Assessing performance validity with the TOMM and automatized sequences task in a pediatric psychiatric inpatient setting.

This study examined the performance of children consecutively admitted to an inpatient psychiatric unit on the Test of Memory Malingering (TOMM) (aged 5-12; n = 96) and Automatized Sequences Task (aged 8-12; n = 67). Eighty-three percent of children passed the TOMM Trial 2 (M raw score = 47.7, SD = 4.7) and 76% of children passed the Automatized Sequences Task total time (M = 23.1 seconds; SD = 8.2). The concordance rate between the TOMM and the total time on the Automatized Sequences Task was 73.1%. Receiver operating characteristic curves indicated that of the Automatized Sequences Task subtests, only Counting 1-20 significantly differentiated children who passed Trial 2 of the TOMM from those who did not pass Trial 2 of the TOMM (area under the curve = .756, p = .006). Performance on both PVTs was unrelated to demographic characteristics and measures of psychological and neuropsychological functioning on both the TOMM and Automatized Sequences Task. Further research is needed to determine whether the nearly 1 in 4 children (23.9%) who performed below recommended cutoffs on Automatized Sequences Task reflects genuine suboptimal effort, cognitive difficulties among these children, and/or other factors.

Neurocognitive predictors of length of stay within a children's psychiatric inpatient program.

This study investigated the neurocognitive predictors of length of stay (LOS) within a children's psychiatric inpatient program. A medical chart review was conducted for 96 children aged 6-14 years who received a neuropsychological evaluation during hospitalization. Correlation and linear regression analyses examined the influence of neurocognition (memory, construction, executive functioning [EF], and intelligence [IQ]) on subsequent LOS. Impairment/performance was calculated by the standard mean composite score and global deficit score (GDS) approaches for each domain and for overall neurocognition. Rates of impairment were similar between the two approaches (ranging from 22.9% to 45.8% across domains). Overall neurocognition (r = .347 & -.270, respectively), EF (r = .333 & -.261, respectively), and construction (r = .287 & -.240), respectively, were significantly associated with LOS utilizing the GDS and composite approaches. After controlling for clinical/demographic predictors of LOS, GDS-Total, GDS-EF/Construction, and EF/Construction composite scores significantly predicted LOS. Further, receiver operating characteristic (ROC) curve detected the GDS was able to distinguish between those children that would and would not end up having a prolonged hospitalization. The GDS and composite score approaches to neurocognitive impairment detection were similarly able to capture neurocognitive impairment and the association of impairment to LOS within a children's psychiatric inpatient program.

Executive and nonexecutive demands of constructional measures within a children's psychiatric inpatient setting.

This study examined the role of executive functioning in constructional task performance (measured with the Rey Complex Figure Test-Copy Condition [RCFT] and Beery-Buktenica Developmental Test of Visual-Motor Integration [Beery-VMI]) within a children's psychiatric inpatient setting. A chart review was conducted for 88 children (aged 6-12) who received a neuropsychological evaluation during a psychiatric inpatient hospitalization. Multiple regression analyses investigated the role of executive and nonexecutive demands on RCFT and Beery-VMI performance. Forty-three percent of the sample displayed a constructional weakness. Children with a constructional weakness had lower FSIQ scores and a higher rate of executive dysfunction. Performance on the RCFT was independently predicted by perceptual ability (i.e., Matrix Reasoning; p = .008; ß = .340) and attention/executive dysfunction (p = .003; ß = -.342; 9.4% of variance), while performance on the Beery-VMI was independently predicted by constructional ability (i.e., Block Design; p = .004, ß = .338). Results of this study demonstrate that the RCFT has greater executive demand than the VMI and yields a greater rate of impaired performance in an inpatient child sample as compared to the VMI. Clinical and research practices should consider the distinct differences between various constructional measures to ensure their proper use and interpretation with consideration to their varying executive and nonexecutive demands.

Neurocognitive deficits in children and adolescents following maltreatment: Neurodevelopmental consequences and neuropsychological implications of traumatic stress.

Childhood maltreatment is a significant risk factor for a host of psychiatric, developmental, medical, and neurocognitive conditions, often resulting in debilitating and long-term consequences. However, there is no available neuropsychological resource reviewing the literature on the associated neurocognitive deficits in children and adolescents. This review comprehensively examines the 23 prior studies that evaluated the intellectual, language, visual-spatial, memory, motor, and/or attention/executive functions in children and adolescents following an experience of childhood abuse and/or neglect. Neurocognitive impairments were frequently reported. Impairments in executive functions were the most frequent and severe reported impairments, although intelligence, language, visual-spatial skills, and memory are also at serious risk for compromised development following maltreatment. However, specific factors such as abuse/neglect duration, severity, type, and timing during development were all associated with neurocognition. This indicates that these factors are of greater importance than just the presence of abuse/neglect in identifying risk for neurocognitive compromise. Such neurocognitive deficits appear to be a consequence to the known neurobiological and brain development abnormalities of this population, suggesting traumatic stress can be a potential cause of neurodevelopmental disorders. These findings have critical implications for the clinical practice and research involving children following childhood maltreatment and other types of traumatic stress.

Failure to maintain set as a predictor of childhood depression within a children's psychiatric inpatient sample.

