Recovery and predictors of language skills two years following pediatric traumatic brain injury

Subtle language processing difficulties may adversely affect scholastic performance, as well as communication and social skills. It is therefore crucial that language skills are monitored following traumatic brain injury (TBI) in childhood. The present study examined language skills in a group of 68 children who had sustained a mild, moderate or severe TBI. Results indicated that during the acute stage a dose-response relationship was evident, where severe TBI was associated with poorest performance and mild TBI with least deficits. By 24 months post-TBI, it was clear that for some language functions, the severe TBI group showed substantial recovery, and at times performed better than the moderate TBI group. Predictors of language and literacy skills at 24 months post TBI included pre-injury communication skills, socio-economic status, age at injury, and Vocabulary, as measured by the Wechsler Intelligence Scale for Children (WISC-111).     

Postconcussion Symptoms

Research pertaining to the self-report of symptoms after traumatic brain injury was reviewed. Cognitive, emotional, and motivational factors have more relevance than demographic (except for female sex) and personality factors. Specific neuropsychological deficits in attention and memory have been found in the early stages after head injury of even mild severity. This is unlikely to be the only factor affecting symptom persistence. Exaggeration of cognitive dysfunction occurs in some cases, but appears unrelated to symptom overreport. Increased emotional distress typically accompanies symptom persistence. The psychological reaction of preoccupation with symptoms and emotional distress is not unique to concussion, but also occurs after severe head injury and back injury and relates more to the personal interpretation of the effect of the trauma than to objective indicators of brain injury severity.     

The Predictive Utility of a Working Memory Span Task Depends on Processing Demand and the Cognitive Task

The relationship between performance in working memory (WM) span tasks, scholastic skills and fluid intelligence was investigated to determine how WM span is related to higher order cognition. The predictive utility of two WM span tasks differing in the demand of the processing task was studied with controlled presentation times and a broad set of academic criterion tasks. Sixty‐eight adolescents (mean age 16 years) completed two WM span tasks, Raven's Progressive Matrices and several scholastic performance measures. The results showed that the more demanding WM span task predicted fluid intelligence, but did not contribute uniquely in explaining scholastic performance. In contrast, the less demanding WM task predicted scholastic performance. The results suggest that the strength of the relation between WM performance and higher order cognition varies in conjunction with both the demand of the WM span task and the type of higher order cognition measure.Copyright © 2016 John Wiley & Sons, Ltd.     

Neuropsychological evaluation in the assessment of personal injury

Neuropsychological evaluation offers unique potentials in the assessment of personal injury claims. Strengths and limitations of major approaches to testing are reviewed, and special attention is given to applications in the particular forensic areas of head injury, toxic environments, physical disease, and malpractice. The varieties of cognitive, emotional, and interpersonal damages which may occur with brain injury are described. Suggestions are provided for forensically appropriate neuropsychological assessment, as well as guidelines offered for discerning inappropriate practices. Issues of neurological malingering, credentialing of the expert, and forensic roles of the neuropsychologist in rehabilitation are discussed.     

Visual signal detection measured by event-related potentials

We compared the performance of 10 well-functioning university students who had experienced a mild head injury (MHI) an average of 6.4 years previously and 12 controls on a series of standard psychometric tests of attention, memory, and thinking and on a series of auditory oddball vigilance tasks to which we also took event-related potentials (ERPs). The MHI and Control groups performed equivalently on all the psychometric tasks and on self-report questionnaires of everyday memory and attention difficulties. The MHI group performed more slowly and with lower accuracy on only the most difficult of the oddball tasks, yet they showed substantially and significantly reduced P300 amplitudes and subsequent attentuation on all the oddball tasks, both easy and difficult. There were no alterations of N1, P2, and N2 components. These data suggest that despite excellent behavioral recovery, subtle information processing deficits involving attention nevertheless may persist long after the original injury and may not be apparent on a variety of standard psychometric measures.     

