Contribution of implicit memory to adaptation of movement extent during reaching against unpredictable spring-like loads: insensitivity to intentional suppression of kinematic performance.

We examined the extent to which intentionally underperforming a goal-directed reaching task impacts how memories of recent performance contribute to sensorimotor adaptation. Healthy human subjects performed computerized cognition testing and an assessment of sensorimotor adaptation, wherein they grasped the handle of a horizontal planar robot while making goal-directed out-and-back reaching movements. The robot exerted forces that resisted hand motion with a spring-like load that changed unpredictably between movements. The robotic test assessed how implicit and explicit memories of sensorimotor performance contribute to the compensation for the unpredictable changes in the hand-held load. After each movement, subjects were to recall and report how far the hand moved on the previous trial (peak extent of the out-and-back movement). Subjects performed the tests under two counter-balanced conditions: one where they performed with their best effort, and one where they intentionally sabotaged (i.e., suppressed) kinematic performance. Results from the computerized cognition tests confirmed that subjects understood and complied with task instructions. When suppressing performance during the robotic assessment, subjects demonstrated marked changes in reach precision, time to capture the target, and reaction time. We fit a set of limited memory models to the data to identify how subjects used implicit and explicit memories of recent performance to compensate for the changing loads. In both sessions, subjects used implicit, but not explicit, memories from the most recent trial to adapt reaches to unpredictable spring-like loads. Subjects did not "give up" on large errors, nor did they discount small errors deemed "good enough". Although subjects clearly suppressed kinematic performance (response timing, movement variability, and self-reporting of reach error), the relative contributions of sensorimotor memories to trial-by-trial variations in task performance did not differ significantly between the two testing conditions. We conclude that intentional performance suppression had minimal impact on how implicit sensorimotor memories contribute to adaptation of unpredictable mechanical loads applied to the hand.

Linking Rivermead Post Concussion Symptoms Questionnaire (RPQ) and Sport Concussion Assessment Tool (SCAT) scores with item response theory.

OBJECTIVE: Despite the public health burden of traumatic brain injury (TBI) across broader society, most TBI studies have been isolated to a distinct subpopulation. The TBI research literature is fragmented further because often studies of distinct populations have used different assessment procedures and instruments. Addressing calls to harmonize the literature will require tools to link data collected from different instruments that measure the same construct, such as civilian mild traumatic brain injury (mTBI) and sports concussion symptom inventories. METHOD: We used item response theory (IRT) to link scores from the Rivermead Post Concussion Symptoms Questionnaire (RPQ) and the Sport Concussion Assessment Tool (SCAT) symptom checklist, widely used instruments for assessing civilian and sport-related mTBI symptoms, respectively. The sample included data from n = 397 patients who suffered a sports-related concussion, civilian mTBI, orthopedic injury control, or non-athlete control and completed the SCAT and/or RPQ. RESULTS: The results of several analyses supported sufficient unidimensionality to treat the RPQ + SCAT combined item set as measuring a single construct. Fixed-parameter IRT was used to create a cross-walk table that maps RPQ total scores to SCAT symptom severity scores. Linked and observed scores were highly correlated (r = .92). Standard errors of the IRT scores were slightly higher for civilian mTBI patients and orthopedic controls, particularly for RPQ scores linked from the SCAT. CONCLUSION: By linking the RPQ to the SCAT we facilitated efforts to effectively combine samples and harmonize data relating to mTBI.

Burnt Out: Rate of Burnout in Neuropsychology Survey Respondents During the COVID-19 Pandemic, Brief Communication.

OBJECTIVE: Due to the COVID-19 pandemic, burnout among healthcare workers has significantly increased. This study evaluated rates of burnout in neuropsychologists one year into the COVID-19 pandemic. METHOD: A survey invitation was sent across five neuropsychology-related listservs in April 2021. Burnout was assessed with the Copenhagen Burnout Inventory (CBI; Kristensen, T. S., Borritz, M., Villadsen, E., & Christensen, K. B. (2005). The Copenhagen Burnout Inventory: A new tool for the assessment of burnout. Work & Stress, 19 (3), 192-207) and differences in Personal, Work, and Client burnout scores were evaluated across patient population and work setting. RESULTS: 57.3% and 51.5% of respondents (N = 130) endorsed moderate-to-high levels of personal and work-related burnout, respectively. In the Personal domain, respondents working with pediatric patients had higher mean scores and a higher proportion of respondents endorsed moderate-to-high levels of burnout. CONCLUSION: More than half of the survey respondents endorsed elevated levels of personal and work-related burnout. This is concerning as burnout is associated with personal challenges and diminished patient care. Potential organizational interventions are discussed.

Differing associations between measures of somatic symptom reporting, personality, and mild traumatic brain injury (mTBI).

