Interaction of obesity and proteins associated with the NLRP3 inflammasome following mild traumatic brain injury.

The NOD-like receptor pyrin domain-containing protein 3 (NLRP3) inflammasome has been associated with worse outcomes from severe traumatic brain injury (TBI). The NLRP3 inflammasome is also strongly associated with other pro-inflammatory conditions, such as obesity. Little is known about the potential effect of mild TBI (mTBI) on the NLRP3 inflammasome and the extent to which modifying factors, such as obesity, may augment the inflammatory response to mTBI. The purpose of this study was to evaluate the association of NLRP3 inflammasome proteins with obese body mass index (BMI ≥ 30) within 24 h of mTBI after presenting to a level 1 trauma center emergency department. This is a secondary analysis of prospectively enrolled patients with mTBI who presented to the emergency department of one U.S. Level 1 trauma center from 2013 to 2018 (n = 243). A series of regression models were built to evaluate the association of NLRP3 proteins obtained from blood plasma within 24 h of injury and BMI as well as the potential interaction effect of higher BMI with NLRP3 proteins (n = 243). A logistic regression model revealed a significant association between IL-18 (p < 0.001) in mTBI patients with obese BMI compared to mTBI patients with non-obese BMI (< 30). Moderation analyses revealed statistically significant interaction effects between apoptotic speck-like protein (ASC), caspase-1, IL-18, IL-1ß and obese BMI which worsened symptom burden, quality of life, and physical function at 2 weeks and 6 months post-injury. Higher acute concentrations of IL-1ß in the overall cohort predicted higher symptoms at 6-months and worse physical function at 2-weeks and 6-months. Higher acute concentrations of IL-18 in the overall cohort predicted worse physical function at 6-months. In this single center mTBI cohort, obese BMI interacted with higher acute concentrations of NLRP3 inflammasome proteins and worsened short- and long-term clinical outcomes.

Evaluating Recovery After Two and Three Repeated Concussions Using Growth Curves.

The results of prior research concerning the effects of repeated concussions have been mixed. The aim of this study was to evaluate how concussion outcomes and presentation changed within patients who were evaluated at a concussion specialty clinic multiple times with a concussion. Subjects included 202 patients (54% male) aged 10-21 years (M = 13.17) who presented to a specialty concussion clinic for two and three concussions (77% sport-related) and were followed through formal clearance. First, growth curve models were estimated to determine recovery time and initial symptom burden across the multiple injuries. Second, covariates were added to these models to evaluate which demographic, risk factor, or injury variables predicted any change that did occur in evaluation or outcome variables. Models indicated that each subsequent concussion linearly resulted in significantly fewer days to recovery (-4.62 days, p < 0.047) across three concussions, and significantly lower (and linear) symptom scores on the post-concussion symptom scale (PCSS) (-2.16, p = 0.05). More severe presentation (i.e., days to recovery; higher symptom score) was significantly associated (-.62, p = 0.005) with greater improvement in recovery time (-.62, p = 0.005) and symptom burden (-.56, p < 0.001) at subsequent injuries. No covariates were significantly associated with improvement (or lack thereof) at subsequent injuries. This study adds to evidence suggesting multiple injuries is not associated with protracted recovery at subsequent injuries, in the context of treatment and full clearance for each injury at a multi-disciplinary clinic.

Network analysis and relationship of symptom factors to functional outcomes and quality of life following mild traumatic brain injury: a TRACK-TBI study.

Introduction: Mild traumatic brain injury (mTBI) is a heterogenous injury which can be difficult to characterize and manage. Using cross-sectional network analysis (NA) to conceptualize mTBI symptoms offers an innovative solution to identify how mTBI symptoms relate to each other. The centrality hypothesis of network theory posits that certain symptoms in a network are more relevant (central) or have above average influence over the rest of the network. However, no studies have used NA to characterize the interrelationships between symptoms in a cohort of patients who presented with mTBI to a U.S. Level 1 trauma center emergency department and how subacute central symptoms relate to long-term outcomes. Methods: Patients with mTBI (Glasgow Coma Scale = 13-15) evaluated across 18 U.S. Level 1 trauma centers from 2013 to 2019 completed the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at 2 weeks (W2) post-injury (n = 1,593) and at 3 months (M3), 6 months (M6), and 12 months (M12) post-injury. Network maps were developed from RPQ subscale scores at each timepoint. RPQ scores at W2 were associated with M6 and M12 functional and quality of life outcomes. Results: Network structure did not differ across timepoints, indicating no difference in symptoms/factors influence on the overall symptom network across time. The cognitive factor had the highest expected influence at W2 (1.761), M3 (1.245), and M6 (1.349). Fatigue had the highest expected influence at M12 (1.275). The emotional factor was the only other node with expected influence >1 at any timepoint, indicating disproportionate influence of emotional symptoms on overall symptom burden (M3 = 1.011; M6 = 1.076). Discussion: Several symptom factors at 2-weeks post-injury were more strongly associated with incomplete recovery and/or poorer injury-related quality of life at 6 and 12 months post-injury than previously validated demographic and clinical covariates. The network analysis suggests that emotional, cognitive, and fatigue symptoms may be useful treatment targets in this population due to high centrality and activating potential of the overall symptom network.

