A description of preschool neuropsychological assessment in the P.I.N.T. Clinic after the first 5 years.

Assessment of preschool-aged children constitutes a dilemma for many neuropsychologists because of a limited set of standardized measures with normative data as well as inadequate understanding of typical developmental trajectories for neuropsychological functions during the first years of life. However, numerous neurological disorders, medical disorders with central nervous system involvement, and even psychiatric disorders have their onset during this time and subsequently impact cognition by altering functional developmental trajectories. Comprehensive neuropsychological evaluations can help to delineate this alteration in developmental trajectory and assist in determining need for specific interventions services so that they can be implemented early as possible in hopes of reducing developmental cognitive impairments. In this descriptive report, potential preschool neuropsychological evaluation procedures are described and a discussion of appropriate reasons for referral and pertinent testing considerations is presented. Additionally, the Preschool and Infant Neuropsychology (P.I.N.T.) Clinic is presented to describe a methodology for conducting preschool neuropsychological assessment.

Glucocorticoid effects on memory function over the human life span.

Glucocorticoids (GCs), produced by the stress-responsive hypothalamic-pituitary-adrenal axis, are well recognized for their regulatory role in peripheral metabolism. GCs are also known to regulate various brain functions, with well-described effects on human cognition. Increased GC exposure in humans-including exposure to the endogenous GC, cortisol-at levels associated with stress, decreases memory and learning function. These results extend evidence from in vitro studies of synaptic and cell function and evidence from animals indicating the GCs can regulate substrates of memory function. While considerable evidence details these effects in adult humans and animals, relatively less is know about the effect of GCs on cognitive function in children and older adults. Investigators have suggested that children, particularly preschool-aged children, may be vulnerable to adverse consequences of increased GC secretion resulting from stress and neuropsychiatric diseases such as depression. Adverse GC effects on memory substrates and memory function in the adult have also fostered concern that age-related changes, including changes in GC receptors and changes in circulating cortisol levels, could lead to age-related increases in the adverse effect of GCs on brain function. Investigators have reported an association between age-related increases in cortisol levels and age-related memory decline, but this association may or may not be due to a direct effect of cortisol on memory substrates. A number of possible treatment approaches to prevent or remediate adverse GC-induced effects are under development. In general, the use of safe and effective agents for blocking adverse GC effects on brain functions including memory may offer benefits to individuals suffering acute and chronic stressors and could prevent brain changes relevant to stress, aging, and stress-related neuropsychiatric diseases.

The MacArthur Three-City Outcome Study: evaluating multi-informant measures of young children's symptomatology.

OBJECTIVE: Three sites collaborated to evaluate the reliability and validity of 2 measures, developed in tandem to assess symptomatology and impairment in 4- to 8-year-old children: the Berkeley Puppet Interview Symptomatology Scales (BPI-S) and the Health and Behavior Questionnaire (HBQ). METHOD: In this case-control study, mothers, teachers, and children reported on multiple dimensions of children's mental health for 120 children (67 community and 53 clinic-referred children). RESULTS: The BPI-S and the parent and teacher versions of the HBQ demonstrated strong test-retest reliability and discriminant validity on a majority of symptom scales. Medium to strong effect sizes (Cohen d) indicated that children in the clinic-referred group were viewed by all 3 informants as experiencing significantly higher levels of symptomatology than nonreferred, community children. CONCLUSION: The availability of a set of multi-informant instruments that are psychometrically sound, developed in tandem, and developmentally appropriate for young children will enhance researchers' ability to investigate and understand symptomatology or the emergence of symptomatology in middle childhood.

Visual attention in children with prenatal cocaine exposure.

Previous studies have reported that developmental disruption of dopaminergic systems results in lateralized deficits in visual attention (Posner et al., 1991; Craft et al., 1992). Infants who were prenatally exposed to cocaine were hypothesized to have increased reaction times to targets in the right visual field on measures of visual attention compared with infants who were not exposed to cocaine. Seventeen children without prenatal exposure to cocaine and 14 children who were exposed to cocaine (age range from 8-40 months) completed a visual attention task, the Mental Development Index of the Bayley Scales of Infant Development, Second Edition; and the Preschool Language Scale, Third Edition. Cocaine-exposed children were slower to orient to stimuli in the right visual field after repeated trials, especially after attention was first cued to the left visual field. They were also less likely to orient to the right when given a choice. Results suggest that the left hemisphere visual attention system is disproportionately affected by prenatal exposure to cocaine.