Pub Date : 2020-02-01DOI: 10.1080/13854046.2019.1619838
Abigail Kramer, K. Casaletto, A. Umlauf, A. Staffaroni, E. Fox, Michelle You, J. Kramer
Abstract Objective: To detect cognitive “impairment,” neuropsychologists rely on normative data to compare patient performance to “normal” peers. However, the true normality of normative samples may be called into question given the high prevalence of preclinical proteinopathies amongst clinically normal older adults. Given its common use in memory clinics, we aimed to develop a robust California Verbal Learning Test (CVLT) normative standard reflecting only the most cognitively stable sample of older adults available. Method: Two hundred and twenty-eight older adults (mean age = 69.9, range = 60–89, 91% White, mean education = 17.6 years) who were clinically normal at baseline and demonstrated clinical stability on longitudinal assessment completed the CVLT at baseline. We applied a standardized algorithm to convert raw scores into normalized scaled scores and then regressed on age, sex, and education using fractional polynomial modeling. Results: There were significant main effects of age and sex across CVLT metrics, but not education. Means and standard deviations were higher and less variable in our robust normative data than the data used to create the CVLT-II and CVLT-3 normative standards. Conclusions: These norms set a higher standard for what should be considered “normal” in the spectrum of age-related memory changes and may help clinicians identify patients with memory and potential neurodegenerative changes in the earliest stages, further optimizing clinical management and clinical trial stratification. As with any standard, these robust norms are only appropriately utilized with patients that closely match the demographic profile of the individuals represented in the sample used for this study.
{"title":"Robust normative standards for the California Verbal Learning Test (CVLT) ages 60–89: A tool for early detection of memory impairment","authors":"Abigail Kramer, K. Casaletto, A. Umlauf, A. Staffaroni, E. Fox, Michelle You, J. Kramer","doi":"10.1080/13854046.2019.1619838","DOIUrl":"https://doi.org/10.1080/13854046.2019.1619838","url":null,"abstract":"Abstract Objective: To detect cognitive “impairment,” neuropsychologists rely on normative data to compare patient performance to “normal” peers. However, the true normality of normative samples may be called into question given the high prevalence of preclinical proteinopathies amongst clinically normal older adults. Given its common use in memory clinics, we aimed to develop a robust California Verbal Learning Test (CVLT) normative standard reflecting only the most cognitively stable sample of older adults available. Method: Two hundred and twenty-eight older adults (mean age = 69.9, range = 60–89, 91% White, mean education = 17.6 years) who were clinically normal at baseline and demonstrated clinical stability on longitudinal assessment completed the CVLT at baseline. We applied a standardized algorithm to convert raw scores into normalized scaled scores and then regressed on age, sex, and education using fractional polynomial modeling. Results: There were significant main effects of age and sex across CVLT metrics, but not education. Means and standard deviations were higher and less variable in our robust normative data than the data used to create the CVLT-II and CVLT-3 normative standards. Conclusions: These norms set a higher standard for what should be considered “normal” in the spectrum of age-related memory changes and may help clinicians identify patients with memory and potential neurodegenerative changes in the earliest stages, further optimizing clinical management and clinical trial stratification. As with any standard, these robust norms are only appropriately utilized with patients that closely match the demographic profile of the individuals represented in the sample used for this study.","PeriodicalId":197334,"journal":{"name":"The Clinical neuropsychologist","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133227410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.1080/13854046.2019.1643923
G. Eglit, S. Jurick, D. Delis, J. Filoteo, M. Bondi, A. Jak
Abstract Objective: The D-KEFS Color Word Interference Test (CWIT) is among the most commonly administered measures of verbally mediated processing speed and executive functioning. Previous research suggests that this test may also be sensitive to performance invalidity. We sought to develop new embedded measures of performance invalidity based on multi-condition performance on the CWIT and to evaluate previously proposed embedded measures for performance invalidity on this test. Method: Newly developed and previously proposed embedded measures were evaluated in three samples: a traumatic brain injury (TBI) sample (N = 224) classified into psychometrically-defined performance-valid and performance-invalid subgroups; the D-KEFS normative sample (N = 1,735); and a Parkinson’s disease sample (N = 166). To explore the resilience of CWIT cutoffs to the effects of age and neurocognitive impairment, the D-KEFS normative sample was stratified into age groups of 8–19, 20–69, and 70–89 and the Parkinson’s disease sample into normal cognition, mild cognitive impairment, and dementia groups. Results: Our newly developed embedded measures derived from within the TBI sample were largely resilient to the effects of age and neurocognitive impairment other than dementia. Overall, a cutoff of ≤18 on the sum of age-corrected scaled scores on all four conditions exhibited the strongest classification accuracy. In contrast, previously proposed cutoffs (Erdodi et al., 2018) produced unacceptable false-positive rates within the TBI sample and generally a high rate of potential false positives in the normative age and clinical groups. Conclusion: Scoring ≤18 on the sum of all conditions on the CWIT appears to be an optimal cutoff for performance invalidity detection in non-demented samples.