Discriminating Young Children with Concussion in an Outpatient Specialty Clinic from Healthy Controls Using the Child Sports Concussion Assessment Tool-5.

OBJECTIVE: To evaluate the clinical utility of the Sports Concussion Assessment Tool-5 Child (Child SCAT5) in an outpatient specialty clinic sample of children aged 5-9 years. STUDY DESIGN: Ninety-six children within 30 days of a concussion (mean = 8.90 ± 5.78 days) and 43 age- and sex-matched healthy controls completed the Child SCAT5, including balance items, cognitive screening, parent and child symptom severity reports, as well as each individual parent- and child-rated symptom severity (0-3). A series of receiver operating characteristic curves with area under the curve (AUC) analysis were performed to evaluate the clinical utility of the Child SCAT5 components to discriminate concussion. RESULTS: The AUC values were nondiscriminate for cognitive screening (0.32) and poor for balance (0.61) items. The AUC values were acceptable for parent-reported symptoms worsening after physical activity (0.73) and mental activity (0.72). The AUCs for symptom severity items were excellent for parent (0.89) and child-reported (0.81) headaches, and were acceptable for parent-reported tired a lot (0.75) and both parent- (0.72) and child-reported (0.72) tired easily. CONCLUSION: With the exception of parent- and child-reported symptoms, the Child SCAT5 provides limited clinical utility for evaluating concussion in children aged 5-9 years seen at an outpatient concussion specialty clinic. The cognitive screening and balance testing items were not useful in discriminating concussion. Parent- and child-reported headache were the only Child SCAT5 items with excellent ability to differentiate concussion from controls in the age group.

The Effects of Rest on Concussion Symptom Resolution and Recovery Time: A Meta-analytic Review and Subgroup Analysis of 4329 Patients.

BACKGROUND: Numerous individual studies suggest that rest may have a negative effect on outcomes following concussion. PURPOSE: To perform a systematic meta-analysis of the effects of prescribed rest compared with active interventions after concussion. STUDY DESIGN: Meta-analysis; Level of evidence, 4. METHODS: A meta-analysis (using the Hedges g) of randomized controlled trials and cohort studies was conducted to evaluate the effects of prescribed rest on symptoms and recovery time after concussion. Subgroup analyses were performed for methodological, study, and sample characteristics. Data sources were obtained from systematic search of key terms using Ovid Medline, Embase, Cochrane Database of Systematic Reviews, APA PsycINFO, Web of Science, SPORTDiscus, and ProQuest dissertations and theses through May 28, 2021. Eligible studies were those that (1) assessed concussion or mild traumatic brain injury; (2) included symptoms or days to recovery for ≥2 time points; (3) included 2 groups with 1 group assigned to rest; and (4) were written in the English language. RESULTS: In total, 19 studies involving 4239 participants met criteria. Prescribed rest had a significant negative effect on symptoms (k = 15; g = -0.27; SE = 0.11; 95% CI, -0.48 to -0.05; P = .04) but not on recovery time (k = 8; g = -0.16; SE = 0.21; 95% CI, -0.57 to 0.26; P = .03). Subgroup analyses suggested that studies with shorter duration (<28 days) (g = -0.46; k = 5), studies involving youth (g = -0.33; k = 12), and studies focused on sport-related concussion (g = -0.38; k = 8) reported higher effect sizes. CONCLUSION: The findings support a small negative effect for prescribed rest on symptoms after concussion. Younger age and sport-related mechanisms of injury were associated with a greater negative effect size. However, the lack of support for an effect for recovery time and the relatively small overall numbers of eligible studies highlight ongoing concerns regarding the quantity and rigor of clinical trials in concussion. REGISTRATION: CRD42021253060 (PROSPERO).

