Do "effort tests" really test effort?

OBJECTIVE: Little is known about how much effort to do well most people exert on cognitive testing. Here, we describe an experimental paradigm to manipulate and measure cognitive effort. METHOD: After baseline cognitive and performance validity testing (PVT), 38 participants were assigned to a standard (SI) or enhanced (EI) incentive condition. On retesting a week later, EI participants were told that they would receive a financial bonus whose amount depended on how much their retest performance improved over baseline. SI participants were told to do their best and promised a chance-based bonus. RESULTS: Larger improvements on retesting were assumed to reflect less effort at baseline. After calculating differences from baseline to follow-up, we compared the EI and SI groups using multivariate analysis of variance. We sought to identify predictors of lower cognitive effort at baseline by correlating change z scores with baseline PVT performance and other hypothesized markers of low cognitive effort. As hypothesized, the EI group showed larger improvements, including improvements on more cognitive tests, and were rated as and reported trying harder at retesting than the SI group. Standard PVT measures did not correlate with low baseline effort; however, resting one's head or slouching during cognitive testing signified low baseline cognitive effort. CONCLUSIONS: This study provides preliminary support for an experimental paradigm to manipulate and investigate cognitive effort, which still remains poorly understood. While PVTs can detect feigned cognitive impairment, they lack the sensitivity to detect low cognitive effort in persons who pass conventional PVT cutoffs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Considerations for the identification of autism spectrum disorder in children with vision or hearing impairment: A critical review of the literature and recommendations for practice.

OBJECTIVE: There is higher risk for autism spectrum disorder (ASD) across many pediatric neurological conditions characterized by vision impairment or hearing loss. Early and accurate identification of ASD is imperative in promoting access to appropriate and early evidenced-based intervention; however, differential diagnosis can be particularly challenging in children with sensory impairment given the heterogeneity of ASD combined with the impact of vision impairment or hearing loss/deafness on development and behavior. A neuropsychologist's unique expertise and appreciation of the interplay between sensory and behavioral manifestations can be valuable for making an early and accurate ASD diagnosis in children who are blind/visually impaired or deaf/hard-of-hearing. This article highlights clinical considerations when identifying ASD within the context of vision impairment or hearing loss/deafness. METHOD: We discuss clinical considerations for the early identification of ASD in children who are blind/visually impaired and deaf/hard-of-hearing. Information presented in the article is based on a critical review of the literature and the expertise of the author group. CONCLUSION: Ongoing development of clinical expertise and evidence-based assessment methods are important when informing the early differential diagnosis of ASD in individuals with sensory impairment. Accurate identification is also vital for the development of targeted interventions across the lifespan.

Therapeutic Hypothermia Modulates the Relationships Between Indicators of Severity of Neonatal Hypoxic Ischemic Encephalopathy and Serum Biomarkers.

Objective: To determine the changes due to therapeutic hypothermia (TH) exposure in the strength of association between traditional clinical and biochemical indicators of severity of neonatal hypoxic-ischemic encephalopathy (HIE) and serum biomarkers. We hypothesized that culmination of TH changes the strength of the relationships between traditional indicators of severity of HIE and serum biomarkers. Methods: This was a single-center observational cohort study of 178 neonates with HIE treated with TH and followed with serum biomarkers: (i) brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) (neurotrophins); (ii) tau and glial fibrillary acidic protein (GFAP) (neural cell injury); and (iii) interleukin 6 (IL-6), IL-8, and IL-10 (cytokines), during their first week of life. Adjusted mixed-effect models tested associations with HIE indicators in relation to TH exposure. Results: At admission, lower Apgar scores and base excess (BE) and higher lactate and nucleated red blood cell (NRBC) count correlated with higher Sarnat scores. These indicators of worse HIE severity, including higher Sarnat score, correlated with lower VEGF and higher tau, GFAP, and IL-10 levels at different time points. Within the first 24 h of life, patients with a Sarnat score >2 had lower VEGF levels, whereas only those with score of 3 also had higher GFAP and IL-10 levels. Tau levels increased during TH in patients with Sarnat score of 3, whereas tau and GFAP increased after TH in those with scores of 2. After adjustments, lower VEGF levels during TH and higher tau, GFAP, and IL-10 levels during and after TH were associated with worse Sarnat scores. Tau and GFAP relationship with Sarnat score became stronger after TH. Conclusion: Therapeutic hypothermia exerts an independent modulatory effect in the relationships between traditional indicators of severity of HIE and serum biomarkers after adjustments. Thus, the timing of biomarker testing in relation to TH exposure must be carefully considered if biomarkers are proposed for patient stratification in novel clinical trials.

Correlation Between White Matter Injury Identified by Neonatal Diffusion Tensor Imaging and Neurodevelopmental Outcomes Following Term Neonatal Asphyxia and Therapeutic Hypothermia: An Exploratory Pilot Study.

AIM: Hypoxic-ischemic encephalopathy is associated with damage to deep gray matter; however, white matter involvement has become recognized. This study explored differences between patients and clinical controls on diffusion tensor imaging, and relationships between diffusion tensor imaging and neurodevelopmental outcomes. METHOD: Diffusion tensor imaging was obtained for 31 neonates after hypoxic-ischemic encephalopathy treated with therapeutic hypothermia and 10 clinical controls. A subgroup of patients with hypoxic-ischemic encephalopathy (n = 14) had neurodevelopmental outcomes correlated with diffusion tensor imaging scalars. RESULTS: Group differences in diffusion tensor imaging scalars were observed in the putamen, anterior and posterior centrum semiovale, and the splenium of the corpus callosum. Differences in these regions of interest were correlated with neurodevelopmental outcomes between ages 20 and 32 months. CONCLUSION: Therapeutic hypothermia may not be a complete intervention for hypoxic-ischemic encephalopathy, as neonatal white matter changes may continue to be evident, but further research is warranted. Patterns of white matter change on neonatal diffusion tensor imaging correlated with neurodevelopmental outcomes in this exploratory pilot study.

Neurocognitive Functions and Behavior in Joubert Syndrome.

Investigators from multiple Italian pediatric neurology and neurogenetics departments studied cognitive functions, behavior, and adaptive functioning in large cohort of 54 patients with Joubert syndrome (JS) as part of a prospective, multi-center study.

The insula-claustrum region and delusions in schizophrenia.

OBJECTIVE: We examined the relationship between cerebral gray matter (GM) volume and severity of delusions and hallucinations in adults with schizophrenia. METHOD: MRI scans in 43 patients with schizophrenia were acquired. Correlations were computed between GM volume and clinician ratings of hallucinations and delusions. RESULTS: The analysis revealed significant inverse correlations between ratings of the severity of delusions and volumes of the left claustrum and right insula. Significant correlations were not observed between cerebral GM volume and ratings of hallucinations. CONCLUSION: The insula/claustrum region may be critical to the experience of delusions and more careful scrutiny of the claustrum in relation to schizophrenia appears warranted.