Symptoms Associated With Exercise Intolerance and Resting Heart Rate Following Mild Traumatic Brain Injury.

OBJECTIVES: People may experience a myriad of symptoms after mild traumatic brain injury (mTBI), but the relationship between symptoms and objective assessments is poorly characterized. This study sought to investigate the association between symptoms, resting heart rate (HR), and exercise tolerance in individuals following mTBI, with a secondary aim to examine the relationship between symptom-based clinical profiles and recovery. METHODS: Prospective observational study of adults aged 18 to 65 years who had sustained mTBI within the previous 7 days. Symptoms were assessed using the Post-Concussion Symptom Scale, HR was measured at rest, and exercise tolerance was assessed using the Buffalo Concussion Bike Test. Symptom burden and symptom-based clinical profiles were examined with respect to exercise tolerance and resting HR. RESULTS: Data from 32 participants were assessed (mean age 36.5 ± 12.6 years, 41% female, 5.7 ± 1.1 days since injury). Symptom burden (number of symptoms and symptom severity) was significantly associated with exercise intolerance (P = .002 and P = .025, respectively). Physiological and vestibular-ocular clinical profile composite groups were associated with exercise tolerance (P = .001 and P = .014, respectively), with individuals who were exercise intolerant having a higher mean number of symptoms in each profile than those who were exercise tolerant. Mood-related and autonomic clinical profiles were associated with a higher resting HR (>80 bpm) (P = .048 and P = .028, respectively), suggesting altered autonomic response for participants with symptoms relating to this profile. After adjusting for age and mechanism of injury (sports- or non-sports-related), having a higher mood-related clinical profile was associated with persisting symptoms at 3 months postinjury (adjusted odds ratio = 2.08; 95% CI, 1.11-3.90; P = .013). CONCLUSION: Symptom-based clinical profiles, in conjunction with objective measures such as resting HR and exercise tolerance, are important components of clinical care for those having sustained mTBI. These results provide preliminary support for the concept that specific symptoms are indicative of autonomic dysfunction following mTBI.

"Broken fragments or a breathtaking mosaic": A mixed methods study of self-reported attributes and aspirations of siblings of individuals with and without neurodevelopmental conditions.

Siblings of individuals with neurodevelopmental conditions (NDCs) experience distinct challenges and have unique strengths compared to siblings of individuals without NDCs. The present study examined attributes and aspirations of siblings of individuals with and without neurodevelopmental conditions, and analyzed the association between qualitative responses and quantitative measures of growth mindset, positive and negative valence, and mental health diagnoses. A novel mixed methods thematic analysis was employed to explore the experiences of 166 siblings (75 NDC and 91 controls, aged 14-26, 66.27% female) completing an online survey as part of a larger study on sibling mental health. The overarching theme described The Process of Self-Actualization and Integration, reflecting the journey siblings undergo in seeking to understand themselves and others amidst psychological challenges. It encompassed three subthemes: Personal Growth and Identity Formation; Connection and Belonginess; and Societal Perspective and Global Consciousness. Qualitative responses were analyzed within a Research Domain Criteria (RDoC) framework, and associations between phenomenology and mental health diagnoses examined. NDC siblings had higher negative valence and lower positive valence embedded in their responses, and quantitatively lower self-reported growth mindset (i.e., beliefs about the capacity for personal growth), compared to control siblings, which correlated with self-reported mental health diagnoses. Findings suggest clinical practice may focus on optimizing self-identified strengths and offer opportunities for self-actualization of hopes and ambitions, while providing support for families to attenuate bioecological factors impacting mental health.

Neuropsychological profiles of adolescents sentenced to detention in Western Australia with and without prenatal alcohol exposure.

BACKGROUND/AIMS: Youth with prenatal alcohol exposure (PAE) are under-recognised in the justice system, warranting improved identification. This study aimed to compare neuropsychological profiles of adolescents, with and without PAE and identify neuropsychological tasks predictive of PAE-group membership. It was hypothesised that participants with PAE would score significantly lower on neuropsychological tests. METHODS: Participants included 85 young people sentenced to detention (mean 15.7 years, 78 males), 46 with PAE. A one-way-multivariate analysis of variance tested differences in neuropsychological functioning between PAE/No-PAE groups, while logistic regression determined tests predictive of PAE. RESULTS: No statistically significant difference in test scores emerged between groups, and regression was not indicative of any models predictive of PAE-group membership. Neuropsychological profiles were characterised by both strengths and weaknesses, with lower verbal and mathematical skills. CONCLUSION(S): While no statistically significant differences were found between the groups, the results provided a unique insight into the neurocognitive profile of Australian youth in detention. Routine screening assessments were recommended for young people sentenced to detention.

