Neurocognitive Intraindividual Variability in Veterans with Mild Traumatic Brain Injury History and Posttraumatic Stress Disorder.

OBJECTIVE: Veterans with a history of blast-related mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) may be at risk for greater cognitive concerns and worse functional outcomes compared to those with either condition in isolation. However, traditional neuropsychological assessment approaches have yielded equivocal results in these populations. The present study examined an alternative method for detecting subtle cognitive inefficiencies: neurocognitive intraindividual variability (IIV), a measure of within-person performance consistency. METHOD: Participants were 79 male Veterans with a history of blast-related mTBI and current PTSD (mTBI/PTSD group; n = 54) or neither diagnosis (controls; n = 25). Mean T-scores and IIV scores were calculated from neuropsychological measures of attention and speed of information processing (A/SoP) as well as executive functioning (EF). RESULTS: Global IIV was significantly higher in the mTBI/PTSD group compared to controls (p = .047, Cohen's d = 0.49). At the domain level, larger effect sizes were observed for EF IIV (Cohen's d = 0.46) compared to A/SoP IIV (d = 0.32), although neither were statistically significant. Within the mTBI/PTSD group, higher Global IIV was associated with worse self-reported executive dysfunction, psychological quality of life, and cognitive post-concussive symptoms; at the domain level, these clinical outcomes were generally associated with greater A/SoP IIV (but not EF IIV). CONCLUSION: Findings extend previous investigations of neurocognitive IIV in individuals with a history of mTBI across PTSD status. Among Veterans with a history of mTBI and comorbid PTSD, neurocognitive variability may be a better indicator of self-reported cognitive inefficiencies and Veteran experience of daily cognitive functioning than mean neuropsychological performances.

Base rates of healthy community-dwelling adults meeting criteria for traumatic encephalopathy syndrome and levels of chronic traumatic encephalopathy certainty.

Objective: The National Institute of Neurological Disorders and Stroke (NINDS) recently revised criteria for Traumatic Encephalopathy Syndrome (TES) (Katz et al.), aiming to improve the specificity of former TES criteria (Montenigro et al.) and adding methods to gauge certainty of underlying Chronic Traumatic Encephalopathy (CTE). This study examined base rates of Montenigro et al. and Katz et al. TES criteria in healthy community-dwelling adults. Method: Participants consisted of healthy adults (n = 835; M = 48.1 ± 18.2 years-old, range = 18-85; 37.1% male; 64.1% White) without known history of neurotrauma or psychiatric or neurological conditions. The former and current TES criteria were operationalized using the NIH Toolbox Cognition, Motor, and Emotion batteries and PROMIS-29. Results: Per Katz et al. criteria, 36.9% had symptoms Suggestive of CTE (i.e. either cognitive impairment or neurobehavioral dysregulation), 4.1% had Possible CTE (i.e. requiring cognitive impairment and two additional criteria), and 0.8% had Probable CTE (i.e. requiring cognitive impairment and three additional criteria). The requirement of cognitive impairment for Possible CTE certainty decreased the base rate of Possible CTE tenfold from Montenigro et al. criteria (40.1%). Conclusion: The Katz et al. criteria were met less frequently by healthy adults than the Montenigro et al. criteria. Requiring cognitive impairment and more supportive TES features when gauging CTE certainty may reduce false-positive diagnoses. This finding supports the role of neuropsychologists in the diagnosis and monitoring of patients in TES research studies. To assess specificity, future research should examine base rates of Katz et al. criteria in other psychiatric and neurological conditions.

Depression, anxiety, and posttraumatic stress in women with and without brain injuries due to intimate partner violence: Psychometric evaluation of measurement approaches and group comparisons.

PURPOSE/OBJECTIVE: The current study examined the psychometric properties of common mental health questionnaires among women survivors of intimate partner violence (IPV) with and without brain injuries due to IPV and evaluated whether women with and without IPV-related brain injuries differed in depression, anxiety, and posttraumatic stress disorder (PTSD) symptom severity. RESEARCH METHOD/DESIGN: Women survivors of IPV with and without IPV-related brain injuries were recruited online through Prolific (N = 205, M = 39.8 ± 11.9 years old, 83.9% non-Hispanic White, 42.4% college-educated). They completed the eight-item Patient Health Questionnaire (PHQ-8), seven-item Generalized Anxiety Disorder scale (GAD-7), and PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (PCL-5). Model fit and internal consistency were estimated for each scale. Groups were compared on mental health symptom severity, with and without controlling for age, education, and IPV severity. RESULTS: Both one-factor and multifactor models showed excellent fit for all scales. PHQ-8 (ω = .91), GAD-7 (ω = .94), and PCL-5 total scores (ω = .95) had strong reliability, and all subscale scores had acceptable-to-strong reliability (ω range = .79-.94). Women with IPV-related brain injuries reported greater physical IPV severity, higher rates of depression, and higher somatic anxiety and PTSD symptom severity. No group differences in mental health symptoms were significant after controlling for IPV severity. CONCLUSIONS/IMPLICATIONS: The PHQ-8, GAD-7, and PCL-5 showed evidence for reliability and validity among women survivors of IPV. Women with IPV-related brain injuries had higher PTSD symptom severity, attributable to greater physical violence exposure in general. Brain injury screening among survivors appears warranted for women with extensive physical IPV experiences. Interventions addressing PTSD, violence prevention, and brain injury recovery may best serve this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Intraindividual Variability in Attention-Deficit/Hyperactivity Disorder: An Ex-Gaussian Approach.

