The factor structure of the CVLT-C in pediatric epilepsy.

The current study used archival data to evaluate the fit of six latent variable models, originally generated by Donders (1999), for the California Verbal Learning Test-Children's Version (CVLT-C; Delis, Kramer, Kaplan, & Ober, 1994) in a large (N = 289) sample of pediatric epilepsy cases presenting at three tertiary treatment centers. Using confirmatory factor analysis, we found that a model including factors of Attention Span, Learning Efficiency, Free Delayed Recall, Cued Delayed Recall, and Inaccurate Recall demonstrated the best relative fit for our data. These findings are consistent with those reported by Donders (1999) in his reanalysis of the CVLT-C standardization sample data, supporting the validity of this factorial model in pediatric epilepsy populations.     

Predictors of neuropsychological test performance after pediatric traumatic brain injury

The influence of neurological and demographic variables on neuropsychological test performance was examined in 100 9-to 16-year-old children with traumatic brain injury (TBI). Regression analyses were conducted to determine the relative contributions of coma, neuroimaging findings, ethnicity, socioeconomic status, and gender to variance in performance on the Wechsler Intelligence Scale for Children-Third Edition (WISC-III), California Verbal Learning Test--Children's Version (CVLT-C), and the Children's Category Test. Both neurological and demographic variables contributed to performance on various WISC-III factor index scores as well as the CVLT-C. No evidence for a moderating effect of demographic variables was found, but speed of information processing mediated the effect of neurological and demographic variables on CLVT-C performance. It is concluded that demographic variables have an incremental effect on the neuropsychological test performance of children with TBI above and beyond the influence of injury severity.     

Executive function outcomes of children with traumatic brain injury sustained before three years

Traumatic brain injury (TBI) is a common cause of disability in childhood. While the outcomes of TBI sustained in school years has been heavily researched, very little is known about the impact of TBI in infants and young children. The aim of this study was to investigate the impact of TBI on executive function (EF) in children who sustained a TBI before 3 years of age. A group of 55 children, 19 with a mild TBI, 16 children with a moderate-severe TBI, and 20 uninjured comparison children participated. The EF of children aged 3 to 6 years were compared using child-based measures of attentional control and information processing. Parents completed questionnaires rating their child's EF. Severity groups differed on the child-based EF measure of attentional control with children with TBI performing below the control group. There were no significant group differences for information processing or parent-rated EF. It appears that children who sustain a TBI before the age of 3 years display impairments in some areas of attentional control 3–4 years postinjury. The findings fit with the existing EF literature for older children.     

Patterns of Memory Performance in Children with Controlled Epilepsy on the CVLT-C

Decreased memory skills have been reported in children with epilepsy. However, standardized instruments to evaluate learning and memory in children have been unavailable until recently. The present study was designed to assess memory patterns in children with epilepsy based on the California Verbal Learning Test-Children's Version (CVLT-C). The test was administered to 44 children with complex partial seizures and 21 children with generalized seizures between 8 and 13 years of age. Children in the study had been treated for epilepsy for at least 6 months, had well-controlled seizures on monotherapy, and had no evidence of anticonvulsant toxicity. Children with head injuries, learning disabilities, or hyperactivity were excluded. Test results did not reflect differences in memory performance based on seizure type. Scores for the entire sample indicated intact new learning, decreased intrusions and perseverative responses, and better short-term than long-term delayed recall. Recognition skills were stronger than long-term delayed recall skills and suggested that memory performance may be improved for these children when a multiple-choice format is available in academic settings.     

Patterns of memory performance in children with controlled epilepsy on the CVLT-C.

Decreased memory skills have been reported in children with epilepsy. However, standardized instruments to evaluate learning and memory in children have been unavailable until recently. The present study was designed to assess memory patterns in children with epilepsy based on the California Verbal Learning Test-Children's Version (CVLT-C). The test was administered to 44 children with complex partial seizures and 21 children with generalized seizures between 8 and 13 years of age. Children in the study had been treated for epilepsy for at least 6 months, had well-controlled seizures on monotherapy, and had no evidence of anticonvulsant toxicity. Children with head injuries, learning disabilities, or hyperactivity were excluded. Test results did not reflect differences in memory performance based on seizure type. Scores for the entire sample indicated intact new learning, decreased intrusions and perseverative responses, and better short-term than long-term delayed recall. Recognition skills were stronger than long-term delayed recall skills and suggested that memory performance may be improved for these children when a multiple-choice format is available in academic settings.     

