The fourth annual meeting of the American College of Professional Neuropsychology (ACPN) poster roster, March 9–10, 2012, Las Vegas, Nevada

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The utility of baseline testing in concussion management

Kate Higgins, MA

Forest Institute of Professional Psychology

2775 2A S. Forest Village Drive

Springfield, MO 65807

Tel. [phone]

E-mail: [email protected]

Objectives: Baseline testing in concussion assessment can be central to effective concussion management. Baseline tests give the athletic trainer, coach, doctor, or neuropsychologist a reference point to guide return-to-play decisions and allow individual athletes to serve as their own controls, rather than relying on normative standards to ascertain when a concussed athlete has returned to “normal” (Covassin et al., 2008; Yard & Comstock, 2009). Baseline testing will further be discussed as it relates to test reliability as well as differences in baseline testing in children, adolescents, and adult athletes. Methods: Approximately 300,000 sports-related concussions are estimated to occur in the United States among high school athletes every year (Faure & Pemberton, 2010); between 1.6 million and 3.8 million concussions occur in the general U.S. population annually (Broglio et al., 2009). Concussion symptoms typically attenuate in 7 to 10 days (sometimes longer in children and adolescents), but proper assessment and management are vital to proper recovery. Several current concussion assessment tools rely on an individual’s baseline or the individual’s test scores before they receive a concussion. Baselines allow assessors to compare an athlete’s scores to their personal norms and can play a vital role in return-to-play decisions. Results: Return-to-play guidelines strongly recommend that athletes not be returned to play until they are completely asymptomatic, and baseline testing can help to operationalize “asymptomatic” for individual athletes (Piland et al., 2010). Because research has suggested that an athlete becomes more susceptible to concussions with each successive concussion he/she suffers, it is vitally important that the athlete is back to baseline and completely asymptomatic before they return to play so that they do not experience another concussion. Conclusions: Baseline testing can be a helpful tool in concussion assessment and management and can be used with a variety of types of concussion assessments.

A neuropsychological case study of pretreatment and posttreatment adult-onset medulloblastoma

Melissa Connolly, M.A.

CHOC Children’s Hospital

Azusa Pacific University

235 W. Grove St. #C19

Pomona, CA 91767

Tel. [phone]; Fax. [phone]

E-mail: [email protected]

Grace Mucci, Ph.D., ABPdN

Objective: Medulloblastoma is a highly malignant and common brain tumor in children, but it is rare in adults, comprising less than 1% of central nervous system malignancies. Most studies examining neurocognitive functioning focus on childhood survivors and little is known regarding functioning in adult survivors. This case study highlights the acute neurocognitive effects of medulloblastoma in a young man and documents the neurocognitive changes measured 1-year postsurgery. Methods: A 22-year-old man diagnosed with medulloblastoma, with previous history of a reading disorder, was evaluated prior to radiation and chemotherapy and after resection and at 1-year follow-up. He had completed his treatment, which included intrathecal chemotherapy and radiation, 4 months prior to follow-up. Previous testing prior to diagnosis was available for comparison. Neuropsychological findings from these 3 time periods were collected and compared. Instruments utilized included the Wechsler Abbreviated Scale of Intelligence, portions of the Delis-Kaplan Executive Function System, and Grooved Pegboard. Results: Results revealed initial declines in intellectual functioning, verbal fluency, and motor skills with profound left hemiparesis, followed by improvements with rehabilitation at 1-year follow-up. Intellectual functioning returned to average range but still below baseline. Verbal fluency skills were a persistent area of weakness, as were motor skills, and the patient continued to present with functional left-sided hemiparesis. Conclusions: The results of this study indicate the acute effects of surgery in an adult diagnosed with medulloblastoma and enduring motor and fluency deficits at follow-up that warrant continued rehabilitation. This adult patient’s pattern of recovery differs from what would typically be seen in a child with medulloblastoma. Future neuropsychological research is needed to effectively understand this populations’ unique needs to help guide the most appropriate and relevant recommendations.

Tone discrimination impairment is uniquely linked to bipolar disorder with psychotic features

RyAnna Verbiest, BA

Psychology Department

University of Nevada, Las Vegas

45S. Maryland Parkway MS 5030

Las Vegas, NV 89154-5030

Tel. [phone]; Fax. [phone]

E-mail: [email protected]

Nicholas S. Thaler, MA,

Erik N. Ringdahl, MA,

Mary Vertinski, BA, and

Daniel N. Allen, Ph.D.

Objective: Auditory perception deficits have been identified in schizophrenia and linked to dysfunction in the primary auditory cortex. Additionally, there is evidence of gray-matter reduction in the superior temporal gyrus during the transition period to psychosis, which may be associated with the severity of positive symptoms in patients with psychotic disorders. Given the consistency with which auditory perception and auditory cortex abnormalities are identified in schizophrenia, it may be that patients with bipolar disorder who exhibit psychotic symptoms will demonstrate similar impairment in simple auditory perception tasks. The current study examines this matter by comparing auditory tone discrimination between 3 groups, including normal controls (NC), individuals with bipolar disorder with no psychotic features (BP–), and individuals with bipolar disorder who exhibit psychotic features (BP+). Methods: Participants included 25 NC, 24 BP–, and 25 BP+ adults (62.2% female; M_age = 36.0 years) who were administered a frequency discrimination task, where they were presented with pairs of tones and asked to determine whether the tones were the “same” or “different.” A 1-way between-groups analysis of variance (ANOVA) with planned comparisons was used to identify differences in the total correct composite score between the 3 groups with the hypothesis that the BP+ group would perform significantly worse than the BP– and NC groups. Results: The 1-way ANOVA was significant, F(2, 71) = 2.28, p < .05, and confirmed that the BP+ group had significantly more errors on the tone discrimination task compared with the other 2 groups. Conclusions: Results confirm that patients with bipolar disorder who also exhibit psychotic symptoms show the greatest impairment in auditory perception, suggesting underlying neuropathophysiology in the primary auditory cortex that may be common to psychosis.

