Sources of poor performance on the Rey-Osterrieth Complex Figure Test among children with learning difficulties: a dynamic assessment approach.

A dynamic assessment approach was used to examine the source of poor performance on the Rey-Osterrieth Complex Figure Test (ROCF) among 202 school-age children referred for learning difficulties. The ROCF was administered in the standard format and then in a structured format that highlighted the design's organizational framework. Manipulating encoding in this way improved recall to at least age-level for the majority of children. Those children who did not benefit from the structured format had relatively poor visual organizational skills. For most children with learning problems, poor ROCF performance stems from metacognitive difficulties; for a minority, the source appears to be more perceptual. A dynamic assessment procedure can enhance the diagnostic utility of the ROCF for children.

Characteristics of children referred for evaluation of school difficulties who have adequate academic achievement scores.

Forty children (7 to 11 years old) referred for evaluation of learning problems, who had scores within the normal range on standardized measures of academic achievement, were compared to 81 similarly referred children who had scored low (< 90) on at least one measure of academic achievement. We tested the hypothesis that children with normal achievement scores who are referred for evaluation of learning problems show neuropsychological profiles comparable to those of children with low achievement. Referral problems, school history, IQ, academic achievement, and neuropsychological function were evaluated. Referred children with normal achievement scores came from more advantaged backgrounds and had less intensive academic interventions, higher IQs, and better decoding skills. Nonetheless, the two groups showed similar neuropsychological profiles. Vulnerability to complexity and decreased automaticity were prominent. Normal-range achievement test scores among children referred for evaluation should not be regarded as indicating absence of neurodevelopmental vulnerability.

The professional self-evaluation of immigrant physicians from the former Soviet Union in Israel.

This study tests the hypothesis that the personal construction of a positive professional identity is central to immigrant physicians' psychosocial well-being. Data are derived from responses to structured questionnaires from the first and third stages of a 5-year, three-stage cohort study of physicians who immigrated to Israel from the former Soviet Union in 1990. At the third stage of the study, in 1995, 387 physicians were working as physicians of a total of 519 respondents. Previous analyses of this research population showed that the immigrants who obtained work in their profession had significantly higher scores on a variety of indicators of psychosocial well-being than those who did not. In this paper, which narrows its focus to those who were working as physicians in 1995, significant positive relationships were found among three measures of self-evaluation, and between professional self-esteem, global self-esteem, and work satisfaction, and adaptation to life in Israel. General practitioners and specialists scored higher on professional self-evaluation than residents. Women scored higher than men, and older respondents (age's 36-45) scored higher than younger respondents (ages 25-35). The immigrant physicians viewed themselves as similar to their Israeli-trained colleagues in terms of their professional role behavior and were particularly positive about their diagnostic skills and the quality of their relationships with their patients. These findings are discussed in terms of role theory, which suggests that the work role of professionals is the most salient component of their self-identify.

Processing speed in children with attention deficit/hyperactivity disorder, inattentive type.

Attention Deficit/Hyperactivity Disorder (ADHD) is among the most common and most often reconceptualized neurobehavioral disorders of childhood. In the most recent DSM-IV, a primarily inattentive subtype of ADHD (AD) has again been identified. This study explores the neuropsychological profile of this group of children. Eighty-two children referred for school-related problems participated. Twenty-five met criteria for AD; 52 met criteria for reading disability (RD); 9 were comorbid for RD and AD. AD children performed poorly on measures of information processing speed. Children with comorbid AD/RD were distinguishable from those with RD on speed of processing measures only. Vulnerability to information processing load may be at the root of many of the behavioral manifestations of AD.

The occupational integration of former Soviet physicians in Israel.

This paper reports the findings of a five-year, three-stage study of the occupational status persistence of 333 physicians who immigrated to Israel from the former Soviet Union in 1990. The first data collection, by way of a structured questionnaire in Russian, was undertaken in 1991, during their participation in preparatory courses for the medical licensure examination. The second and third stages of data collection were undertaken by mail in 1993 and 1995. Data are presented regarding the influence of gender and age on employment status and on the relationship between employment status and psycho-social well-being, including work and general satisfaction, self-esteem, mood, health and overall adaptation, at both stages. The dynamics of occupational integration are investigated by looking at the effects of occupational stability vs occupational change between stage 2 and stage 3 on the psycho social outcome variables. After three years in Israel, men were more likely to be working as physicians than women, and women were more likely to be unemployed. However, after five years, women were equally likely to have found work in their profession, albeit in lower status positions. Younger respondents were more successful than older respondents in passing the licensure examination, finding work in their profession, and entering residency programs. The gap between them did not close between stage 2 and stage 3. At both stage 2 and stage 3, those working as physicians had significantly more positive well-being scores than those not working as physicians. All occupational groups had more positive scores at stage 3 than at stage 2, except for those who were working in non-medically related jobs. The greatest improvement in psycho-social well-being was among those who became physicians between stage 2 and stage 3, compared to those who were not physicians at either stage and those who were physicians at both stages.