Higher intraindividual variability (IIV) of response times is consistently noted in children with attention-deficit/hyperactivity disorder (ADHD). The current study investigated whether an ex-Gaussian estimate of IIV in children ages 6-13 years-old could differentiate between children with and without ADHD. Children completed a computerized go/no-go task to estimate trial-by-trial IIV and a continuous performance test (CPT) to estimate inattention and hyperactivity/impulsivity. Parents completed questionnaires assessing inattention and hyperactive/impulsive behaviors. IIV, commission errors, and attention problems as rated by parents were significantly greater in the ADHD group. Groups did not differ on errors of omission, but IIV was predictive of omission errors and parent ratings of inattention and hyperactivity/impulsivity. IIV predicted group membership (ADHD vs Control) whereas errors of omission did not. However, IIV did not improve diagnostic accuracy when parent ratings were used, such that parent ratings were superior at determining diagnosis. Current results support the use of IIV, based on the ex-Gaussian approach, as an objective measure of attention problems over omission errors on sustained attention CPT-type tasks. Additionally, while parent ratings of attention impairment remain the best predictor of ADHD diagnostic status, IIV may be helpful in determining when further assessment is required in the absence of those ratings.

Cognitive, Sleep-Arousal, Physical, and Affective Domain Scores on the Post-Concussion Symptom Scale: Added Utility in Detecting Symptom Elevations among Student-Athletes with a Remote History of Concussion.

OBJECTIVE: The evaluation of self-reported symptoms is a standard component of concussion assessment and management. Clinicians typically evaluate a total symptom severity score rather than scores corresponding to specific symptom domains (i.e., cognitive, sleep-arousal, physical, and affective symptoms). This study examined (i) whether elevations in specific symptom domains would be missed when interpreting only the total symptom severity score and (ii) if a single symptom domain elevation was more common than having elevated symptoms across multiple domains. METHOD: Adolescent student-athletes (N = 1,008) with concussion history (i.e., ≥6 months since last concussion) completed the Post-Concussion Symptom Scale (PCSS). The PCSS total score and cognitive, sleep-arousal, physical, and affective domain scores were calculated. To determine if symptoms were elevated, scores were compared to normative data matched on gender and pre-existing conditions, with scores considered elevated if they were ≥84th percentile. The frequency of total and domain score elevations were calculated and stratified by gender and number of prior concussions (i.e., 1 or ≥2 prior concussions). RESULTS: Overall, 26% of student-athletes had an elevated symptom domain score without being elevated on the total score. The most common symptom presentation was to have a single elevated symptom domain (21%), followed by two (11%), three (8%), or four elevated domains (6%). CONCLUSIONS: Interpreting PCSS symptom domains may be beneficial in detecting student-athletes with elevated symptoms following a remote concussion. Roughly a quarter of student-athletes have domain-specific symptom elevations that would be missed by interpreting the total score alone.

The Neurobehavioral Symptom Inventory: Psychometric Properties and Symptom Comparisons in Women With and Without Brain Injuries Due to Intimate Partner Violence.

This study psychometrically evaluated the Neurobehavioral Symptom Inventory (NSI) among women survivors of intimate partner violence (IPV) and compared symptoms between women with no brain injury history (n = 93) and women with IPV-related brain injury history (n = 112). Women completed the NSI and questionnaires on traumatic brain injury (TBI), hypoxic-ischemic brain injury (HI-BI), and lifetime IPV history. A four-factor NSI model, including affective, somatosensory, cognitive, and vestibular factors, had the best fit (comparative fit index = 0.970, root mean square error of approximation = 0.064), with strong reliability for the total score (ω = .93) and subscale scores (ω range = .72-.89). In group comparisons, women with IPV-related brain injuries reported greater total, affective, and cognitive symptom severity after adjusting for age and education; however, no group differences were observed after adjusting for IPV severity. When examining lifetime number of brain injuries, HI-BI count was independently predictive of total, cognitive, and vestibular symptom severity after adjusting for age, education, and IPV severity; whereas TBI count did not independently predict any NSI scores after adjusting for these covariates. The NSI had acceptable psychometric properties for measuring neurobehavioral symptoms among women survivors of IPV. The association between HI-BI count and cognitive and vestibular symptoms may indicate the importance of studying repetitive nonfatal strangulation as an injury mechanism in this population.