Multidomain concussion symptoms in adolescents: A network analysis.

Concussion is a heterogeneous injury involving symptoms and impairment that represent multiple domains (e.g., anxiety, cognitive, vestibular). Network analysis, a modeling technique that estimates relationships among symptoms, provides a statistically sound and clinically practical method for evaluating these interrelationships. The purpose of this study was to examine, using network analysis, relationships among clinical assessments and multidomain symptom report within a sample of adolescent patients following a concussion. Participants included 326 patients (49.7% female) aged 10-21 years presenting to a concussion specialty clinic within 28 days of a diagnosed concussion. Participants completed the Post-Concussion Symptom Scale (PCSS) and Vestibular-Ocular Motor Screening (VOMS) tool at initial visit. Network models were applied to PCSS symptoms initially, and then applied to VOMS and PCSS symptom data together. Dizziness (Expected influence (EI) = 1.10) and sadness (EI = 1.91) were most central (i.e., highest cumulative partial correlations) to the symptom network. Numerous interdomain relationships were supported, including irritability with mental fogginess (edgeweight = 0.12), dizziness with headache (edgeweight = 0.16), and dizziness with vision problems (edgeweight = 0.13). Community analyses resulted in VOMS groupings by domain (e.g., vestibular) and symptom (e.g., dizziness). The findings suggest a more direct focus on symptom interrelationships, such as how dizziness contributes to emotional symptoms, may help guide and better target treatments. Also, results suggest grouping VOMS assessment by symptom (e.g., dizziness) and item (e.g., vestibular-ocular reflex) may better reflect underlying impairments reflected by these symptom-item combinations.

Comparison of Clinical Outcomes Between Athletes With Immediate and Delayed Onset of Symptoms Following Sport-Related Concussion.

OBJECTIVE: To compare characteristics and clinical outcomes of adolescent athletes with immediate and delayed onset of symptoms following sport-related concussion (SRC). A secondary objective was to describe the symptoms that are delayed and the timing of symptom onset. DESIGN: Prospective, repeated measures study. SETTING: Concussion Specialty Clinic. PARTICIPANTS: One hundred fifty-two participants (63.3% men) aged 11 to 24 (15.78 ± 3.47) evaluated within 7 days (3.47 ± 1.66) of sustaining an SRC. INDEPENDENT VARIABLE: Group classification of immediate (IMMEDIATE) or delayed onset of symptoms (DELAYED; >60 seconds following mechanism of injury) through structured clinical interview. MAIN OUTCOME MEASURES: Group comparisons on demographic and medical history factors, concussion and clinical profile symptom scores, computerized neurocognitive test scores, vestibular/oculomotor screening scores, and days to medical clearance. RESULTS: 24.3% of athletes in the sample were DELAYED. The groups did not differ on demographics and medical history. The DELAYED group had increased likelihood of posttraumatic migraine (PTM) as a primary/secondary clinical profile ( P = 0.03). Groups did not differ on any other clinical profiles ( P > 0.05). Groups did not differ on recovery time ( P = 0.47), the IMMEDIATE group higher dizziness on vestibular/ocular motor screening ( P = 0.016) and increased likelihood of dizziness being the initial symptom experienced ( P < 0 .001). CONCLUSIONS: The results indicated that delayed onset of symptoms in athletes were relatively common following SRC, supporting continued evaluation of athletes for several days following suspected injuries. Delayed onset of symptoms was associated with PTM, whereas immediate onset was associated with more pronounced vestibular dysfunction, suggesting that clinicians should consider the timing of symptom onset when assessing and treating athletes following SRC.

The Role of Age, Sex, Body Mass Index, and Sport Type on the Dynamic Exertion Test in Healthy Athletes: A Cross-Sectional Study.