Nonconventional medicine in Israel: consultation patterns of the Israeli population and attitudes of primary care physicians.

This paper reports the findings of a study of nonconventional medicine in Israel. Data regarding patterns and correlates of consultations with alternative medicine practitioners were obtained from structured face-to-face interviews with a representative sample of 2030 Jewish adults aged 45 to 75. In addition, in-depth open-ended interviews were conducted with a convenience sample of 20 primary care physicians in order to explore their beliefs, attitudes and behaviors regarding nonconventional medicine. Six percent of the respondents interviewed in the population study visited an alternative practitioner in the year prior to the interview. For most of them, the consultation was a consequence of disappointment with the lack of success of conventional medical treatment. Most felt that the alternative medicine treatment had helped. Nearly 40% were seeing their regular primary care physician at the same time as they were seeing an alternative medical practitioner. Women were more likely than mean to consult an alternative medicine practitioner; consulters rated their health status more negatively than non-consulters. Consulters had a higher level of education than non-consulters, but the two groups did not differ in terms of age or economic status. Nearly all of the physicians stated that they refer patients to alternative practitioners; in most cases, the referrals are in response to patients' requests. Although skeptical of the scientific basis of alternative medicine therapies, most of the physicians believed that some therapies, even if only because of the "placebo effect", were effective in some cases. Almost all felt that the Ministry of Health, which today does not recognize any form of alternative medicine, should establish control over the training and practice of alternative medical practitioners. The findings from both parts of the study suggest that patients and primary care physicians in Israel do not view nonconventional medicine as a threat to conventional medicine, but rather as complementary to it.

Medical and psychosocial predictors of morbidity and mortality: results of a 26 year follow-up.

This study investigates the extent to which sociodemographic, medical and psychosocial factors measured in 1967 among 1,649 American-born Israelis predict their physical and emotional health status 26 years later. In 1993, mail questionnaires were completed by 673 (40.8%) of the 1967 respondents. Evidence was obtained regarding the death of 204 (12.4%) of the 1967 respondents. The 1967 predictor variables included: sociodemographic characteristics, self-assessed health and medical risk factors, and psychosocial resources. The 1993 outcome variables included a multidimensional measure of health, physical functioning, and emotional well-being. Bivariate and multivariate statistical analyses were used to determine the predictive power of the variables measured in 1967 on the 1993 health outcomes, controlling for potential confounders. These analyses showed that the deceased in 1993 were older than the respondents; in 1967 they had reported more health problems and had more medical risk factors; they also had less formal education, were less likely to be married, and had lower adjustment scores than the respondents. Among the 1993 respondents, the addition of psychosocial variables to the explanation of health outcomes, controlling for sociodemographic and medical risk factors, contributes strongly (13%) to emotional well-being. Their contribution to general health and physical functioning is weak (2 to 3%), but statistically significant. These results show the importance of a multifactorial approach to the long-term prediction of health and illness outcomes.

[Consultations with practitioners of alternative medicine].

More than 2,000 Jewish adults, aged 45-75, in urban areas of Israel were interviewed regarding consultations with practitioners of alternative medicine. 6% (122) of the respondents reported visiting such practitioners in the year prior to the interview. Homeopathy was the most frequent therapy, followed by reflexology, naturopathy, and acupuncture. The most common medical complaint was pain, particularly back pain. The most frequent reason for consulting the practitioner was disappointment with the outcome of conventional treatment. 39% of respondents who visited a practitioner were being treated by a conventional physician at the same time, for the same problem. The medical problems of a large majority had been relieved, but 22% said they were not helped by the practitioner. Women were more likely than men to consult a practitioner. Respondents with secondary or higher education were more likely to visit than those with less education. There were no age or socio-economic differences between users and nonusers. The mean payment for the whole series of treatments was NIS 770 (about $250). Respondents who visited practitioners reported worse health and more pain than nonusers, and were also more likely to have visited their conventional primary care physician in the past month. The findings suggest that nonconventional medicine should be seen as complementary to, rather than in competition with conventional medicine.

Performance of children with ADHD on the Rey-Osterrieth complex figure: a pilot neuropsychological study.

This study evaluates the performance of boys with Attention Deficit Hyperactivity Disorder (ADHD) on the Rey-Osterrieth Complex Figure (ROCF) taking into consideration familiality and comorbid psychiatric and learning disorders (LD). Sixty-five children with ADHD performed at developmentally lower levels of Copy Organization and Recall Style than did 45 controls. ADHD children with LD scored significantly lower on Copy Organization than did ADHD children without LD, whereas psychiatric comorbidity and familiality had no effect. These results suggest that a developmental analysis of the ROCF identifies organizational difficulties associated with ADHD and that these impairments cannot simply be attributed to comorbidities associated with ADHD.

Neuropsychological assessment in preoperative and postoperative evaluation.