{"title":"Utility of the D-KEFS Color Word Interference Test as an embedded measure of performance validity","authors":"G. Eglit, S. Jurick, D. Delis, J. Filoteo, M. Bondi, A. Jak","doi":"10.1080/13854046.2019.1643923","DOIUrl":"https://doi.org/10.1080/13854046.2019.1643923","url":null,"abstract":"Abstract Objective: The D-KEFS Color Word Interference Test (CWIT) is among the most commonly administered measures of verbally mediated processing speed and executive functioning. Previous research suggests that this test may also be sensitive to performance invalidity. We sought to develop new embedded measures of performance invalidity based on multi-condition performance on the CWIT and to evaluate previously proposed embedded measures for performance invalidity on this test. Method: Newly developed and previously proposed embedded measures were evaluated in three samples: a traumatic brain injury (TBI) sample (N = 224) classified into psychometrically-defined performance-valid and performance-invalid subgroups; the D-KEFS normative sample (N = 1,735); and a Parkinson’s disease sample (N = 166). To explore the resilience of CWIT cutoffs to the effects of age and neurocognitive impairment, the D-KEFS normative sample was stratified into age groups of 8–19, 20–69, and 70–89 and the Parkinson’s disease sample into normal cognition, mild cognitive impairment, and dementia groups. Results: Our newly developed embedded measures derived from within the TBI sample were largely resilient to the effects of age and neurocognitive impairment other than dementia. Overall, a cutoff of ≤18 on the sum of age-corrected scaled scores on all four conditions exhibited the strongest classification accuracy. In contrast, previously proposed cutoffs (Erdodi et al., 2018) produced unacceptable false-positive rates within the TBI sample and generally a high rate of potential false positives in the normative age and clinical groups. Conclusion: Scoring ≤18 on the sum of all conditions on the CWIT appears to be an optimal cutoff for performance invalidity detection in non-demented samples.","PeriodicalId":197334,"journal":{"name":"The Clinical neuropsychologist","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123240099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.1080/13854046.2019.1643922
L. Richey, N. Doninger
Abstract Objective: This study examined the relationship between tests of performance validity (PVT) and symptom validity (SVT) among claimants undergoing independent neuropsychological evaluations. Previous research comparing PVTs with SVTs has examined symptom validity with respect to overreporting impairment, whereas the current study focused on how PVTs predict underreporting of psychological symptoms and minimization of negative personality characteristics. Method: The sample included 99 claimants presenting with psychological and cognitive complaints who were assessed in a private practice setting. Participants were administered several SVTs (MMPI-2 Lie Scale (L), Superlative Self Presentation Scale (S), Correction Scale (K)) and PVTs, including Reliable Digit Span (RDS), California Verbal Learning Test forced choice recognition, the Victoria Symptom Validity Test (VSVT), and the Test of Memory Malingering (TOMM). Results: Analyses revealed moderate yet significant (p<.001) negative correlations between the L Scale and PVTs with exception of the VSVT. These relationships were substantiated by moderate to large effect sizes (d = 0.56–0.81) when comparing L Scale scores in above and below PVT cutoff conditions. Significant relationships between PVTs and the K and S Scales were not observed. Exploratory analyses revealed that PVT/L Scale relationships were not significantly moderated by presenting concern. Conclusions: Claimants exhibiting invalid PVT performance were more likely to endorse virtuous personality characteristics on the L Scale, supporting the idea that PVT and SVT constructs are interrelated, particularly in the domain of underreporting moral flaws.