Can the sensitivity and specificity of the TOMM be increased with differential cutoff scores?

Jessica H. Gunner, MA

Social Sciences 399

University at Albany

1400 Washington Ave.

Albany, NY 12222

Tel. [phone]

E-mail: [email protected]

Julie K. Lynch, Ph.D., and

Robert J. McCaffrey, Ph.D.

Objective: The sensitivity of the Test of Memory Malingering (TOMM) to suboptimal effort has been identified as inferior to other symptom validity tests (SVTs). The purpose of this study was to examine 2 cutoffs that differ from the standard TOMM criteria and have been suggested to increase TOMM sensitivity. Methods: An archival analysis was conducted on 44 files. Average age was 45.52 years (SD = 10.10), education was 14.39 years (SD = 2.86), and Full-Scale IQ was 95.48 (SD = 11.35). There were 20 men and 41 of the participants were right-handed. The criteria for suboptimal effort was defined as failing 2 or more SVTs. SVTs included the Rey15-item test, Victoria Symptom Validity Test, Word Memory Test, and the Reliable Digit Span. In addition to the standard TOMM criteria, the classification accuracy of 2 alternative cutoffs was examined: (a) < 49 on Trial 2 or the Retention Trial, and (b) ≤ 39 on Trial 1. Results: When using failure on 2 or more SVTs as the criterion for suboptimal effort, the standard TOMM cutoff’s sensitivity (SN) = .40, specificity (SP) = 1.0, false-negative rate (FN) = .60, and false-positive rate (FP) = .0. Classification accuracy statistics for the cutoff of < 49 on Trial 2 or the Retention Trial were as follows: SN = .75, SP = .92, FN = .24, and FP = .08. The cutoff of ≤ 39 on Trial 1 had an SN of .60, SP of .96, FN of .40, and FP of .04. Conclusions: Results indicated that the standard TOMM criteria are the least sensitive; however, the standard TOMM was the most specific with 0 FPs. The alternative cutoffs had substantially higher SN while maintaining adequate SP. The highest SN was found for the cutoff of <49 on Trial 2 or the Retention Trial.

The assessment of interpersonal problem-solving skills in adults with bipolar disorder

Carla Farcello, BA

Psychology Department

University of Nevada, Las Vegas

4505 S. Maryland Parkway MS 5030

Las Vegas, NV 89154-5030

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E-mail: [email protected]

John T. Egan,

Nicholas S. Thaler, MA,

Erik N. Ringdahl, MA, and

Daniel N. Allen, Ph.D.

Objective: The Assessment of Interpersonal Problem-Solving Skills (AIPSS; Donahue et al., 1990) is a videotape-based measure designed to assess social skills in patients with clinical disorders. Previous studies have established that patients with schizophrenia (SZ) exhibit global social skills deficits on all subscales compared with controls, but less information is available in this regard for bipolar disorder (BD). This is an issue, as patients with BD appear to exhibit impaired social skills, though not to the degree of patients with SZ. The presence of psychotic features may also predict more severe impairment. The current study examined AIPSS performance in patients with BD with and without psychotic features and compared to controls. Method: This study included 74 adults. Twenty-five were diagnosed with BD with psychotic features (BD+), 24 were diagnosed with BD without psychotic features, and 25 were healthy controls with no history of mood or psychotic disorders. Participants were 61.3% female and mean age was 36.0 years (SD = 13.0). All participants were administered the AIPSS. Results: The overall multivariate analysis of variance was significant, Wilks’s λ = 3.68, p < .01. Follow-up 1-way analyses of variance identified significant differences for the Description of Events variable and the Sending variables. Post-hoc Tukey tests indicated that controls performed significantly better on the Description of Events and Sending Performance variables compared with both BD groups, while the control group performed better than the BD+ group on the Sending Content and Sending Overall variables. Conclusions: These findings provide strong support that individuals with BD experience deficits on social functioning. Specifically, individuals with BD with or without psychotic features have significantly more difficulty describing social faux pas compared with controls and also exhibit interpersonal dysfunction when asked to replay the scenarios in vivo. Findings suggest that social skills deficits are present in BD regardless of the presence or absence of psychosis.

Affect identification impairments in bipolar disorder with and without psychotic features

Nicholas S. Thaler, MA

Psychology Department

University of Nevada, Las Vegas

4505 S. Maryland Parkway MS 5030

Las Vegas, NV 89154-5030

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E-mail: [email protected]

Mary Vertinski, BA,

Erik N. Ringdahl, MA,

Houston Woolery, and

Daniel N. Allen, Ph.D.