In-person versus online delivery of a behavioral sleep intervention (Sleeping Sound©) for children with ADHD: protocol for a parallel-group, non-inferiority, randomized controlled trial.

BACKGROUND: Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience sleep difficulties such as difficulty initiating and maintaining sleep. Problem sleep may impact children's daily functioning and behaviors and exacerbate ADHD symptoms. Most effective behavioral interventions to improve sleep are conducted in person, limiting accessibility to treatment for individuals in remote or rural communities or those who are unable to attend a clinic. This trial aims to assess the efficacy of delivering an established behavioral intervention online, Sleeping Sound with ADHD©, compared to a face-to-face delivery mode. METHODS: This parallel group, non-inferiority, randomized controlled trial (RCT) will include at least 68 children, aged 5-12 years old with ADHD. Families of children will be recruited from private developmental and psychological clinics and social media, within the state of Western Australia (WA). Once written informed consent and baseline questionnaires are completed, families are randomized to receive the behavioral intervention either in-person or online via Telehealth services. The intervention targets the assessment and management of reported sleep problems, through two individual consultations and a follow-up phone call with a trained clinician. The sleep outcomes assessed consist of a parent-reported sleep questionnaire and actigraphy. DISCUSSION: To the best of our knowledge, this is the first RCT to investigate sleep treatment modality for children with ADHD. If effective, clinicians can provide an evidence-based sleep intervention in an accessible manner. TRIAL REGISTRATION: ANZCTR, ACTRN12621001681842 . Registered 9 December 2021-Retrospectively registered.

Post-Concussion Symptoms, Cognition and Brain Connectivity in an Australian Undergraduate Population: A Quantitative Electroencephalography Study.

BACKGROUND: An estimated 99 in 100,000 people experience a traumatic brain injury (TBI), with 85% being mild (mTBI) in nature. The Post-Concussion Symptom Scale (PCSS), is a reliable and valid measure of post-mTBI symptoms; however, diagnostic specificity is challenging due to high symptom rates in the general population. Understanding the neurobiological characteristics that distinguish high and low PCSS raters may provide further clarification on this phenomenon. AIM: To explore the neurobiological characteristics of post-concussion symptoms through the association between PCSS scores, brain network connectivity (using quantitative electroencephalography; qEEG) and cognition in undergraduates. HYPOTHESES: high PCSS scorers will have (1) more network dysregulation and (2) more cognitive dysfunction compared to the low PCSS scorers. METHODS: A sample of 40 undergraduates were divided into high and low PCSS scorers. Brain connectivity was measured using qEEG, and cognition was measured via neuropsychological measures of sustained attention, inhibition, immediate attention, working memory, processing speed and inhibition/switching. RESULTS: Contrary to expectations, greater frontoparietal network dysregulation was seen in the low PCSS score group (p = 0.003). No significant difference in cognitive dysfunction was detected between high and low PCSS scorers. Post-hoc analysis in participants who had experienced mTBI revealed greater network dysregulation in those reporting a more recent mTBI. CONCLUSIONS: Measuring post-concussion symptoms alone is not necessarily informative about changes in underlying neural mechanisms. In an exploratory subset analysis, brain network dysregulation appears to be greater in the early post-injury phase compared to later. Further analysis of underlying PCSS constructs and how to measure these in a non-athlete population and clinical samples is warranted.

Alexithymia as a risk factor for poor emotional outcomes in adults with acquired brain injury.

Emotional disorders are pervasive in the acquired brain injury (ABI) population, adversely affecting quality of life and rehabilitation. This study aimed to explore the unique associative effects of alexithymia as measured by the Perth Alexithymia Questionnaire (PAQ; i.e., difficulty identifying positive/negative feelings, difficulty describing positive/negative feelings, and externally orientated thinking), on emotional outcomes as measured by the Depression Anxiety Stress Scale-21 (DASS-21) and Mayo-Portland Adaptability Inventory (MPAI-4) Adjustment index, in 83 adults with ABI. The addition of alexithymia to hierarchical multiple regression models (controlling for demographic, injury-related, and functional outcome variables) yielded statistically significant changes in R2 for all emotional outcome measures (i.e., Depression, Anxiety, Stress, and Adjustment). Difficulty identifying negative feelings was found to be a significant unique predictor of Depression (ß = .43 p = <.001), Anxiety (ß = .40, p <.001), Stress (ß = .49, p <.001), and Adjustment (ß = .26, p = .001). Externally oriented thinking was found to be a significant unique predictor of Adjustment (ß = -.15, p = .033). These findings strengthen the argument that alexithymia, especially difficulties identifying negative feelings, may be an important risk factor for psychological distress in ABI and should be considered during early rehabilitation.