The Sport Concussion Assessment Tool: A multidimensional symptom model for detecting elevated post-concussion symptoms.

Objective: Investigate whether a four-factor model of post-concussion symptoms (i.e. cognitive, physical, affective, and sleep-arousal) aids in identifying student-athletes with persistent concerns not reflected by a total symptom score. Method: Collegiate student-athletes (N = 32,066) from the Concussion Assessment Research and Education consortium completed the Sport Concussion Assessment Tool, 3rd edition Symptom Evaluation at baseline and two post-injury follow-ups (i.e. beginning RTP and 6-month). Confirmatory factor analysis was used to compare a one- and four-factor model of post-concussion symptoms. Normative reference data were compared across stratifications (e.g. sex, prior concussions, and number of pre-existing conditions) using Mann-Whitney U tests, and elevation rates (i.e. ≥84th percentile) for subscales and the total score were recorded. Results: The four-factor model fit well before and after injury (CFIs > .95). Greater symptom severity on the subscale and total scores was associated with female sex (ps<.001, r range: .07 to .14) and more pre-existing conditions (ps<.001, η2 range: .01 to .04), while having more prior concussions was only related to total symptom scores (ps<.001, η2<.01). After a concussion, a sizeable portion of student-athletes (i.e., RTP = 11.8%; 6-month = 8.3%) had subscale elevations despite no total score elevation. Physical subscale elevations at RTP were the most common (i.e., 11.9%), driven by head and neck pain. Conclusion: After a sport-related concussion, a four-factor symptom model can be used to assess persistent symptoms in collegiate student-athletes. Identifying athletes with domain-specific elevations may help clinicians identify areas for further assessment and, in some cases, personalized rehabilitation plans.

Test-Retest Reliability and Reliable Change on the NIH Toolbox Cognition Battery.

OBJECTIVE: Researchers and practitioners can detect cognitive improvement or decline within a single examinee by applying a reliable change methodology. This study examined reliable change through test-retest data from the English-language National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) normative sample. METHOD: Participants included adults (n = 138; age: M ± SD = 54.8 ± 20.0, range: 18-85; 51.4% men; 68.1% White) who completed test-retest assessments about a week apart on five fluid cognition tests, providing raw scores, age-adjusted standard scores (SS), and demographic-adjusted T-scores (T). RESULTS: The Fluid Cognition Composite (SS: ICC = 0.87; T-score: ICC = 0.84) and the five fluid cognition tests had good test-retest reliability (SS: ICC range = 0.66-0.85; T-score: ICC range = 0.64-0.86). The lower and upper bounds of 70%, 80%, and 90% confidence intervals (CIs) were calculated around change scores, which serve as cutoffs for determining reliable change. Using T-scores, 90% CI, and adjustment for practice effects, 32.3% declined on one or more tests, 9.7% declined on two or more tests, 36.6% improved on one or more tests, and 5.4% improved on two or more tests. CONCLUSIONS: It was common for participants to show reliable change on at least one test score, but not two or more test scores. Per an 80% CI, test-retest difference scores beyond these cutoffs would indicate reliable change: Dimensional Change Card Sort (SS ≥ 14/T ≥ 10), Flanker (SS ≥ 12/T ≥ 8), List Sorting (SS ≥ 14/T ≥ 10), Picture Sequence Memory (SS ≥ 19/T ≥ 13), Pattern Comparison (SS ≥ 11/T ≥ 8), and Fluid Cognition Composite (SS ≥ 10/T ≥ 7). The reliable change cutoffs could be applied in research or practice to detect within-person change in fluid cognition at the individual level.

Treatment of chronic symptoms following mild traumatic brain injury with transcranial LED: a sham run-in pilot study of photobiomodulation therapy.

PRIMARY OBJECTIVE: We evaluated whether photobiomodulation with red/near infrared light applied transcranially via light emitting diodes (LED) was associated with reduced symptoms and improved cognitive functioning in patients with chronic symptoms following mild traumatic brain injury. RESEARCH DESIGN: Participants (3 men, 6 women; 22-61 years-old) underwent a 6-week intervention involving 18 40-minute transcranial LED treatment sessions. METHODS AND PROCEDURES: Reliable change indices were calculated for 10 neuropsychological test scores and 3 self-report questionnaires of subjective cognition, post-concussion symptoms, and depression at baseline and following treatment. Questionnaires were also administered after 2-week sham and at 1-month and 2-month follow-ups. MAIN OUTCOME AND RESULTS: Only 2 participants improved on neuropsychological testing. On questionnaires, 4 reported improved cognition, 5 reported improved post-concussion symptoms, and 3 reported improved depression. Significant improvement in 2 or more domains was reported by 4 participants and mostly maintained at both follow-ups. CONCLUSIONS: Most participants did not improve on neuropsychological testing. A minority self-reported improvement in symptoms, potentially explained by the intervention, psychiatric medication changes, placebo effects, or other factors. Selecting participants with different clinical characteristics, and dosing and delivery system changes, may produce different results. A study design accounting for placebo effects appears warranted in future trials.

