Internalizing and somatic symptoms influence the discrepancy between subjective and objective cognitive difficulties in adults with ADHD who have valid and invalid test scores.

OBJECTIVES: This study investigated the relationship between various intrapersonal factors and the discrepancy between subjective and objective cognitive difficulties in adults with attention-deficit hyperactivity disorder (ADHD). The first aim was to examine these associations in patients with valid cognitive symptom reporting. The next aim was to investigate the same associations in patients with invalid scores on tests of cognitive symptom overreporting. METHOD: The sample comprised 154 adults who underwent a neuropsychological evaluation for ADHD. Patients were divided into groups based on whether they had valid cognitive symptom reporting and valid test performance (n = 117) or invalid cognitive symptom overreporting but valid test performance (n = 37). Scores from multiple symptom and performance validity tests were used to group patients. Using patients' scores from a cognitive concerns self-report measure and composite index of objective performance tests, we created a subjective-objective discrepancy index to quantify the extent of cognitive concerns that exceeded difficulties on objective testing. Various measures were used to assess intrapersonal factors thought to influence the subjective-objective cognitive discrepancy, including demographics, estimated premorbid intellectual ability, internalizing symptoms, somatic symptoms, and perceived social support. RESULTS: Patients reported greater cognitive difficulties on subjective measures than observed on objective testing. The discrepancy between subjective and objective scores was most strongly associated with internalizing and somatic symptoms. These associations were observed in both validity groups. CONCLUSIONS: Subjective cognitive concerns may be more indicative of the extent of internalizing and somatic symptoms than actual cognitive impairment in adults with ADHD, regardless if they have valid scores on cognitive symptom overreporting tests.

Neuropsychological assessment, intervention, and best practices for women with non-Central nervous system cancer: A scoping review of current standards.

Objective: Existing literature has sought to characterize the broad cognitive impact of non-central nervous system cancer and its treatment, including chemotherapy, radiation, surgery, and hormonal regulation. However, despite the frequency of women that are diagnosed with breast and gynecological cancer, there is limited research on the specific cognitive experiences of women undergoing cancer treatment. Presently, the current literature lacks concise guidance for neuropsychologists to support the cognitive health of women facing cancer, despite the acknowledged impact of cancer interventions and chronic illness on cognitive outcomes. Method: Applying scoping review criteria outlined by Peters et al. (2015) and adhering to Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a comprehensive examination of literature spanning multiple databases (Google Scholar, PubMed, PsychINFO) with a focus on the cognitive impact of cancer treatment on women. Conclusions: Women are subject to unique treatment-related outcomes due to the impact of hormonal alterations, differences in metabolization of certain chemotherapies, and psychosocial risk factors. Despite the known impact of cancer intervention, chronic illness, and cancer-related sequelae on cognitive outcomes, the current literature does not parsimoniously outline best practices for neuropsychologists to promote the health of women experiencing cancer. The current paper (1) provides an overview of the cognitive implications of cancer treatment with an intentional focus on cancers that are more prevalent in women versus men, (2) addresses the characteristics of this impact for women undergoing cancer intervention(s), and (3) provides possible intervention and treatment strategies for mental health providers and neuropsychologists.

Exploring Subfactors of Adult Cognitive Disengagement Syndrome and Impact on Neuropsychological Performance.

OBJECTIVE: This study investigated subfactors of cognitive disengagement syndrome (CDS; previously referred as sluggish cognitive tempo) among adults referred for neuropsychological evaluation of attentiondeficit/hyperactivity disorder (ADHD). METHOD: Retrospective analyses of data from 164 outpatient neuropsychological evaluations examined associations between CDS subfactors and self-reported psychological symptoms and cognitive performance. RESULTS: Factor analysis produced two distinct but positively correlated constructs: "Cognitive Complaints'' and "Lethargy." Both correlated positively with symptom reports (rs = 0.26-0.57). Cognitive Complaints correlated negatively with working memory, processing speed, and executive functioning performance (rs = -0.21 to -0.37), whereas Lethargy correlated negatively only with processing speed and executive functioning performance (rs = -0.26 to -0.42). Both predicted depression symptoms, but only Cognitive Complaints predicted inattention symptoms. Both subfactors demonstrated modest to nonsignificant associations with cognitive performance after accounting for estimated premorbid intelligence and inattention. CONCLUSION: Findings indicate a bidimensional conceptualization of CDS, with differential associations between its constituent subfactors, reported symptoms, and cognitive performance.