{"title":"A Comparison of Performance Validity Measures in Predicting MMPI-2 Lie Scale Results","authors":"L. Richey, N. Doninger","doi":"10.1080/13854046.2019.1643922","DOIUrl":"https://doi.org/10.1080/13854046.2019.1643922","url":null,"abstract":"Abstract Objective: This study examined the relationship between tests of performance validity (PVT) and symptom validity (SVT) among claimants undergoing independent neuropsychological evaluations. Previous research comparing PVTs with SVTs has examined symptom validity with respect to overreporting impairment, whereas the current study focused on how PVTs predict underreporting of psychological symptoms and minimization of negative personality characteristics. Method: The sample included 99 claimants presenting with psychological and cognitive complaints who were assessed in a private practice setting. Participants were administered several SVTs (MMPI-2 Lie Scale (L), Superlative Self Presentation Scale (S), Correction Scale (K)) and PVTs, including Reliable Digit Span (RDS), California Verbal Learning Test forced choice recognition, the Victoria Symptom Validity Test (VSVT), and the Test of Memory Malingering (TOMM). Results: Analyses revealed moderate yet significant (p<.001) negative correlations between the L Scale and PVTs with exception of the VSVT. These relationships were substantiated by moderate to large effect sizes (d = 0.56–0.81) when comparing L Scale scores in above and below PVT cutoff conditions. Significant relationships between PVTs and the K and S Scales were not observed. Exploratory analyses revealed that PVT/L Scale relationships were not significantly moderated by presenting concern. Conclusions: Claimants exhibiting invalid PVT performance were more likely to endorse virtuous personality characteristics on the L Scale, supporting the idea that PVT and SVT constructs are interrelated, particularly in the domain of underreporting moral flaws.","PeriodicalId":197334,"journal":{"name":"The Clinical neuropsychologist","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133790085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.1080/13854046.2019.1666922
V. D. Del Bene, J. Brandt
Abstract Objective: With the increasing focus on reducing medical errors and the aging of the physician workforce has come growing concern for cognitive impairment among physicians. This study sought to establish and validate an approach to detecting neuropsychological impairment among physicians. Method: The neuropsychological test performance of 30 physicians referred clinically for neuropsychological evaluations was compared to that of 39 normal community-practicing urologists. We derived 9 key variables from the cognitive and motor tests as dependent variables. Impairment among the clinically-referred doctors was operationalized as scoring ≤5th percentile of the community physicians on at least 3, 4, 5, or 6 of the 9 variables. Using this approach, all clinically-referred physicians were classified as either “impaired” or “ambiguous.” Results: A cutoff of ≥5 impaired test scores provided the best balance among competing models. Using this criterion, 14 of the clinically-referred doctors (46%) were impaired and 16 remained ambiguous. The impaired physicians: (1) were older, (2) were more often suspected of having a neurodegenerative disorder, and (3) were more likely to have discontinued practicing medicine. These findings serve as initial validation of our methodology. Conclusions: Using conservative criteria derived from normal community physicians, we could identify a substantial subgroup of clinically-referred physicians who are unambiguously neurocognitively impaired. Replication and refinement of our method with larger samples are recommended, as are the development of specialty-specific criteria for impairment.