The Short Executive Function Scale.

This study involved a psychometric evaluation of the Short Executive Function Scale (SEFS), a new 15-item self-report questionnaire measuring five constructs: Planning, Inhibition, Working Memory, Shifting, and Emotional Control. Participants included 717 U.S. undergraduate students (M = 18.9 years old, SD = 1.9; 78.8% cisgender female, 81.7% White) who completed the SEFS. A subset of 156 participants (M = 18.8 years old, SD = 0.9; 79.5% cisgender female, 83.3% White) completed the SEFS again at 2- to 3-month retest along with the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A) and the Patient Health Questionnaire (PHQ-8). The five-factor model fit well (CFI = 0.941, RMSEA = 0.079) and each scale had acceptable internal consistency (ω range: .68-.81) and test-retest reliability (ICC range: .75-.89). Apart from Shifting, all SEFS scales had significantly larger convergent validity coefficients with their respective BRIEF-A scales (r range: -.25 to -.70) than discriminant validity coefficients with the PHQ-8 (r range: -.06 to -.28). These findings provide preliminary psychometric support for the SEFS.

Preliminary Evaluation of the Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries with Glial Fibrillary Acidic Protein.

Glial fibrillary acidic protein (GFAP) has become the most promising biomarker for detecting traumatic abnormalities on head computed tomography (CT) in patients with traumatic brain injury (TBI), but most studies have not addressed the potential added value of combining the biomarker with clinical variables that confer risk for intracranial injuries. The Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries in Adults were the first clinical decision rules in the field with an incorporated biomarker, the S100 astroglial calcium-binding protein B (S100B), which is used in the Mild (Low Risk) group defined by the guidelines. Our aim was to evaluate the performance of the guidelines when S100B was substituted with GFAP. The sample (N = 296) was recruited from the Tampere University Hospital's emergency department between November 2015 and November 2016, and there were 49 patients with available GFAP results who were stratified in the Mild (Low Risk) group (thus patients undergoing biomarker triaging). A previously reported cutoff of plasma GFAP ≥140 pg/mL was used. Within the Mild (Low Risk) group (n = 49), GFAP sensitivity (with 95% confidence intervals in parentheses) for detecting traumatic CT abnormalities was 1.0 (0.40-1.00), specificity 0.34 (0.19-0.53), the negative predictive value (NPV) 1.0 (0.68-1.00), and the positive predictive value (PPV) 0.16 (0.05-0.37). The sensitivity and specificity of the modified guidelines with GFAP, when applied to all imaged patients (n = 197) in the whole sample, were 0.94 (0.77-0.99) and 0.20 (0.15-0.28), respectively. NPV was 0.94 (0.80-0.99) and PPV 0.18 (0.13-0.25). In the Mild (Low Risk) group, none of the patients with GFAP results below 140 pg/mL had traumatic abnormalities on their head CT. These findings were derived from a small patient subgroup. Future researchers should replicate these findings in larger samples and assess whether GFAP has added or comparable value to S100B in acute TBI management.

Detecting cognitive decline in high-functioning older adults: The relationship between subjective cognitive concerns, frequency of high neuropsychological test scores, and the frontoparietal control network.

OBJECTIVE: Neuropsychologists have difficulty detecting cognitive decline in high-functioning older adults because greater neurological change must occur before cognitive performances are low enough to indicate decline or impairment. For high-functioning older adults, early neurological changes may correspond with subjective cognitive concerns and an absence of high scores. This study compared high-functioning older adults with and without subjective cognitive concerns, hypothesizing those with cognitive concerns would have fewer high scores on neuropsychological testing and lower frontoparietal network volume, thickness, and connectivity. METHOD: Participants had high estimated premorbid functioning (e.g., estimated intelligence ≥75th percentile or college-educated) and were divided based on subjective cognitive concerns. Participants with cognitive concerns (n = 35; 74.0 ± 9.6 years old, 62.9% female, 94.3% White) and without cognitive concerns (n = 33; 71.2 ± 7.1 years old, 75.8% female, 100% White) completed a neuropsychological battery of memory and executive function tests and underwent structural and resting-state magnetic resonance imaging, calculating frontoparietal network volume, thickness, and connectivity. RESULTS: Participants with and without cognitive concerns had comparable numbers of low test scores (≤16th percentile), p = .103, d = .40. Participants with cognitive concerns had fewer high scores (≥75th percentile), p = .004, d = .71, and lower mean frontoparietal network volumes (left: p = .004, d = .74; right: p = .011, d = .66) and cortical thickness (left: p = .010, d = .66; right: p = .033, d = .54), but did not differ in network connectivity. CONCLUSIONS: Among high-functioning older adults, subjective cognitive decline may correspond with an absence of high scores on neuropsychological testing and underlying changes in the frontoparietal network that would not be detected by a traditional focus on low cognitive test scores.