Verbal memory deficits in children with less than 750 g birth weight.

Numerous studies have documented memory deficits in very low birthweight (VLBW, < 1500 g) children, yet we know little about the nature of these memory problems. To clarify memory sequelae and examine memory deficits in relation to the degree of low birth weight, we administered the California Verbal Learning Test-Children's Version (CVLT-C) to a regional sample of 57 < 750 g birthweight children and to groups of 53 750-1499 g birthweight children and 49 term-born controls. Group comparisons revealed significant differences between the < 750 g birthweight group and term-born children on measures of list learning, delayed recall, and inaccurate recall. In addition, the percentage improvement in correct recognitions relative to long-term delayed recall was greater in the < 750 g group than in the term-born controls. Similar differences were observed between VLBW children with and without abnormal neonatal cerebral ultrasounds (high- and low-risk groups). Differences in learning rate between the VLBW and term-born groups, and between high- and low-risk VLBW children, were evident even when vocabulary skill was covaried or when children with neurosensory deficits or IQ < 80 were excluded from analysis. The findings document deficits in verbal memory in the subset of VLBW children at greatest biological risk, and suggest that acquisition processes are selectively impaired.     

The effect of age-at-testing on verbal memory among children following severe traumatic brain injury

Memory deficits are a common sequelae following childhood traumatic brain injury (TBI), which often have serious implications on age-related academic skills. The current study examined verbal memory performance using the Rey Auditory Verbal Learning Test (RAVLT) in a pediatric TBI sample. Verbal memory abilities as well as the effect of age at-testing on performance were examined. A sample of 67 children following severe TBI (age average = 12.3 ± 2.74) and 67 matched controls were evaluated using the RAVLT. Age effect at assessment was examined using two age groups: above and below 12 years of age during evaluation. Differences between groups were examined via the 9 RAVLT learning trials and the 7 composite scores conducted out of them. Children following TBI recalled significantly less words than controls on all RAVLT trials and had significantly lower scores on all composite scores. However, all of these scores fell within the low average range. Further analysis revealed significantly lower than average performance among the older children (above 12 years), while scores of the younger children following TBI fell within average limits. To conclude, verbal memory deficits among children following severe TBI demonstrate an age-at-testing effect with more prominent problems occurring above 12 years at the time of evaluation. Yet, age-appropriate performance among children below 12 years of age may not accurately describe memory abilities at younger ages following TBI. It is therefore recommended that clinicians address child’s age at testing and avoid using a single test as an indicator of verbal memory functioning post TBI.     

Verbal Memory Deficits in Children with Less than 750 g Birth Weight

Numerous studies have documented memory deficits in very low birthweight (VLBW, &lt; 1500 g) children, yet we know little about the nature of these memory problems. To clarify memory sequelae and examine memory deficits in relation to the degree of low birth weight, we administered the California Verbal Learning Test–Children’s Version (CVLT-C) to a regional sample of 57 &lt; 750 g birthweight children and to groups of 53 750–1499 g birthweight children and 49 term-born controls. Group comparisons revealed significant differences between the &lt; 750 g birthweight group and term-born children on measures of list learning, delayed recall, and inaccurate recall. In addition, the percentage improvement in correct recognitions relative to long-term delayed recall was greater in the &lt; 750 g group than in the term-born controls. Similar differences were observed between VLBW children with and without abnormal neonatal cerebral ultrasounds (high- and low-risk groups). Differences in learning rate between the VLBW and term-born groups, and between high- and low-risk VLBW children, were evident even when vocabulary skill was covaried or when children with neurosensory deficits or IQ &lt; 80 were excluded from analysis. The findings document deficits in verbal memory in the subset of VLBW children at greatest biological risk, and suggest that acquisition processes are selectively impaired.     