BACKGROUND: The dynamic exertion test (EXiT) was developed to help inform return to play after sport-related concussion, but some factors may threaten the internal validity of EXiT and affect clinical interpretation. OBJECTIVE: To compare age, sex, BMI, and sport types across EXiT physiological [pre-EXiT and post-EXiT percentage of maximum heart rate (HR %max) and blood pressure (BP)], performance (change-of-direction task completion time and committed errors), and clinical [symptoms and rating of perceived exertion (RPE)] outcomes among healthy adolescents and adults. STUDY DESIGN: Cross-sectional. METHODS: Eighty-seven participants ( F = 55, 37.4%) reported symptoms and RPE during the EXiT, which consists of a 12-minute treadmill running protocol, and the dynamic circuit, ball toss, box shuffle (SHUF) and carioca (CAR), zig zag (ZZ), proagility (PA), and arrow agility (AA) tasks. Independent samples t tests were conducted for pre-EXiT and post-EXiT HR %max and BP and change-of-direction task completion time and Mann-Whitney U tests for errors, symptoms, and RPE. A series of 1-way analysis of variance (ANOVAs) and Kruskal-Wallis H tests were conducted to compare collision, contact, and noncontact sport types. RESULTS: Adolescents had lower completion time across AA ( P = 0.01) and male athletes lower than female athletes on CAR, ZZ, PA, and AA ( P < 0.04). Male athletes reported greater RPE after the SHUF, CAR, and AA ( P < 0.03). HR %max , errors, and symptoms were equivocal across all subgroups ( P > 0.05). CONCLUSION: Age and sex should be considered in the interpretation of performance and clinical, but not physiological, EXiT outcomes. The EXiT is a standardized exercise assessment and generalizable to healthy athletes.

Temporal Differences in Concussion Symptom Factors in Adolescents following Sports-Related Concussion.

OBJECTIVE: To evaluate temporal differences in concussion symptoms up to 30 days following a sports-related concussion. STUDY DESIGN: Adolescent and young adult athletes (n = 782) were separated based on time since injury at presentation as Early (0-7 days; n = 321, age: 15.4 ± 1.9 years, 51.7% female), Middle (8-14 days; n = 281, age: 15.8 ± 2.2 years, 54.8% female), and Late (15-30 days; n = 180, age: 15.6 ± 1.8 years, 52.8% female). All participants completed the 22-item Post-Concussion Symptom Scale at first visit. A confirmatory factor analysis was completed separately for each time since injury cohort using a 4-component model reported previously. RESULTS: The confirmatory factor analysis model fit was acceptable for Early, Middle, and Late (using cognitive-migraine-fatigue, affective, sleep, and somatic factors). Both affective (change = 0.30; P = .01; Cohen d = 0.30) and sleep (change = 0.51; P ≤ .001; Cohen d = 0.47) factors were significantly greater in the Late group compared with the Early, but not Middle, groups. The previously reported 4-factor symptom model, including cognitive-migraine-fatigue, affective, somatic, and sleep factors, was appropriate for adolescents up to 30 days' postinjury. However, adolescents who presented between 15 and 30 days' postinjury reported greater affective and sleep symptoms than those who presented within 1 week. CONCLUSIONS: Clinicians should consider these temporal differences when evaluating concussion symptoms in adolescents, as greater affective and sleep symptoms can be predictive of prolonged recovery/persistent complications.

Multisource Network and Latent Variable Models of Sluggish Cognitive Tempo, ADHD-Inattentive, and Depressive Symptoms with Spanish Children: Equivalent Findings and Recommendations.

Multisource network and latent variable models were used to examine the construct validity of sluggish cognitive tempo (SCT) symptoms relative to attention-deficit/hyperactivity disorder-inattentive (ADHD-IN) and depressive symptoms. The five objectives were to determine the (1) distinctiveness of SCT, ADHD-IN, and depressive symptom communities, (2) similarity of the three symptom communities across mother, father, and teacher ratings, (3) individual symptoms with the strongest influence on other symptoms, (4) individual symptoms with the strongest relations to academic and social impairment, and (5) similarity between network and latent variable model results. Mothers, fathers, and teachers rated SCT, ADHD-IN, and depressive symptoms for 2,142 Spanish children (49.49% girls, ages 8-13 years, third to sixth grade). Walktrap community analysis resulted in SCT, ADHD-IN, and depressive symptom communities with three SCT symptom communities within the overall SCT symptom community (daydreams, mental confusion, and hypoactive communities). The symptom networks were also similar across mothers, fathers, and teachers, especially mothers and fathers. Finally, for all three sources, the same two SCT and two ADHD-IN symptoms showed unique relations with academic impairment and the same depressive symptom showed unique relations with social impairment. A latent variable model yielded equivalent results. Both models thus supported the validity of SCT symptoms relative to ADHD-IN and depressive symptoms. Complexities are noted in the selection of network and latent variable models to study child and adolescent psychopathology with recommendations for their selection.

