Changes in ImPACT Cognitive Subtest Networks Following Sport-Related Concussion.

OBJECTIVE: High school athletes are administered ImPACT at the start of the academic year or sport season and again after suspected concussion. Concussion management involves the comparison of baseline and post-injury cognitive scores with declines in scores providing evidence for concussive injury. A network framework may provide additional information about post-concussive cognitive changes and expand characterization of sport-related concussion (SRC) recovery. DESIGN: Retrospective cohort study. SETTING: High school. PARTICIPANTS: High school athletes (n = 1553) were administered ImPACT at baseline (T1), post-SRC (T2 = 72 h of injury), and prior to return to play (T3 = within two weeks post-injury). INDEPENDENT VARIABLES: ImPACT cognitive subtest scores. MAIN OUTCOME MEASURES: Cognitive networks were calculated and compared over three time points. Centrality indices were calculated to determine the relative importance of cognitive variables within networks. RESULTS: Network connectivity increased from T1 to T2 and remained hyperconnected at T3. There was evidence of network reorganization between T1 and T3. Processing speed was central within each network, and visual memory and impulsivity became more central over time. CONCLUSIONS: The results suggest potential evidence of cognitive network change over time. Centrality findings suggest research specific to visual memory and impulse control difficulties during the post-concussion recovery period is warranted. Network analysis may provide additional information about cognitive recovery following SRC and could potentially serve as an effective means of monitoring persisting cognitive symptoms after concussion.

A systematic review and meta-analysis of factors influencing ImPACT concussion testing in high school and collegiate athletes with self-reported ADHD and/or LD.

OBJECTIVE: Sport concussion is a common injury, and athletes with attention-deficit/hyperactivity disorder (ADHD) and/or learning disorder (LD) are at increased risk and require specialized attention in clinical settings. Although systematic reviews of the relationship between ADHD/LD and concussion are reported in the literature, these reviews do not include quantitative syntheses. Additionally, no reviews have focused on the most commonly utilized concussion assessment, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The current review provides an update of sport concussion assessment in athletes with ADHD and/or LD from 2000 to 2021 on these topics: baseline and postconcussion performance on ImPACT, baseline and postconcussion symptom reporting using the Postconcussion Symptom Scale, invalid baseline classification on ImPACT, and self-reported history of concussion. METHOD: Meta-analyses were conducted on baseline ImPACT performance, symptom reporting, invalid baseline classification, and concussion rates. Thirty-four studies were included in systematic review and 19 were included in meta-analyses. RESULTS: Decreased baseline performance was found for athletes with ADHD (trivial to small effects), LD (small-to-medium effects), and ADHD/LD (small-to-medium effects). Increased baseline symptom reporting was found for athletes with ADHD (small effect). Increased odds of invalid baseline performance (trivial effect) and self-reported concussion history (small effect) were found in ADHD. CONCLUSIONS: These results provide the first quantitative synthesis of the literature in this area. It is recommended that future research further examines these topics in athletes with LD and co-occurring ADHD/LD (given the focus on ADHD), as well as the effects that all of these conditions may have on concussion recovery and return-to-play decision-making. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Expanding the cross-cultural psychological assessment tool box with IQ test short forms.

OBJECTIVE: Short forms of standard intelligence tests are useful in clinical and research settings where administration of a full intelligence test is impractical or unnecessary. In cross cultural contexts where few tests are available, including brief intelligence tests, short forms may be particularly useful to meet clinical and research needs. However, there is little cross-cultural research on the validity of short forms. This study evaluated feasibility of short form development for the Spanish version of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and examined comparability of short-form IQ estimates in Spanish- and English-speaking children with Attention-Deficit/Hyperactivity Disorder (ADHD). METHOD: Participants included children with ADHD who were administered the WISC-IV Spanish (n = 165) or WISC-IV (n = 299). Full Scale IQs (FSIQs) were calculated for two-, three-, four-, and five-subtest short forms. Misclassification rates, mean absolute differences, and intraclass correlation coefficients (ICCs) were used to determine short form accuracy in estimating FSIQ. RESULTS: The WISC-IV short forms examined had generally strong psychometric properties (e.g., ICCs ranged from .78 to .94) and level of accuracy in estimating FSIQ did not differ across primary language of Spanish or English. CONCLUSIONS: Findings support feasibility of IQ short form development to help address mental health disparities in research and clinical screening for Spanish- and English-speaking pediatric populations with ADHD.