Despite a wealth of studies in adults and adolescents, only a handful of studies have examined executive function in childhood depression. This study utilized retrospective chart review of a children's psychiatric inpatient program to evaluate executive function via Wisconsin Card Sorting Test (WCST) in 33 children (6-12 years old) with a depressive disorder and 61 age/sex-matched children without a depressive disorder referred for neuropsychological evaluation. WCST categories, perseverative errors, and failure to maintain set errors were examined as potential predictors of depressive disorder diagnosis and self-reported depressive symptoms. After controlling for age, length of hospital stay, and ADHD, failure to maintain set significantly predicted depressive disorder diagnosis. Failure to maintain set was also significantly associated with self-reported depressive symptoms. Current findings provide preliminary evidence to suggest that failure to maintain set may reflect a core deficit of childhood depression. While findings are preliminary, this may have important implications for the diagnosis and treatment of childhood depression.

Neurocognitive Phenotypes in Severe Childhood Psychiatric Disorders.

This study investigated the presence of potential neurocognitive phenotypes within a severe childhood psychiatric sample. A medical chart review was conducted for 106 children who received a neuropsychological evaluation during children's psychiatric inpatient program hospitalization. A hierarchical cluster analysis was conducted to identify distinct clinical clusters based on neurocognitive measures. Cluster analysis identified four distinct clusters, subsequently labeled neurocognitive phenotypes: "intact cognition" (27%), "global dysfunction" (20%), "organization/planning" (21%), and "inhibition-memory" (32%). Significant differences were identified in history of legal involvement and antipsychotic medications at hospital admission. Differences between none-minimal and moderate-high neurocognitive dysfunction were identified in age, amount of diagnoses and antipsychotic medications at admission, and hospital length of stay. Current findings provide preliminary evidence of underlying neurocognitive phenotypes within severe childhood psychiatric disorders. Findings highlight the importance of neuropsychological evaluation in the treatment of childhood psychiatric disorders.

Verbal Memory Abilities in Severe Childhood Psychiatric Disorders and the Influence of Attention and Executive Functions.

Despite prior adult research regarding the influence of executive functions on memory performance, there has been inconsistent prior research on the role of executive functions on memory performance in children, particularly those children with severe psychiatric disorders. A medical chart review was conducted for 76 children (ages 6-12 years) who received a neuropsychological evaluation during children's psychiatric inpatient program hospitalization. A series of hierarchical regression analyses investigated the role of attention/executive and non-executive functions in verbal memory performance (immediate recall, delayed recall, and delayed recognition). Demographic and verbal measures were entered into blocks 1 and 2 for all analyses, followed by attention and executive functions (i.e., attention span, sustained attention, verbal fluency, cognitive flexibility, inhibitory control, and planning/organization). Nearly 15% of the participants displayed memory impairment. Results of regression analyses indicated attention/executive dysfunction severity predicted overall memory performance. Attention span predicted performance on all three memory conditions. Planning/organization accounted for unique variance in immediate recall condition while inhibitory control accounted for unique variance in delayed recall condition. These results indicate that verbal memory problems frequently occur in severe childhood psychiatric disorders. Further, planning/organization deficits may influence immediate recall, while inhibitory control deficits may influence delayed recall. Alternatively, delayed recognition memory may be the most resistant to the negative influence of executive deficits on verbal memory performance in childhood psychiatric disorders.

The Role of Inhibitory Control in the Hospitalization of Children with Severe Psychiatric Disorders.

OBJECTIVE: Inhibitory control is a heterogeneous domain involving multiple inhibitory processes at levels of behavior, attention/cognition, and emotion/motivation. Prior studies have identified an underlying role of inhibitory control in the manifestation of childhood-onset psychiatric symptoms. This study investigated the inhibitory control abilities of children within a severe, childhood psychiatric sample. METHOD: A medical chart review was conducted for 100 children who received a neuropsychological evaluation during a children's psychiatric inpatient program hospitalization from 2010 to 2014. Three measures neurocognitive of inhibitory control, Stroop Color-Word Score, CPT-II Commission Errors, and WCST Failure to Maintain Set were used in the present study. The presence of externalizing behaviors at hospital admission was classified as poor behavioral/self-control. RESULTS: Forty-eight percent of the sample displayed evidence of inhibitory control impairment on neurocognitive measures, with 40% displaying response inhibition impairment and only 5-7% displaying interference control impairment. Similarly elevated rates of impairment were found in those children without attention deficit hyperactivity disorder (ADHD). Depressive disorders were associated with interference control, while ADHD was associated with interference control and response inhibition. Receiver Operating Characteristic analysis found that response inhibition predicted a prolonged hospitalization in an older males subgroup but not in the younger males or females subgroups. CONCLUSIONS: Current findings suggest that inhibitory control impairments are highly prevalent in the children's psychiatric inpatient setting and associated with specific psychiatric disorders, although the influence of these impairments on subsequent outcome may be limited to a select portion of children. These findings highlight the importance of neuropsychological evaluation and management in childhood psychiatric disorders.

How many is enough? Determining optimal sample sizes for normative studies in pediatric neuropsychology.

The purpose of this investigation was to determine how confidence intervals (CIs) for pediatric neuropsychological norms vary as a function of sample size, and to determine optimal sample sizes for normative studies. First, the authors calculated 95% CIs for a set of published pediatric norms for four commonly used neuropsychological instruments. Second, 95% CIs were calculated for varying sample size (from n = 5 to n = 500). Results suggest that some pediatric norms have unacceptably wide CIs, and normative studies ought optimally to use 50 to 75 participants per cell. Smaller sample sizes may lead to overpathologizing results, while the cost of obtaining larger samples may not be justifiable.