Confabulations in a teenager with a right frontal hemispherotomy: Possible underlying mechanisms

Figures & data

Table 1. Results of the clinical neuropsychological assessment.

Domain	Results	Tests
Intellectual efficiency	VCI = 70 (CI 95% = 65-83), VSI = 72 (CI 95% = 67-82) PRI = 72 (CI 95% = 67-81) WMI = 67 (CI 95% = 62-79) PSI = 77 (CI 95% = 71-89) TIQ = 66 (CI 95% = 61-74)	WISC V
Speech and language	Index = 63 Fluent and intelligible verbal productions but poor lexicon (∼7 years old), semantic paraphasias, morpho-syntaxic and discursive deficit	PPVT KABC II Frog story
Fine motor skills	Dominant hand (right): −1.4 SD Non dominant hand (left): −4.3 SD	Purdue Pegboard
Short-term & working memory	Digit span: SS = 3 (direct order:5, reversed order:3) Picture span: SS = 5	WISC V
Episodic memory	General memory Index: 58 Encoding/learning index: 63 Visual immediate/delayed memory index: 75/96 Verbal immediate/delayed memory index: 55/59	CMS
	Encoding: SS = 8, Delayed recall: NS = 7, Recognition: NS = 8 1 intrusion and 1 interference	Word list CMS
	Encoding: −1 SD, Recognition: 12/15 (1 omission, 2 false recognitions)	Rey’s 15 figures test
Semantic memory	Information: SS = 3 Vocabulary: SS = 3	WISC V
Executive and attentional functions	Verbal category fluency: −1 SD/Figural fluency: −3 SD Inhibition: −0.9 SD Flexibility: > PR16 Planification: Total move score: SS = 104 Total correct score: SS = 100 Total initiation time: SS = 90 Total problem solving time: SS = 100 Inattention: T-score = 62 (inconsistency and variability of RT) Sustained attention deficit (significant errors’ increase across blocks)	Fluency tests Stroop Color Trail Towers of London CPT III
Social cognition	Affect recognition: SS = 5 Fear recognition: PR =2-5 Anger recognition: PR <2 TOM contextual: 3/5 Failure to detect sarcasm and bluff Detects the faux-pas but fails to justify	NEPSY II NEPSY II Happé stories Baron-Cohen faux-pas
Questionnaires	Executive Behaviour: GEC = PR.78, MI = PR.78, BRI = PR.86 Emotional control (PR.98)^a Working memory (PR.92)^a Everyday memory General mean: 1.77 (-1.5 SD)/0.92 (-0.2 SD) Retrieval factor: 2 (-1.2 SD)/1.4 (-0.5 SD) Attentional factor: 2.25 (-2.55 SD)/0.5 (-0.1 SD) Temporal estimation (total correct = 21/34) Temporal orientation: 4/4 Temporal sequences: 5/6 Objective duration estimation: 2/10 Subjective duration estimation: 4/5 Anticipation: 6/9	BRIEF (parental report) EMQ-R (Royle & Lincoln 2008) Auto-/Parental Ratings QTE (Quartier)

^aBRIEF: The higher the percentile, the more severe the deficit. SS = standard score; SD = standard deviation; PR = Percentile Rank, WISC V: Wechsler Intelligence Scale for children, 5th edition; PPVT = Peabody picture vocabulary test; CMS = children memory scale; BRIEF = behavioral rating inventory of executive function; GEC = global executive composite, MI = metacognitive index, BRI = behavioral regulation index; CPT III = continuous performance test, 3rd edition; RT = reaction time; NEPSY II: Developmental Neuropsychological Assessment, 2nd edition; TOM = theory of mind; EMQ-R = Everyday Memory Questionnaire-revised form, QTE = Questionnaire d’Estimation Temporelle.

Table 2. Results obtained in the experimental memory tasks and complementary questionnaires, compared to typically developing age-controls and IQ-matched controls.