Confirmatory factor analysis of imPACT cognitive tests in high school athletes.

ImPACT is the most commonly utilized computerized neurocognitive assessment for the clinical management of sport concussion. The cognitive composite scores that ImPACT currently reports include Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time, and Impulse Control. However, exploratory factor analytic studies report that two or more factors may better represent ImPACT's latent structure, suggesting that the current cognitive composites may not adequately represent the cognitive constructs ImPACT assesses. The latent structure of ImPACT cognitive baseline scores was examined using exploratory (EFA) and confirmatory factor analysis (CFA) of valid baseline ImPACT scores for 36,091 high school athletes. These athletes were randomly divided into two samples. The first sample was a calibration sample used for EFA and the second sample was a cross-validation sample used for CFA to estimate the best model identified in the calibration phase, along with other models that were reported in the literature or based on theoretical considerations, including hierarchical and bifactor models. EFA identified a first-order four-factor solution consisting of Visual Memory, Visual Reaction Time, Verbal Memory, and Working Memory constructs. CFA indicated that this four-factor model provided superior fit for the data, while the current five-composite structure of ImPACT provided a poor fit for the data. The latent constructs identified in this study using CFA do not map well onto the composite scores that are currently used to interpret ImPACT performance. Future research should investigate whether interpretation of ImPACT based on the constructs identified here will be more useful for clinical decision making than current approaches. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Influence of Special Education, ADHD, Autism, and Learning Disorders on ImPACT Validity Scores in High School Athletes.

OBJECTIVE: The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is commonly used to assist with post-concussion return-to-play decisions for athletes. Additional investigation is needed to determine whether embedded indicators used to determine the validity of scores are influenced by the presence of neurodevelopmental disorders (NDs). METHOD: This study examined standard and novel ImPACT validity indicators in a large sample of high school athletes (n = 33,772) with or without self-reported ND. RESULTS: Overall, 7.1% of athletes' baselines were judged invalid based on standard ImPACT validity criteria. When analyzed by group (healthy, ND), there were significantly more invalid ImPACT baselines for athletes with an ND diagnosis or special education history (between 9.7% and 54.3% for standard and novel embedded validity criteria) when compared to athletes without NDs. ND history was a significant predictor of invalid baseline performance above and beyond other demographic characteristics (i.e., age, sex, and sport), although it accounted for only a small percentage of variance. Multivariate base rates are presented stratified for age, sex, and ND. CONCLUSIONS: These data provide evidence of higher than normal rates of invalid baselines in athletes who report ND (based on both the standard and novel embedded validity indicators). Although ND accounted for a small percentage of variance in the prediction of invalid performance, negative consequences (e.g., extended time out of sports) of incorrect decision-making should be considered for those with neurodevelopmental conditions. Also, reasons for the overall increase noted here, such as decreased motivation, "sandbagging", or disability-related cognitive deficit, require additional investigation.

Examination of the Influence of Cognitive Behavior Therapy Components, Consumer Satisfaction and Engagement in Mothers Referred for Drug Abuse and Child Neglect on Treatment Outcomes.

