Using the TOMM for evaluating children's effort to perform optimally on neuropsychological measures.

Suboptimal effort is a threat to the validity of neuropsychological evaluations. Numerous papers have been devoted to this subject and a large number of measures have been developed in an attempt to detect suboptimal effort. To date, however, the clinical literature has focused almost exclusively on identifying suboptimal effort in adults, whereas suboptimal effort among children has not been addressed thoroughly in the clinical neuropsychological literature. The present study investigated whether or not already established effort measures could be used with children. The Test of Memory Malingering (TOMM) and the Rey-15-item test were administered to 128 children in two sites, the USA and Cyprus. The results indicated that the TOMM has the potential to be used as a measure for identifying children who do not put forth maximal effort during neuropsychological evaluations. In contrast, the Rey-15-item test does not appear to be a promising measure of effort for use with children, especially younger children.     

PERFORMANCE ON THE TEST OF MEMORY MALINGERING IN A MIXED PEDIATRIC SAMPLE

Performance on the Test of Memory Malingering (TOMM) was evaluated in a sample of 100 consecutively referred 6 to 16–year-old children with a wide range of clinical diagnoses. In the complete sample, 97 children met actuarially defined criteria for sufficient effort on the TOMM. Two children were correctly identified as providing suboptimal effort and only one case was a possible false positive. Performance on the second trial of the TOMM did not vary with gender, ethnicity, parental occupation, performance on an independent memory test, or length of coma. Although younger children tended to be somewhat less efficient on the TOMM than older children, more than 90% of children in the 6-8 years range met criteria originally developed for adults for sufficient effort on the TOMM. It is concluded that the TOMM is a potentially useful measure of effort in the clinical neuropsychological evaluation of school-age children.     

Performance on the test of memory malingering in a mixed pediatric sample.

Performance on the Test of Memory Malingering (TOMM) was evaluated in a sample of 100 consecutively referred 6 to 16-year-old children with a wide range of clinical diagnoses. In the complete sample, 97 children met actuarially defined criteria for sufficient effort on the TOMM. Two children were correctly identified as providing suboptimal effort and only one case was a possible false positive. Performance on the second trial of the TOMM did not vary with gender, ethnicity, parental occupation, performance on an independent memory test, or length of coma. Although younger children tended to be somewhat less efficient on the TOMM than older children, more than 90% of children in the 6-8 years range met criteria originally developed for adults for sufficient effort on the TOMM. It is concluded that the TOMM is a potentially useful measure of effort in the clinical neuropsychological evaluation of school-age children.     

Neuropsychological changes in children with cancer: The treatment of missing data in longitudinal studies

Researchers conducting longitudinal studies with children or adults are inevitably confronted with problems of attrition and missing data. Missing data in longitudinal studies is frequently handled by excluding from analyses those cases for whom data are incomplete. This approach to missing data is not optimal. On the one hand, if data are missing at random, then dropping incomplete cases ignores information collected on those cases that could be used to improve estimates of population parameters (e.g., means, variances, covariances, and growth rates) and improve the power of significance tests of statistical hypotheses. On the other hand, if data are not missing at random, then dropping incomplete cases leads to biased parameter estimates and hypothesis tests that may be internally and externally invalid. This study uses three years of follow-up data from a longitudinal investigation of neuropsychological outcomes of cancer in children to demonstrate the problems presented by missing data in repeated measures designs and some solutions. In evaluating potential biasing effects of attrition, the study extends previous research on neuropsychological outcomes in pediatric cancer by inclusion of patients whose disease had relapsed, and by comparison of surviving and nonsurviving patients. Although the data presented have specific relevance to the study of neuropsychological outcome in pediatric cancer, the problems of missing data and the solutions presented are relevant to a wide variety of diseases and conditions of interest to researchers in child and adult neuropsychology.     

Executive control within strategic deception: a window on early cognitive development?