{"title":"Identifying neuropsychologically impaired physicians","authors":"V. D. Del Bene, J. Brandt","doi":"10.1080/13854046.2019.1666922","DOIUrl":"https://doi.org/10.1080/13854046.2019.1666922","url":null,"abstract":"Abstract Objective: With the increasing focus on reducing medical errors and the aging of the physician workforce has come growing concern for cognitive impairment among physicians. This study sought to establish and validate an approach to detecting neuropsychological impairment among physicians. Method: The neuropsychological test performance of 30 physicians referred clinically for neuropsychological evaluations was compared to that of 39 normal community-practicing urologists. We derived 9 key variables from the cognitive and motor tests as dependent variables. Impairment among the clinically-referred doctors was operationalized as scoring ≤5th percentile of the community physicians on at least 3, 4, 5, or 6 of the 9 variables. Using this approach, all clinically-referred physicians were classified as either “impaired” or “ambiguous.” Results: A cutoff of ≥5 impaired test scores provided the best balance among competing models. Using this criterion, 14 of the clinically-referred doctors (46%) were impaired and 16 remained ambiguous. The impaired physicians: (1) were older, (2) were more often suspected of having a neurodegenerative disorder, and (3) were more likely to have discontinued practicing medicine. These findings serve as initial validation of our methodology. Conclusions: Using conservative criteria derived from normal community physicians, we could identify a substantial subgroup of clinically-referred physicians who are unambiguously neurocognitively impaired. Replication and refinement of our method with larger samples are recommended, as are the development of specialty-specific criteria for impairment.","PeriodicalId":197334,"journal":{"name":"The Clinical neuropsychologist","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116248442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.1080/13854046.2019.1660806
Kelly Sarmiento, G. Gioia, Michael W. Kirkwood, S. Wade, K. Yeates
Abstract Objective: In 2018, the Centers for Disease Control Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. This commentary summarizes the key recommendations in the CDC Pediatric mTBI Guideline most relevant for neuropsychologists and discusses research gaps and topics that should receive attention in future iterations of the Guideline. Method: We described the methods used to develop the Guideline, which included a comprehensive Systematic Review. We also distilled and presented key practice strategies reflected in Guideline. Results: To optimize care of pediatric patients with mTBI, neuropsychologists should: use validated, age-appropriate symptom scales, assess evidence-based risk factors for prolonged recovery, provide patients with instructions on return to activity customized to their symptoms, and counsel patients to return gradually to nonsports activities after a short period of rest. Future iterations of the Guideline should encompass a review and guidance on care of patients with psychiatric and psychological difficulties, as well as the potential use of imaging to assess patients with persistent symptoms. Expanded research on mTBI among girls, children age 8 and under, and effective treatments for pediatric mTBI will be beneficial to inform care practices. Conclusions: Recommendations in the CDC Pediatric mTBI Guideline highlight multiple opportunities for neuropsychologists to take action to improve the care of young patients with mTBI and to advance research in the field. Multiple resources and tools are available to support implementation of these recommendations into clinical practice.
{"title":"A commentary for neuropsychologists on CDC’s guideline on the diagnosis and management of mild traumatic brain injury among children","authors":"Kelly Sarmiento, G. Gioia, Michael W. Kirkwood, S. Wade, K. Yeates","doi":"10.1080/13854046.2019.1660806","DOIUrl":"https://doi.org/10.1080/13854046.2019.1660806","url":null,"abstract":"Abstract Objective: In 2018, the Centers for Disease Control Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. This commentary summarizes the key recommendations in the CDC Pediatric mTBI Guideline most relevant for neuropsychologists and discusses research gaps and topics that should receive attention in future iterations of the Guideline. Method: We described the methods used to develop the Guideline, which included a comprehensive Systematic Review. We also distilled and presented key practice strategies reflected in Guideline. Results: To optimize care of pediatric patients with mTBI, neuropsychologists should: use validated, age-appropriate symptom scales, assess evidence-based risk factors for prolonged recovery, provide patients with instructions on return to activity customized to their symptoms, and counsel patients to return gradually to nonsports activities after a short period of rest. Future iterations of the Guideline should encompass a review and guidance on care of patients with psychiatric and psychological difficulties, as well as the potential use of imaging to assess patients with persistent symptoms. Expanded research on mTBI among girls, children age 8 and under, and effective treatments for pediatric mTBI will be beneficial to inform care practices. Conclusions: Recommendations in the CDC Pediatric mTBI Guideline highlight multiple opportunities for neuropsychologists to take action to improve the care of young patients with mTBI and to advance research in the field. Multiple resources and tools are available to support implementation of these recommendations into clinical practice.","PeriodicalId":197334,"journal":{"name":"The Clinical neuropsychologist","volume":"207 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116158544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-02DOI: 10.1080/13854046.2019.1637027