Psychological interventions for child maltreatment have predominately been limited to family-supported, multi-component behavioral therapies. Although these comprehensive programs have resulted in positive outcomes, they are relatively costly and there is limited information available as to how the components of these programs influence treatment outcomes. In this study, the CBT components of an evidence-based treatment for child neglect and drug abuse (Family Behavior Therapy) were examined in regards to consumer preferences, consumer engagement and treatment outcomes. Thirty-five mothers identified for child neglect and drug abuse were administered various CBT components successively and cumulatively based on their preferences. Repeated measure ANOVAs indicated that participants chose to receive components that were specific to managing antecedents to drug abuse and child neglect most frequently, followed by parenting skills training, communication skills training, and job/financial skills training. No differences were found in treatment providers' ratings of the participants' engagement across intervention components throughout treatment. Participants rated the intervention components as similarly helpful. Partial correlations revealed that participants' ratings of helpfulness and provider ratings of participants' engagement were not associated with improved drug use outcomes at 6- and 10-months post baseline. Participants' ratings of helpfulness were associated with child maltreatment outcomes at 10-month post baseline, and provider ratings of participants' engagement were associated with child maltreatment outcomes at both 6- and 10-month post baseline. Participants identified for neglect not related to drug exposure in utero improved at a higher percentage than did participants identified for in utero drug exposure, and receiving behavioral intervention components more frequently led to greater percentages of participants improving in both drug use and child maltreatment outcomes.

Deconstructing Cognitive Heterogeneity in Puerto Rican Spanish-Speaking Children With ADHD.

OBJECTIVE: There is limited understanding of the cognitive profiles of Spanish-speaking children with Attention-Deficit/Hyperactivity Disorder (ADHD). The current study investigated the cognitive cluster profiles of Puerto Rican Spanish-speaking children with ADHD using the Wechsler Intelligence Scales for Children-Fourth Edition Spanish (WISC-IV Spanish) Index scores and examined the association between cognitive cluster profiles with other potentially relevant factors. METHOD: Hierarchical cluster analysis was used to identify WISC-IV clusters in a sample of 165 Puerto Rican children who had a primary diagnosis of ADHD. To examine the validity of the ADHD clusters, analysis of variances and chi-square analyses were conducted to compare the clusters across sociodemographics (e.g., age and education), type of ADHD diagnosis (ADHD subtype, Learning Disorder comorbidity), and academic achievement. RESULTS: Clusters were differentiated by level and pattern of performance. A five-cluster solution was identified as optimal that included (C1) multiple cognitive deficits, (C2) processing speed deficits, (C3) generally average performance, (C4) perceptual reasoning strengths, and (C5) working memory deficits. Among the five clusters, the profile with multiple cognitive deficits was characterized by poorer performance on the four WISC-IV Spanish Indexes and was associated with adverse sociodemographic characteristics. CONCLUSIONS: Results illustrate that there is substantial heterogeneity in cognitive abilities of Puerto Rican Spanish-speaking children with ADHD, and this heterogeneity is associated with a number of relevant outcomes.

Contingency management adapted for African-American adolescents with obesity enhances youth weight loss with caregiver participation: a multiple baseline pilot study.

BACKGROUND: Contingency management (CM) interventions, which use operant conditioning principles to encourage completion of target behavioral goals, may be useful for improving adherence to behavioral skills training (BST). Research-to-date has yet to explore CM for weight loss in minority adolescents. OBJECTIVE: To examine the effects of CM in improving adolescent weight loss when added to BST. DESIGN: The study utilized an innovative experimental design that builds upon multiple baseline approaches as recommended by the National Institutes of Health. PARTICIPANTS/SETTING: Six obese African-American youth and their primary caregivers living in Detroit, Michigan, USA. INTERVENTION: Adolescents received between 4 and 12 weeks of BST during a baseline period and subsequently received CM targeting weight loss. MAIN OUTCOME MEASURES: Youth weight. STATISTICAL ANALYSIS PERFORMED: Linear mixed effects modeling was used in the analysis. RESULTS: CM did not directly affect adolescent weight loss above that of BST (p=0.053). However, when caregivers were involved in CM session treatment, contingency management had a positive effect on adolescent weight loss. The estimated weight loss due to CM when caregivers also attended was 0.66 kg/week (p<0.001, [95% CI; -1.96, -0.97]) relative to the baseline trajectory. CONCLUSION: This study demonstrates application of a novel experimental approach to intervention development and demonstrated the importance of parent involvement when delivering contingency management for minority youth weight loss. Lessons learned from contingency management program implementation are also discussed in order to inform practice.