Recently it has been claimed that the difficulty young children have with tests of strategic deception may be due to limitations in executive control rather than lack of insight into mental concepts. In the studies reported here we asked how reducing the executive demands of one measure of strategic deception, the windows task (J. Russell, N. Mauthner, S. Sharpe, & T. Tidswell, 1991), would affect performance. Study 1 demonstrated that both providing an artificial response medium and having children play in partnership enabled 3-year-olds to adopt a successful strategy. Study 2 examined whether social or executive factors accounted for the good performance of children when they played in partnership. Study 3 ruled out the possibility that the effectiveness of the artificial media was a result of reducing social intimidation-the manipulations were effective even in the presence the opponent. These results argue for executive factors playing a substantial role in the development of strategic deception.     

Word Memory Test Performance in Children

One-hundred and thirty-five children between the ages of 7 and 18 years were evaluated clinically. Their diagnoses included Fetal Alcohol Syndrome (FAS) or Effects, Schizophrenia, Bipolar Mood Disorder, various neurological diseases, Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder, Oppositional-Defiant Disorder and learning disabilities. As part of a comprehensive neuropsychological assessment, the children were given the Word Memory Test (WMT; Green, Allen, & Astner, 1996; Green & Astner, 1995), containing various subtests which measure, respectively, effort and verbal memory. Although age and verbal intelligence are known to affect scores on most ability tests, they were not found to be significant determinants of WMT effort scores. Younger children did not score any lower on the effort subtests than older children. The children scored as well as a group of parents seeking custody of their children and they scored higher than adult patients with mild head injuries. The computerized WMT requires some basic reading skills and some children with lower than a grade 3 reading level scored at a relatively low level on the effort subtests. The current data suggest that most children with at least a grade 3 reading level can pass the WMT using the adult criteria. It is concluded that the WMT is potentially useful in the evaluation of effort during pediatric neuropsychological evaluations. Further research is needed to replicate these findings and to develop child norms for the memory subtests.     

Word memory test performance in children.

One-hundred and thirty-five children between the ages of 7 and 18 years were evaluated clinically. Their diagnoses included Fetal Alcohol Syndrome (FAS) or Effects, Schizophrenia, Bipolar Mood Disorder, various neurological diseases, Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder, Oppositional-Defiant Disorder and learning disabilities. As part of a comprehensive neuropsychological assessment, the children were given the Word Memory Test (WMT; Green, Allen, & Astner, 1996; Green & Astner, 1995), containing various subtests which measure, respectively, effort and verbal memory. Although age and verbal intelligence are known to affect scores on most ability tests, they were not found to be significant determinants of WMT effort scores. Younger children did not score any lower on the effort subtests than older children. The children scored as well as a group of parents seeking custody of their children and they scored higher than adult patients with mild head injuries. The computerized WMT requires some basic reading skills and some children with lower than a grade 3 reading level scored at a relatively low level on the effort subtests. The current data suggest that most children with at least a grade 3 reading level can pass the WMT using the adult criteria. It is concluded that the WMT is potentially useful in the evaluation of effort during pediatric neuropsychological evaluations. Further research is needed to replicate these findings and to develop child norms for the memory subtests.     

Detecting deception: the scope and limits

With the increasing interest in the neuroimaging of deception and its commercial application, there is a need to pay more attention to methodology. The weakness of studying deception in an experimental setting has been discussed intensively for over half a century. However, even though much effort has been put into their development, paradigms are still inadequate. The problems that bedevilled the old technology have not been eliminated by the new. Advances will only be possible if experiments are designed that take account of the intentions of the subject and the context in which these occur.     