The Impact of Adverse Childhood Experiences on Symptom and Performance Validity Tests Among a Multiracial Sample Presenting for ADHD Evaluation.

OBJECTIVE: Adverse childhood experiences (ACEs) are commonly reported in individuals presenting for attention-deficit hyperactivity disorder (ADHD) evaluation. Performance validity tests (PVTs) and symptom validity tests (SVTs) are essential to ADHD evaluations in young adults, but extant research suggests that those who report ACEs may be inaccurately classified as invalid on these measures. The current study aimed to assess the degree to which ACE exposure differentiated PVT and SVT performance and ADHD symptom reporting in a multi-racial sample of adults presenting for ADHD evaluation. METHOD: This study included 170 adults referred for outpatient neuropsychological ADHD evaluation who completed the ACE Checklist and a neurocognitive battery that included multiple PVTs and SVTs. Analysis of variance was used to examine differences in PVT and SVT performance among those with high (≥4) and low (≤3) reported ACEs. RESULTS: Main effects of the ACE group were observed, such that high ACE group reporting demonstrated higher scores on SVTs assessing ADHD symptom over-reporting and infrequent psychiatric and somatic symptoms on the Minnesota Multiphasic Personality Inventory-2-Restructured Form. Conversely, no significant differences emerged in total PVT failures across ACE groups. CONCLUSIONS: Those with high ACE exposure were more likely to have higher scores on SVTs assessing over-reporting and infrequent responses. In contrast, ACE exposure did not affect PVT performance. Thus, ACE exposure should be considered specifically when evaluating SVT performance in the context of ADHD evaluations, and more work is needed to understand factors that contribute to different patterns of symptom reporting as a function of ACE exposure.

The Effect of Adverse Childhood Experiences on ADHD Symptom Reporting, Psychological Symptoms, and Cognitive Performance Among Adult Neuropsychological Referrals.

OBJECTIVE: Adverse childhood experiences (ACEs) are early life experiences that influence mental health outcomes, though there are mixed findings reported in relation to attention deficit hyperactivity disorder (ADHD) symptoms. The current study compared adults who experienced ACEs on measures of ADHD symptom reporting, psychological symptoms, and neurocognitive test performance. METHOD: The sample (n = 115) had mean age of 28.42 (SD = 6.46); educational attainment of 16.47 years (SD = 1.99); and was 35% male/65% female and racially/ethnically diverse. Participants completed measures of ACEs, ADHD symptoms, psychopathology, and perceived stress, as well as neuropsychological tests. RESULTS: The high ACEs group endorsed higher levels of childhood/adulthood inattentive, impulsive, and hyperactive symptoms, and overall childhood symptoms when compared to the low ACEs group. CONCLUSIONS: This study provides a more comprehensive understanding of the association between ACEs and cognitive/mental health outcomes. Greater ACEs resulted in higher ADHD symptom reporting but not significantly greater psychological symptoms or worse neurocognitive performance.

Prevalence of neurodevelopmental delays in infants with perinatal HIV infection in comparison with HIV exposure in rural South Africa.

BACKGROUND: Assessing neurodevelopmental functioning in early infancy is essential as this is a critical period for infant development. Infants born to mothers with HIV are at a greater risk of developmental delays than those born to mothers without HIV. In this study, we analyzed differences in early neurodevelopmental functioning for infants with HIV exposure versus HIV infection to inform infant screening and early intervention. METHODS: Participants were recruited from community health centers in Mpumalanga Province, South Africa. Prenatally, mothers completed baseline demographic assessment at 8 to 24-week gestation periods. Infant neurodevelopment was assessed using the Bayley Infant Neurodevelopmental Screener (BINS) 12 months postnatally. Five areas of development were assessed: cognition, receptive communication, expressive communication, fine motor ability, and gross motor ability. FINDINGS: Postnatal infant assessment using the BINS revealed that infants were at risk for neurodevelopmental delays across all domains assessed. Notably, infants exposed to HIV, regardless of HIV status, were 'at emerging risk' or 'at clear risk' for cognitive (43.5%), receptive communication (38.2%), expressive communication (53.1%), fine motor (49.9%), and gross motor delays (55.6%). Differences were noted by HIV status in the cognition domain, such that HIV-exposed infants were more likely to be at emerging or clear risk than HIV-infected infants. There was a different trend with gross motor delays, such that HIV-infected infants were at a greater risk for motor delays than HIV-exposed, uninfected infants. CONCLUSION: Screening tools for this vulnerable population provide valuable early life assessment to determine infant needs for intervention and treatment planning. Such interventions may mitigate the impact of HIV status on neurodevelopmental health generally and cognition.