	NM results	Age-control norms: mean (standard deviation)	IQ-control norms: mean (standard deviation)
Confabulation questionnaire (adapted from Dalla Barba et al., 2019)	Semantic autobiographical memory: 10/10 Orientation: 9/10 “I don’t know” questions: 80% confabulations	NA	NA
Source memory (speech-monitoring task, from Debbane et al., 2010)	Nb correct recognition (target items): 40/48	33.16/48 (5.83)	32.58/48 (6.36)
	Nb false recognition: 11	4.89 % (2.66)	5.74 % (3.02)
	Percentage source confusions: 16/40 (40%)	28.41 % (2.66)	34.85 % (2.66)
	Internal misattributions: 47.6 %	27.83 % (13.24)	39.02 % (14.06)
	External misattributions: 31.5 %	29.14 % (13.53)	30.36 % (13.78)
Episodic Future Thinking Task (Feller et al., 2021)	Recollection (total = 8)
	- Specific episodic narratives: 8 (100%)	79.78% (25.04)	65.29% (25.79)
	- Extended narratives: 0 (0%)	12.59% (18.82)	18.07% (17.01)
	- Categoric narratives: 0 (0%)	7.63% (15.31)	16.64% (19.5)
	- Experiential index (sum): 36	32.09 (8.5)	18 (7.51)
	- Subjective appreciation index (sum): 25.5	24.85 (5.55)	15.46 (7.32)
	Production (total = 8)
	- Specific episodic narratives: 1 (12.5%)	58.06% (29.15)	48.99% (37.15)
	- Extended narratives: 3 (37.5%)	22.56% (17.61)	9.7% (13.53)
	- Categoric narratives: 4 (50%)	19.37% (22.31)	41.31% (37.87)
	- Experiential index (sum): 26	27.42 (8.6)	13.83 (6.44)
	- Subjective appreciation index (sum): 15	21.67 (6.24)	10.71 (4.83)
Self esteem	Rosenberg Self-Esteem Scale (Valliere &Vallerand	32.02 (4.88)	NA
	French adaptation, 1990): 32 points
	Social self esteem (Michaud et al., 2006)
	Self-competence:
	Self-assertion/social anxiety: 21/35 points	24.3/35 (5.5)
	Initiative/social communication: 32/35 points	26.7/35 (5.2)
	Extraversion/leadership: 16 points	13.6/21 (3.6)
	Self-disclosure/relational empathy: 19 points	16/21 (3.6)
	Social self-acceptance, popularity, relationships
	Social acceptance/popularity: 18/20 points	17.9/25 (3.7)
	Interest and social motivation: 18/20 points	16.1/20 (3.1)
	Success and motivation in love relationships: 14/20	14.3/20 (3.2)
Psychotic-like experiences (PQ-16)	Prodromal Questionnaire – short version 16 items (Ising et al., 2012): 0/16 A score ≥ 6 indicates the presence of psychotic-like experiences requiring a more in-depth clinical assessment	not clinical	NA

NA = not available.

Table 3. Statistical analyses for the experimental tasks, comparing the patient’s scores to an IQ-control sample (A) and to an age-control sample (B).

A
Test	IQ-Control sample			Case’s score	Significance test^a		Estimated percentage of the control population obtaining a higher/lower score than the case^b		Estimated size effect ZCC
	n	mean	SD		t	p	Point	95% CI	point	95% CI
Source Memory/False recognition Source Memory/Source confusions	19	5.74	3.02	11	1.698	.05	94.65	84.38-99.29	1.742	1.011-2.454
	19	34.85	2.66	40	1.887	.03	96.23	87.59-99.65	1.936	1.155-2.699
Autobio Memory/Episodic recollection Autobio Memory/Specific narratives (EFT)	24	65.29	25.79	100	1.319	0.1	89.98	78.28-97.09	1.346	0.782-1.895
	24	48.99	37.15	12.5	−0.962	0.17	17.293	7.15-31.36	−0.982	1.465-0.485
B
Test	Age-Control sample			Case’s score	Significance test^a		Estimated percentage of the control population obtaining a higher/lower score than the case^b		Estimated size effect ZCC
	n	mean	SD		t	p	Point	95% CI	point	95% CI
Source Memory/False recognition Source Memory/Source confusions	19	4.89	2.66	11	2.239	.01	98.098	92.20-99.92	2.297	1.419-3.158
	19	28.41	2.66	40	4.247	.000	99.97	99.79-100	4.357	2.870-5.831
Autobio Memory/Episodic recollection Autobio Memory/Specific narratives (EFT)	33	79.78	25.04	100	0.796	0.21	78.392	65.86-88.42	0.808	0.409-1.197
	33	58.06	29.15	12.5	−1.54	0.06	6.672	1.927-14.78	−1.563	2.06-1.046

^aCrawford and Howell (1998): the results are for a one-tailed test.

^bCrawford & Garthwaite (2002).

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