Co-design of dementia prevention program for Aboriginal Australians (DAMPAA).

INTRODUCTION: Dementia is highly prevalent in older Aboriginal Australians, with several modifiable risk factors. Currently, there is limited evidence on how to prevent cognitive decline in Aboriginal Australians. METHODS: Based on our Theory of Change (ToC) framework, we co-developed the Dementia risk management and prevention program for Aboriginal Australians (DAMPAA) aged over 45 years in partnership with Aboriginal community-controlled organizations (ACCOs) and Elders. Qualitative data were collected through ACCO staff workshops, Elders yarning, and governance groups to inform the protocol. Additionally, we conducted a small pilot study. RESULTS: Expected DAMPAA ToC outcomes are: (1) improved daily function, (2) better cardiovascular risk management, (3) falls reduction, (4) improved quality of life, and (5) reduced cognitive decline. Attendance enablers are social interaction, environment, exercise type/level, and logistics. DISCUSSION: Findings suggest that ToC is an effective collaborative approach for co-designing Aboriginal health programs.

Exploring offending characteristics of young people with foetal alcohol spectrum disorder in Western Australia.

Neurodevelopmental impairments resulting from Foetal Alcohol Spectrum Disorder (FASD) can increase the likelihood of justice system involvement. This study compared offence characteristics in young people with FASD to demographically matched controls (n = 500) in Western Australia. A novel approach (i.e. association rule mining) was adopted to uncover relationships between personal attributes and offence characteristics. For FASD participants (n = 100), file records were reviewed retrospectively. Mean age of the total sample was 15.60 years (range = 10-24), with 82% males and 88% Australian Aboriginal. After controlling for demographic factors, regression analyses showed FASD participants were more likely than controls to be charged with reckless driving (odds ratio, OR = 4.20), breach of bail/community orders (OR = 3.19), property damage (OR = 1.84), and disorderly behaviour (OR = 1.54). Overall, our findings suggest justice-involved individuals with FASD have unique offending profiles. These results have implications for sentencing, diversionary/crime prevention programs and interventions.

Apathy and Depression as Predictors of Activities of Daily Living Following Stroke and Traumatic Brain Injuries in Adults: A Meta-Analysis.

Apathy and depression are common sequelae of acquired brain injury (ABI). Apathy is a syndrome characterized by diminished motivation and purposeful behaviours. Depression is a mood disorder featuring sadness, worthlessness, anhedonia and suicidal ideation. Both are associated negatively with activities of daily living (ADL), the skills required to fulfil basic and complex physical needs. However, the current literature's results are inconsistent and based on relatively small sample sizes. Furthermore, the unique and combined effects of apathy and depression as predictors of ADL have not yet been estimated. This is important, as both may have implications for planning rehabilitation after an ABI. Consequently, we aimed to estimate the association between apathy, depression and ADL in the stroke and traumatic brain injured population via meta-analysis and meta-analytic path-analysis. Based on the meta-analyses (N = 1,166 to N = 1,389), we estimated the following statistically significant bivariate effects: depression and apathy (r = .53, 95% CI: .42/.63), depression and ADL (r = -.27, 95% CI: -.43/-.11), apathy and ADL (r = -.41, 95% CI: -.51/-.31). A meta-analytic mediation model found that depression had a significant indirect effect onto ADL (ß = -.17, 95% CI: -.26/-.09), while apathy had a significant direct effect (ß = -.34, 95% CI: -.48/-.19) onto ADL (model R2 = .16). We interpreted the results to suggest that apathy and depression may impact adversely on engagement with ADL in people with ABI, although the potential influence of depression on ADL may occur primarily through its influence on apathy. Thus, greater focus on apathy by practitioners may be merited in cases with ABI.

Adverse childhood experiences, associated stressors and comorbidities in children and youth with fetal alcohol spectrum disorder across the justice and child protection settings in Western Australia.