Autistic traits and neuropsychological performance in 6- to-10-year-old children: a population-based study

Clinical studies of children with autism spectrum disorder (ASD) provide evidence for poorer neuropsychological performance within specific domains compared to age, gender, and sometimes IQ-matched controls. Since recent evidence suggests that autistic symptoms form a spectrum that extends into the general population, it was our goal to evaluate the nature of the relationship between autistic traits and neuropsychological performance across the continuum in the general population. We examined neuropsychological performance across five different domains in 1019 6-to-10-year-old children participating in a population-based study of child development. Autistic traits were assessed when the children were 6 years of age using the Social Responsiveness Scale and ASD diagnoses were obtained via medical records. Neuropsychological functioning was measured using the NEPSY-II-NL and included the domains of attention and executive function, memory and learning, sensorimotor functioning, language, and visuospatial functioning. We found that children with higher autistic traits showed significantly lower neuropsychological performance in all domains investigated and that this association remained even after excluding children with the highest autistic traits or confirmed ASD. When comparing 41 children with confirmed ASD diagnosis to typically developing controls, children with ASD showed significantly lower neuropsychological performance across all domains. Taken together, our results suggest that children with both ASD and subclinical autistic traits have lower neuropsychological performance. Thus, this may provide an understanding of why some children without an ASD diagnosis may require some additional assistance within academic settings.     

Auditory and visual differences in time perception? An investigation from a developmental perspective with neuropsychological tests

Adults and children (5- and 8-year-olds) performed a temporal bisection task with either auditory or visual signals and either a short (0.5-1.0s) or long (4.0-8.0s) duration range. Their working memory and attentional capacities were assessed by a series of neuropsychological tests administered in both the auditory and visual modalities. Results showed an age-related improvement in the ability to discriminate time regardless of the sensory modality and duration. However, this improvement was seen to occur more quickly for auditory signals than for visual signals and for short durations rather than for long durations. The younger children exhibited the poorest ability to discriminate time for long durations presented in the visual modality. Statistical analyses of the neuropsychological scores revealed that an increase in working memory and attentional capacities in the visuospatial modality was the best predictor of age-related changes in temporal bisection performance for both visual and auditory stimuli. In addition, the poorer time sensitivity for visual stimuli than for auditory stimuli, especially in the younger children, was explained by the fact that the temporal processing of visual stimuli requires more executive attention than that of auditory stimuli.     

Strategy application disorder: the role of the frontal lobes in human multitasking

Strategy application disorder is a term used to describe a pattern of deficits, usually associated with frontal lobe dysfunction, where people show disorganisation, absentmindedness and problems with planning and decision making in everyday life despite normal performance on traditional neuropsychological tests. It is argued that the prototypical situation which presents problems for these cases are those which require multitasking, and although good cases are rare in the literature, those that do exist show a characteristic neuropsychological pattern. Moreover, this pattern is confirmed in recent group studies of multitasking and of the relationship between multitasking tests (such as the Six Element Test), failures in everyday life and other neuropsychological measures. At present the evidence suggests that the potential frontal brain regions most implicated in multitasking are the anterior cingulate; B.A. 10 and immediately adjacent areas; and the right dorsolateral prefrontal cortex, with each making a unique contribution to different aspects of performance. Furthermore, recent studies show striking dissociations between performances on multitasking tests and two of the most commonly administered measures of executive function: the verbal fluency test and the Wisconsin Card Sorting Test, which sets a minimum level for a fractionation of the executive syndrome in humans. Received: 31 March 1999 / Accepted: 23 July 1999     

Neuropsychological evaluation of neurologically asymptomatic HIV-infected children

Forty-two children born to HIV positive mothers (29 infected at different stages of the disease, according to the Disease Control Classification Centers, and 13 noninfected) underwent evaluation using a battery of neuropsychological tests. Executive function impairments were present in all infected children, whereas memory and visuo-prassic deficits were evident only in those with full-blown AIDS. Language abilities and overall intelligence were spared. Performance of seroreverters was in the normal range. These findings suggest that even in neurologically asymptomatic children, neuropsychological evaluation can identify early impairment of specific cognitive functions. The findings are discussed in the light of the prognostic power of neuropsychological assessment for early signs of HIV neurological involvement.     

Early neuropsychological correlates of later clock drawing and clock copying abilities among school aged children.