Neuropsychological assessment in the surgical management of the epilepsies includes comprehensive neuropsychological examination for baseline, diagnostic, and follow up purposes, and specialized diagnostic procedures. The developmental competence of the individual provides an organizing principle for psychological work and is reflected in the neurosurgical strategy. Adaptive functioning and psychosocial adjustment are as important in determining outcome as performance on neuropsychological tasks. The techniques and tools of neuropsychological assessment are discussed in this article; presurgical functioning and post-surgical status and management affect outcome.

Neurobehavioral and neurologic outcome in long-term survivors of posterior fossa brain tumors: role of age and perioperative factors.

We evaluated the neuropsychological and neurologic outcome of 15 long-term survivors of posterior fossa tumors who were treated between 1970 and 1984 with cranial irradiation (n = 15) and surgery (n = 14). The interval between diagnosis and evaluation ranged from 4 to 20 years (median = 10 years). Earlier age at diagnosis (< 6 years) was associated with an increased incidence of severe neurologic and neuropsychological sequelae. Hydrocephalus, obtundation, and tumor extension outside the vermis also were more prevalent in the younger group. Poor neurobehavioral outcomes in young children with posterior fossa tumors may be related to more aggressive tumor growth or complications of the initial therapy and not solely due to toxicity from craniospinal irradiation.

The perception of curvature can be selectively disrupted in prosopagnosia.

A brain-damaged patient with prosopagnosia and a group of age- and education-matched control subjects evaluated curved and straight versions of different sorts of stimuli in different tasks. The patient consistently required more time to encode curved than straight stimuli, relative to the control subjects. Specifically, he had a deficit when he compared curved lines that were simultaneously visible, when he compared curved lines with those previously seen, when he examined a curved shape to determine whether an X was on or off the shape, and when he read curved script. He also made more errors when he named pictures of curved objects. Implications of these findings for some types of clinical disorders and for the role of "end-stopped" cells in visual cortex are discussed.

Neurobehavioral test strategies for environmental exposures in pediatric populations.

The Agency for Toxic Substances and Disease Registry convened a workshop in Atlanta, GA, that evaluated approaches and methods to ascertain whether there are neurobehavioral sequelae to children and adults exposed to hazardous substances in the environment. This article, developed from that workshop, addresses the feasibility of employing extant neurobehavioral tests to screen pediatric populations. A matrix lists basic functions to be assessed during eight developmental periods ranging from birth to high school. The best of these neurobehavioral tests for pediatric populations and the types of assessment tools that are still needed are discussed. We make 10 specific recommendations to establish a hazardous substances neurobehavioral screen for pediatric populations, including appointing a review panel, developing a structured questionnaire, convening a conference on design and analysis, addressing minority and socially disadvantaged populations, coordinating adult and child assessment methods, information sharing among Federal agencies, baseline data, methodology research, research associated with hazardous worksites, and establishment of a pediatric databank.

Assessment of developmental toxicity: neuropsychological batteries.

Assessment of change in behavioral functioning in children as a function of neurotoxicity is not a trivial undertaking. Psychological tests, widely (though erroneously) considered to be the "gold standard" for measurement of behavior in humans, are not adequate for the task; they tap the structure of cognition, not the behavioral repertoire, and cannot (alone) address developmental change. Comprehensive neurobehavioral assessment must be undertaken within a multidisciplinary assessment strategy incorporating knowledge of brain and brain development, cognitive processes and their development, brain-behavior relationships, and detailed knowledge of neurotoxicants, their action and the exposure thereto. Initial assessment batteries must be adequately broad ranging and must incorporate strategies and data for evaluating the impact of predictable nonbrain variables; they must also be cost efficient to respond to the realities of funding and the exigencies of field testing. Measures of neuropsychological outcome are optimally characterized as they relate to behavioral domains specified in terms of the competencies of infants and children of different ages; relevant information is derived from demographic, socioeconomic, medical, developmental, and educational sources, as well as from detailed observational data and performance on psychological tests. Two levels of assessment are proposed.

Emigrant physicians evaluate the health care system of the former Soviet Union.

This study is a retrospective evaluation of the Soviet health care system by 1,100 Jewish physicians who immigrated to Israel in 1990, but were professionally active in the former Soviet Union before and during the Gorbachev era. Medical education and the process of specialization; gender differences within the medical profession; sources of work satisfaction and dissatisfaction; self-evaluations of professional behavior; and assessments of patient behavior are included in this empirical study. Although high levels of dissatisfaction were found regarding instrumental aspects of work, the physicians reported high levels of satisfaction with their relationships with colleagues and patients. The recent emigrants assessed their own role behavior and that of their patients more critically than did physicians who left the Soviet Union in 1972, and who answered identical questions in 1975. Among the recent emigrants, men, older physicians, and those with higher status within the profession tended to be more satisfied with their work and less critical about their own and their patients' behavior than their female, younger and lower status colleagues. The subjective perceptions of former "insiders," which complement the reports that have appeared in recent years in the medical literature, are discussed in terms of the impact of glasnost and perestroika on reporting behavior and on the real deterioration that occurred in the health care system of the former Soviet Union.