Objective: Somatic complaints are known to complicate recovery after mild traumatic brain injury (mTBI), but the construct is poorly understood due to evolving definitions of associated disorders and uncertainty related to its position within the broader construct network of psychopathology. Methods: To better understand measures of somatic symptom reporting widely used with mTBI patients, we examined relationships between the Brief Symptom Inventory-18 Somatization (SOM) scale, the Minnesota Multiple Personality Inventory-2-Restructured Form Somatic Complaints (RC1) scale, other measures of psychological and personality functioning, and mTBI in both athlete concussion (n = 100) and civilian trauma (n = 75 mTBI, n = 79 orthopedic injury) samples. Results: The association between post-injury SOM and RC1 was moderate (r=.37-.46) and similar to associations between these inventories and depression and anxiety symptoms. In civilians with mTBI, RC1 was more strongly associated with diverse personality dimensions than SOM. mTBI athletes reported increases in somatic symptoms from pre- to post-injury, with larger group effect sizes on SOM (ηp2 = 0.34, p < .001) than RC1 (ηp2 = 0.09, p = .003). Civilian mTBI patients showed a trend for somewhat higher post-injury RC1 scores than orthopedic trauma controls (ηp2 = 0.02, p = .068). Conclusions: Findings add to the current knowledge of the influence of somatic complaints in mTBI. BSI-18 SOM and MMPI-2-RF RC1 are not interchangeable, as they are only modestly correlated and demonstrate differing associations with other clinical outcomes and mTBI.

Initial changes in neuropsychologists clinical practice during the COVID-19 pandemic: A survey study.

Objective: In light of the COVID-19 pandemic, a majority of clinicians have had to quickly and dramatically alter their clinical practices. Two surveys were administered on 3/26/2020 and 3/30/2020, respectively, to document immediate changes and challenges in clinical practice.Method: Two surveys were administered between 3/26/2020 and 3/30/2020, via SurveyMonkey and Google Forms, asking clinicians questions pertaining to practice issues during the early stages of the COVID-19 pandemic. Quantitative responses from the second survey were stratified by clinical setting (Medical Hospital vs. Private Practice) prior to analysis. Qualitative, free-response items were coded by the authors to better understand immediate changes in practice and other concerns.Results: 266 neuropsychologists completed Survey 1 and 230 completed Survey 2. Results suggest that practices immediately moved towards remote service provision. A meaningful proportion of clinicians and their staff were immediately affected economically by the pandemic, with clinicians in private practice differentially affected. Furthermore, a small but significant minority of respondents faced ethical dilemmas related to service provision and expressed concerns with initial communication from their employment organizations. Respondents requested clear best-practice guidelines from neuropsychological practice organizations.Conclusions: It is clear that field of neuropsychology has drastically shifted clinical practices in response to COVID-19 and is likely to continue to evolve. While these responses were collected in the early stages of stay-at-home orders, policy changes continue to occur and it is paramount that practice organizations consider the initial challenges expressed by clinicians when formulating practice recommendations and evaluating the clinical utility of telehealth services.

Refined Measurement of Verbal Learning and Memory: Application of Item Response Theory to California Verbal Learning Test - Second Edition (CVLT-II) Learning Trials.

OBJECTIVE: This study was conducted to investigate how items contained within the California Verbal Learning Test - Second Edition (CVLT-II; Delis, D. C., Kramer, J. H., Kaplan, E., & Ober, B. A. (2000). California Verbal Learning Test (2nd ed.). San Antonio, TX: Psychological Corporation) learning trials function and to evaluate whether weighted scoring approaches might improve quantification of verbal memory. METHOD: Archival data from 577 individuals (338 healthy young adults, 239 medical or psychiatric patients referred to a neuropsychology clinic) were obtained and evaluated using item response theory. RESULTS: The serial position effect was evident across trials, but was most evident in Trials 1, 2, and 3. CVLT-II Trial 5 was the most effective among the five learning trials in quantifying verbal memory, although it was most effective when measuring lower memory ability levels. In contrast, CVLT-II Trial 1 items had, on average, the highest difficulty levels. Various weighted scoring approaches did not appear incrementally helpful in improving prediction of memory performance. CONCLUSION: Specific items and trials differentially discriminate between examinees with low levels of memory ability; it is important to thoroughly evaluate item properties of tests used in clinical decision-making.

Erroneous conclusions: The impact of failing to identify invalid symptom presentation when conducting adult attention-deficit/hyperactivity disorder (ADHD) research.