Multisource Longitudinal Network and Latent Variable Model Analyses of ADHD Symptoms in Children.

Objective: Multisource longitudinal network analysis was used to determine if between-child and within-child variance of attention-deficit/hyperactivity disorder (ADHD) symptoms provided unique findings of ADHD relative to latent variable model (LVM) analyses.Method: Mothers and fathers of 802 Spanish first-grade children (54% boys) provided ratings of ADHD symptoms at two time points six weeks apart (assessment 1: 723 mothers and 603 fathers; assessment 2: 667 mothers and 584 fathers). Network and latent variable models were applied to the ratings.Results: Inattention, hyperactivity, and mixed hyperactive/impulsive symptom communities occurred for the within- and between-children's symptom networks with the results being consistent across mothers and fathers, especially for the between-children's symptom networks. LVM analyses identified three factors with the same symptoms on each factor as in the symptom communities. These models also showed invariance across mothers and fathers as well as assessments.Conclusions: Longitudinal networks provided several useful insights for ADHD, including centrality symptoms that differed across between- and within-child levels. However, many findings were also largely consistent with the LVM analyses. Future studies should use novel methods (e.g., intensive longitudinal measurement) and analytic tools to determine if more unique theoretical and clinical findings emerge when applying network analysis to longitudinally measured ADHD symptoms.

Is Overparenting Associated with Adolescent/Young Adult Emotional Functioning and Clinical Outcomes Following Concussion?

Overparenting (O-P), or "helicopter" parenting, has warranted increased attention across the past decade. It is characterized as being overly involved, protective, and low on granting autonomy, and is associated with deleterious psychosocial outcomes outside of the concussion literature. This study examined the association of overparenting and patient emotional distress and clinical outcomes (i.e., symptoms, neurocognitive test scores, recovery time) post-concussion. Adolescents/young adult concussion patients (injury < 30 days) and parents (N = 101 child-parent dyads) participated. Patient participants completed measures of depression, anxiety, stress, and concussion clinical outcomes while parents concurrently completed an overparenting measure. Results of a general linear model found that overparenting was associated with higher anxiety and stress report of the child. Overparenting had a significant positive correlation with concussion recovery, although of a small magnitude. Emotional distress level, but not overparenting, was moderately associated with worse performance on clinical outcomes, including neurocognitive testing, vestibular/ocular motor dysfunction, and concussion symptom severity.

Psychometric and Normative Information on the Child and Adolescent Behavior Inventory in a Nationally Representative Sample of United States Children.

OBJECTIVE: Psychometric and normative information is provided for the Sluggish Cognitive Tempo, Attention Deficit/Hyperactivity Disorder (ADHD) Inattention, ADHD Hyperactivity/Impulsivity, Oppositional Defiant Disorder, Callous-Unemotional Behaviors (Limited Prosocial Emotions specifier), Anxiety, Depression, Social Impairment, Friendship Difficulties, and Academic Impairment Scales of the Child and Adolescent Behavior Inventory (CABI) with a nationally representative sample of U.S. children. METHOD: Mothers of 2,056 kindergarten to sixth-grade children (M ± SDage = 8.49 ± 2.15 years; 49% girls) completed the CABI, and 307 randomly selected mothers completed the CABI again 4 weeks later. RESULTS: The 10-factor model (one factor for each CABI scale) provided a close fit for the total sample as well as for boys and girls separately. Each scale showed invariance of like-item loadings and thresholds for boys and girls across a 4-week interval with excellent test-retest factor correlations and no significant factor mean changes. Normative information (T-scores) is provided for the 10 scales separately for boys and girls, with test information functions supporting the use of the scales for screening purposes. CONCLUSION: The normative information on the CABI provides support for the use of the 10 scales to inform the clinical care of individual children, with the positive psychometric properties of the scores providing additional support for the use of the scales for research. Copies of the scale and norms are available for free to clinicians and researchers.

Evidence for the taxonic latent structure for DSM-5 intermittent explosive disorder in adults.