Multivariate examination of embedded indicators of performance validity for ADHD evaluations: A targeted approach.

This study investigated the individual and combined utility of 10 embedded validity indicators (EVIs) within executive functioning, attention/working memory, and processing speed measures in 585 adults referred for an attention-deficit/hyperactivity disorder (ADHD) evaluation. Participants were categorized into invalid and valid performance groups as determined by scores from empirical performance validity indicators. Analyses revealed that all of the EVIs could meaningfully discriminate invalid from valid performers (AUCs = .69-.78), with high specificity (≥90%) but low sensitivity (19%-51%). However, none of them explained more than 20% of the variance in validity status. Combining any of these 10 EVIs into a multivariate model significantly improved classification accuracy, explaining up to 36% of the variance in validity status. Integrating six EVIs from the Stroop Color and Word Test, Trail Making Test, Verbal Fluency Test, and Wechsler Adult Intelligence Scale-Fourth Edition was as efficacious (AUC = .86) as using all 10 EVIs together. Failing any two of these six EVIs or any three of the 10 EVIs yielded clinically acceptable specificity (≥90%) with moderate sensitivity (60%). Findings support the use of multivariate models to improve the identification of performance invalidity in ADHD evaluations, but chaining multiple EVIs may only be helpful to an extent.

A scoping review of stereotype threat for BIPOC: Cognitive effects and intervention strategies for the field of neuropsychology.

OBJECTIVE: Abundant evidence documents stereotype threat's (ST) detrimental effect on test performance across identities and contexts (i.e., eliciting underperformance). Review of the literature shows varied aspects of both stereotyped identities and cognition are inconsistently explored across studies. Only a portion of the literature focuses on ST's impact on Black, Indigenous, and People of Color (BIPOC). It is important to understand and learn to mitigate ST, particularly for historically marginalized and systemically oppressed BIPOC patients. Relevance exists for neuropsychologists, who engage in activities (i.e., assessments) that may activate ST, and should be aware of additional factors impacting testing results and clinical decision making. METHOD: Using scoping review criteria (Peters et al., 2015) and Preferred Reporting Item for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we reviewed literature across multiple databases (Google Scholar, PubMed, PsychINFO) on ST and cognition with a focus on BIPOC. RESULTS: The current literature suggests that race-based ST may be implicated in underperformance for executive functioning and separately working memory. There is limited research on the effects of ST for memory, language, attention, and visuospatial skills. CONCLUSION: Research on ST requires additional attention to establish interventions to mitigate negative effects in practice. These results provide 1) an overview of the cognitive implications of ST, 2) address the scope of this impact for BIPOC, and 3) provide possible intervention and training strategies for neuropsychologists and other clinicians to work to mitigate the effects of ST on BIPOC.

Mentorship in clinical neuropsychology: Survey of current practices, cultural responsiveness, and untapped potential.

INTRODUCTION: Neuropsychology trainees have identified mentorship as an important factor in their training. Limited past work has been conducted on mentorship within neuropsychology, and there is a need to better understand the experiences and perspectives of neuropsychology mentors. METHOD: Self-identified mentors in clinical neuropsychology completed a survey about their mentorship practices, including culturally responsive mentorship, as well as perceived barriers and challenges to providing effective mentorship. Themes were derived using qualitative analyses for free response questions, and descriptive statistics were calculated for quantitative variables. RESULTS: Mentors identified assessment, professionalism, and ethics as top priorities in mentorship, which may reflect the overlap within neuropsychology of assessment supervision and mentoring. Reported best practices included being self-aware and engaging in a personalized approach to mentorship relationships that varies depending upon the needs of the mentee. A majority reported that their training program is not diverse and they themselves do not mentor trainees from diverse backgrounds which provides a clear area for targeted efforts to recruit and retain diversity in the discipline. Mentors described practices related to discussing diversity-related differences with their trainees including self-disclosure, creating a safe space for conversations, and tailoring discussions to the individual trainee. They reported an interest in more training on how to engage in culturally competent mentorship. Two barriers to providing effective mentorship identified most by mentors were time constraints and a lack of training. CONCLUSIONS: These results highlight a variety of perspectives and approaches to mentorship, which may be beneficial for mentors to consider as they reflect on their mentorship practices and/or for trainees as part of their professional development toward becoming future mentors themselves. These results also highlight the need for a greater emphasis on mentorship training within neuropsychology, including training in culturally responsive mentorship practices.