BACKGROUND: Individuals with Fetal Alcohol Spectrum Disorder (FASD) are at risk of having adverse childhood experiences (ACEs), especially those with child protection and/or justice system involvement. The complex relationship between FASD and psychosocial vulnerabilities in the affected individual is an important clinical risk factor for comorbidity. This study (1) explored the ACEs and associated stressors in individuals with FASD; (2) investigated the association between ACEs and negative outcomes, i.e., justice/child protection system involvement; and (3) examined the relationship between ACEs and comorbid conditions such as mood and neurodevelopmental disorders. METHODS: Data were collected retrospectively via file review from diagnostic clinics in Western Australia. Life adversity was coded using a standardised ACEs questionnaire. A total of 211 participants (72% males) with FASD with a mean age of 11 years (range = 2-21) were included in the final sample. 70% of the total sample had been involved with the child protection system and 40% had trouble with the law. RESULTS: Exposure to drinking/substance misuse at home (70%) and domestic violence (52%) were the two most common ACEs across the total sample. In the entire cohort, 39% had four or more ACEs, indicating higher risks of poor health outcomes. Additional stressors recorded were disengagement from school (43%), transiency (19%), victims of bullying (12%), traumatic brain injury (9%) and homelessness (5%). ACEs such as drinking/substance misuse at home, emotional neglect and physical neglect were positively associated with child protection system involvement. Additionally, exposure to domestic violence was positively correlated with justice system involvement. Higher rates of life adversity in this clinical population were associated with an increased number of comorbidities. Specifically, those with FASD who had comorbidities such as attachment disorder, substance use disorder, and PTSD also reported higher ACEs scores. CONCLUSION: ACEs were common in this clinical population. Increased ACEs in this sample were associated with increased comorbidities and involvement with the child protection and/or justice system. This highlights that prevention, intervention and early diagnosis of FASD are important for at risk children to reduce the negative effects of ACEs.

A comprehensive group-based cognitive behavioural treatment for blood-injection-injury phobia.

OBJECTIVES: A key feature of blood-injection-injury (BII) phobia is activation of disgust responses, in addition to fear. Yet, standard treatments have largely neglected addressing disgust responses. The disorder is further complicated by fainting in 75% of sufferers. Moreover, treatments have been traditionally delivered in an individual format, which may not be as efficient as group treatment. The aim of this study was to develop a group-based programme for BII phobia, with components targeting fear, disgust, and fainting, to determine feasibility and effectiveness of such an intervention. METHODS: Participants took part in an 8-session, group-based Cognitive Behavioural Therapy (CBT) programme for BII phobia (N = 40). The key outcome measure was the Multidimensional Blood/Injury Phobia Inventory, which assesses a range of phobic stimuli and responses (including fear, disgust, and fainting). RESULTS: There were significant improvements, with large effect sizes, across symptoms over the course of treatment. Participants with higher disgust sensitivity reported higher pre-treatment symptom severity and greater life interference than those with lower disgust scores. Despite this, neither pre-treatment disgust sensitivity nor fainting history impacted on treatment response. For the first time, however, we showed that greater reductions in disgust to BII stimuli were associated with greater overall symptom reductions, highlighting the importance of disgust in the treatment of this disorder, and potentially others. CONCLUSION: Despite the heterogeneous nature of BII phobia, this group-based, modified CBT intervention was effective in reducing a variety of phobic responses, including fear, disgust, and fainting. PRACTITIONER POINTS: Disgust is a key maintaining factor in blood-injection-injury phobia, which clinicians should consider in their assessment and treatment of this disorder. There is little in the existing literature to guide clinicians in this regard. This study examined a novel group treatment for blood-injection-injury phobia which included strategies to target disgust, in addition to traditional CBT strategies to address fear and fainting. The treatment was feasible and acceptable. Symptoms of fear, disgust, and fainting reduced significantly over treatment. Changes in disgust symptoms were associated with overall symptom changes, however a control group is needed to determine the effects of individual treatment components and to make more robust conclusions about the benefits of this enhanced approach.

The Prevalence and Characteristics of Alexithymia in Adults Following Brain Injury: A Meta-Analysis.

