall of Digits subtest was used to predict group membership. In general, the DAS core subtests were found to be good measures of cognitive ability in children classified with ADHD and did not appear to be influenced by attention problems.

Perinatal complications as predictors of infantile autism.

This study investigated the relationship between reported perinatal complications and autism. The biological mothers of 183 autistic children and 209 normals completed the Maternal Perinatal Scale (MPS), a maternal self-report that surveys complications of pregnancies and medical conditions of the mother. Previous research in this area has been limited, with no definitive conclusions. A discriminant analysis was performed to consider perinatal complications as predictors between the autistic and normal subjects. Using the MPS, 65% of the autistic cases were correctly grouped. The results further indicated significant differences on 3 of the 10 factors of the MPS, in particular, Gestational Age, Maternal Morphology, and Intrauterine Stress. When considered in an item by item fashion, 5 items were found to significantly predict group membership (prescriptions taken during pregnancy, length of labor, viral infection, abnormal presentation at delivery, and low birth weight). Finally, 3 maternal medical conditions were found to be highly significant and contribute to the separation between groups, including urinary infection, high temperatures, and depression.

Generalizability of sensory and motor tests.

Differences between practitioners in the selection of tests of specific pathognomonic sensory and motor signs, administration procedures, and scoring criteria have resulted in inconsistencies that have confounded attempts to study the incidence and patterns of deficits. Tests of sensory-motor functioning have been standardized in the Dean-Woodcock Sensory-Motor Battery (D-WSMB; Dean and Woodcock, in preparation). This study used the D-WSMB to: (a) estimate the point-prevalence of pathognomonic signs in a normal adult; (b) identify items with difficulty levels likely to result in overidentification of abnormality; (c) estimate the interrater agreement and reliability for items; and (d) identify tests most vulnerable to subjective interpretation. Results suggested adequate to excellent rater agreement and reliability. Specific minor modifications are recommended to improve the reliability of these tests.