The Factor Structure of the CVLT-C in Pediatric Epilepsy

The current study used archival data to evaluate the fit of six latent variable models, originally generated by Donders (1999) Donders. 1999. Structural analysis of the California Verbal Learning Test—Children's Version in the standardization sample. Developmental Neuropsychology, 15(3): 395–406. [CSA][Taylor &; Francis Online], [Web of Science ®] , [Google Scholar], for the California Verbal Learning Test-Children's Version (CVLT-C; Delis, Kramer, Kaplan, &; Ober, 1994 Delis, D. C., Kramer, J. H., Kaplan, E. and Ober, B. A. 1994. California Verbal Learning Test—Children's Version, San Antonio, TX: Psychological Corporation.  [Google Scholar]) in a large (N = 289) sample of pediatric epilepsy cases presenting at three tertiary treatment centers. Using confirmatory factor analysis, we found that a model including factors of Attention Span, Learning Efficiency, Free Delayed Recall, Cued Delayed Recall, and Inaccurate Recall demonstrated the best relative fit for our data. These findings are consistent with those reported by Donders (1999) Donders. 1999. Structural analysis of the California Verbal Learning Test—Children's Version in the standardization sample. Developmental Neuropsychology, 15(3): 395–406. [CSA][Taylor &; Francis Online], [Web of Science ®] , [Google Scholar] in his reanalysis of the CVLT-C standardization sample data, supporting the validity of this factorial model in pediatric epilepsy populations.     

Attention After Pediatric Traumatic Brain Injury: A Multidimensional Assessment

Attentional disturbance is a common complaint after TBI in children and adolescents, however, few studies have assessed post-traumatic attentional functions. The attentional constructs proposed by Mirsky, Anthony, Duncan, Ahearn, and Kellam (1991) provided a multidimensional framework for prospective assessment of late attentional disturbance after mild-moderate (n = 34) and severe (n = 57) traumatic brain injury (TBI). Attention was evaluated from 5 to 8 years after TBI in children ages 0 to 15 years at the time of injury. Children with severe TBI performed more poorly than children with mild-moderate TBI on tests comprising the focus/execute and shift constructs. Younger children scored below older children irrespective of injury severity on the Digit Span subtest and interstimulus interval scores from an adaptive rate continuous performance test reflecting the encode and sustain constructs of Mirsky et al. (1991). Age × Severity interaction effects were found for speeded perceptual-motor tests; scores were reduced following mild-moderate and severe TBI in younger children and following severe TBI in older patients. Results are discussed in terms of the vulnerability of skills in a rapid stage of development to disruption by acquired brain injury.     

Response inhibition in children with and without ADHD after traumatic brain injury

Children with attention‐deficit hyperactivity disorder (ADHD) and traumatic brain injury (TBI) show deficient response inhibition. ADHD itself is a common consequence of TBI, known as secondary ADHD (S‐ADHD). Similarity in inhibitory control in children with TBI, S‐ADHD, and ADHD would implicate impaired frontal‐striatal systems; however, it is first necessary to delineate similarities and differences in inhibitory control in these conditions. We compared performance of children with ADHD and those with TBI without pre‐injury ADHD on a stop signal, response inhibition task. Participants were 274 children aged 6–14 years. There were 92 children with ADHD, 103 children with TBI, and 79 typically developing children who served as controls. Among the TBI participants, injury severity ranged from mild to severe. Children with ADHD and TBI showed deficient inhibition. The deficit in children with ADHD was as great as or greater than that in children with TBI, regardless of degree of TBI severity or the presence of S‐ADHD. The finding indicates that TBI results in deficient inhibition regardless of the development of S‐ADHD.     

Posttraumatic stress symptoms in children following orthopedic or traumatic brain injury.