Objective: Patients with bipolar disorder (BD) exhibit deficits in social cognition, with theory of mind consistently evidenced as a trait impairment. Studies on affect identification, however, have been more mixed with both positive and negative findings. However, a subset of patients with BD exhibit psychotic symptoms during mood episodes. It may be that patients with psychotic features (BD+) may be impaired in affect identification while those without psychotic features (BD–) exhibit sparing in this domain. Methods: Participants included 49 adults diagnosed with bipolar I disorder (25 BD+, 24 BD–) and 25 healthy controls. Participants were 62.2% female and mean age was 36.0 years (SD = 13.4). A modified version of the Bell-Lysaker Emotional Recognition Test (BLERT) served as the measure of affect identification. Participants observed each item and then were prompted to identify the primary emotion exhibited by the person in the measure. Exploratory correlations were run between BLERT scores and symptomatology for the BD groups. Results: The overall multivariate analysis of variance was significant, Wilks’s λ = 2.86, p < .05. Follow-up analyses of variance and Tukey tests indicated that the BD+group performed poorer on all measures compared with the controls. In addition, the BD+group performed poorer on the auditory-only items compared with the BD– group. Correlations between the Brief Psychiatric Rating Scale and BLERT scores were nonsignificant. Conclusions: These results provide some of the first evidence that affect identification is impaired in patients with BD+ while spared in patients with BD–, and such impairments are independent of current symptomatology. This highlights the impact that psychosis may have on social cognition. Of interest, auditory affect identification emerged as a particularly strong deficit in the BD+ group. Other studies have explored the relationship between auditory discrimination impairments and schizophrenia. It may be that such impairments are characteristic of psychosis itself rather than selective to the schizophrenia population.

A comparison of the standard category test with a new computer version

Graham M. Silk-Eglit, BA

Social Sciences 399

University at Albany

1400 Washington Ave.

Albany, NY 12222

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E-mail: [email protected]

Andrea S. Miele, MA,

Jessica H. Gunner, MA,

Julie K. Lynch, Ph.D., and

Robert J. McCaffrey, Ph.D.

University at Albany

Objectives: The Halstead-Reitan Category Test was designed to provide clinicians with information regarding brain dysfunction, including executive functions such as abstract reasoning, logic, and response to feedback. Due to its apparatus, ease of implementation of the standard computed tomography (CT) is limited. A new computerized CT has attempted to address these issues (Hom, 2011). This study sought to determine the equivalence of this novel computerized CT relative to the standard projector administration. Methods: Participants (n = 29) were recruited from an undergraduate research pool of a large state university. Average age was 19.6 years (SD = 2.8), average education was 12.9 years (SD = 1.1), and 75.9% (n = 22) of the sample was female. Participants were randomly assigned to 2 conditions; half completed the standard CT first and half completed the computer version first. Mean number of errors was compared between both versions of the CT for all 7 subtests, total errors, and neuropsychological deficit scores (NDS). Results: Data were non-normally distributed; therefore, log transformations were completed across all subtests, total errors, and NDS. Analyses revealed no significant differences between standard and computer CT administration. Conclusion: This study supports the equivalence of the computer version of the CT compared with the standard version.

Effects of anxiety symptomatology in cognitively impaired older adults on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)

Kathryn J Dunham, MA

The School of Professional Psychology at Forest Institute

1304 W Maplewood St.

Springfield, MO 65807

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E-mail: [email protected]

Summer N. Rolin, MS,

Jason M. Sibson, BS,

Stacy A. Ogbeide, MS, and

Mark W. Glover, Ph.D.

Objectives: Anxiety and depression are both believed to effect performance on tests of cognition. Recent findings suggest that mild levels of anxiety positively affect learning (Bierman, Comijs, Jonker, & Beekman, 2005) while depressive features negatively affect cognitive performance (Benitez, Horner, & Bachman, 2011). Anxiety has been shown to have a negligible effect on test performance when depression is used as a covariate (Biringer et al., 2005). The current study aimed to determine the effects of anxiety on performance on cognitive tests in cognitively impaired older adults, while controlling for depressive symptoms. Methods: Forty-three archived cases from a local inpatient geriatric unit were reviewed. The sample was mostly female (60.5%) and Caucasian (97.7%), with an average age of 74.19 years (SD = 6.75). Inclusion criteria for the study required the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Zung Self-Rating Anxiety Scale (ZSAS), and Geriatric Depression Scale-Short Form scores. Results: A 1-way between-groups multivariate analysis of covariance was performed to investigate anxiety levels on cognitive functioning. The RBANS total and subscale scores were used as dependent variables. The independent variable was anxiety. The covariate was depression scores. Preliminary assumption testing was conducted with no serious violations noted. There was no significant difference found between anxiety levels on RBANS scaled scores, F(6, 35) = 1.29, p = .287; Wilks’s Lambda =.82; partial eta squared =.18. Conclusions: This study indicates that a mild level of anxiety, as assessed by the ZSAS, does not cause suppression or elevation of cognitive test scores when depressive features are controlled for. The results differed from previous research and indicated that mild levels of anxiety do not positively or negatively affect cognitive performance in older adults who have varying levels of cognitive impairment.

Age trajectory of neuropsychological performance: Executive functions and attention

Keith McGoldrick, MA

Fielding Graduate University

4476 Market Street

Ventura, CA 93003

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E-mail: [email protected]

Tonya L. Bennett, MA,

Whillma Quenicka, MS,

Khoosheh Daneshi, MA, and

Henry V. Soper, Ph.D.

Objectives: Subjective experience as a neuropsychologist suggests that the mean performance becomes worse in executive functions as one gets older, but there are few concrete data on this. The age trajectory for attention is not known. Mean performance for tasks in these areas were compared across ages. Methods: To track the trajectory of neuropsychological functioning, data were drawn from a popular comprehensive set of normative data for the Expanded Halstead-Reitan Battery. Norms for 12 years of education were used. For the executive functions, the average performance at each age level for each sex was computed for the Category Test, Trail-Making Test-Part B, Thurstone Word Fluency, Letter Fluency, and Category Fluency. The results from the Seashore Rhythm Test, Boston Naming Test, and Boston Diagnostic Ideational Material were similarly computed. Those levels were compared to what they would have been for the youngest group (aged 20–34 years old). Results: No noteworthy gender differences in performance were revealed. The tasks of executive functions declined, but there was variability. Tasks involving letter fluency were down only about 0.5 standard deviations by retirement age (65 years), but category fluency declined in a linear manner to more than 1 standard deviation. Similarly, the Category Test and Trail-Making Test-Part B performances declined by more than a full standard deviation by retirement age. With regard to attention, the Trail-Making Test-Part A declines about 1.5 standard deviations by retirement age, but Speech Sounds Perception does not decline appreciably till after age 55 and Seashore Rhythms maintains a drop of no more than 0.5 standard deviations until age 70. Conclusions: In the normal population, it appears that executive abilities do deteriorate over time, though tasks involving letter fluency are affected less. Among the attention tests evaluated, the one involving more frontal function, Trail-Making Test-Part A, shows more deterioration over time than those that are more perceptual.

