Inflated scaled scores on the digital WISC-V coding subtest in a Canadian sample.

This study examined performance differences in the traditional paper-and-pencil and new digital versions of the Coding subtest from the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) using a cross-sectional sample. A total of 212 school-aged children between 6 and 14 years old were included in the sample, with 116 completing the paper version and 96 completing the digital version administered on a tablet in 2017-2018. One-way ANOVA revealed a significant difference with large effect size between mean scaled scores, with the digital version resulting in higher scaled scores than the paper version, F (1, 210) = 67.57, p < 0.001, d = 1.14, ηp2 = 0.24. That is, normed digital scores appear inflated as compared to paper scores. No difference in raw scores was observed when controlling for age, F (1, 209) = 0.54, p > 0.05. Post-hoc analyses were performed to account for potential confounds in demographic differences and to maximize group equivalence, with the same pattern of results. Findings have important implications for clinical interpretation of Coding scores when administering the digital version of the task. Clinicians, including psychologists and neuropsychologists, should be aware of the limitations of the new digital version of this subtest, including differences in standardized performance and task requirements. Future studies using random assignment and/or repeated-measures design are needed to replicate these findings.

Executive Functioning Rating Scale as a Screening Tool for ADHD: Independent Validation of the BDEFS-CA.

Objective: This study provides independent examination of the validity of the Barkley Deficits of Executive Functioning Scale-Children and Adolescents (BDEFS-CA) in a sample of children diagnosed with ADHD (n = 50) and typically developing controls (n = 50). Method: Parents of participants completed the BDEFS-CA and the Conners 3 rating scales. Validity of BDEFS-CA was examined using a confirmatory factor analysis, correlational analyses with Conners 3 ratings, and receiver operating characteristic (ROC) curve analysis of diagnostic accuracy. Results: Findings support the construct, concurrent, and discriminant validity of the BDEFS-CA in a mixed sample. Conclusion: Findings provide independent examination of the validity of the BDEFS-CA as a measure of executive dysfunction and a screening tool for ADHD.

Reduced graphomotor procedural learning in children and adolescents with ADHD.

PURPOSE: The present study sought to determine if children and adolescents with ADHD demonstrate reduced procedural learning of a graphomotor program. METHOD: Thirty-two children and adolescents between age 9 and 15 with (n = 16) and without ADHD (n = 16) participated in the study. Each group of participants practiced a novel grapheme on a digitizing tablet 30 times. Participants with ADHD were off stimulant medication or were medication naïve. RESULTS: Control participants demonstrated significant improvement in graphomotor fluency from the beginning to the end of practice, T = 2, z = -2.534, p = .009, whereas participants with ADHD did not, T = 4, z = -1.810, p = .074. CONCLUSIONS: Consistent with findings in adults with ADHD, results indicate that graphomotor procedural learning in children and adolescents with ADHD is attenuated. Findings have implications for future research that may inform remediation of handwriting difficulties, academic accommodations, and using digitizing technology for neuropsychological assessment.

Novel reading index for identifying disordered reading skill development: A preliminary study.

Children with ADHD are at high risk of developing a Reading Disability (RD), although the reasons remain unclear. ADHD-associated impairments, including processing speed, can complicate clinical evaluation for a co-occurring RD diagnosis. We propose a novel metric to (a) assess reading development and (b) provide an alternative method to classifying readers that may aid investigations for etiologies of RD in ADHD. Specifically, as both phonological decoding and word recognition skills are important precursors of reading fluency, we propose a new quantitative method comparing these skills after accounting for variations in perception, motor response, or processing speeds. Forty boys (14 control, 15 ADHD, 11 ADHD/ + RD) completed a lexical decision task testing decoding and another assessing word recognition. Response time data was modeled using a Drift Diffusion approach to estimate the underlying reading skills. Using these reading skill estimates, we calculated a novel Reading Tendency Index and classified participants into three reading groups (Decoders, Balanced Readers, and Sight Readers). The reading and cognitive performance of these groups were consistent with theoretical predictions and subsequently provided external validity for the novel Reading Tendency Index classification. Our findings demonstrate a potential classification tool for readers based on individual's developed, reading tendencies.

Short-term test-retest reliability of the ImPACT in healthy young athletes.