Phillip K. Martin, R. Schroeder, D. Olsen, Halley Maloy, A. Boettcher, N. Ernst, H. Okut
Abstract Objective: The present study, adhering to Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines, is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) to examine traditional and alternative cutoffs across Trial 1, Trial 2, and Retention. Method: Search criteria identified 539 articles published from 1997 to 2017. After application of selection criteria, 60 articles were retained for meta-analysis. Classification accuracy statistics were calculated using fixed- and random-effects models. Results: For Trial 1, a cutoff of <42 was found to result in the highest sensitivity value (0.59–0.70) when maintaining specificity at ≥0.90. Traditional cutoffs for Trial 2 and Retention were highly specific (0.96–0.98) and moderately sensitive (0.46–0.56) when considering all available studies and only neurocognitive/psychiatric samples classified by known-groups design. For both trials, a modified cutoff of <49 allowed for improved sensitivity (0.59–0.70) while maintaining adequate specificity (0.91–0.97). A supplementary review revealed that traditional TOMM cutoffs produced >0.90 specificity across most samples of examinees for whom English is not the primary language, but well-below acceptable levels in individuals with dementia. Conclusions: The TOMM is highly specific when interpreted per traditional cutoffs. In individuals not suspected of significant impairment, findings indicate that a less conservative TOMM Trial 2 or Retention cutoff of <49 can be interpreted as invalid, especially in settings associated with higher base rates of invalidity and, thus, higher positive predictive power. A cutoff of <42 on Trial 1 can also be interpreted as invalid in most settings.
{"title":"A systematic review and meta-analysis of the Test of Memory Malingering in adults: Two decades of deception detection","authors":"Phillip K. Martin, R. Schroeder, D. Olsen, Halley Maloy, A. Boettcher, N. Ernst, H. Okut","doi":"10.1080/13854046.2019.1637027","DOIUrl":"https://doi.org/10.1080/13854046.2019.1637027","url":null,"abstract":"Abstract Objective: The present study, adhering to Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines, is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) to examine traditional and alternative cutoffs across Trial 1, Trial 2, and Retention. Method: Search criteria identified 539 articles published from 1997 to 2017. After application of selection criteria, 60 articles were retained for meta-analysis. Classification accuracy statistics were calculated using fixed- and random-effects models. Results: For Trial 1, a cutoff of <42 was found to result in the highest sensitivity value (0.59–0.70) when maintaining specificity at ≥0.90. Traditional cutoffs for Trial 2 and Retention were highly specific (0.96–0.98) and moderately sensitive (0.46–0.56) when considering all available studies and only neurocognitive/psychiatric samples classified by known-groups design. For both trials, a modified cutoff of <49 allowed for improved sensitivity (0.59–0.70) while maintaining adequate specificity (0.91–0.97). A supplementary review revealed that traditional TOMM cutoffs produced >0.90 specificity across most samples of examinees for whom English is not the primary language, but well-below acceptable levels in individuals with dementia. Conclusions: The TOMM is highly specific when interpreted per traditional cutoffs. In individuals not suspected of significant impairment, findings indicate that a less conservative TOMM Trial 2 or Retention cutoff of <49 can be interpreted as invalid, especially in settings associated with higher base rates of invalidity and, thus, higher positive predictive power. A cutoff of <42 on Trial 1 can also be interpreted as invalid in most settings.","PeriodicalId":197334,"journal":{"name":"The Clinical neuropsychologist","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122797186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-05DOI: 10.1080/13854046.2019.1696892
M. Niermeyer, Y. Suchy
Abstract Objective: Certain transient contextual factors (i.e. higher expressive suppression, pain, and non-restorative sleep) are all associated with temporary decrements in performance on measures of executive functioning (EF), making clinical interpretation of EF scores challenging. Additionally, pain, non-restorative sleep, and expressive suppression are thought to be mutually interrelated with one another and with depression. This study sought to investigate how these factors impact EF when considered simultaneously. Methods: A total of 95 community-dwelling older adults completed the Push-Turn-Taptap (PTT) task as a measure of EF, and self-report measures of expressive suppression, pain interference, non-restorative sleep, and depressive symptoms. Results: Expressive suppression and pain interference, but not non-restorative sleep, demonstrated unique relationships with EF performance when all factors were considered simultaneously. Expressive suppression fully mediated the relationship between non-restorative sleep and EF performance, but not when controlling for depression. When a single contextual burden composite was generated collapsing across transient contextual factors, a composite that included all three examined factors (i.e. including non-restorative sleep) accounted for more variance in EF scores beyond depression than a composite that only included expressive suppression and pain interference. Conclusion: Expressive suppression, pain interference, and non-restorative sleep share some overlap with one another and with depression, but nonetheless have an additive negative effect on EF performance beyond depression. Quantifying these transient contextual factors may improve the accuracy of EF assessment and, by extension, the utility of EF measures in predicting daily functioning. These transient contextual factors also represent targets that, if better managed, may reduce EF lapses in daily life.
