Race-Norming of Neuropsychological Tests

Recent studies in the United States indicate that some neurologically intact minority groupings perform well below White Americans on neuropsychological tests. This has sparked the production of race-norms, especially for African Americans, that seek to reduce false positive rates (i.e., neurologically intact individuals misdiagnosed with cognitive impairment) in neuropsychological assessments. There are problems with this enterprise including: possible justification for inferior/superior treatment of different racial groupings; unknown effects on false negative rates (i.e., cognitive deficit misdiagnosed as normal); the overlooking of factors possibly responsible for group racial differences (e.g., acculturation); non-scientific and non-operational definitions of race/ethnic groupings; and an impossibly large number of potential race/ethnic groupings for which to generate race-norms. An alternative approach is to use a single set of combined race/ethnic norms and estimate preexisting neuropsychological skill levels by using individual comparison standards. This alternative has been poorly researched, a situation that needs correcting.     

The Impact of Neuropsychological Deficits on Functional Stroke Outcomes

This review examines the available literature on neuropsychological outcomes of stroke and the literature on the ability of specific areas of neuropsychological deficit to predict functional stroke outcome. The literature reviewed indicates that post-stroke deficits in executive function, memory, language, and speed of processing are common, with those identified as having progressive ‘post-stroke dementia’ presenting with a similar, though more impaired profile, with increased impairments particularly noted in the area of memory. It is clear that some aspects of neuropsychological functioning (e.g., presence of neglect, aphasia, anosognosia; and verbal memory and attention deficits) show promise as a means of predicting post-stroke functional outcomes. Examining the available literature, it becomes evident that there is a need for long-term, large scale (i.e., population based) follow-up studies, evaluating likely long-term neuropsychological outcomes of stroke and their prognostic utility.     

Multidimensional differences between adolescent substance abusers and users

High-school-aged adolescents responded to a 48-item survey about their substance use. From an original sample of 190 respondents, groups were created through consequence variables (e.g., school, family, medical, and legal problems) into abuse (n = 41) and use (n = 115) categories. Variables were organized along multidimensional lines: stimulus (e.g., frequency of substance use, use in school), organismic (e.g., age, grade), and response (e.g., driving a car while under the influence). From 27 comparisons of the abuse and use groups 16 significant differences emerged.     

A Multimodal Study of Childhood Trauma and Distress Tolerance in Young Adulthood

Individuals with a history of childhood trauma experience deficits in emotion regulation. However, few studies have investigated childhood trauma and both perceived (i.e., self-report) and behavioral measures of distress tolerance. The current study evaluated associations between childhood trauma (i.e., physical abuse, sexual abuse, and witnessing family violence) and measures of perceived (Distress Tolerance Scale) and behavioral distress tolerance (i.e., Paced Auditory Serial Addition Test, breath-holding). Participants were 320 undergraduate students with a history of interpersonal trauma (e.g., sexual/physical assault). Structural equation modeling was used to evaluate associations between frequency of childhood trauma type and distress tolerance. Greater childhood physical abuse was associated with higher perceived distress tolerance. Greater levels of witnessing family violence were associated with lower behavioral distress tolerance on the breath-holding task. No significant effects were found for Paced Auditory Serial Addition Test performance. Associations between childhood trauma and emotion regulation likely are complex and warrant further study.     

The relationship of neuropsychological impairment to conduct disorder in adolescence: A conceptual review

This review is an attempt to expand the understanding of the neuropsychological mechanisms that may influence the expression of violent or aggressive behavior in adolescents. Although a relative large literature of adult studies examining the relation of neuropsychological impairment and aggression exists, the research literature investigating this relationship in adolescents is much smaller. With a few exceptions, the delinquent literature suffers from methodological problems, including biased sampling methods, small numbers of subjects, failing to objectively diagnose conduct disorder, incorrect use of specific statistical procedures, and lacking of appropriate control groups. In general, a mixed pattern of neuropsychological deficits are displayed across studies, depending on the sampling method, methodological design, statistics employed, control groups, and assessment tools that were utilized. Verbal deficits have been frequently displayed across the literature, while evidence for executive dysfunction varies, depending on the specific construct being evaluated (e.g., attention, cognitive flexibility, concept formation, planning abilities) and the specific population. Relatively inconsistent findings have been observed for visuospatial, sensory, and motor deficits. This article provides a critical review of this literature and discusses the varying impact that any neurological insult will have, depending on premorbid personality and cognitive functioning, location of the lesion, age at which the injury occurred, child's pre- and postinjury environment, and ability of the brain to adapt to acquired deficits as the result of the insult. On the basis of this review and neuropsychological theory, four subgroups within this population are proposed (i.e., adolescents with subcortical injuries, dominant hemisphere temporal-parietal injuries, nondominant hemisphere temporal-parietal injuries, and injuries to the prefrontal regions), which may better explain the neuropsychological and behavioral outcomes exhibited by this heterogeneous population. Recommendations for future research are offered.     