BACKGROUND: Identification of individuals with clinically significant aggressive behavior is critical for the prevention and management of human aggressive behavior. A previous population-based taxometric study reported that the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV) intermittent explosive disorder (IED) belongs to its own discrete class (taxon) rather than existing along a continuum. METHODS: This study sought to extend previous population-based findings in a clinical research sample of adults with DSM-5 IED (n = 346), adults with non-aggressive DSM-5 disorders (n = 293), and adults without any DSM-5 disorder (n = 174), using standardized assessments of DSM-5 diagnoses, aggression, and other related measures not available in past studies. RESULTS: Analyses revealed a taxonic latent structure that overlapped with the DSM-5 diagnosis of IED. Within the sample, taxon group members had higher scores on a variety of measures of psychopathology than did the complement members of the sample. Comorbidity of other diagnoses with IED did not affect these results. CONCLUSION: These findings support the proposition that DSM-5 IED represents a distinct behavioral disorder rather than the severe end of an aggressive behavior continuum.

Network Analysis of ADHD and ODD Symptoms: Novel Insights or Redundant Findings with the Latent Variable Model?

A latent variable model (LVM) and network analysis (NA) were applied to mother and father ratings of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms to determine if NA offers unique insights relative to the LVM. ADHD-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and ODD symptoms along with academic competence behaviors (reading, arithmetic, and writing skills) were rated by mothers and fathers of Brazilian (n = 894), Thai (n = 2075), and United States (n = 817) children (Mage = 9.04, SD = 2.12, 49.5% females). LVM indicated that (1) the ADHD-IN, ADHD-HI, and ODD three-factor model yielded a close global-fit with no localized ill-fit; (2) nearly all loadings were substantial; (3) like-symptom loadings, like-symptom thresholds, and like-factor means showed invariance across mothers and fathers; (4) the three factors showed convergent and discriminant validity across mothers and fathers; and (5) only the ADHD-IN showed a unique negative relationship with academic competence. NA indicated that (1) a walktrap community analysis resulted in ADHD-IN, ADHD-HI, and ODD symptom communities; (2) the three symptom communities were consistent across mothers and fathers; (3) only three ADHD-IN symptoms showed unique relationships with the three academic competence items. NA has proven useful for numerous mental disorders. In the current study, NA results were mostly congruent with the LVM model, with a few notable exceptions. The results are discussed in the context of model assumptions and application considerations in the context of ADHD/ODD symptoms relative to other symptom dimensions.

Consistency of Limited Prosocial Emotions Across Occasions, Sources, and Settings: Trait- or State-Like Construct in a Young Community Sample?

Limited prosocial emotions (LPE, also referred to as callous-unemotional [CU] traits) are considered to reflect a more trait- than state-like construct. Our first objective was to determine the amount true score variance in CU/LPE that was consistent (trait consistency) over two occasions (12-month interval) of measurement versus specific (occasion-specificity) to each occasion. Our second objective was to determine the convergent validity of the consistent (trait) and occasion-specific (state) variance in CU/LPE symptom ratings within and across settings. Mothers, fathers, primary teachers, and ancillary teachers rated the CU/LPE symptoms in sample of 811 Spanish children (55% boys) on two occasions (i.e., end of first and second grades). CU/LPE symptom ratings showed more trait consistency than occasion-specificity for mothers and fathers, slightly more occasion-specificity than trait consistency for primary teachers, and much more occasion-specificity than trait consistency for ancillary teachers. Convergent validity for trait consistency was strong for fathers with mothers but weaker for primary with ancillary teachers. There was essentially no convergent validity for either trait consistency or occasion-specificity across home and school settings. CU/LPE symptom ratings within this age range represented a more trait-like construct for mothers and fathers and more state-like construct for primary teachers and ancillary teachers. In contrast, earlier studies showed ADHD and ODD ratings to be trait-like within and across home and school. The study of CU/LPE in young children should therefore include multiple sources in multiple settings across occasions to better understand the consistent and occasion-specific nature of the CU/LPE construct.

How Consistent Is Sluggish Cognitive Tempo Across Occasions, Sources, and Settings? Evidence From Latent State-Trait Modeling.