The present study examined the short-term test-retest reliability of the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) variables with healthy 11- to 14-year-old athletes. 53 young athletes (Mage = 12.4 years, 9 female) were administered the ImPACT on two separate occasions two weeks apart. Participants were instructed to complete the Post-Concussion Symptom Scale (PCSS) and the baseline computerized neurocognitive test during both the baseline and retest phases. Intraclass correlation (ICC), standard error of measurement (SEM), and reliable change index (RCI) were used as reliability metrics. PCSS Total Symptoms and Visual-Motor Speed were the only scores to reach clinical reliability standards (i.e., R > 0.7). None of the scores exceeded RCI cut-offs. Results indicate that the composite scores of the ImPACT are differentially reliable in a preadolescent sample across a two-week retest period, with only motor processing speed and self-reported symptoms exceeding clinical reliability standards. The findings support the view that neurocognitive testing should not be the sole determining factor in concussion assessment. This study highlights the importance of continuing research with younger athletes to assess the reliability of neurocognitive measures in concussion management programs. Future research should focus on a larger, heterogeneous sample, including children with learning disabilities and ADHD.

[Formula: see text]Parent rating of executive function in fetal alcohol spectrum disorder: A review of the literature and new data on Aboriginal Canadian children.

Aboriginal children in Canada are at high risk of fetal alcohol spectrum disorder (FASD) but there is little research on the cognitive impact of prenatal alcohol exposure (PAE) in this population. This paper reviews the literature on parent report of executive functioning in children with FASD that used the Behavior Rating Inventory of Executive Function (BRIEF). New data on the BRIEF is then reported in a sample of 52 Aboriginal Canadian children with FASD for whom a primary caregiver completed the BRIEF. The children also completed a battery of neuropsychological tests. The results reveal mean scores in the impaired range for all three BRIEF index scores and seven of the eight scales, with the greatest difficulties found on the Working Memory, Inhibit and Shift scales. The majority of the children were reported as impaired on the index scores and scales, with Working Memory being most commonly impaired scale. On the performance-based tests, Trails B and Letter Fluency are most often reported as impaired, though the prevalence of impairment is greater for parent ratings than test performance. No gender difference is noted for the parent report, but the boys had slightly slower intellectual functioning and were more perseverative than the girls on testing. The presence of psychiatric comorbidity is unrelated to either BRIEF or test scores. These findings are generally consistent with prior studies indicating that parents observe considerable executive dysfunction in children with FASD, and that children with FASD may have more difficulty with executive functions in everyday life than is detected by laboratory-based tests alone.

Development of graphomotor fluency in adults with ADHD: Evidence of attenuated procedural learning.

PURPOSE: The present study sought to determine if adults with ADHD demonstrate reduced graphomotor learning relative to controls. METHOD: Twenty-eight control adults (n=14) and adults with ADHD (n=14) were recruited and wrote a novel grapheme on a digitizing tablet 30 times. Participants with ADHD were counterbalanced on and off stimulant medication. RESULTS: Control participants, F(1,13)=13.786, p=.003, ω(2)partial=.460, and participants with ADHD on medication, F(1,13)=10.462, p=.007, ω(2)partial=.387, demonstrated significant improvement in graphomotor fluency with equivalent practice whereas participants with ADHD off medication did not, F(1,12)=0.166, NS. CONCLUSIONS: Results indicate that graphomotor program learning in adults with ADHD may occur more slowly than typically developing peers. Findings have implications for providing accommodations to adults with ADHD, potential benefits of stimulant medication, and using digitizing technology as a neuropsychological assessment instrument.

Variability of kinematic graphomotor fluency in adults with ADHD.

Although graphomotor differences and variability of performance have been observed in children with attention deficit hyperactivity disorder (ADHD), no study has investigated whether this variability manifests in the kinematic graphomotor domain in adults with ADHD. Fourteen ADHD and 20 control participants wrote a novel grapheme and common word on a digitizing tablet 30 times each, with ADHD participants counterbalanced on and off stimulant medication. Variability of graphomotor fluency was significantly greater in ADHD versus control participants only in the novel writing task, both on, F(1,31)=5.988, p=.020, and off stimulant medication, F(1,32)=8.789, p=.006. Results suggest that motor control differences in ADHD are not limited to childhood and extend into adulthood. Given sufficient additional research, variability of kinematic graphomotor fluency may increase the sensitivity/specificity of differential diagnoses and/or represent a biomarker for ADHD.