Although widely used in empirical study and bedside neuropsychological evaluation of geriatric populations, there is little literature on clock copying and drawing among children. However, existing research suggests that clock drawing tests (CDTs) may be effective and efficient tools for assessing neurocognitive development in children. This paper reports data on clock drawing on demand (CDT-D) and clock drawing to copy (CDT-C) among a non-clinical sample of elementary school aged children and identifies predictive relationships between earlier measures of executive function, visuo-construction, and visual-motor coordination and CDT performance 3 years later. Similar to findings with adult samples, analyses revealed better performance on copying than on drawing. Longitudinal analyses indicate that general intelligence significantly predicted performance on both tasks. Visual-motor coordination only predicted performance on the drawing on demand subtest of the CDT.     

Effort responses to suboptimal reward cues are related to striatal dopaminergic functioning

Reward cues have been found to increase the investment of effort in tasks even when cues are presented suboptimally (i.e. very briefly), making them hard to consciously detect. Such effort responses to suboptimal reward cues are assumed to rely mainly on the mesolimbic dopamine system, including the ventral striatum. To provide further support for this assumption, we performed two studies investigating whether these effort responses vary with individual differences in markers of striatal dopaminergic functioning. Study 1 investigated the relation between physical effort responses and resting state eye-blink rate. Study 2 examined cognitive effort responses in relation to individually averaged error-related negativity. In both studies effort responses correlated with the markers only for suboptimal, but not for optimal reward cues. These findings provide further support for the idea that effort responses to suboptimal reward cues are mainly linked to the mesolimbic dopamine system, while responses to optimal reward cues also depend on higher-level cortical functions.     

The impact of culture and education on non-verbal neuropsychological measurements: a critical review

Clinical neuropsychology has frequently considered visuospatial and non-verbal tests to be culturally and educationally fair or at least fairer than verbal tests. This paper reviews the cross-cultural differences in performance on visuoperceptual and visuoconstructional ability tasks and analyzes the impact of education and culture on non-verbal neuropsychological measurements. This paper compares: (1) non-verbal test performance among groups with different educational levels, and the same cultural background (inter-education intra-culture comparison); (2) the test performance among groups with the same educational level and different cultural backgrounds (intra-education inter-culture comparisons). Several studies have demonstrated a strong association between educational level and performance on common non-verbal neuropsychological tests. When neuropsychological test performance in different cultural groups is compared, significant differences are evident. Performance on non-verbal tests such as copying figures, drawing maps or listening to tones can be significantly influenced by the individual's culture. Arguments against the use of some current neuropsychological non-verbal instruments, procedures, and norms in the assessment of diverse educational and cultural groups are discussed and possible solutions to this problem are presented.     

儿童面对不同对象的欺骗表现及其相关的社会性特点

为进一步探讨儿童欺骗行为的表现及其影响因素,在研究一中,分别引入陌生的成年女性、成年男性、同龄女孩、同龄男孩等四种游戏对手,探讨159名幼儿园大班的儿童在面对不同对象的情况下外显欺骗行为是否发生变化？结果表明,被试性别、对手年龄和对手性别三因素之间交互作用显著,儿童更倾向于欺骗成年女性以及和自己性别不同的同伴。研究二采用儿童社会化量表进一步考察儿童欺骗行为和其它社会性特点的关联。结果表明隐蔽的动作欺骗和意志维度显著相关,外显的动作欺骗和好胜心维度显著相关,说谎和自我概念维度显著相关     

Detecting performance invalidity in children: Not quite as easy as A,B, C, 1, 2, 3 but automatized sequences appears promising