A critical appraisal of the role of neuropsychological deficits in preschool ADHD

The present study aimed at improving our understanding of the role of neuropsychological deficits in preschool Attention Deficit Hyperactivity Disorder (ADHD). The study included 52 children in the ADHD group and 72 controls (age 4–6 years). Both laboratory measures and teacher reports of executive deficits (i.e., working memory, inhibition, and shifting), delay-related behaviors (i.e., the preference for minimizing delay), and emotional functions (i.e., emotion recognition and regulation) were included. Variable-oriented analyses were complemented with person-oriented analyses (i.e., identifying the proportion of patients considered impaired). Results showed that the ADHD group differed from controls with regard to all measures of executive functioning and most measures of delay-related behaviors, but few differences were found for emotional functioning. A substantial subgroup (23%) of children with ADHD did not have a neuropsychological deficit in any domain. There were subgroups with executive or delay-related deficits only, but no pure emotional subgroup. The overlap between different neuropsychological deficits was much larger when teacher reports were used as opposed to laboratory measures. Regarding functional impairments, large mean differences were found between the ADHD group and controls. However, neuropsychological deficits were not able to explain individual variations in daily life functioning among children with ADHD. In conclusion, the present study identified some important methodological and theoretical issues regarding the role of neuropsychological functioning in preschool ADHD.     

强迫性特征在药物成瘾行为中的易感性及其前额叶-反奖赏系统神经基础

强迫性是一种与不顾严重后果的固着行为密切相关的神经心理结构, 大脑神经系统对强迫性行为的调控机制崩溃是导致药物成瘾的直接原因。以往研究对于奖赏系统(中脑-皮层-边缘神经环路)在成瘾行为中的作用及机制已经具有丰富的了解, 但针对药物成瘾的强迫性特征本身以及前额叶-反奖赏系统神经环路在成瘾行为中的作用机制了解有限, 尤其是缺乏对药物成瘾强迫性特征的系统考察、缺少遗传学研究以及非兴奋剂类药物的汇聚证据。项目拟结合人类成瘾行为的遗传学视角(海洛因成瘾者与其无药物使用的兄弟姐妹对照), 结合神经认知、脑电生理、神经影像等不同层面的方法和技术, 对药物成瘾强迫性的外在表征、神经生物学基础以及与个体差异有关的遗传易感性进行探索, 期在进一步识别药物成瘾的神经生物标记, 为探寻潜在的药物或非药物干预靶点提供更多证据。     

Alcohol,head injury,and neuropsychological function

Evidence is reviewed indicating that the extent of alcohol abuse alone cannot account for the neuropsychological deficits observed in alcoholics, and that alcohol abuse and head injury may interact in some patients to influence neuropsychological status. Alcohol abuse both increases the risk for head trauma and potentiates the resulting brain injury, which can lead to negative neuropsychological consequences. Clinicians involved in the treatment of addiction should assess patients for history of head injury, and neuropsychological deficits consequent to both head injury and ethanol. These deficits may limit patient ability to comply with addiction rehabilitation programs. Conversely, clinicians in acute care and rehabilitation of the sequelae of head trauma should routinely assess their patients for substance abuse, because such abuse can have a significant impact on recovery from brain injury.     

Forgetting of trauma cues in adults reporting continuous or recovered memories of childhood sexual abuse

According to betrayal trauma theory, adult survivors of childhood sexual abuse (CSA) who were molested by their caretakers (e.g., a father) are especially likely to dissociate ("repress") their memories of abuse. Testing college students, some reporting CSA, DePrince and Freyd (2004) found that those scoring high on a dissociation questionnaire exhibited memory deficits for trauma words when they viewed these words under divided-attention conditions. Replicating DePrince and Freyd's procedure, we tested for memory deficits for trauma words relative to neutral words in adults reporting either continuous or recovered memories of CSA versus adults denying a history of CSA. A memory deficit for trauma words under divided attention was expected in the recovered-memory group. Results were inconsistent with this prediction, as all three groups exhibited better recall of trauma words than neutral words, irrespective of encoding conditions.     

