Pediatric Neuropsychology

Review of Neurodevelopmental Disorders in Children and Adolescents

Investigating the BRIEF and BRIEF-SR in Adolescents with Mild Traumatic Brain Injury Abstract To date, limited research has investigated the Behavioral Rating Inventory of Executive Function (BRIEF) and BRIEF Self-Report (BRIEF-SR) in adolescents presenting exclusively with mild traumatic brain injuries (mTBI). The present study was retrospective and included 163 adolescents (43% male; M age = 14.80; M days since injury = 34.10) referred for neuropsychological evaluation after mTBI. Results revealed that mean BRIEF and BRIEF-SR clinical scale scores in the sample were generally similar to those in the standardization sample, commensurate with previous literature on the trajectory of cognitive and symptom recovery after mTBI. Adolescents reported significantly higher scores than their parents only on Emotional Control, with no differences emerging on other clinical scales. Confirmatory factor analyses indicated that the two-factor model of the BRIEF-SR (Metacognition and Behavioral Regulation; Comparative Fit Index (CFI) = 0.97) provided relatively and statistically significant better fit than a one-factor model extracted in exploratory analyses. Results also indicated that a three-factor model of the BRIEF capturing Metacognition, Behavioral Regulation, and Emotional Regulation (CFI = 0.98) provided relatively and significantly better fit than the two-factor model. These results suggested that adolescents in the post-acute phase of mTBI recovery may rate their own executive dysfunction in terms of metacognitive and behavioral difficulties, while their parents may observe executive dysfunction in these two dimensions in addition to emotional dysfunction. Relationships to previous literature, limitations of the present study, and implications for clinical practice are discussed.

Test and Book Reviews in Pediatric Neuropsychology

Correction to: Automatized Sequences as a Performance Validity Test? Difficult If You Have Never Learned Your ABCs In the original article the name of author Allyson G. Harrison was misspelled. The original article has been updated and her name is correct here.

Pediatric Performance Validity Testing: State of the Field and Current Research

One-Minute PVT: Further Evidence for the Utility of the California Verbal Learning Test—Children's Version Forced Choice Recognition Trial Abstract Objective To replicate previous research on the forced choice recognition trial for the California Verbal Learning Test—Children's Version (FCR-C). Method Classification accuracy of the FCR-C was computed in 178 children referred for neuropsychological assessment to a tertiary care hospital. Results FCR-C ≤ 14 produced the best combination of sensitivity (.12–.42) and specificity (.88–.96). Unlike some of the criterion performance validity tests (PVTs), base rate of failure on the FCR-C was evenly distributed across age ranges. Conclusion The FCR-C is a quick and inexpensive PVT, unaffected by cognitive maturation, and highly specific to psychometrically defined invalid performance.

Automatized Sequences as a Performance Validity Test? Difficult If You Have Never Learned Your ABCs Abstract Accurate identification of symptom exaggeration is essential when determining whether or not data obtained in pediatric evaluations are valid or interpretable. Apart from using freestanding performance validity tests (PVTs), many researchers encourage use of embedded measures of test-related motivation, including the newly developed automatized sequences test (AST). Such embedded measures are based on identification of performance patterns that are implausible if the test taker is investing full effort; however, it is unclear whether or not persons with pre-existing cognitive difficulties such as specific learning disabilities (SLD) might be falsely accused of poor test motivation due to actual but impaired learning of basic sequences. This study examined the specificity of the AST by reviewing performance of 83 SLD adolescents. Anywhere from 22 to 41% of SLD adolescents investing good effort failed one or more of the tasks included in the AST, and those with lower intelligence scores had higher rates of failure. Clinicians should therefore be cautious if using this PVT with individuals who have a documented history of reading, learning, or intellectual problems.