A cluster analytic study of the Wechsler Intelligence Test for Children-IV in children referred for psychoeducational assessment due to persistent academic difficulties.

Wechsler Intelligence Test for Children-IV core subtest scores of 472 children were cluster analyzed to determine if reliable and valid subgroups would emerge. Three subgroups were identified. Clusters were reliable across different stages of the analysis as well as across algorithms and samples. With respect to external validity, the Globally Low cluster differed from the other two clusters on Wechsler Individual Achievement Test-II Word Reading, Numerical Operations, and Spelling subtests, whereas the latter two clusters did not differ from one another. The clusters derived have been identified in studies using previous WISC editions. Clusters characterized by poor performance on subtests historically associated with the VIQ (i.e., VCI + WMI) and PIQ (i.e., POI + PSI) did not emerge, nor did a cluster characterized by low scores on PRI subtests. Picture Concepts represented the highest subtest score in every cluster, failing to vary in a predictable manner with the other PRI subtests.

Neuropsychologic and functional outcome after complicated mild traumatic brain injury.

OBJECTIVE: To investigate the extent to which neuropsychologic and functional outcome after complicated mild traumatic brain injury (TBI) parallels that of moderate TBI recovery. DESIGN: A longitudinal study comparing neuropsychologic and functional status of persons with complicated mild TBI and moderate TBI at discharge from inpatient rehabilitation and at 1 year postinjury. SETTING: Rehabilitation hospital with a Traumatic Brain Injury Model System. PARTICIPANTS: Persons with complicated mild TBI (n=102), each with an intracranial brain lesion documented through neuroimaging and a highest Glasgow Coma Scale (GCS) score in the emergency department between 13 and 15, and 127 persons with moderate TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM instrument, Disability Rating Scale, Community Integration Questionnaire, Wechsler Memory Scale logical memory I and II, Rey Auditory Verbal Learning Test, Trail-Making Test, Controlled Oral Word Association Test, Symbol Digit Modalities Test, Wisconsin Card Sorting Test, and block design. RESULTS: Few differences in neuropsychologic performance existed between the TBI groups. Less severely impaired information processing speed and verbal learning were seen in the complicated mild TBI group at rehabilitation discharge and 1 year postinjury. Despite overall improvement across cognitive domains within the complicated mild TBI group, some degree of impairment remained at 1 year postinjury on those measures that had identified participants as impaired soon after injury. No differences on functional ability measures were found between the TBI groups at either time period postinjury, with both groups exhibiting incomplete recovery of functional status at the 1-year follow-up. CONCLUSIONS: When classifying severity of TBI based on GCS scores, consideration of a moderate injury designation should be given to persons with an intracranial bleed and a GCS score between 13 and 15.

Persistent symptoms associated with factors identified by the WHO Task Force on Mild Traumatic Brain Injury.

The current study examined the role of factors identified by the World Health Organization's Task Force on Mild Traumatic Brain Injury as being associated with poor outcome after mild traumatic brain injury. Employing symptom severity ratings at 3 months post-injury greater than "mild," subgroups of Higher-Severity (20%) and Lower-Severity (80%) participants were identified. Findings revealed that individuals who report greater symptom complaints at 3 months post-MTBI may be identifiable soon after injury on the basis of the magnitude and severity of early self-reported symptoms, pre-morbid psychological issues, and involvement in compensation-seeking. Injury severity factors did not differ between the groups.

The repeatable battery for the assessment of neuropsychological status (RBANS): clinical utility in a traumatic brain injury sample.

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph, 1998), a neuropsychological screening measure initially designed to assess the cognitive deficits associated with dementia, has since been clinically implemented with other neurological populations including traumatic brain injury (TBI). This study evaluated the clinical utility of the RBANS in a TBI population by comparing the profiles of 51 TBI cases and 34 non-head-injured controls. Across RBANS' Index Scores, the TBI group performed at a significantly lower level than the controls; sensitivity to TBI and likelihood ratios ranged from modest to strong; and specificity was high. Particularly efficacious was the clinical efficiency exhibited by the Total Scale Index (summary score) of the RBANS.