Alexithymia is the inability to identify and describe one's own emotions. Some research suggests that organic alexithymia may occur after acquired brain injury (ABI). However, the results in the literature are inconsistent, when comparisons are made against healthy controls. Furthermore, a precise estimate of alexithymia prevalence in the ABI population has not yet been reported. Consequently, this meta-analysis aimed to estimate the prevalence and characteristics of alexithymia in ABI, as measured by the Toronto Alexithymia Scale-20 (TAS-20). Based on 22 unique ABI samples, a series of random-effects meta-analyses estimated moderate to large positive effect sizes (i.e., greater alexithymia in ABI samples) for the TAS-20 total scale (Hedges' g = 1.00, 95% CI [0.75, 1.35]), as well as the subscales: difficulty identifying feelings (Hedges' g = 0.92, 95% CI [0.66, 1.17]), difficulty describing feelings (Hedges' g = 0.69, 95% CI [0.50, 0.87]) and externally oriented thinking (Hedges' g = 0.75, 95% CI [0.64, 0.85]). Furthermore, a meta-regression identified a larger effect size (TAS-20 total scale score) for traumatic brain injury (TBI) samples, in comparison to non-TBI samples. Finally, the prevalence of clinically significant levels of alexithymia (TAS-20 total scale ≥ 68.4; i.e., two SDs above the general population mean) in ABI patients was estimated at 15.2%. We interpreted the results to suggest that ABI may have a substantial negative impact on affective processing abilities and, thus, comprehensive assessment of emotional functioning deficits following ABI should be considered by practitioners.

Metacognitive knowledge and functional outcomes in adults with acquired brain injury: A meta-analysis.

Pronounced difficulties in functional outcomes often follow acquired brain injury (ABI), and may be due, in part, to deficits in metacognitive knowledge (being unaware of one's cognitive strengths and limitations). A meta-analytic review of the literature investigating the relationship between metacognitive knowledge and functional outcomes in ABI is timely, particularly given the presence of apparently inconsistent findings. Twenty-two articles revealed two distinct methods of measuring metacognitive knowledge: (1) absolute (the degree of inaccurate self-appraisal regardless of whether the error tends towards under- or over-confident estimations) and (2) relative (the degree and the direction of the inaccuracy) discrepancy. Separate meta-analyses were conducted for absolute and relative discrepancy studies to assess the relationship between metacognitive knowledge and functional outcomes (affect-related quality of life, family and community integration, and work outcomes). The pattern of results found suggested that better metacognitive knowledge is related to better overall functional outcomes, but the relationship may differ depending on the outcome domain. These findings generally support the importance of focusing on metacognitive knowledge to improve outcomes following ABI. Nonetheless, the relatively small effect sizes observed suggest that other predictors of functional outcome should be investigated, including other subdomains of metacognition.

A Meta-Analysis of Neuropsychological Predictors of Outcome Following Stroke and Other Non-Traumatic Acquired Brain Injuries in Adults.

A number of cognitive abilities have been reported to predict outcome following a non-traumatic acquired brain injury (ABI) in adults. However, the results are inconsistent. Furthermore, the unique and combined capacity of these cognitive abilities to predict ABI outcome has not been evaluated. Consequently, we employed meta-analysis and multiple regression to evaluate the capacity of various neuropsychological domains to predict two separate outcome variables in adults: (1) activities of daily living; and (2) quality of life. Based on the activities of daily living meta-analysis (N = 2384), we estimated the following significant bivariate effects: memory (r = .31, 95% CI: .20/.41]), language (r = .33, 95% CI:.26/.40), attention (r = .38, 95% CI: .30/.46]), executive functions (r = .29, 95% CI: .19/.39]), and visuospatial abilities (r = .41, 95% CI: .34/ .48). Based on the quality of life meta-analysis (N = 1037), we estimated the following significant bivariate effects: memory (r = .12, 95% CI: .03/.20]), language (r = .19, 95% CI: .06/ .32), attention (r = .30, 95% CI: .16/.44]), executive functions (r = .24, 95% CI: .12/.37) and visuospatial/constructional abilities (r = .30, 95% CI: .14/.46). Meta-analytic structural equation modelling (metaSEM) identified two significant, unique predictors of activities of daily living, attention and visuospatial abilities, and the model accounted for 21% of the variance (multiple R2 = .21, 95%CI: .16/.26). For the corresponding quality of life metaSEM, no statistically significant unique predictors were identified, however, a significant multiple correlation was observed, multiple R2 = .11 (95%CI: 04/.18). We conclude that practitioners may be able to predict, with some degree of accuracy, functional outcome following a stroke and other non-traumatic ABI in adults. We also provide some critical commentary on the nature and quality of the measures used in this area of research to represent the cognitive dimensions of interest.