Repetitive Head Injury and Cognitive, Physical, and Emotional Symptoms in Women Survivors of Intimate Partner Violence.

Many women survivors of intimate partner violence (IPV) experience repetitive head injuries in their lifetime, but limited research has examined the cumulative effects of multiple head injuries on post-concussion symptom severity in this population. This study examined how number of lifetime head injuries and episodes of loss of consciousness (LOC) due to head injuries were related to current cognitive, physical, and emotional symptoms among women survivors of IPV. Cisgender women from Kentucky were recruited following a protective order against an intimate partner, including 268 women with no reported lifetime head injuries and 250 women with one or more IPV-related head injuries (mean [M] = 17.2 head injuries, standard deviation [SD] = 50.5, median [Mdn] = 4, range = 1-515; M = 1.8 LOC episodes, SD = 4.3, Mdn = 1, range = 0-35, respectively). Participants underwent in-person interviews about lifetime physical and sexual IPV history, head injury history, and current cognitive, physical, and emotional symptoms. Sociodemographic characteristics, physical and sexual IPV severity, and current symptom severity were examined in relation to number of head injuries and LOC episodes. A higher number of head injuries was associated with greater age, White race, less than high school education, unemployment, and rural residence. No sociodemographic variables differed based on number of LOC episodes. Greater number of lifetime head injuries and LOC episodes correlated significantly with physical IPV severity (rho = 0.35, p < 0.001; rho = 0.33, p < 0.001, respectively) and sexual IPV severity (rho = 0.22, p < 0.001; rho = 0.19, p = 0.003). Greater number of head injuries and LOC episodes correlated significantly with greater cognitive (rho = 0.33, p < 0.001; rho = 0.23, p < 0.001, respectively), physical (rho = 0.36, p < 0.001; rho = 0.31, p < 0.001), emotional (rho = 0.36, p < 0.001; rho = 0.18, p = 0.004), and total symptom severity (rho = 0.39, p < 0.001; rho = 0.26, p < 0.001). In group comparisons, participant groups stratified by number of head injuries (i.e., 0, 1-3, 4+) differed in total symptom severity (p < 0.001, η2 = 0.15), with greater symptom burden associated with more head injuries. Participants with and without LOC differed in symptom severity: cognitive (p < 0.001, d = 0.45), physical (p < 0.001, d = 0.60), emotional (p = 0.004, d = 0.37), and total symptom severity (p < 0.001, d = 0.53). Group differences between participants with and without LOC remained significant after controlling for sociodemographic variables and IPV severity. There was no cumulative effect of LOC, in that participants with 1 LOC episode did not differ from participants with 2 + LOC episodes (p > 0.05). Based on hierarchical regression analyses, only physical symptoms were independently related to number of head injuries (p = 0.008, ΔR2 = 0.011) and number of LOC episodes (p = 0.014, ΔR2 = 0.021) after controlling for sociodemographic characteristics and IPV severity. Among women survivors of IPV, cumulative head injuries appear related to greater symptom severity. Greater head injury history was independently related to worse physical symptoms (e.g., headaches, dizziness, sleep problems), whereas cognitive and emotional symptoms were, in part, attributable to cumulative physical and emotional trauma due to IPV. Women survivors of IPV with repetitive head injuries have unmet neurobehavioral health needs that may benefit from targeted interventions.

Head Injury Due to Intimate Partner Violence: Injury Characteristics, Subacute Symptoms, and Receipt of Care.