The relation of methamphetamine use and violence: A critical review

Methamphetamine (MA), a psychostimulant drug, was first produced in Germany and Japan in the late 1800s. MA use and trafficking have been a problem since the 1970s in the United States (U.S.) [National Drug Intelligence Center (NDIC). (2006). National Drug Threat Assessment 2006. Retrieved March 18, 2006 from http://www.usdoj.gov.ndic/pubs11/18862/MA.htm] and have increased in recent years [Office of Applied Studies (OAS). (September 16, 2005). The National Survey on Drug Use and Health report: Methamphetamine use, abuse, and dependence: 2002, 2003, and 2004. Rockville, MD: Substance Abuse and Mental Health Services Administration]. MA is associated with violent behavior yet the nature of this relation remains poorly understood, largely due to methodological shortcomings. The present paper critically examines the empirical literature on MA use and its relation to violence. Methodological issues and challenges are discussed and suggestions for future research are provided.     

Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment

Historically, substance use problems were thought to be more prevalent in lesbian, gay, and bisexual (LGB) populations, and correcting skewed perceptions about substance abuse among LGB individuals is critically important. This review provides an update on empirical evidence on LGB substance use patterns and treatment outcome, with specific focus on clinical implications of findings. Compared to earlier studies, the recent research included in this review has used more sophisticated methodologies and more representative samples, and also has investigated multiple dimensions of sexual orientation in relation to substance use patterns. Findings from recent research suggest that lesbians and bisexual women are at greater risk for alcohol and drug use disorders and related problems, and that gay and bisexual men are at greater risk for illicit drug use and related problems. Several sociocultural factors have emerged as correlates of substance use patterns in LGB populations (e.g., affiliation with gay culture, HIV status), and several demographic characteristics (e.g., female, older age) do not appear to be as robust of protective factors against substance abuse for LGB individuals compared to heterosexual populations. Bisexual identity and/or behavior in particular seem to be related to increased risk for substance abuse. In terms of treatment outcome, limitations of extant research prevent conclusions about the relative impact of LGB-specific interventions, and further research that includes women and uses more equivalent comparison interventions is needed. Clinical implications of research findings are discussed for case identification, selection of treatment goals (e.g., moderation vs. abstinence), targets for intervention, and specific treatment modalities.     

Hot and Cool Executive Function and its Relation to Theory of Mind in Children with and without Autism Spectrum Disorder

Previous research has clearly demonstrated that autism spectrum disorder (ASD) involves deficits in multiple neuropsychological functions, such as executive function (EF) and theory of mind (ToM). A conceptual distinction is commonly made between cool and hot EF. In ASD, continued attention has been paid to the cool areas of executive dysfunction. Cool EF has been strongly related to ToM, but research has not taken into account the association between hot EF and ToM in ASD. The present study investigated the associations between hot and cool EF and ToM in 56 school-aged children with ASD and 69 controls on tasks tapping cool EF (i.e., working memory, inhibition, planning), hot EF (i.e., affective decision making, delay discounting), and ToM (i.e., mental state/emotion recognition and false belief). Significant group differences in each EF measure support an executive dysfunction in both domains in ASD. Strong associations between delay discounting and ToM mental state/emotion recognition were found, suggesting that hot EF makes a unique contribution to ToM above and beyond cool EF in typical development and ASD. This study improves understanding of the profile of higher-order cognitive deficits in children with ASD, which may inform diagnosis and intervention.     

Brain lesion and memory functioning: Short-term memory deficit is independent of lesion location

We analyzed the effects of patterns of brain lesions from penetrating head injuries on memory performance in participants of the Vietnam Head Injury Study (Grafman et al., 1988). Classes of lesion patterns were determined by mixture modeling (L. K. Muthén & B. O. Muthén, 1998-2004). Memory performance was assessed for short-term memory (STM), semantic memory, verbal episodic memory, and visual episodic memory. The striking finding was that large STM deficits were observed in all classes of brain-injured individuals, regardless of lesion location pattern. These effects persist despite frequent concomitant effects of depressive symptomatology and substance dependence. Smaller deficits in semantic memory, verbal episodic memory, and visual episodic memory depended on lesion location, in a manner roughly consistent with the existing neuropsychological literature. The theoretical and clinical implications of the striking, seemingly permanent STM deficits in individuals with penetrating head injuries are discussed.     