The Demographic and Neurocognitive Profile of Clients Diagnosed With Fetal Alcohol Spectrum Disorder in PATCHES Paediatrics Clinics Across Western Australia and the Northern Territory.

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is a diagnosis relating to neurocognitive impairments associated with prenatal alcohol exposure. A key aspect of improving FASD diagnostic processes and management is understanding the demographic and neurocognitive profile of those living with FASD. The aim of this study was to describe the demographic and neurocognitive profile of the first 199 individuals diagnosed with FASD in PATCHES Paediatrics clinics. METHODS: A retrospective cross-sectional descriptive study design was conducted with individuals diagnosed with FASD between 2013 and 2018 through a multidisciplinary team according to the Australian FASD Diagnostic Guidelines. RESULTS: Participants were primarily male 133 (66.8%) and Aboriginal Australian 147 (73.9%), aged 2 to 31 (mean 10.5), with 94 (47.3%) from remote or very remote parts of Western Australia. Participants came from low 119 (59.8%), medium 48 (24.1%), and high 32 (16.1%) socioeconomic (SE) backgrounds. Low SE background was found to be a predictor of number of sentinel facial features (Wald χ2 (1) = 4.03, p < 0.05). Most received a diagnosis of FASD with <3 sentinel features 165 (82.9%). Participants either had 6 or more 46 (23.1%), 5 44 (22.1%), 4 55 (27.6%), or 3 (27.1%) neurodevelopmental domains impaired. Executive functioning was the most commonly impaired neurodevelopmental domain 158 (79.4%), and 31 (61%) reported sleep disturbance. ADHD was the most observed comorbid condition (41.7%). CONCLUSIONS: This study improves our current understanding of neurocognitive and demographic profiles in individuals with FASD that have been clinically referred for diagnosis within Western Australia and the Northern Territory, and highlights the importance of prevention and early assessment/diagnosis as well as guidance regarding more targeted interventions. FASD affects individuals from all cultural and SE backgrounds. Individuals from middle to higher SE groups are at risk of FASD with prevention efforts needing to target these sectors of society. Suggestions for future research directions are also provided.

Neuropsychological Predictors of Outcome Following Traumatic Brain Injury in Adults: a Meta-Analysis.

Several neuropsychological dimensions are correlated with functional outcome (e.g., ability to return to family and community roles) following traumatic brain injury (TBI). Commonly investigated neuropsychological dimensions include verbal memory, visuo-spatial construction, set-shifting, generativity, and processing speed. Unfortunately, small sample sizes across relevant studies have contributed to inconsistent results. Furthermore, no studies have concurrently measured all of the candidate neuropsychological predictors, most of which are known to be inter-correlated. Thus, the unique predictive effects associated with the candidate predictors in TBI recovery have never been investigated. Consequently, this study used both meta-analysis and multiple regression to statistically evaluate neuropsychological candidate predictors across two outcome variables (1) the Glasgow Outcome Scale-Extended (GOS-E) and (2) the Disability Rating Scale (DRS). Seven studies met inclusion criteria. Based on the meta-analyses, the following neuropsychological dimensions were found to be correlated with the GOS-E: immediate verbal memory (r = .43, 95% CI [.27, .58]), delayed verbal memory (r = .43, 95% CI [.21, .61]), visuo-spatial construction (r = .29, 95% CI [.15, .53]), set-shifting (r = -.31, 95% CI [-.45, -.15], and generativity (r = .44, 95% CI [.32, .54]). By contrast, only one neuropsychological dimension was found to be significantly related to the DRS (generativity: r = -.21, 95% CI [-.39, -.01]). Multiple regression on the GOS-E relevant meta-analytically derived correlation matrix determined that all neuropsychological dimensions were significant predictors of the GOS-E (multiple R 2 = .31) with the exception of immediate verbal memory or learning. However, due to analytic characteristics, these findings must be interpreted with caution. Results were consistent with the need to consider multiple neuropsychological abilities in recovery and rehabilitation following TBI.

Confirmatory factor analysis of the Sleep Disturbance Scale for Children (SDSC) in a clinical sample of children and adolescents.