Women survivors of intimate partner violence (IPV) have increased risk of repetitive neurotrauma in their lifetime but have received less research focus compared with populations of athletes, veterans, and emergency department patients. The current study examined the importance of IPV as a contextual mechanism of injury, by comparing women survivors of IPV based on whether they experienced a head injury due to IPV or a head injury not due to IPV. The analyses involved archival data from in-person interviews conducted with women who received a protective order against an intimate partner in Kentucky from 2001 to 2004 (n = 641). Women were excluded if they reported no head injury history (n = 268), resulting in two groups compared based on a retrospective cohort design: 255 women with at least one self-reported IPV-related head injury (M = 33.8 ± 9.0 years old, range: 19-65; 87.5% White) and 118 women with self-reported head injuries due to reasons other than IPV (M = 32.2 ± 9.1 years old, range: 18-62; 89.0% White). Participants were compared on injury characteristics, lifetime physical and sexual IPV severity, subacute symptoms of head injury, and receipt of care for head injury. Compared with women with head injuries unrelated to IPV, women with IPV-related head injuries reported a higher number of lifetime head injuries (Mdn[range]: IPV-related = 3[1-515] vs. non-IPV-related = 1[1-13], p < 0.001, r = 0.51) and a higher number of head injuries involving loss of consciousness (Mdn[range]: IPV-related = 1[1-35] vs. non-IPV-related = 1[1-4], p < 0.001, r = 0.27), but lower rates of hospitalization (IPV-related = 56.1% vs. non-IPV-related = 73.7%, p = 0.001, odds ratio [OR] = 2.20 [95% confidence interval (CI): 1.36, 3.55]) and formal rehabilitation (IPV-related = 3.2% vs. non-IPV-related = 9.4%, p = 0.011, OR = 3.18 [1.24, 8.13]) following head injury. Women with IPV-related head injuries had greater lifetime severity of physical IPV (p < 0.001, d = 0.64 [0.41, 0.86]) and sexual IPV (p < 0.001, d = 0.38 [0.16, 0.60]). Women with IPV-related head injuries endorsed all symptoms at greater rates than women with non-IPV-related head injuries (ps < 0.001), including physical (e.g., headaches: OR = 3.15 [1.81, 5.47]; dizziness: OR = 2.65 [1.68, 4.16]), cognitive (e.g., trouble problem solving: OR = 2.66 [1.53, 4.64]; inattention: OR = 2.39 [1.52, 3.78]), and emotional symptoms (e.g., depression: OR = 7.39 [4.48, 12.20]; anxiety: OR = 4.60 [2.82, 7.51]). The total count of symptoms endorsed was higher for women with IPV-related head injury than women with head injuries unrelated to IPV (p < 0.001, d = 0.71 [0.49, 0.94]). When controlling for lifetime physical and sexual IPV, IPV-related head injury was independently associated with symptom count (ß = 0.261, p < 0.001) and accounted for additional variance in symptom count (ΔR2 = 0.06, p < 0.001). Among women survivors of IPV, those reporting IPV-related head injuries reported greater subacute symptoms, but a lower likelihood of being hospitalized or receiving rehabilitative care. Women with self-reported IPV-related head injuries represent an underserved population that is often unevaluated following injury and may have many unmet care needs. Future studies should examine persistent symptoms following IPV-related head injuries and interventions that would be most beneficial for this population.

Post-Concussion Symptoms in Women With Head Injury Due to Intimate Partner Violence.

Limited research has examined the symptom sequelae of head injuries in women survivors of intimate partner violence (IPV), despite this community being at increased risk for neurotrauma due to partner abuse. The current study compared post-concussion symptom severity between women with and without IPV-related head injuries. Women were recruited from court jurisdictions in Kentucky, USA, after receiving a protective order for partner abuse. The sample included 268 women with no prior head injuries (age: M[standard deviation (SD)] = 31.8[9.8], 77.2% White) and 251 women with lifetime IPV-related head injuries (age: M[SD] = 31.8[9.8], 88.0% White). Women with IPV-related head injuries were slightly older (t = 2.46, p = 0.014) with lower education (χ2 = 5.81, p = 0.016), were more frequently unemployed (χ2 = 9.23, p = 0.002), and had a higher likelihood of residing in a rural setting (χ2 = 30.16, p < 0.001). Women with IPV-related head injuries were also more often White (χ2 = 10.47, p = 0.001), but this group difference was almost entirely related to rural versus urban residence. Women with IPV-related head injuries reported a higher severity of lifetime physical IPV (t = 7.27, p < 0.001, d = 0.64, 95% confidence interval [CI]: [.46, .82]) and sexual IPV (t = 4.65, p < 0.001, d = 0.41 [0.24, 0.59]). A three-factor model of post-concussion symptoms, inclusive of cognitive, physical, and emotional symptoms, fit well (χ2 = 368.99, p < 0.0001, comparative fit index [CFI] = 0.974, Tucker-Lewis index [TLI] = 0.968, root mean square error of approximation [RMSEA] = 0.079 [0.071, 0.087]), and showed evidence for strong measurement invariance across women with and without IPV-related head injuries. The subscale and total scores each had acceptable reliability: cognitive (ω = 0.88 [0.86, 0.90]), physical (ω = 0.74 [0.70, 0.77]), and emotional (ω = 0.88 [0.86, 0.89]), and total score (ω = 0.93 [0.92, 0.95]). Women with IPV-related head injuries reported all individual post-concussion symptoms at a significantly higher frequency, with medium group differences in cognitive (t = 7.57, p < 0.001, d = 0.67 [0.50, 0.85]) and physical symptoms (t = 7.73, p < 0.001, d = 0.68 [0.51, 0.86]) and large group differences in emotional (t = 8.51, p < 0.001, d = 0.75 [0.57, 0.93]) and total symptoms (t = 9.07, p < 0.001, d = 0.80 [0.62, 0.98]). All sociodemographic characteristics were independently associated with post-concussion symptoms, as were physical IPV (total score: r = 0.28 [0.19, 0.35], p < 0.001) and sexual IPV severity (total score: r = 0.22 [0.13, 0.30], p < 0.001). In hierarchical regression analyses, controlling for sociodemographic characteristics (i.e., age, race/ethnicity, education, unemployment, and rural/urban residence) and physical and sexual IPV severity, IPV-related head injury was independently significant and accounted for significant additional variance when predicting cognitive (ΔR2 = 0.05, p < 0.001), physical (ΔR2 = 0.03, p < 0.001), emotional (ΔR2 = 0.07, p < 0.001), and total symptoms (ΔR2 = 0.06, p < 0.001). Negative-binomial regression resulted in similar findings. This study demonstrates that multiple sociodemographic and IPV history variables are related to post-concussion symptom severity, but IPV-related head injury was independently associated with greater symptom severity. Women with IPV-related head injuries may be at increased risk for unaddressed health problems spanning cognitive, physical, and emotional domains. Future research is needed to psychometrically evaluate assessment instruments for this population and to assess efficacy of interventions to address their unique health care needs.