Research has yet to determine how much of the variance in sluggish cognitive tempo (SCT) symptom ratings is consistent across occasions, sources, and settings versus specific to occasion, source, and setting. Our first objective was to determine the amount of variance in SCT ratings that was consistent ( trait consistency) across three occasions of measurement over 12 months versus specific to the occasion ( occasion-specificity) with ratings by mothers, fathers, primary teachers, and secondary teachers of 811 Spanish children. Our second objective was then to determine the convergent validity for trait consistency and occasion-specificity variance components within and across settings. SCT ratings reflected mostly trait consistency for mothers, fathers, and primary teachers (less so for secondary teachers) with the convergent validity for trait consistency also being strong for mothers with fathers and for primary teachers with secondary teachers. Across home and school, however, convergent validity for trait consistency was low and even lower for occasion-specificity. SCT appears to be more trait-like rather than state-like, with similar levels of trait consistency across occasions and convergent validity within settings as attention-deficit/hyperactivity disorder (ADHD) symptoms in a prior study. However, SCT symptoms had slightly weaker convergent validity for trait consistency across settings relative to ADHD symptoms.

Latent State-Trait Modeling: A New Tool to Refine Temperament Methodology.

Questions concerning longitudinal stability and multi-method consistency are critical to temperament research. Latent State-Trait (LST) analyses address these directly, and were utilized in this study. Thus, our primary objective was to apply LST analyses in a temperament context, using longitudinal and multi-method data to determine the amount of trait vs. state variance, as well as convergence for measures of Distress to Limitations (DL) facets. Mothers' ratings and independent observations of DL behaviors collected on two occasions (8 months old and 12 months old) for 148 infants (49.2% female) were utilized. Single source latent state-trait (LST) analyses indicated that parent ratings of DL behavior (PDL) contained more trait (M = 61%) than state residual (M = 39%) variance, whereas independent observations (IO) of DL behavior contained substantially more state residual (75%) than trait (25%) variance. A multiple source LST analysis indicated virtually zero convergence for either trait or state residual variance between PDL and IO ratings (M = 2%). In conclusion, PDL ratings were more trait-like across the four-month interval, whereas IO ratings of DL were more state-like in nature. Also, no convergence was found between the two methods of measurement. Results are discussed with an emphasis on implications for the utility of LST analyses in temperament research.

Network analysis of psychopathy in forensic patients.

The question of which features represent the most central components of psychopathy remains unresolved and is the subject of considerable debate. Network analysis, which is a relatively new way to conceptualize mental disorders that emphasizes complex causal systems, provides a means to graphically and quantitatively describe the centrality of the various symptoms of a disorder. We applied association and adaptive LASSO networks on two samples of forensic patients. The first sample included forensic inpatients (N = 277) who were administered the Psychopathy Checklist-Revised (Hare, 2003), and the second sample included patients who previously had been civilly committed (N = 1136), who were administered the Psychopathy Checklist: Screening Version (Hart, Cox, & Hare, 1995). The models indicated the items on the affective facet are highly central across both samples and methods, and the item "lack of remorse" was especially central to the networks. Conversely, interpersonal, lifestyle, and antisocial facets generally resulted in low centrality in the models of both samples. Thus, the models lend support to the importance of affective deficits as the primary feature of psychopathy when psychopathy is assessed using the Hare Psychopathy Checklist measures. (PsycINFO Database Record

Trait and state variance in oppositional defiant disorder symptoms: A multi-source investigation with Spanish children.

The objective was to determine and compare the trait and state components of oppositional defiant disorder (ODD) symptom reports across multiple informants. Mothers, fathers, primary teachers, and secondary teachers rated the occurrence of the ODD symptoms in 810 Spanish children (55% boys) on 2 occasions (end first and second grades). Single source latent state-trait (LST) analyses revealed that ODD symptom ratings from all 4 sources showed more trait (M = 63%) than state residual (M = 37%) variance. A multiple source LST analysis revealed substantial convergent validity of mothers' and fathers' trait variance components (M = 68%) and modest convergent validity of state residual variance components (M = 35%). In contrast, primary and secondary teachers showed low convergent validity relative to mothers for trait variance (Ms = 31%, 32%, respectively) and essentially zero convergent validity relative to mothers for state residual variance (Ms = 1%, 3%, respectively). Although ODD symptom ratings reflected slightly more trait- than state-like constructs within each of the 4 sources separately across occasions, strong convergent validity for the trait variance only occurred within settings (i.e., mothers with fathers; primary with secondary teachers) with the convergent validity of the trait and state residual variance components being low to nonexistent across settings. These results suggest that ODD symptom reports are trait-like across time for individual sources with this trait variance, however, only having convergent validity within settings. Implications for assessment of ODD are discussed. (PsycINFO Database Record