In adult populations, embedded performance validity indicators are well established, as they are time efficient, resistant to coaching, and allow for more continuous monitoring of effort than standalone measures. Although several recent studies have demonstrated the appropriateness of using standalone validity tests with school-age children, a paucity of pediatric work has examined embedded indicators. The present study investigated the value of a simple automatized sequences task to detect performance invalidity in 439 clinically referred patients with mild head injury aged 8 through 17 years. Sixteen percent of the participants failed the Medical Symptom Validity Test (MSVT). Thirteen percent failed the MSVT and also performed below established cutoffs on either the Test of Memory Malingering or Wechsler Digit Span subtest. The group classified as providing invalid data performed significantly worse than the group passing the MSVT across all sequencing conditions. Sensitivity and specificity for the total time on the sequencing task compared favorably to data produced for many respected adult-based embedded indicators (i.e., sensitivity around 50% when specificity ≥ 90%). Classification statistics for any embedded performance validity test can be expected to be worse in more severely affected populations; however, the current sequencing task appears to have value in detecting invalid performance in relatively high-functioning older children and adolescents. The fact that the task takes less than a couple of minutes to administer makes it especially appealing.     

Effect of motivation on academic fluency performance in survivors of pediatric medulloblastoma

It has been proposed previously that extrinsic motivation may enable survivors of childhood medulloblastoma to significantly improve aspects of neurocognitive performance. In healthy populations, enhanced motivation has been shown to promote academic fluency, a domain likely more relevant to the educational outcomes of pediatric medulloblastoma survivors than academic skill development. The present study investigates the effect of enhanced extrinsic motivation on fluent (i.e., accurate and efficient) academic performance in pediatric medulloblastoma survivors. Participants were 36 children, ages 7–18, who had completed treatment for medulloblastoma. Participants completed a neuropsychological battery that included administration of equivalent tasks on Forms A and B of the Woodcock-Johnson III Tests of Achievement. Half were randomly assigned to an incentive condition prior to the administration of Form B. Provision of a performance-based incentive resulted in statistically significant improvement, but not normalization of function, in performance on measures of academic fluency. No demographic, treatment-related, academic, neuropsychological, or self-perception variables predicted response to incentive. Findings suggest that academic performance of survivors may significantly improve under highly motivating conditions. In addition to implications for educational services, this finding raises the novel possibility that decreased motivation represents an inherent neuropsychological deficit in this population and provides a rationale for further investigation of factors affecting individual differences in motivational processes. Further, by examining effort in a context where effort is not inherently suspect, present findings also significantly contribute to the debate regarding the effects of effort and motivation on neuropsychological performance.     

State of Multicultural Neuropsychological Assessment in Children: Current Research Issues

Scientific attention to cultural considerations in child neuropsychological assessment has not developed parallel to the focus these issues have received in adult and elderly neuropsychological assessment. There are limited data on the presence, magnitude, etiology, and implications of culture-related differences in cognitive test performance among children. This preliminary report reviews the available empirical literature on the current state of multicultural neuropsychological assessment in children. The review identified articles by searching PubMed and PsycINFO databases, and the tables of contents of Developmental Neuropsychology and Child Neuropsychology from 2003-2008. Of the 1,834 abstracts reviewed, ten papers met inclusion criteria for the review. Five studies were completed in America; four of these compared performance between ethnic groups while the fifth examined neighborhood level poverty indicators exclusively within African-American children. Of the five international studies, all established local normative data and/or were exploratory investigations of neuropsychological functions in specific cultural groups, including Taiwanese infants, South African youth, and bilingual British children. Taken together, the results yield important clinical and research data that begin to inform many of the complex and fascinating mechanisms by which ethnic identity and culture impact cognitive development and the neuropsychological assessment of children. A critique of the existing literature and directions for future research are provided.     

Adults' ability to detect children's lying

Adults are poor deception detectors when examining lies told by adults, on average. However, there are some adults who are better at detecting lies than others. Children learn to lie at a very young age, a behavior that is socialized by parents. Yet, less is known about the ability to detect children's lies, particularly with regard to individual differences in the ability to detect this deception. The current study explored adult raters' ability to discern honesty in children who lied or told the truth about committing a misdeed. Results showed that adults are no better at detecting children's lies than they are with adult lies. In particular, adults were very poor at identifying children's honest statements. However, individual differences did emerge, suggesting that the ability to detect lying in children might be facilitated by relevant experience working with children. Implications for legal and mental health contexts are discussed.