Detecting Invalid Performance in Youth with Traumatic Brain Injury Using the Child and Adolescent Memory Profile (ChAMP) Lists Subtest Abstract Background Neuropsychological assessment must include determinants of validity. This study sought to develop an embedded performance validity indicator for the Child and Adolescent Memory Profile (ChAMP) Lists verbal memory subtest. Methods Children and adolescents (N = 103; mean age = 14.6 years, SD = 2.4, range = 8–18) who were on average 25 weeks (SD = 15.1) post-traumatic brain injury (TBI; 85% mild and 15% moderate-severe) were administered ChAMP Lists and two stand-alone performance validity tests (PVTs; Test of Memory Malingering; Medical Symptom Validity Test). Nineteen patients were deemed to have invalid performance defined as failure on both PVTs. Binary logistic regression and classification statistics were used to determine a cutoff score for invalid performance on ChAMP Lists using failure on two PVTs as the criterion. Results Invalid performance was not associated with demographics, injury type, or time since injury, but was significantly correlated with ChAMP Lists scaled scores. Only ChAMP Lists Recognition predicted validity grouping and had excellent discrimination (area under the curve of 93%). A cutoff scaled score of 7 or less on ChAMP Lists Recognition achieved sensitivity for invalid performance at 79% while maintaining specificity at 91%. A more stringent cutoff score of 5 or less on ChAMP Lists Recognition achieved sensitivity for invalid performance at 63% with specificity at 95%. Conclusion This study yields a promising embedded performance validity indicator for ChAMP Lists Recognition with good sensitivity and excellent specificity for detecting invalid performance in youth with TBI.

Why Children Fail the Test of Memory Malingering: Review of False Positive Performance in Pediatric Studies Abstract Rationale The Test of Memory Malingering (TOMM) is a commonly utilized performance validity test currently recommended for pediatric use with children as young as 5 years of age. Yet, a small sample of children struggles to pass the TOMM due to true cognitive difficulties. The systematic search and review identified the reported cases of false positive and overall failing TOMM performance in children. The goal of this project was to increase the understanding of the cognitive constructs and minimum cognitive abilities necessary for children to pass the TOMM. The secondary goal was to use the existing data to suggest clinical guidelines related to use of the TOMM with children. Methods and Results A comprehensive search of PubMed/MEDLINE, EMBASE, Web of Science, and PsycINFO was conducted, returning an initial 12,052 results. After duplicate articles were removed, 10,583 remained; 61 were evaluated for eligibility and 22 were included as our final sample. Results suggested that false positives were observed in children with low IQ, memory issues, complex medical presentation, and younger children. Conclusions Without relevant, quality validation and normative studies, the TOMM should not be used clinically with young children or children suspected of having significant cognitive issues. Failing performance on the TOMM does not necessarily indicate poor effort or invalidate the neuropsychological profile. Instead, it may be reflective of other factors, particularly in children below age 6, children with lower intellectual abilities (especially FSIQ ≤ 75), children with multiple diagnoses, or children with more severe neurological diagnoses. Clinical recommendations are also discussed.

The Rey-Osterrieth Complex Figure: a Useful Measure of Organizational Skills for Adolescents with ADHD? Abstract Deficits in organization, time management, and planning (OTMP) abilities are common in adolescents with attention-deficit/hyperactivity disorder (ADHD) and contribute to impairment. Assessment of these skills is vital, but few measures have been validated for youth with ADHD. The Rey-Osterrieth Complex Figure (ROCF) task is frequently used in research and clinical settings despite limited validity evidence. The present study evaluated whether ROCF performance, as scored via the Boston Qualitative Scoring System, exhibited validity as a measure of OTMP skills in a large (N = 285) sample of adolescents comprehensively diagnosed with ADHD. ROCF performance exhibited minimal associations with measures of OTMP, executive functioning, or aspects of academic impairment affected by OTMP abilities; all correlations were nonsignificant after accounting for the influence of intelligence. Further, ROCF task performance did not differ by ADHD presentation or medication status. Correlations with other variables that may be confounded with ROCF performance (anxiety symptoms, depressive symptoms, parent education) also demonstrated nonsignificant correlations with all BQSS scores. The ROCF may not adequately capture OTMP abilities of adolescents with ADHD; future directions for the assessment of OTMP skills are discussed.