Age trajectory of neuropsychological performance: Sensory/motor functioning

Tonya L. Bennett, MA

Fielding Graduate University

4476 Market Street

Ventura, CA 93003

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E-mail: [email protected]

Whillma Quenicka, MS,

Keith McGoldrick, MA, and

Henry V. Soper, Ph.D.

Objectives: Motor slowing is a well-known phenomenon in neuropsychology, so we decided to look at the age trajectory of three sensory/motor tasks and the mean time per block of the Tactual Performance Task (TPT). Methods: We compared the absolute mean performance for a number of sensory/motor tasks using data from a compendium of the Expanded Halstead-Reitan Battery. The data for the dominant or nondominant performances on the Finger Tapping Test, Grip Strength Test, Grooved Pegboard, and TPT as well as the bimanual performance on the latter test were used. The mean scores at each age were compared to those of the youngest group (aged 20–34 years) to try to determine any loss in function. Results: No noteworthy gender differences were revealed and there were no differences between the trajectories of the dominant and nondominant hands. On the TPT, the performance basically maintained through age 40 (no more than a 0.4-standard deviation loss). From age 50 years, there was a gradual but steady loss at age 80 of more than 2 standard deviations. For the Grooved Pegboard, there was a gradual decline of 1.3 standard deviations by age 60 years followed by a sharper decline of almost 3 standard deviations by age 80 years. Grip Strength remained stable to about ages 45 to 50 years and then showed a gradual decline of 1.8 standard deviations by age 80. Finger Tapping showed about a 0.4-standard deviation decline by age 60 and then a slow decline of about 1.7 standard deviations by age 80. Conclusions: Although the expected declines were observed, there was relatively little until retirement age, which is rather surprising given the assumption that most people greatly reduce their athletic activity well before that time. Even after that time, the losses were relatively minor and less than what would be expected from an aging body.

Age trajectory of neuropsychological performance: Impairment rating and verbal skills

Tonya L. Bennett, MA

Fielding Graduate University

4476 Market Street

Ventura, CA 93003

Tel. [phone]; Fax. [phone]

E-mail: [email protected]

Keith McGoldrick, MA,

Whillma Quenicka, MS, and

Henry V. Soper, Ph.D.

Objectives: Although normative data will let us know how the average person compares to his or her age mates, a question arises as to what happens to the absolute neuropsychological performance, regardless of age, especially for average impairment rating and verbal skills, as we age. Previously, we found that performance in most, but not all, areas of intellectual functioning deteriorate with age. Methods: To track the trajectory of neuropsychological functioning, data were drawn from a popular comprehensive set of normative data for the Expanded Halstead-Reitan Battery. Norms for 12 years of education were used. For the average impairment rating, the Aphasia Screening Test, the Boston Naming Test, and the Boston Diagnostic Ideation Material, the average performance at each age level for each sex was computed and then those levels were compared to the t scores for what they would have been for the youngest group (aged 20–34 years). Results: No noteworthy gender differences in performance were revealed. The average impairment rating declined substantially in a linear manner so that by retirement age (65 years), the performance had dropped 2 standard deviations. Performance on the Boston Naming Test, on the other hand, showed no substantive deterioration through at least age 55 years, and even by age 65 years, it had dropped only to a t score of 44. However, the number of errors on the Aphasia Screening Test and performance on the BDAE Complex Ideational Material were maintained through age 80 years. Conclusions: In the normal population, it appears that verbal abilities, especially those around aphasia, hold up pretty well through age 80 years, although confrontational naming, which can involve slightly more executive functioning, does show a moderate decline. The average impairment rating, which is derived from many tests of executive functioning, does show significant decline even by retirement age.

Age trajectory of neuropsychological performance: Verbal and visual episodic memory

Whillma Quenicka, MS

Fielding Graduate University

4476 Market Street

Ventura, CA 93003

Tel. [phone]; Fax. [phone]

E-mail: [email protected]

Keith McGoldrick, MA,

Tonya L. Bennett, MA, and

Henry V. Soper, Ph.D.

Objectives: Memory is known to deteriorate in many age-related disorders and the normal elderly complain about their memory, but we decided to look at the normal age trajectory of certain memory functions by comparing the average performance of various ages as presented in a compendium of norms for aspects of the California Verbal Learning Test (CVLT) and the memory aspects of the Tactual Performance Test (TPT). Methods: To track the trajectory of episodic memory, average normative data for 12 years of education for various ages were compared to the norms for 20 to 34 years of age. For verbal episodic memory, the average performance on CVLT Trials 1–5, Short-Delay Free Recall, and Long-Delay Free Recall at each age level for each sex was computed. For visual episodic memory, the TPT scores for memory and location were used. Results: No noteworthy gender differences were revealed. For the CVLT Trials 1–5 and the Short/Long-Delay Free Recall, there was a gradual decline to 1 standard deviation at age 65 and then a more rapid decline to a 2-standard deviation loss at age 80 years. For the “visual” memory (TPT), which is really a cross-modal memory, both the location memory results showed a monotonic loss of 1.3 standard deviations to about age 65 and then another loss to about 2 standard deviations by age 70 for location and age 80 for memory. Conclusions: Normally it appears that there is a gradual loss in memory functioning from ages 20 to 34 years old to age 60 to 65 years old and then a more severe decline during the next decade or so. These latter results should be viewed with caution, because, although there is substantial decline in functioning on these tasks after age 65 years, the cause may be an organic basis or may be from being retired.