Neuropsychological outcomes of pediatric demyelinating diseases: a review

Immune-mediated central nervous system (CNS) demyelinating diseases impact various areas of the brain, optic nerves, and/or spinal cord and can result in a wide range of neurologic symptoms including adverse cognitive outcomes. Neuropsychological outcomes in adult multiple sclerosis (MS) are well documented, while literature on such outcomes in pediatric cohorts is more limited. Furthermore, literature on neuropsychological outcomes in pediatric acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), and transverse myelitis (TM) is even more limited. This paper is the first to review what is known about neuropsychological outcomes associated with immune-mediated CNS demyelinating diseases, with a focus on pediatric MS, ADEM, NMO, and TM. Additionally, this review illuminates the need to clarify differences in neuropsychological sequelae between conditions, characterize longitudinal cognitive outcomes, and investigate neuropsychological outcomes in relation to clinical variables (e.g., age of onset, disease duration, number of relapses) and psychosocial variables (e.g., fatigue, emotional problems, behavioral functioning) to better understand neuropsychological outcomes associated with these conditions.     

Substance use and abuse among children and teenagers

During the past several years, there has been a renewed national concern about drug abuse, culminating in the current "war on drugs." In this review, we emphasize that even though child or teenage drug use is an individual behavior, it is embedded in a sociocultural context that strongly determines its character and manifestations. Our focus is on psychoactive substances both licit (cigarettes and alcohol) and illicit (e.g., cannabis and cocaine). We feel that it is critical to draw a distinction between use and abuse of drugs and to do so from a multidimensional perspective that includes aspects of the stimulus (drug), organism (individual), response, and consequences. Our selective review of substance use and abuse among children and adolescents covers epidemiology (patterns and extent of drug use), etiology (what generates substance use), prevention (how to limit drug use), treatment (interventions with drug users), and consequences (effects and outcomes of youthful drug use).     

Neuropsychological Performance in Gulf War Era Veterans: Traumatic Stress Symptomatology and Exposure to Chemical–Biological Warfare Agents

Because complaints of diminished concentration and memory are among the most common health symptoms reported by Gulf War (GW) veterans with unexplained illnesses, this study investigated neuropsychological functions among GW veterans and controls. Relationships between neuropsychological performance, severity of posttraumatic stress disorder (PTSD) symptomatology, and exposure to chemical–biological warfare agents (CBW) were assessed. Participants were 225 veterans recruited from three cohorts: GW-deployed veterans from Ft. Devens, MA ( n = 141) and New Orleans, LA (n = 37), and Germany-deployed veterans from a Maine National Guard unit (n = 47). A comprehensive evaluation was completed. Severity of subclinical PTSD symptomatology was significantly related to scores on specific neuropsychological tests. PTSD symptom severity in GW-deployed veterans was found to be greater and associated with a broader range of neuropsychological deficits than in Germany-deployed veterans. PTSD severity was associated with lower performance on a range of neuropsychological tasks, whereas CBW exposure contributed to performance deficits on specific cognitive tasks.     

Factors that distinguish aggression toward animals from other antisocial behaviors: Evidence from a community sample

Animal cruelty is a form of passive and active aggression that is largely undocumented and unreported. Given that animals are voiceless victims, we have to rely on witnesses and frontline staff (e.g., veterinarians) to report incidents of abuse, which suggests the number of convicted animal abusers is an under‐representation of actual perpetrators. The primary aim of the current study was to identify the static and dynamic factors that distinguish animal abusers from non‐abuse offenders (i.e., individuals who self‐reported antisocial behavior, but not animal abuse), and non‐offenders (i.e., individuals who have not engaged in any antisocial behavior) in a community sample. The secondary aim was to identify the potential pathways that distinguish animal abuse perpetration from other types of antisocial behavior. Three hundred and eighty‐four participants took part in this retrospective, correlational study. We found that animal abusers share similar socio‐demographic characteristics to other offenders but are distinct in their exposure to animal harm/killing during childhood. Low animal‐oriented empathy and low self‐esteem distinguished animal abusers from non‐abuse offenders when controlling for confound variables and other psychological characteristics. We also found that low animal‐oriented empathy mediated the relationship between childhood exposure to animal killing and animal abuse perpetration, and that this relationship was stronger among participants with anger regulation issues. This is the first study to examine similarities and differences between animal abusers, non‐abuse offenders, and non‐offenders on socio‐demographic and psychological characteristics. The findings highlight potential treatment targets that are unique to animal abusers with implications for prevention and intervention strategies.