A typology of behavior problems in preschool children.

The purpose of this study was to produce a typology of behavior problems in preschool children. Distinct subtypes were identified through the use of cluster analytic techniques on data from the Behavior Assessment System for Children (BASC)-Parent Rating Scales. Analyses were based on archival data collected on a sample of 268 children, aged 2 to 5 years, who were referred to determine their suitability for a day treatment program. Five distinct and reliable subtypes of preschool children's behavior problems emerged. Ratings of adaptive and social skills based on the BASC Adaptive Scales and measures from the Parenting Stress Index served as external variables to assess the distinctiveness of the derived subtypes. The findings provide evidence for the reliability and validity of the subtypes identified in this study that are consistent with the findings of previous subtyping investigations focusing on school-aged children.

Reliability and validity of the RBANS in a traumatic brain injured sample.

The RBANS has become increasingly utilized in various populations since it reliably assesses individual neurocognitive domains in a rapid, efficient manner. The present study examined the convergent validity of the RBANS to frequently administered instruments in a moderate-severe traumatic brain injured (M-S TBI) sample. Fifty-seven individuals who sustained a M-S TBI were included in this study. The RBANS subtests showed moderate to strong internal reliability within the sample. Most of the subtests displayed moderate to strong correlations with the other neuropsychological tests, including the CVLT-II, COWAT, and WAIS-III subtests. The strongest correlations were within the RBANS Attention Index, with both the Digit Span and Coding subtests showing strong correlations with their WAIS-III counterparts. The RBANS measures distinct abilities that supplement other neuropsychological instruments that assess similar functions within a TBI sample. In addition to its administration advantages, the results of this study provide support for the use of the RBANS as a clinical valid and reliable tool in the brief screening of individuals with M-S TBI.

Empirically derived ability-achievement subtypes in a clinical sample.

The purpose of the present study was to identify reliable and clinically meaningful patterns of ability and achievement using the WISC-III and WIAT. Cluster analysis was used to group the 182 WISC-III and WIAT profiles (10 WISC-III subtests and 4 WIAT subtests) of children between the ages of 9 and 14 years. Theoretical and empirical considerations were used to identify a cluster solution, which involved comparison of several five-, six- and eight-cluster solutions. A five-cluster solution was selected as being representative of the data, which was well replicated across three hierarchical clustering methods (i.e., complete linkage, average linkage-within groups, and average linkage-between groups (UPGMA)). The clusters were labeled based on their most salient characteristics, which included a group of predominantly low ability and achievement, a group demonstrating a pattern of verbal processing deficits, a group demonstrating a pattern of visual spatial/processing speed deficits, a group with low ability and achievement with average processing speed, and a group with deficits consistent with an ACID pattern. The external validity of the five subtypes was assessed through an evaluation of the relationship between cluster membership and neuropsychological test data. Most predictions regarding neuropsychological performance were supported by the data, providing further evidence of the validity of the five-cluster solution. Clinical implications of the ability-achievement typology and suggestions for future research are discussed.

Evaluating the utility of ICD-10 diagnostic criteria for postconcussion syndrome following mild traumatic brain injury.

The present study investigated the utility of the International Classification of Diseases and Related Health Problems, 10th edition (ICD-10) diagnostic criteria for postconcussion syndrome (PCS) symptoms by comparing symptom endorsement rates in a group of patients with mild traumatic brain injury (MTBI) to those of a noninjured control group at one month and three months post-injury. The 110 MTBI patients and 118 control participants were group-matched on age, gender, and education level. Seven of the nine self-reported ICD-10 PCS symptoms differentiated the groups at one month post-injury and two symptoms differentiated the groups at three months post-injury: symptom endorsement rates were higher in the MTBI group at both time periods. Fatiguing quickly and dizziness/vertigo best differentiated the groups at both time periods, while depression and anxiety/tension failed to differentiate the groups at either time period. Collectively, the ICD-10 PCS symptoms accurately classified the MTBI patients at one month post-injury, with the optimal positive test threshold of endorsement of five symptoms coinciding with a sensitivity and specificity of 73% and 61%, respectively. The ICD-10 PCS symptoms were unable to accurately classify the MTBI patients at three months post-injury.