The brain injury sentence completion test and its utility in the assessment of subjective experiences in clients with brain injury

Jason J. Baker, Ph.D.

6232 N. 7th Street, Suite 100

Phoenix, AZ 85014

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E-mail: [email protected]

Amy M. Rose, Psy.D.

Objectives: The Brain Injury Sentence Completion Test (BISCT) was created for assessing the subjective experiences and perceptions of individuals with brain injury. Although self-report inventories are very useful in documenting aspects of clients’ emotional, behavioral, and personality functioning, objective measures may not fully capture the unique phenomenological experiences of clients following brain injury. This study was conducted to determine the effectiveness of the measure in a sample of individuals with brain injury. Method: The BISCT is a 12-item sentence completion test. A total of 74 clients (47 men, 27 women), including both inpatients and outpatients, completed the BISCT. The current study consisted of primarily adults, although a few children (ages 10+ years) were included in the sample. The instrument was administered to inpatients as part of a neuropsychological evaluation or psychotherapy session and to outpatients as part of a broad neuropsychological battery. Results: All responses were analyzed qualitatively, and sample responses and a case study were used to illustrate the results. Conclusion: The current study illustrates how the sentence completion test format can provide valuable qualitative information about the phenomenological experiences (e.g., emotional functioning, coping mechanisms, frustrations, support systems, and level of awareness) of clients with brain injury in both inpatient and outpatient settings and provides unique information not assessed by objective self-report measures. As demonstrated in the case example, this information can be useful in formulating recommendations and treatment strategies for clients. Future research is needed to further explore the use of the BISCT with younger children. Development of a quantitative scoring system may be useful, yet the qualitative information obtained on the BISCT seems most helpful in better understanding these clients’ perspectives.

WAIS-IV working memory index performance is not impaired by cold pressor-induced pain

Joseph Etherton, Ph.D.

Psychology Department

Texas State University

601 University Drive

San Marcos TX 78666

Tel. [phone]

E-mail: [email protected]

Claire Allen, BA,

Rebecca Cormier, BA,

Nicolle Cumley, BA,

Amanda Kruger, BA,

Laura Pacheco, BA, and

Arianna Skinner-Barney

Objectives: Research on pain and working memory has been inconsistent: Some studies report no impairment and others report impairment only at high pain levels and only for complex working-memory tasks. The current study examined whether laboratory-induced pain causes impaired performance on Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Working Memory Index (WMI) performance. Induced pain is examined in isolation, apart from extraneous variables associated with patients with chronic pain (e.g., medication use), allowing for an estimate of the effect of pain per se on working memory. Methods: Forty healthy undergraduate volunteers (27 women, M_age = 20.3 years) were administered the WAIS-IV WMI subtests (Arithmetic, Digit Span). Twenty participants randomly assigned to a pain group were first administered either the Arithmetic or Digit Span subtest first (order was counterbalanced), and then they were administered the other WMI subtest during cold pressor-induced pain (mean pain rating = 6.8, SD = 1.7, 0–10 pain-rating scale). A control group of 20 participants underwent the same procedure but immersed their hand in warm water (nonpainful) rather than ice water while taking the second WMI subtest. Results: Scaled scores for subtests during water immersion (control or cold pain) were compared via analysis of variance with scaled scores for subtests administered normally. No decrement was observed for pain induction; scaled score means were equivalent for subtests across all conditions. Conclusions: The results indicate that no significant decrement in performance on WAIS-IV-measured working memory should be expected as a result of induced pain, even at moderate pain levels. This suggests that pain does not significantly disrupt working memory. However, patients with chronic pain may differ from healthy volunteers in their experience of pain, potentially limiting generalizability.

Cold pressor-induced pain does not impair WAIS-IV processing speed index performance

Joseph Etherton, Ph.D.

Psychology Department

Texas State University

601 University Drive

San Marcos TX 78666

Tel. [phone]

E-mail: [email protected]

Claire Allen, BA,

Rebecca Cormier, BA,

Nicolle Cumley, BA,

Amanda Kruger, BA,

Laura Pacheco, BA, and

Arianna Skinner-Barney

Objectives: This study examined whether laboratory-induced pain causes impaired performance on Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Processing Speed Index (PSI) performance. This question is driven by previous research indicating that both induced and chronic pain cause impairment in some cognitive domains but not others and by a paucity of research on the influence of pain on specific WAIS-IV index scores. This method allows for an estimate of the degree to which pain in isolation should be expected to impair processing speed, and findings may have implications for patients with complaints of chronic pain. Methods: Forty healthy undergraduate volunteers (27 women, M_age = 20.3 years) were administered the subtests of the WAIS-IV PSI: Symbol Search and Coding. Twenty participants randomly assigned to a pain group were first administered either Coding or Symbol Search first (order was counterbalanced) and then were administered the second PSI subtest during cold pressor-induced pain (mean pain rating = 6.8, SD = 1.7, 0–10 pain-rating scale). A control group of 20 participants underwent the same procedure but immersed their hand in warm water rather than ice water while taking the second PSI subtest. Results: Scaled scores for subtests during water immersion (control or cold pain) were compared via analysis of variance with scaled scores for subtests administered normally. No decrement was observed for pain induction; scaled score means were equivalent for subtests across all conditions. Conclusions: The results indicate that no significant decrement in performance on the PSI should be expected as a result of induced pain, even at moderate pain levels. This suggests that clinical complaints of slowed processing speed cannot likely be explained by pain per se. However, patients with chronic pain may differ from healthy volunteers in their experience of pain, potentially limiting generalizability.