Acute Intellectual Effects of Pediatric Head Trauma

The current study compared Wechsler Intelligence Scale for Children-III (WISC-III) performances of 30 children who sustained head injury with the performance of orthopedic controls matched on gender, age, race, and parental education and occupational attainment. Children were followed during initial hospitalization, trauma severity variables were recorded, and duration of posttraumatic amnesia (PTA) was determined by serial testing of mental status. The WISC-III was administered immediately following resolution of amnesia. Although the majority of patients sustained mild injuries, children with head injuries obtained significantly lower IQ and factor scores than nonneurologically injured children. Consistent with past research, performance-based scores including Performance IQ, Perceptual Organization, and Processing Speed were more sensitive to head trauma than their verbal counterparts. Standardized measurement of PTA appeared to be a better predictor of IQ status following injury than Glasgow Coma Scale score on admission or length of unconsciousness.     

Detection of malingering of psychiatric disorder with the personality assessment inventory: an investigation of criminal defendants

To assess the diagnostic accuracy of the Personality Assessment Inventory (PAI; Morey, 1991) Validity scales for the detection of malingered psychiatric disorders, we divided a sample of criminal defendants referred for forensic evaluation by the federal courts into malingering and not malingering groups based on their performance on the Structured Interview of Reported Symptoms (Rogers, Gillis, & Bagby, 1990). Logistic regression analyses (LGAs) revealed that there were no differences between the malingering and not malingering groups with respect to age, race, years of education, history of drug abuse, or number of previous felony convictions. LGA with malingering versus not malingering as the criterion revealed that the PAI Negative Impression Management (NIM) scale but not the Rogers Discriminant Function (RDF; Rogers, Sewell, Morey & Ustad, 1996) nor the Malingering index (MAL; Morey, 1996) significantly differentiated the malingering from the not malingering group. Receiver operating characteristics analyses demonstrated acceptable sensitivity and specificity for the NIM scale but not the RDF scale or the MAL index. We discuss the results in terms of the suggested cutoff scores for the PAI Validity scales in detecting criminal defendants who are attempting to feign psychiatric disorder.     

MMPI-2 assessment of malingered emotional distress related to a workplace injury: a mixed group validation

In this study, we examined the capacity of MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 2001) validity indexes to identify malingered depression associated with a workplace injury. We compared 27 graduate students simulating depression with archival records of 33 inpatients diagnosed with major depressive disorder. We employed a mixed-group validation design to generate true positive rates (TPR) and false positive rates (FPR) for the various MMPI-2 validity scales [F, FB, F(p), FBS, F - K, Ds2] while we accounted for base rates of malingering in each sample. The Fake Bad scale (FBS) was the only validity measure that produced acceptable TPR and FPR or a significant correlation with malingering status.     

A taxonomy of neurobehavioral functions applied to neuropsychological assessment after head injury

Neuropsychological dysfunctions after traumatic brain injury are classified into a taxonomy to plan a comprehensive examination, and organize and report findings for diagnosis and treatment: consciousness, information processing, sensorimotor, neurophysiological, cerebral personality disorders, intelligence, memory, language, stress, psychodynamic, identity and weltanschauung, adaptation, complex adaptive functions, and development of children. Widerange sampling enhances the detection of acute and late-developing dysfunctions, and diagnosis of complex syndromes. Historical, personality, and injury data are components of the assessment. Issues discussed include underestimation of brain injury, malingering, interaction of symptoms, symptom persistence, and noncerebral lesional contributors to impairment after mild head injury.     

Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes

Compared 16 children with attention deficit hyperactivity disorder (ADHD) combined type (ADHD-C), 14 children with ADHD predominantly inattentive type (ADHD-I), and 17 controls on parent and teacher ratings of social status and performance, self-report of social knowledge and performance, and observations of behavior on an emotional regulation task. Analyses revealed distinct patterns of social dysfunction between ADHD subgroups. Children with ADHD-C were rated as showing more aggressive behavior; furthermore, they displayed emotional dysregulation characterized by high intensity and high levels of both positive and negative behavior. In contrast, children with ADHD-I were perceived as displaying social passivity and showed deficits in social knowledge on the self-report measure but did not evidence problems in emotional regulation. Regression analyses revealed that social performance, emotional regulation, and, to a lesser degree, social knowledge, were predictive of social status. The application of these findings to understanding the nature of the social deficits in the ADHD subtypes and directions for future research are discussed.     

Assessing child-rearing style in ecological settings: its relation to culture, social class, early age intervention and scholastic achievement

Middle- and lower-class black and white adolescents were observed interacting with their mothers during a discussion of seven child-rearing problems. Maternal references to a range of disciplinary measures were identified, analyzed, and related to the subjects' scholastic performances concurrently. A factor analysis of process measures confirmed earlier findings based on self-report data concerning parental disciplinary style. Low SES mothers who participated in an early-age intervention and upper middle-class mothers tended to be less punitive than those in the low SES untreated group. Black mothers were less permissive than those in the white group. Parental disciplinary style was found to be significantly related to school performance. The results are discussed in terms of the development of methodological procedures for interaction analysis in semi-structured, ecological research, for the evaluation of process variables in early-age intervention follow-ups and theory relating disciplinary style to intellectual development.     

Practical guidelines in the use of symptom validity and other psychological tests to measure malingering and symptom exaggeration in traumatic brain injury cases

The detection of malingering or symptom exaggeration has become an essential component in forensic neuropsychological evaluations, particularly in cases involving personal injury claims. Symptom Validity Tests refer to those measures that can be utilized to detect test performance that is so poor that it is below the level of probability, oftentimes even among brain-damaged populations. This article outlines legal standards for expert testimony in regard to forensic neuropsychological personal injury evaluations. The article provides an outline of specific Symptom Validity Tests and Indicators, and reviews literature supporting test sensitivity and validity. In addition, the use of symptom checklists and questionnaires is discussed, as well as the appropriate use of Symptom Validity Tests and Indicators to establish the presence or absence of malingering or symptom exaggeration.     

Assessing personality with a structured employment interview: construct-related validity and susceptibility to response inflation

The authors evaluated the extent to which a personality-based structured interview was susceptible to response inflation. Interview questions were developed to measure facets of agreeableness, conscientiousness, and emotional stability. Interviewers administered mock interviews to participants instructed to respond honestly or like a job applicant. Interviewees completed scales of the same 3 facets from the NEO Personality Inventory, under the same honest and applicant-like instructions. Interviewers also evaluated interviewee personality with the NEO. Multitrait-multimethod analysis and confirmatory factor analysis provided some evidence for the construct-related validity of the personality interviews. As for response inflation, analyses revealed that the scores from the applicant-like condition were significantly more elevated (relative to honest condition scores) for self-report personality ratings than for interviewer personality ratings. In addition, instructions to respond like an applicant appeared to have a detrimental effect on the structure of the self-report and interview ratings, but not interviewer NEO ratings.     

California verbal learning test indicators of Malingered Neurocognitive Dysfunction: sensitivity and specificity in traumatic brain injury

The present study used well-defined traumatic brain injury (TBI) and mixed neurological (other than TBI) and psychiatric samples to examine the specificity and sensitivity to Malingered Neurocognitive Dysfunction (MND) of four individual California Verbal Learning Test (CVLT) variables and eight composite CVLT malingering indicators. Participants were 275 traumatic brain injury and 352 general clinical patients seen for neuropsychological evaluation. The TBI patients were assigned to one of five groups using the Slick, Sherman, and Iverson (1999) criteria: no incentive, incentive only, suspect, and malingering (both Probable MND and Definite MND). Within TBI, persons with the strongest evidence for malingering (Probable and Definite) had the most extreme scores. Good sensitivity (approximately 50%) in the context of excellent specificity (> 95%) was found in the TBI samples. Issues related to the appropriate clinical application of these data are discussed.     