     

The role of executive functioning in CBT: a pilot study with anxious older adults

Cognitive behavior therapy (CBT) is an effective treatment for late life anxiety and depression. The successful use of CBT is assumed to rely on cognitive skills known as executive functions (EF; e.g., hypothesis generation, allocation of attention, self-monitoring) governed by the prefrontal cortex. Because older adults sometimes have executive deficits as a consequence of normal aging, EF may be a mediator of CBT outcome in older samples. The current pilot study tested the hypothesis that older adults with executive deficits (as measured by neuropsychological tests) would show decreased therapeutic benefit from CBT for generalized anxiety disorder, as compared to a group with intact EF. Results indicated differential response to CBT within the dysfunction group depending on the stability (and possibly, the etiology) of executive deficits from pre- to posttreatment. Those whose EF scores remained low from pre- to posttreatment did not respond to CBT, while those whose scores improved responded quite well, similar to an Intact EF group. Results indicate that some, but not all, older adults with executive dysfunction show decreased benefit from CBT, and are consistent with the assumption that executive skills are important for the successful use of CBT. However, some participants may show improvement on both mood and cognitive skills during treatment, which is discussed further.     

Selflessness as a Foundation of Spiritual Transcendence: Perspectives From the Neurosciences and Religious Studies

Although of increasing scientific interest, the neurologic foundations of spiritual experiences remain ambiguous due to the neurological complexity of such experiences and the lack of a clear taxonomy of “spiritual experiences.” A previously proposed preliminary neuropsychological model of spirituality (Johnstone & Glass, 2008) suggests that decreased self-orientation (or increased selflessness), associated with reduced right hemisphere/right parietal lobe (RH/RPL) functioning, serves as a neuropsychological foundation of spiritual transcendence (defined as the ability to emotionally and cognitively connect with higher powers beyond the self or experience cosmic unity). This model was based on research that indicates that transcendent spiritual experiences are related to reduced activation of portions of the RH/RPL during religious rituals (e.g., Buddhist meditation, Christian prayer), as well as research that indicates that individuals with RH/RPL dysfunction report increased transcendence. This model has been supported by research with other populations (e.g., brain injury, epilepsy, tumor) and technologies (e.g., repetitive transcranial magnetic stimulation), although limitations in the model persist. The current article addresses such weaknesses by demonstrating the existence of “spiritual transcendence” as a psychometrically valid construct, identifying specific self-orientation processes (e.g., physical self, mental self, autobiographical self) that may serve as a foundation for transcendence, and explaining how transcendent experiences can involve both a decreased and enhanced sense of the self. To further support the model, citations from the texts of multiple faith traditions are offered to illustrate the importance of selflessness in transcendent experiences across diverse religions. Suggestions for future research and practical implications are offered.     

Treatment Effects for Common Outcomes of Child Sexual Abuse: A Current Meta-Analysis

The present meta-analysis examined the effects of psychosocial treatments at reducing deleterious outcomes of sexual abuse. The meta-analysis included a total of 35 published and unpublished studies written in English, focusing on youth under the age of 18, and evaluating the effectiveness of treatments for the most common negative outcomes of sexual abuse: PTSD symptoms, externalizing problems, and internalizing problems. Results revealed medium effect sizes for PTSD symptoms, externalizing problems, and internalizing problems following treatment for sexual abuse. This study also examined the potential moderating effects of treatment (e.g., modality, duration, inclusion of caregiver) and participant (e.g., age, gender, ethnicity) characteristics. Results indicated that longer interventions were associated with greater treatment gains while group and individual treatments were equally effective. These findings shed new light on treatment effectiveness and provide useful information regarding the conditions under which treatment may be most effective. Future directions for research in this area are discussed.