Performance Validity Testing on the NIH Toolbox Cognition Battery: Base Rates of Failed Embedded Validity Indicators in the Adult Normative Sample.

OBJECTIVE: The goal of this study was to determine the base rates of failing proposed embedded validity indicators (EVIs) for the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) in the normative sample. METHOD: Participants included adults in the NIHTB-CB normative sample with data to calculate age-adjusted standard scores (n = 855; ages: M(SD) = 46.9(17.3), range: 18-85; 65.0% women; education: M(SD) = 14.1(2.5) years) or demographically adjusted T-scores (n = 803; ages: M(SD) = 47.3(17.3), range: 18-85; 65.3% women; education: M(SD) = 14.2(2.5) years) for all tests. The NIHTB-CB includes two tests of crystallized cognition and five tests of fluid cognition. Individual norm-referenced test performances were categorized as falling above or below liberal and conservative cutoffs based on proposed univariate EVIs. The number of univariate EVI failures was summed to compute multivariable EVIs. EVI failure rates above 10% were considered high false-positive rates, indicating specificity < .90. Using chi-square analyses, the frequencies of EVI failures were compared based on gender, race/ethnicity, education, and crystallized composite. RESULTS: The multivariable EVIs had predominantly low false-positive rates in the normative sample. EVI failure rates were most common among participants with low crystallized composites. Using age-adjusted standard scores, EVI failure rates varied by education, race/ethnicity, and estimated premorbid intelligence. These differences were mostly eliminated when using demographically adjusted T-scores. CONCLUSIONS: Multivariable EVIs requiring ≥ 4 failures using liberal cutoffs or ≥ 3 failures using conservative cutoffs had acceptable false-positive rates (i.e., < 10%) using both age-adjusted standard scores and demographically adjusted T-scores. These multivariable EVIs could be applied to large data sets with NIHTB-CB data to screen for potentially invalid test performances.

Multivariate base rates of potentially problematic scores on the NIH Toolbox Emotion Battery.

OBJECTIVE: To examine the normal frequency of obtaining one or more scores considered potentially problematic based on normative comparisons when completing the NIH Toolbox Emotion Battery (NIHTB-EB). METHOD: Participants (N = 753; ages 18-85, 62.4% women, 66.4% non-Hispanic White) from the NIHTB norming study completed 17 scales of emotional functioning fitting into three subdomains (i.e., Negative Affect, Psychological Well-being, Social Satisfaction). Scores were considered potentially problematic if they were 1 SD above/below the mean, depending on the orientation of the scale, and cutoffs for 1.5 and 2 SD were also included for reference. Multivariate base rates quantified the rate at which participants obtained one or more potentially problematic scale or subdomain scores. RESULTS: The portion of participants obtaining one or more potentially problematic scores on the NIHTB-EB scales and subdomains was 61.2 and 23.2%, respectively. Participants who were younger (i.e., 18-49) or had less education had higher rates of potentially problematic scores within specific subdomains. There were no significant differences by sex or race/ethnicity. CONCLUSIONS: Elevated scores on the NIHTB-EB were common in the normative sample and related to education/age. The multivariate base rates provided indicate obtaining one or more potentially problematic scores on the NIHTB-EB is broadly normal among adults, which may guard against overinterpreting a single score as clinically significant. These base rates should be considered in the context of other assessment findings, such as interviews, medical history or informant reports, to ensure that true emotional problems are not dismissed, and normal variation in emotional functioning is not pathologized.