Physiologic Response,Perceptual Threshold,and Rorschach Test Anxiety Indices

This study examined the sensitivity and specificity of the Trauma Symptom Inventory (TSI, Briere, 1995), a self-report measure of psychological sequelae of potentially traumatic events, to malingering. An optimal cutting score for a validity scale—Atypical Responding (ATR)—designed to identify exaggeration or other unusual response sets was developed in an analogue sample of 155 college students and subsequently applied to TSI profiles from several samples of patients with various psychiatric disorders. Use of a cross-validated T-score cutoff of 61 and below on the ATR scale produced good sensitivity (81%) and specificity (92%) rates in the analogue sample. Participants in the analogue sample who reported a history of traumatic experiences were no more able to successfully malinger trauma, symptoms than were participants without such histories. Furthermore, false-positive rates in the clinical samples were generally low, suggesting that relatively few genuinely symptomatic individuals would be misclassified as malingering.     

School performance and IQ-test scores at age 13 as related to birth weight and gestational age

The cohort in the present longitudinal research program consisted of 873 children in an entire school grade, in a Swedish community. The present results showed a main effect of birth weight; low birth weight (LBW) children had lower school performance and intelligence-test (IQ) scores at age 13 than did normal birth weight (NBW) children irrespective of parental SES. Second, there was no significant main effect of gestational age (GA) on scholastic performance and IQ-test scores. Third, there was a significant main effect of the combination of birth weight and GA on scholastic performance and IQ-test scores. The LBW children born at term (38-40 pregnancy weeks; pw) had significantly lower scores and school grades as compared to the control group while the LBW children born with short gestational age (34-37 pw) and with very short gestational age (less than 34 pw) had significantly lower scores and marks in fewer areas of academic attainment.     

Cognitive sequelae of repeated head injury in a population of intravenous drug users

The relationship between closed head injury and performance on neuropsychological (NP) tests was investigated in a group of intravenous drug users (IVDUs). Subjects with repeated head traumas involving loss of consciousness (LOC) performed worse than both a control group without LOC and reference group with only a single episode of LOC. There were no significant differences between the last two groups. Performance on tests of memory, attention, and motor performance was significantly worse in the group with repeated head injury. The average time since the last episode of LOC was more than 11 years. We conclude from these findings that a single episode of LOC does not result in significant cognitive impairment in this population. Two or more episodes, however, are more likely to produce chronic cognitive impairment.     

A causal model of mathematics performance in early adolescence: the role of sex

Using path analysis, the present investigation was done to clarify possible causal linkages among general scholastic aptitude, academic achievement in mathematics, self-concept of ability, and performance on a mathematics examination. Subjects were 122 eighth-grade students who completed a mathematics examination as well as a measure of self-concept of ability. Aptitude and achievement measures were obtained from school records. Analysis showed sex differences in prediction of performance on the mathematics examination. For boys, this performance could be predicted from scholastic aptitude and previous achievement in mathematics. For girls, performance only could be predicted from previous achievement in mathematics. These results indicate that the direction, strength, and magnitude of relations among these variables differed for boys and girls, while mean levels of performance did not.     

Sawdust For Brains: Definition and Disconfirmation After Mild Traumatic Brain Injury

Abstract

Mild brain injury, despite its name, has lasting effects for many of its sufferers. This article is a firsthand account of one person's struggle with its onset and effects. Mot least of the symptoms is the sense of disconfirmalion and confusion that ensues because sufferers usually look “normal.” However, inside, their cognitive functioning and sense of self have changed markedly. Moreover, the effects often last longer than seem likely to medical professionals and laypeople alike, leading to evaluations of malingering or prior emotional distress. This first-person account is framed within the context of current literature on mild head injury.