Examined posttraumatic stress (PTS) symptoms in children following pediatric traumatic brain injury (TBI). Children (ages 6-12) with TBI (n = 81) and orthopedic injury (OI; n = 59) were assessed 6 and 12 months postinjury. Parents of children with severe TBI reported higher levels of child PTS symptoms than did parents of children with moderate TBI or OI at the 6- and 12-month follow-ups. Group differences in child-reported PTS symptoms emerged at the 12-month follow-up with higher symptom levels reported by children with severe TBI than by those with moderate TBI or OI. At both follow-ups, rates of clinically significant symptom levels were higher in the severe TBI group than in the moderate TBI or OI groups. The group differences in parent and child reports were significant even after taking ethnicity, social disadvantage, and age at injury into account. Parent and child reports of child PTS symptoms were related to family socioeconomic status. Implications for clinical intervention with children and families following pediatric TBI are discussed.     

Prospective Memory and Pediatric Traumatic Brain Injury: Effects of Cognitive Demand

This study investigated the effects of pediatric traumatic brain injury (TBI) on prospective memory. Fourteen children and 14 adolescents with TBI were compared with 25 and 23 noninjured children and adolescents, respectively. Based on a prefrontal model, the cognitive demand on the ongoing component of a prospective-memory task was manipulated. Overall, those with TBI had poorer prospective-memory performance than their noninjured peers. Performance was worse in a high cognitive-demand condition than a low, and younger children performed worse than adolescents. Decreases in performance from the low- to high-demand conditions were not significantly different between the two children's groups but were between the two adolescents' groups. Furthermore, the age and injury effects were reflected in the performances on executive function tests: the Self-ordered Pointing Task (SOPT), and the Stroop Color Word Interference Test. The Tower of London (TOL), which did not produce age or injury effects, was nevertheless found to be an important predictor of performance on the high-demand task in those with TBI. Although previous research has demonstrated impaired prospective memory performance in children with TBI, this study attempted to explain why this might occur, specifically that the prefrontal regions might be implicated.     

Metamemory following childhood brain injury: A consequence of executive impairment

In this study, we investigated the influence of children’s level of executive functioning on two types of metamemory knowledge following a traumatic brain injury (TBI). For this purpose, 22 children (aged 7 to 14 years) who had sustained a moderate to severe TBI and 44 typically developing children were recruited. The children with TBI were divided into two groups according to the severity of their executive impairment. Injury severity was determined by the Glasgow Coma Scale (GCS) score on admission or by the duration of unconsciousness. All children were then tested on both their knowledge of general memory functioning and their level of memory self-awareness, respectively assessed using the total number of correct responses on an adapted version of a metamemory interview and a self-other discrepancy score on a questionnaire evaluating everyday memory abilities. Data analyses revealed that participants with TBI who suffered impaired executive functions demonstrated less general metamemory knowledge, and underestimated the frequency of their memory problems, compared with children with TBI who had preserved executive functions and with control participants. Considering the well-established effect of metamemory knowledge on people’s spontaneous implementation of strategies, the interest and the importance of these findings on both theoretical and clinical grounds are discussed.     

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.     

Subtle Motor Findings During Recovery from Pediatric Traumatic Brain Injury: A Preliminary Report

Pediatric traumatic brain injury (TBI) is a heterogeneous condition, varying in both severity and sequelae. The long-term motor deficits following severe TBI requiring inpatient rehabilitation are better established than those following milder forms of TBI. The authors examined motor performance 2 and 12 months postinjury in children without overt motor impairment using standard measures of upper limb function and the Physical and Neurological Examination for Subtle Signs (PANESS). The PANESS was sensitive to differences between children with TBI and uninjured children as well as to changes in children with TBI over time. These data suggest that subtle motor deficits are present after milder forms of TBI and, particularly those related to balance and gait, may persist even 12 months postinjury.     