{"title":"The vulnerability of executive functioning: The additive effects of recent non-restorative sleep, pain interference, and use of expressive suppression on test performance","authors":"M. Niermeyer, Y. Suchy","doi":"10.1080/13854046.2019.1696892","DOIUrl":"https://doi.org/10.1080/13854046.2019.1696892","url":null,"abstract":"Abstract Objective: Certain transient contextual factors (i.e. higher expressive suppression, pain, and non-restorative sleep) are all associated with temporary decrements in performance on measures of executive functioning (EF), making clinical interpretation of EF scores challenging. Additionally, pain, non-restorative sleep, and expressive suppression are thought to be mutually interrelated with one another and with depression. This study sought to investigate how these factors impact EF when considered simultaneously. Methods: A total of 95 community-dwelling older adults completed the Push-Turn-Taptap (PTT) task as a measure of EF, and self-report measures of expressive suppression, pain interference, non-restorative sleep, and depressive symptoms. Results: Expressive suppression and pain interference, but not non-restorative sleep, demonstrated unique relationships with EF performance when all factors were considered simultaneously. Expressive suppression fully mediated the relationship between non-restorative sleep and EF performance, but not when controlling for depression. When a single contextual burden composite was generated collapsing across transient contextual factors, a composite that included all three examined factors (i.e. including non-restorative sleep) accounted for more variance in EF scores beyond depression than a composite that only included expressive suppression and pain interference. Conclusion: Expressive suppression, pain interference, and non-restorative sleep share some overlap with one another and with depression, but nonetheless have an additive negative effect on EF performance beyond depression. Quantifying these transient contextual factors may improve the accuracy of EF assessment and, by extension, the utility of EF measures in predicting daily functioning. These transient contextual factors also represent targets that, if better managed, may reduce EF lapses in daily life.","PeriodicalId":197334,"journal":{"name":"The Clinical neuropsychologist","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126400801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-04DOI: 10.1080/13854046.2019.1696408
C. Chovaz, V. Lynn Ashton Rennison, Dominica O. Chorostecki
Abstract Objective Administration of performance validity tests (PVT) during neuropsychological assessments is standard practice, with the Test of Memory Malingering (TOMM) being a commonly used measure. The TOMM has been well validated in hearing populations with various medical and psychiatric backgrounds. A major gap in the literature is the use of the TOMM amongst culturally Deaf individuals who use American Sign Language (ASL) as their first and preferred language. The purpose of this study was to explore the use of the TOMM with this population to determine if there may be differences related to the use of semantic knowledge and recall using signs rather than spoken phonemes. Method This study recruited 30 culturally Deaf, community-dwelling adults, who self-reported that they were not involved in litigation ordisability claims. In addition to the TOMM, participants were screened for cognitive ability using non-verbal components of the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II) and the Mini Mental State Examination: ASL Version (MMSE:ASL). Results Nonverbal intelligence for this sample was within the average range of ability. No participants scored lower than the standard cut-off score for Trial 2 or the Retention Trial on the TOMM (≤44 raw score to indicate invalid responding). Trial 1 performances ranged from 44 to 50, Trial 2 performances ranged from 49 to 50, and Retention performances ranged from 49 to 50. Conclusion These results support the use of the same standard cut-off scores established for hearing individuals in culturally Deaf individuals who use ASL.