The importance of serial neuropsychological assessment in the differential diagnosis of mixed dementia

Michael J. Raymond, Ph.D., ABN

Neuropsychology Services

John Heinz Institute of Rehabilitation Medicine

150 Mundy Street

Wilkes Barre, PA 18702

Tel. [phone]

Objective: This case study describes the neuropsychological profile of a 58-year-old, Caucasian, single, right-handed woman with a Ph.D. in counseling psychology. Reportedly, she had experienced reduced cognitive efficiency and, in particular, memory loss, which had been gradually progressive during the previous 2 years. This resulted in her being placed on a medical leave of absence as a tenured professor in psychology from a local university. Methods: Dementia is best defined as a reduction in cognitive functioning including language, memory, executive functions, and a host of other neurocognitive and behavioral symptoms. It may represent a variety of etiologies, which are often described as vascular, degenerative, mixed, or potentially reversible, in individuals younger than 65 years of age (presenile). Dr. A.M. underwent baseline neuropsychological assessment on March 9, 2009. At that time, she obtained a Full-Scale IQ (89) as well as generalized cognitive limitations. However, the neuropsychological data were viewed cautiously secondary to her marginal performance on symptom validity testing (e.g., Word Memory Test, Verbal Symptom Validity Test). Thus, it was opined by the evaluating neuropsychologist that “her effort was not full across testing and that significant exaggeration of cognitive deficits was evident.” Dr. A.M. continued to experience significant adaptive deficits, which precluded her from teaching and maintaining a small private practice. She was placed on a medical leave of absence on two separate occasions in 2009 and 2011. A cerebral magnetic resonance imaging without contrast enhancement (December 3, 2010) suggested scattered nonspecific periventricular white matter and subcortical signal abnormalities consistent with ischemic changes, postinflammatory process, or demyelination. She was referred to the undersigned for repeat neuropsychological assessment on January 20, 2011. Results: Results of Dr. A.M.’s neuropsychological evaluation (January 20, 2011) suggested generalized and profound cognitive limitations as evidenced by a score on a standardized neuropsychological index (abbreviated GNDS 53). The Halstead Impairment Index was not calculated secondary to the patient’s inability to complete specific subtests (e.g., Tactual Performance Task). However, if extrapolated, her Halstead Impairment Index would have been 1.0 (severe range). The test results appeared valid based on symptom validity testing (e.g., Test of Memory Malingering), and as a result of all reviewed and analyzed data, her profile was consistent with mixed dementia (vascular and degenerative). Conclusion: This case study underscores the importance of completing serial neuropsychological assessments in the differential diagnosis of mixed dementia, especially with questionable baseline test results.

The Word Finding Test: Current validity and relevance

Jose G. Vega, Ph.D., ABN

Institute for Forensic Psychiatry

Colorado Mental Health Institute at Pueblo 1600 W. 24th Street Pueblo, CO 81003

Tel. [phone]; Fax. [phone]

E-mail: [email protected]

Jose G. Vega, Ph.D., PC,

Heather Henkell, MA, M.Phil., and

J. G. Vega III, MBA

Objectives: The Word Finding Test (WFT) was devised to evaluate one’s ability to discern the meaning of nonsense words through verbal contexts. Given the test was created almost 40 years ago, a consideration is whether the test continues to be a valid measure of verbal reasoning and whether or not the words and contexts used are relevant today. This study examined correlations between the WFT and verbal measures on the Wechsler Adult Intelligence Scale (WAIS) and Halstead Reitan-Battery (HRB) to examine the validity of the WFT. Further, to assess the relevance of each item, minimum, maximum, and mean scores were compared. Methods: A retrospective analysis of outpatients at a private practice, who were referred mostly from a vocational rehabilitation program, was conducted. All patients were administered the WFT, HRB, and WAIS. Results: The WFT was significantly correlated with the GNDS and LNDS, but not the RNDS from the HRB. Surprisingly, the WFT was significantly correlated with both Verbal IQ and Performance IQ. Because the WFT was significantly correlated with measures of processing speed, this suggests it also measures cognitive processing speed. Seven of the 20 items on the WFT received mean scores of less than 1.5 out of 5. On 3 items, none of the participants tested earned a score greater than 3, and on 1 item, none of the participants earned any points. Conclusions: The WFT continues to be a valid measure of verbal reasoning; however, concerns were raised given the relevance of some of the items. The fact that some items did not result in a range of responses suggests the words or contexts used are outdated. Although this study had a small N, it highlights the potential of the WFT as a measure of verbal reasoning but raises the issue that the test may require updating.

Effect of effort on Meyers Neuropsychological Battery performance

Marguery Covarrubias, Ph.D.