The effects of alcoholism comorbidity on neurocognitive function following traumatic brain injury.

Alcoholism and traumatic brain injury (TBI) often produce neuropsychological deficits. However, the extent and manner by which these factors interact is unclear. In this study, it was hypothesized that alcoholism would have compounding cognitive effects in individuals with TBI and alcoholism. Participants were divided into three groups, including a patient comparison (PC) group and groups with TBI with or without alcoholism histories. Participants were administered the Wechsler Adult Intelligence Scale-Revised and major components of the Halstead-Reitan Neuropsychological Test Battery. Comparing the groups on test performance, the TBI groups performed significantly worse than the PC group but did not significantly differ from each other. Thus, the effects of TBI on cognitive function overshadow preexisting deficits from the alcoholism.

Promoting the implementation of an evidence-based intervention for adolescent marijuana abuse in community settings: testing the use of intensive quality assurance.

The development and evaluation of effective strategies for transporting evidence-based practices to community-based clinicians has become a research and policy priority. Using multisystemic therapy programs as a platform, an experimental design examined the capacity of an Intensive Quality Assurance (IQA) system to promote therapist implementation of contingency management (CM) for adolescent marijuana abuse. Participants included 30 therapists assigned to Workshop Only (WSO) versus IQA training conditions, and 70 marijuana-abusing youths and their caregivers who were treated by these clinicians. Analyses showed that IQA was more effective than WSO at increasing practitioner implementation of CM cognitive-behavioral techniques in the short-term based on youth and caregiver reports, and these increases were sustained based on youth reports. On the other hand, IQA did not increase therapist use of CM monitoring techniques relative to WSO, likely because of an unanticipated ceiling effect. Both sets of findings contribute to the emerging literature on the transport of evidence-based practice to real-world clinical settings.

Sensitivity of the comprehensive trail making test to traumatic brain injury in adolescents.

The current study examined the sensitivity of the Comprehensive Trail Making Test (CTMT Reynolds) to neurocognitive deficits in adolescents with traumatic brain injury (TBI). Participants included 60 adolescents, 30 who had sustained TBI and 30 healthy controls (HC) that were individually matched to the TBI sample on age, gender, ethnicity, and geographical region. For both the TBI and HC groups the mean age was 15.0 years (S.D.=2.3 years, range=11-19). The TBI group had a mean IQ of 81.7 (S.D.=14.9), had sustained moderate to severe brain injury, and was assessed an average of 21.1 months (S.D.=20.7) following injury. The TBI group performed approximately 2 standard deviations below the control sample mean on each of the five CTMT trails as well as on the composite index and these differences were significant (p<.001). Significant correlations were present between the CTMT trails and clinical variables associated with brain injury severity. Finally, receiver operating characteristic analyses indicated good classification of the TBI and control cases for the CTMT, although some variability in classification accuracy was present among the various trails. Results suggest that the CTMT is sensitive to TBI in adolescents but continued research is needed with larger samples of individuals with TBI and other types of neurological disorders to further establish the present findings.

Development of an Audio-Tape Review System for Supporting Adherence to an Evidence-Based Treatment.

In bridging the science to service gap, effective, yet practical, strategies are needed for supporting practitioner implementation of evidence-based treatments. The development and preliminary evaluation of an adherence monitoring system to support clinician fidelity to an evidence-based treatment for substance-abusing adolescents was tested for community-based practitioners. Session tapes were monitored for adherence to a family-based approach to CM (CM/FB) for 27 practitioners during baseline, post-workshop, and follow-up periods. Approximately half of the practitioners were randomized to receive intensive quality assurance following a CM/FB workshop as part of a larger study. Findings supported the clinical feasibility of the developed system as well as the face and content validity, reliability, and concurrent validity. Future directions are discussed in light of these results, including instructions for the use of the developed system to efficiently train clinicians to adequate fidelity.