Construct and Criterion Validity of the Comprehensive Trail Making Test in Children and Adolescents with Traumatic Brain Injury

The current study examined the construct and criterion validity of the Comprehensive Trail Making Test (CTMT) when used to evaluate children and adolescents with traumatic brain injury (TBI). Participants included 100 children and adolescents, 50 who had sustained TBI and 50 normal comparisons (NC). Analyses indicated that the CTMT factor scores were significantly correlated with tests of perceptual organizational ability, processing speed, and motor function and provided support for its construct validity. Additionally, correlations between the various CTMT scores suggested that a different pattern of associations was present in the TBI group compared to the NC group. Finally, the TBI group performed significantly worse (p < .001) on all of the CTMT scores, including each of the five CTMT trails as well as the factor and composite index scores. Results support the construct and criterion validity of the CTMT when used to assess children and adolescents with TBI.     

Cognitive and developmental influences in visual-motor integration skills in young children

Measures of visual-motor integration skills continue to be widely used in psychological assessments with children. However, the construct validity of many visual-motor integration measures remains unclear. In this study, we investigated the relative contributions of maturation and cognitive skills to the development of visual-motor integration skills in young children (N = 856). We used a block regression analysis to determine the contribution of maturation, as indicated by age, followed by broad cognitive factors (Study 1) and subsequently by individual subtests in verbal and nonverbal domains subsumed under each factor (Study 2) in explaining score variance of the Bender Visual-Motor Gestalt Test (2nd ed.; BG-II; Brannigan & Decker, 2003) Copy and Recall scores in children between the ages of 4 and 7 years. Results confirm that maturation accounted for a large proportion of variance in both BG-II Copy and Recall performance, above which Stanford-Binet Intelligence Scale (5th ed.; SB-5; Roid, 2003) Quantitative Reasoning and Fluid Reasoning factors significantly contributed to visual-motor integration performance for the Copy phase, and SB-5 Quantitative Reasoning and Visual-Spatial factors accounted for a significant amount of variance for the Recall phase. Additionally, nonverbal domains were more related to visual-motor performance than verbal domains. Results from this study are interpreted to suggest nonverbal reasoning and visual-spatial attention are important contributing factors to visual-motor integration, as measured by the BG-II. Developmental implications of visual-motor integration skills, nonverbal problem solving, and mathematical competence are discussed.     

Theory of mind skills 1 year after traumatic brain injury in 6- to 8-year-old children

This study examined the longer-term effects of traumatic brain injury (TBI) on theory of mind (ToM) skills of children who were between the ages of 5 and 7 years at the time of injury. Fifty-two children with orthopaedic injury, 30 children with moderate TBI, and 12 children with severe TBI were evaluated approximately 1 year post-injury (mean age=6.98 years, SD=0.59, range=6.02–8.26). Children with severe TBI did not engage in representation of first- and second-order mental states at a developmental level comparable to their peers, suggesting stagnation or lack of development, as well as regression of putatively existing ToM skills. Age, task-specific cognitive demands, and verbal abilities were strong predictors of ToM performance. However, even after taking those factors into account, children with severe TBI had poorer ToM performance than children with orthopaedic injuries.     

Social Problem-Solving Skills in Children with Traumatic Brain Injury: Long-Term Outcomes and Prediction of Social Competence

The effects of childhood traumatic brain injury (TBI) on social problem-solving were examined in 35 children with severe TBI, 40 children with moderate TBI, and 46 children with orthopedic injuries (OI). The children were recruited prospectively following injuries that occurred between 6 and 12 years of age. They were followed longitudinally, and ranged from 9 to 18 years of age at the time of the current study, which occurred on average 4 years post injury. They were administered a semi-structured interview used in previous research on social problem-solving to assess the developmental level of their responses to hypothetical dilemmas involving social conflict. Children in the severe TBI group defined the social dilemmas and generated alternative strategies to solve those dilemmas at the same developmental level as did children in the OI group. However, they articulated lower-level strategies as the best way to solve the dilemmas and used lower-level reasoning to evaluate the effectiveness of the strategies. After controlling for group membership, race, socioeconomic status, IQ, and age, children's social problem-solving, and particularly the developmental level of their preferred strategies for resolving conflicts, predicted parents ratings of children's social skills, peer relationships, aggressive behavior, and academic performance. The findings indicate that children with severe TBI demonstrate selective, long-term deficits in their social problem-solving skills that may help to account for their poor social and academic outcomes.