Coast Psychiatric Associates

1600 Ximeno Ave, Suite 230

Long Beach, CA 90804

Tel. [phone]; Fax. [phone]

E-mail: [email protected]

John Knippa, Ph.D., FACPN

Objectives: Effort is a major factor influencing neuropsychological test performance. The goal of this study was to evaluate the effect of effort on a standardized neuropsychological battery. Methods: Data from the Meyers Neuropsychological Battery (MNB) were examined according to level of performance on an effort measure (i.e., Word Memory Test [WMT]) in a mixed sample (n = 470) of forensic, military, and clinical referrals. It was hypothesized that performance data would show moderate correlations with effort variables. Further hypothesized was that MNB domain scores would differentially relate to effort measures. A between-groups design was employed to evaluate the relationships between WMT and MNB domains, as well as differences between WMT score deciles versus the MNB. Results: Significant moderate correlations were found between WMT and MNB summary variables (r = .57, p < .01). Further, WMT data were moderately correlated with the MNB domains of Verbal Memory, Attention/Working Memory, Processing Speed, Verbal Reasoning, and Visual Reasoning, in descending order (r = .49–.40, p < .01). The WMT data groups yielded significantly different profiles (multivariate analysis of variance, p < .01), accounting for 23% to 27% of variance in the Processing Speed, Verbal Memory, Attention/Working Memory, and Verbal Reasoning variables. Moderate correlations were observed between the MNB summary variable and WMT data (Immediate Recognition, “easy mean,” Multiple Choice, Delayed Recognition, Paired Associates, “hard mean,” and Consistency, in descending order [r = .56–.50, p < .01]), with mild correlation of MNB and WMT recall measures (r = .38–.20, p < .01). Conclusions: These results support the need to consider effort when interpreting neuropsychological data. Effort scores show higher correspondence to battery summary scores than to MNB domain scores. Furthermore, those WMT variables designed to be most sensitive to effort have a greater correlation with performance data than do those WMT measures that are most sensitive to “ability.”

Prevalence of developmental disorders in returning veterans

Gary C. Warner, Ph.D.

Rochester VA/OPC

Canandaigua VAMC

University of Rochester School of Medicine and Dentistry

465 Westfall Rd.

Rochester, NY 14620

Tel. [phone]; Fax. [phone]

E-mail: [email protected]

Andrea Miele, MA,

Mina Dunnam, Ph.D.,

Kerry Donnelly, Ph.D., ABPP,

James P. Donnelly, Ph.D.,

C. James Kittleson, Psy.D., ABPP, and

Charles Bradshaw, Ph.D.

Objective: Veterans returning from deployment commonly report difficulties in attention/concentration and other executive functions. Attention-deficit hyperactivity disorder (ADHD) has been a suspected contributing cause despite limited information about its prevalence in veterans. The present study investigated rates of ADHD and related conditions (oppositional defiant disorder [ODD] and conduct disorder) in a large sample of Operation Enduring Freedom/Operation Iraqi Freedom veterans participating in a multisite cohort study of mild traumatic brain injury. Methods: Five hundred current war veterans (90% male; average age = 32.2 years, SD = 8.9 years; modal education = “some college”) were assessed via the Barkley ADHD scales. Three methods of analyzing the Barkley scales were employed: 1 according to Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria and 2 methods according to Barkley’s (2006) normative data. Results: Base rates differed depending on classification method. When DSM-IV criteria were employed, ADHD and ODD in childhood occurred at around 5% and 8.6%, respectively, while current ADHD and ODD were reported at around 15% and 36%. When Barkley’s normed count system was used (positive symptom count >1.5 standard deviations from the mean), ADHD and ODD in childhood occurred at around 2% and 3.6% with higher rates of current ADHD symptoms (nearly 30%) and ODD (41.5%). Barkley’s normed symptom summary/severity (>1.5 standard deviations from the mean) also revealed low levels of childhood ADHD and ODD (2% and 2.5%), with ADHD increasing in adulthood to 27%. DSM-IV indicators of conduct disorder were found in 7 individuals (1.4%). Conclusions: Three methods of classification yielded similar rates in ADHD. Prevalence was low in this veteran sample and was comparable to rates cited in the general population (3% to 7%). Retrospective recall of childhood symptoms was much lower than the current symptom report, and clinicians should be aware of this response bias among patients who present for evaluation of ADHD. This is the only known study to systematically explore these indexes.

Cross-validation of concurrent validation of a new measure of executive functioning

Arthur MacNeill Horton Jr., Ed.D., ABPP, ABN

Psych Associates of Maryland

120 Sister Pierre Drive, Suite 403

Towson, MD 21204

E-mail: [email protected]

Cecil R. Reynolds, Ph.D., ABN, ABPdN

Objective: This poster replicates earlier research that found relationships between traditional measures of executive functioning (Category Test [CT], Trail-Making Test-Part B [TMT-B], and Stroop Color Word Test-Color Word [CW]) and a new measure of executive functioning, the Test of Verbal Conceptualization and Fluency (TVCF), to provide additional evidence for concurrent validation. Methods: Twenty adult patients referred by neurologists and psychiatrists for outpatient neuropsychological evaluation at a private practice office were administered neuropsychological batteries that included the CT, TMT-B, CW, and TVCF and symptom validity tests (SVTs) such as the Word Memory Test and Test of Memory Malingering. The TVCF includes subtests such as Category Fluency, Number Correct, Perseverative Errors, Number of Categories, Letter Naming, and Trails C (TC). Fifteen patients were women, and 20 were Caucasian; 19 patients were right-handed. Diagnoses included head trauma (5), stroke (5), anoxia (3), multiple sclerosis (2), epilepsy (2), brain tumor (1), Alzheimer disease (1), and hydrocephalus (1). Ages ranged from 23 to 77 years (M = 48.8 years, SD = 13.8), and education ranged from 12 to 20 years (M = 15.8 years, SD = 2.41). All participants signed informed consent documents and passed the SVTs. Results: Correlations were mostly moderate and ranged from .57 (CW/TC) to .02 (CT/TC). Conclusions: Correlations between traditional and new measures of executive functioning were mostly moderate, consistent with earlier research, and further support the concurrent validity of the TVCF and the theoretical construct of executive functioning.