Social support and the stress-buffering hypothesis: Effects on stress and mental health in adolescent football athletes.

CONTEXT: Football sports participation has been linked to both positive and negative effects on overall health. Social support, a network which provides individuals with resources to effectively cope, may positively influences one's stress and mental health. However, little research has been conducted in this population. OBJECTIVE: To examine the relationships between social support, psychological stress, and mental health in adolescent football athletes. DESIGN: Cross-Sectional. SETTING: High school athletes, pre-and-post-competitive football season in XXX. PARTICIPANTS: Black/African American adolescent athletes (N=93) competing for a school-sponsored football team. MAIN OUTCOME MEASURES: Participants completed a battery of social support, psychological stress, and mental health symptom measures using the National Institutes of Health Toolbox Application and Patient-Reported Outcomes Measurement Information System following a competitive season. T-score means, Pearson correlations, and multiple regression analyses were conducted. RESULTS: Social support was negatively correlated with psychological stress (Emotional support r=-.386, Family relationships r=-.412, Peer relationships r=-.265) and mental health (Depression r=-.367 and r=-.323 for Emotional support and Family relationships, respectively), whereas psychological stress and mental health (Depression r=.751 and Anxiety r=.732) were positively correlated with one another. In regression analyses, social support measures (i.e., Emotional Support, Family Relationships, and Peer Relationships) were used to predict psychological stress (F=7.094, p<.001, R2=0.191), depression symptoms (F=5.323, p<.001, R2=0.151), and anxiety symptoms (F=1.644, p=.190, R2=0.052). CONCLUSIONS: In line with the stress buffering hypothesis, social support in the form of family relationships and overall emotional support garnered through sport participation may reduce psychological stress and help to preserve mental health of football athletes. Findings indicate perceived social support may act as a positive resource for the coping of Black/African American adolescent athletes. Further research is warranted to understand the effects of stress and social support on the mental health of adolescents, particularly racial and ethnic minorities who are underrepresented in athletic training literature.

Electrophysiological variability during tests of executive functioning: A comparison of athletes with and without concussion and sedentary control participants.

OBJECTIVE: Sport participation may benefit executive functioning (EF), but EF can also be adversely affected by concussion, which can occur during sport participation. Neural variability is an emerging proxy of brain health that indexes the brain's range of possible responses to incoming stimuli (i.e., dynamic range) and interconnectedness, but has yet to be characterized following concussion among athletes. This study examined whether neural variability was enhanced by athletic participation and attenuated by concussion. METHOD: Seventy-seven participants (18-25 years-old) were classified as sedentary controls (n = 33), athletes with positive concussion history (n = 21), or athletes without concussion (n = 23). Participants completed tests of attention switching, response inhibition, and updating working memory while undergoing electroencephalography recordings to index neural variability. RESULTS: Compared to sedentary controls and athletes without concussion, athletes with concussion exhibited a restricted whole-brain dynamic range of neural variability when completing a test of inhibitory control. There were no group differences observed for either the switching or working memory tasks. CONCLUSIONS: A history of concussion was related to reduced dynamic range of neural activity during a task of response inhibition in young adult athletes. Neural variability may have value for evaluating brain health following concussion.

Recent Advances in Neuropsychological Test Interpretation for Clinical Practice.

Much attention in the field of clinical neuropsychology has focused on adapting to the modern healthcare environment by advancing telehealth and promoting technological innovation in assessment. Perhaps as important (but less discussed) are advances in the development and interpretation of normative neuropsychological test data. These techniques can yield improvement in diagnostic decision-making and treatment planning with little additional cost. Brooks and colleagues (Can Psychol 50: 196-209, 2009) eloquently summarized best practices in normative data creation and interpretation, providing a practical overview of norm development, measurement error, the base rates of low scores, and methods for assessing change. Since the publication of this seminal work, there have been several important advances in research on development and interpretation of normative neuropsychological test data, which may be less familiar to the practicing clinician. Specifically, we provide a review of the literature on regression-based normed scores, item response theory, multivariate base rates, summary/factor scores, cognitive intraindividual variability, and measuring change over time. For each topic, we include (1) an overview of the method, (2) a rapid review of the recent literature, (3) a relevant case example, and (4) a discussion of limitations and controversies. Our goal was to provide a primer for use of normative neuropsychological test data in neuropsychological practice.