{"title":"The validity of the test of memory malingering (TOMM) with deaf individuals","authors":"C. Chovaz, V. Lynn Ashton Rennison, Dominica O. Chorostecki","doi":"10.1080/13854046.2019.1696408","DOIUrl":"https://doi.org/10.1080/13854046.2019.1696408","url":null,"abstract":"Abstract Objective Administration of performance validity tests (PVT) during neuropsychological assessments is standard practice, with the Test of Memory Malingering (TOMM) being a commonly used measure. The TOMM has been well validated in hearing populations with various medical and psychiatric backgrounds. A major gap in the literature is the use of the TOMM amongst culturally Deaf individuals who use American Sign Language (ASL) as their first and preferred language. The purpose of this study was to explore the use of the TOMM with this population to determine if there may be differences related to the use of semantic knowledge and recall using signs rather than spoken phonemes. Method This study recruited 30 culturally Deaf, community-dwelling adults, who self-reported that they were not involved in litigation ordisability claims. In addition to the TOMM, participants were screened for cognitive ability using non-verbal components of the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II) and the Mini Mental State Examination: ASL Version (MMSE:ASL). Results Nonverbal intelligence for this sample was within the average range of ability. No participants scored lower than the standard cut-off score for Trial 2 or the Retention Trial on the TOMM (≤44 raw score to indicate invalid responding). Trial 1 performances ranged from 44 to 50, Trial 2 performances ranged from 49 to 50, and Retention performances ranged from 49 to 50. Conclusion These results support the use of the same standard cut-off scores established for hearing individuals in culturally Deaf individuals who use ASL.","PeriodicalId":197334,"journal":{"name":"The Clinical neuropsychologist","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127393843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-03DOI: 10.1080/13854046.2019.1696409
P. Marshall, J. Hoelzle, M. Nikolas
Abstract Objective: Identify assessment measures that augment the clinical interview and improve the diagnostic accuracy of adult ADHD assessment. Method: The sometimes limited research literatures concerning the diagnostic efficacies of the clinical interview, standard and novel ADHD behavior rating scales, performance and symptom validity testing, and cognitive tests are critically reviewed. Results: Based on this qualitative review, both clinical interviews alone and ADHD behavior rating scales alone have adequate sensitivity but poor specificity in diagnosing ADHD. Response validity and symptom validity tests have reasonably good sensitivity and very good specificity in detecting invalid symptom presentation. Cognitive test batteries have inadequate sensitivity and specificity in identifying ADHD. Using cognitive tests in conjunction with behavior rating scales significantly improves the specificity of an assessment battery. Executive function behavior rating scales and functional impairment rating scales are unlikely to improve the diagnostic accuracy of ADHD assessment. Conclusions: Based on this review, key clinical interview questions, behavior rating scales, symptom validity tests, and cognitive tests that have promise to enhance current assessment practices are recommended. These are the authors’ personal opinions, not consensus standards, or guidelines promulgated by any organization. These measures are incorporated in a practical, somewhat abbreviated, battery that has the potential to improve clinicians’ ability to diagnose adult ADHD.
{"title":"Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in young adults: A qualitative review of the utility of assessment measures and recommendations for improving the diagnostic process","authors":"P. Marshall, J. Hoelzle, M. Nikolas","doi":"10.1080/13854046.2019.1696409","DOIUrl":"https://doi.org/10.1080/13854046.2019.1696409","url":null,"abstract":"Abstract Objective: Identify assessment measures that augment the clinical interview and improve the diagnostic accuracy of adult ADHD assessment. Method: The sometimes limited research literatures concerning the diagnostic efficacies of the clinical interview, standard and novel ADHD behavior rating scales, performance and symptom validity testing, and cognitive tests are critically reviewed. Results: Based on this qualitative review, both clinical interviews alone and ADHD behavior rating scales alone have adequate sensitivity but poor specificity in diagnosing ADHD. Response validity and symptom validity tests have reasonably good sensitivity and very good specificity in detecting invalid symptom presentation. Cognitive test batteries have inadequate sensitivity and specificity in identifying ADHD. Using cognitive tests in conjunction with behavior rating scales significantly improves the specificity of an assessment battery. Executive function behavior rating