Neuropsychological evaluation of severe traumatic brain injury: A case study

Arthur MacNeill Horton Jr., Ed.D., ABPP, ABN

Psych Associates of Maryland

120 Sister Pierre Drive, Suite 403

Towson, MD 21204

E-mail: [email protected]

Cecil Reynolds, Ph.D., ABN, ABPdN

Objectives: While mild traumatic brain injury has been a focus of neuropsychological research for many years, patients who suffered severe traumatic brain injury often died. In the present case, the patient survived a severe traumatic brain injury and her Glasgow Coma Scale score was 7. The case study presents a unique opportunity to assess the neuropsychological effects of severe traumatic brain injury. Methods: A 40-year-old right-handed adult Caucasian woman with 12 years of education had been thrown from an all-terrain vehicle and hit the right frontal portion of her head. A computed tomography scan of the head showed bilateral frontal and left temporal encephalomalacia lesions. The patient had made a remarkable recovery and was ambulatory but still had problems with short-term memory, reduced attention span, emotions (mood changes, blunt speech, and social withdrawal), vertigo, slowed speech, and lack of a sense of smell and taste. Results: Major areas of neuropsychological deficits included adaptive problem-solving skills, short-term verbal memory, short-term nonverbal memory, attention and concentration, bilateral tactual perceptual discrimination skills, categorical and phonemic verbal fluency, bilateral motor weakness and motor slowness with the right hand (the dominant upper extremity), visual motor integration skills, and cognitive flexibility (resistance to distraction). Conclusions: Neuropsychological abilities demonstrated patterns of strengths and weaknesses suggesting the unique contributions ofthe portions of the frontal lobe to executive functioning.

Neurobehavioral toxicological analysis of a rampage gunman

Raymond Singer

Jack Thrasher

Objective: In September 2008, a 28-year-old man went on a shooting rampage that left 6 people dead and 4 others wounded. Upon arraignment, he told the judge that God told him to kill. An evaluation was conducted to determine if exposure to various neurotoxic agents impacted the defendant’s sanity. Methods: Review of records (criminal, educational, historical, medical, toxicological), a diagnostic neuropsychological interview, family members’ interviews, police reports, and administration of neuropsychological/behavioral tests were carried out. Results: The defendant had a history of exposure to multiple neurotoxic substances. He lived in a new formaldehyde-emitting mobile home from birth to age 14 years with psychomotor symptoms. From 2001 to 2007, he worked as a union painter with resulting headaches and other symptoms. By 2003, there were reports of hallucinations. From 2006 to 2008, he lived in an extremely moldy trailer. Sampling of the trailer in 2009 revealed numerous ERMI moldiness index samples were at Level 4, showing the greatest likelihood of having a mold problem; mold and mycotoxin samples found 30.5 ppb trichothocenes; 57 ng/sample LSD from ergotamines in the ceiling, 86 ng on a bed pillow; 28.9 ppb ochratoxin A on a mattress cover; and 14 ppb ochratoxin A in the defendant’s urine. In April 2008, he had overdosed dermal exposure to pyrethroids for treating probably hallucinated lice. Neuropsychological testing postoffense (April 2009) found IQ at the 42nd percentile, Working Memory at the 1st percentile, Processing Speed at the 27th percentile, Visual Immediate Memory at the 7th percentile, the Booklet Category Test at the 11th percentile, Trail-Making Test at the 1st percentile, and other findings. Borderline personality disorder was identified by the NEO-3. Multiple tests for malingering, including the Test of Memory Malingering, were negative. Conclusion: Significant mental illness was found, with neuropsychological results consistent with adult-onset neurotoxicity, including mycotoxicosis. The defendant was found not guilty by reason of insanity on some counts, guilty on other counts, spared the death penalty, committed to a mental hospital until cured, and then committed to prison for life.

Inpatient cognitive-behavioral treatment of executive dysfunction

Randolph W. Parks, Ph.D., Psy.D.

Choate Mental Health Center

Illinois Department of Human Services

1000 North Main Street

Anna, IL 62906

Tel. [phone], Ext. 2602; Fax. [phone]

E-mail: [email protected]

Jonathan D. Warshawsky, Ph.D.,

Kristine L. Buelow, MA,

Elliott J. Fitzpatrick, MA, and

Janet L. Pregel, Ph.D.

Objective: Neuropsychologists are faced with unique challenges for inpatient treatment of individuals with severe psychopathology. Often these patients have impairments in problem-solving and self-monitoring skills, which adversely impact activities of daily living. These cognitive deficits are collectively referred to as executive-functioning impairments. We chose to use a cognitive-behavioral intervention that addresses executive-functioning deficits in our population consisting primarily of individuals with serious mental illness, such as schizophrenia. We describe how a modified Executive Board System may be applied to psychiatric inpatient rehabilitation. Methods: Procedures involve small patient groups that meet 1 to 2 times weekly. Participants generate topics of discussion and write them on large white erasable boards. The staff facilitator focuses patients on 1 topic at a time and then asks the individuals to give practical solutions to the identified problems. This is accomplished first by identifying subcomponents, followed by putting component elements in sequence, and adapting solutions to daily routines. Results: Theoretically, these compensatory cognitive-behavioral strategies minimize the executive deficits and draw on the collective strengths of the group process. Conclusion: This patient-initiated psychotherapeutic approach is an important factor in individualized treatment planning, because the majority of topics generated involve crucial aspects of care. These treatment themes often include medication management, amelioration of disruptive behaviors, and discharge planning. All of these topics are central to both internal hospital clinical policies and external monitoring organizations.