The Sleep Disturbance Scale for Children was developed as a parent-report measure to screen for sleep disturbances within the preceding 6 months. Notably, the scale was developed using a sample of typically developing children and children with sleep disorders. The aim of this study was to factor analyse the Sleep Disturbance Scale for Children using a clinical sample of children with a range of neuropsychological conditions and co-morbidities, and determine whether the original six-factor structure was retained. Four-hundred and sixteen children aged 5-17 years were assessed at the Neurosciences Unit (Perth, Western Australia) as part of routine, clinical neuropsychological assessment. Parents and guardians also completed the Sleep Disturbance Scale for Children to rate their child's sleep. Confirmatory factor analysis of the original Sleep Disturbance Scale for Children model (Bruni et al. J. Sleep Res., 1996, 5: 251-261) revealed a less than ideal fit. Three adjustments were made to the model based on factor loadings and modification indices. The sleep hyperhidrosis factor (including items 9 and 16) along with item 10 was removed, leaving a five-factor Sleep Disturbance Scale for Children model. The five-factor model (Sleep Disturbance Scale for Children-R) was factor analysed, and examination of model fit statistics indicated that this new model produced good fit. Additional analyses revealed that older children had greater difficulty falling and staying asleep, and with daytime sleepiness. However, no significant differences were observed across gender, diagnosis or socioeconomic status. The results of this study suggest that the Sleep Disturbance Scale for Children-R may be a more appropriate measure when assessing clinical samples. However, further research is required to validate the Sleep Disturbance Scale for Children-R against objective measures of sleep and to determine appropriate t-score cut-offs.

Australian psychologists' knowledge, confidence, and practices in fetal alcohol spectrum disorder diagnostic assessment.

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is a neurodevelopmental disorder caused by prenatal alcohol exposure (PAE). There are many documented barriers to FASD diagnostic assessment, including a limited number of trained clinicians. This study aimed to establish baseline levels of Australian psychologists' knowledge and practices in FASD assessment to develop training and improve future diagnostic capacity. METHODS: An online survey was completed by 106 Australian psychologists. The survey elicited respondents' demographics, knowledge about FASD, confidence in various aspects of assessment and perceived future training needs. RESULTS: Respondents reported a broad understanding of the FASD diagnostic term and potential harm of prenatal alcohol exposure (PAE). However, most respondents were not confident in their ability to conduct the psychometric assessments that provide a diagnostic assessment of FASD or ask about PAE. There was a significant positive correlation between the number of correct knowledge items and the psychologists' confidence in conducting FASD assessments. The clinical neuropsychologists demonstrated significantly greater knowledge and confidence in applying FASD diagnostic criteria and assessing PAE than school, clinical, and other psychologists. Most psychologists were more confident in their ability to apply the diagnostic criteria for other neurodevelopmental disorders. CONCLUSIONS: Recognition of FASD is growing in Australia, however, further work is required to improve clinicians' understanding of and confidence in completing FASD assessments. Most participants indicated a preference for online training to learn more about FASD assessment.

Competencies unique to clinical neuropsychology: A consensus statement of educators, practitioners, and professional leaders in Australia.

Objective: To delineate the unique role of clinical neuropsychologists in contemporary Australian clinical practice and present a comprehensive consensus-based set of clinical neuropsychology competencies to guide and standardize the training of clinical neuropsychologists. Method: Twenty-four national representatives of the clinical neuropsychology profession (71% female, M = 20.1, SD = 8.1 years clinical practice), including tertiary-level educators, senior practitioners and members of the executive committee of the peak national neuropsychology body, formed the Australian Neuropsychology Alliance of Training and Practice Leaders (ANATPL). Informed by a review of existing international competency frameworks and Australian Indigenous psychology education frameworks, a provisional set of competencies for clinical neuropsychology training and practice were developed, followed by 11 rounds of feedback and revisions. Results: The final set of clinical neuropsychology competencies achieved full consensus and falls into three broad categories: generic foundational (i.e. general professional psychology competencies applied to clinical neuropsychology); specific functional (i.e. specific to clinical neuropsychology areas of practice) competencies relevant to all career stages; and functional competencies relevant to advanced career stages. Competencies span a number of knowledge and skill-based domains including neuropsychological models and syndromes, neuropsychological assessment, neuropsychological intervention, consultation, teaching/supervision and management/administration. Conclusion: The competencies reflect recent advances in the field of clinical neuropsychology, including expanded intervention competencies, culturally-informed neuropsychological practice and use of emerging technologies. They will be available as a resource to guide curriculum development for clinical training, as well as providing a useful framework for professional practice and advocacy more broadly within the discipline of clinical neuropsychology.