scales and functional impairment rating scales are unlikely to improve the diagnostic accuracy of ADHD assessment. Conclusions: Based on this review, key clinical interview questions, behavior rating scales, symptom validity tests, and cognitive tests that have promise to enhance current assessment practices are recommended. These are the authors’ personal opinions, not consensus standards, or guidelines promulgated by any organization. These measures are incorporated in a practical, somewhat abbreviated, battery that has the potential to improve clinicians’ ability to diagnose adult ADHD.","PeriodicalId":197334,"journal":{"name":"The Clinical neuropsychologist","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115354319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-02DOI: 10.1080/13854046.2019.1694703
J. Lace, A. Grant, P. Ruppert, D. Kaufman, Carson L. Teague, Kimberly T. Lowell, J. Gfeller
Abstract Objective While the Neuropsychological Assessment Battery, Screening Module (S-NAB) is a commonly used cognitive screening measure, no composite embedded performance validity test (PVT) formula has yet been described within it. This study sought to empirically derive PVT formulas within the S-NAB using an analog simulation paradigm. Method Seventy-two university students (M age = 18.92) were randomly assigned to either an Asymptomatic (AS) or simulated mild traumatic brain injury (S-mTBI) group and were administered a neuropsychological test battery that included the S-NAB and standalone and embedded PVTs. The AS group was instructed to perform optimally, and the S-mTBI group received symptom and test coaching to help simulate mTBI-related impairment. Both groups received warnings regarding the presence of PVTs throughout the test battery. Results Groups showed significant differences (all ps < .001) on all S-NAB domain scores and PVTs. In the S-NAB, the Attention (S-ATT) and Executive Function (S-EXE) domains showed the largest effect sizes (Cohen’s ds = 2.02 and 1.79, respectively). Seven raw scores from S-ATT and S-EXE subtests were entered as predictor variables in a direct logistic regression (LR). The model accurately classified 90.3% of cases. Two PVT formulas were described: (1) an exponentiated equation from LR results and (2) an arithmetic formula using four individually meaningful variables. Both formulas demonstrated outstanding discriminability between groups (AUCs = .96–.97) and yielded good classification statistics compared to other PVTs. Conclusions This study is the first to describe composite, embedded PVT formulas within the S-NAB. Implications, limitations, and appropriate future directions of inquiry are discussed.
{"title":"Detecting noncredible performance with the neuropsychological assessment battery, screening module: A simulation study","authors":"J. Lace, A. Grant, P. Ruppert, D. Kaufman, Carson L. Teague, Kimberly T. Lowell, J. Gfeller","doi":"10.1080/13854046.2019.1694703","DOIUrl":"https://doi.org/10.1080/13854046.2019.1694703","url":null,"abstract":"Abstract Objective While the Neuropsychological Assessment Battery, Screening Module (S-NAB) is a commonly used cognitive screening measure, no composite embedded performance validity test (PVT) formula has yet been described within it. This study sought to empirically derive PVT formulas within the S-NAB using an analog simulation paradigm. Method Seventy-two university students (M age = 18.92) were randomly assigned to either an Asymptomatic (AS) or simulated mild traumatic brain injury (S-mTBI) group and were administered a neuropsychological test battery that included the S-NAB and standalone and embedded PVTs. The AS group was instructed to perform optimally, and the S-mTBI group received symptom and test coaching to help simulate mTBI-related impairment. Both groups received warnings regarding the presence of PVTs throughout the test battery. Results Groups showed significant differences (all ps < .001) on all S-NAB domain scores and PVTs. In the S-NAB, the Attention (S-ATT) and Executive Function (S-EXE) domains showed the largest effect sizes (Cohen’s ds = 2.02 and 1.79, respectively). Seven raw scores from S-ATT and S-EXE subtests were entered as predictor variables in a direct logistic regression (LR). The model accurately classified 90.3% of cases. Two PVT formulas were described: (1) an exponentiated equation from LR results and (2) an arithmetic formula using four individually meaningful variables. Both formulas demonstrated outstanding discriminability between groups (AUCs = .96–.97) and yielded good classification statistics compared to other PVTs. Conclusions This study is the first to describe composite, embedded PVT formulas within the S-NAB. Implications, limitations, and appropriate future directions of inquiry are discussed.","PeriodicalId":197334,"journal":{"name":"The Clinical neuropsychologist","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114717279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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