Invalid symptom report during assessment confounds the differential diagnosis process. This study examined differences in neuropsychological functioning between individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD) and depression and/or anxiety disorders before and after participants meeting diagnostic criteria for malingered neurocognitive dysfunction were excluded. One hundred sixty-one adult patients undergoing ADHD assessment [M age 27.98 (8.35)] were evaluated and assigned to one of two groups based on medical records, a clinical interview, and self-report measures (depression/anxiety disorder n = 85; ADHD and depression/anxiety disorders n = 76). When all patients were considered, individuals with comorbid ADHD and depression/anxiety symptoms performed more poorly on 10 of 18 neuropsychological measures compared with those with only a depression/anxiety disorder (Cohen's d ranged from .32 to .72). In contrast, there was no evidence that the cumulative effect of ADHD and depression/anxiety resulted in diminished cognitive performance after excluding 54 patients with invalid symptom presentation. Additionally, the magnitude of association between self-report of ADHD symptoms and performance on neuropsychological test measures decreased dramatically. Thus, it is imperative that researchers administer performance and symptom validity measures to identify invalid symptom presentation when conducting large-scale studies. The failure to do so may result in inaccurate conclusions regarding the neurocognitive functioning of patients with ADHD and comorbid conditions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Acute elevation of serum inflammatory markers predicts symptom recovery after concussion.

OBJECTIVE: To test the hypothesis that acute elevations in serum inflammatory markers predict symptom recovery after sport-related concussion (SRC). METHODS: High school and collegiate football players (n = 857) were prospectively enrolled. Forty-one athletes with concussion and 43 matched control athletes met inclusion criteria. Serum levels of interleukin (IL)-6, IL-1ß, IL-10, tumor necrosis factor, C-reactive protein, interferon-γ, and IL-1 receptor antagonist and Sport Concussion Assessment Tool, 3rd edition (SCAT3) symptom severity scores were collected at a preinjury baseline, 6 and 24-48 hours postinjury, and approximately 8, 15, and 45 days following concussion. The number of days that athletes were symptomatic following SRC (i.e., duration of symptoms) was the primary outcome variable. RESULTS: IL-6 and IL-1RA were significantly elevated in athletes with concussion at 6 hours relative to preinjury and other postinjury visits, as well as compared to controls (ps ≤ 0.001). IL-6 and IL-1RA significantly discriminated concussed from control athletes at 6 hours postconcussion (IL-6 area under receiver operating characteristic curve 0.79 [95% confidence interval (CI) 0.65-0.92], IL-1RA AUC 0.79 [95% CI 0.67-0.90]). Further, IL-6 levels at 6 hours postconcussion were significantly associated with the duration of symptoms (hazard ratio for symptom recovery = 0.61 [95% CI 0.38-0.96], p = 0.031). CONCLUSIONS: Results support the potential utility of IL-6 and IL-1RA as serum biomarkers of SRC and demonstrate the potential of these markers in identifying athletes at risk for prolonged recovery after SRC. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that serum levels of IL-6 and IL-1RA 6 hours postconcussion significantly discriminated concussed from control athletes.

The role of neurocognitive tests in the assessment of adult attention-deficit/hyperactivity disorder.

Despite widespread recognition that attention-deficit/hyperactivity disorder (ADHD) is a lifelong neurodevelopmental disorder, optimal methods of diagnosis among adults remain elusive. Substantial overlap between ADHD symptoms and cognitive symptoms of other mental health conditions, such as depression and anxiety, and concerns about validity in symptom reporting have made the use of neuropsychological tests in ADHD diagnostic assessment appealing. However, past work exploring the potential diagnostic utility of neuropsychological tests among adults has often relied on a relatively small subset of tests, has failed to include symptom and performance validity measures, and often does not include comparison groups of participants with commonly comorbid disorders, such as depression. The current study examined the utility of an extensive neuropsychological measure battery for diagnosing ADHD among adults. Two hundred forty-six participants (109 ADHD, 52 depressed, 85 nondisordered controls) completed a multistage screening and assessment process, which included a clinical interview, self, and informant report on behavior rating scales, performance and symptom validity measures, and an extensive neuropsychological testing battery. Results indicated that measures of working memory, sustained attention, response speed, and variability best discriminated ADHD and non-ADHD participants. While single test measures provided performed poorly in identifying ADHD participants, analyses revealed that a combined approach using self and informant symptom ratings, positive family history of ADHD, and a reaction time (RT) variability measure correctly classified 87% of cases. Findings suggest that neuropsychological test measures used in conjunction with other clinical assessments may enhance prediction of adult ADHD diagnoses. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Invariant two-component structure of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph, 1998 , 2012 ) is a brief neurocognitive instrument used to evaluate cognitive functioning in clinical settings. Prior investigations of the factor structure have revealed subtle differences across samples. It was hypothesized that these differences are primarily the result of methodological decisions made by researchers. The present study utilized empirically supported extraction criteria (parallel analysis; minimum average partial procedure) and uniformly investigated 5 samples. RBANS data from 4 previously published studies (Carlozzi, Horner, Yang, & Tilley, 2008 ; Duff, Hobson, Beglinger, & O'Bryant, 2010 ; Duff et al., 2006 ; Wilde, 2006 ) were reanalyzed, and a new clinical sample was obtained from the Gundersen Health System Memory Center. The congruence of factor structures was investigated by conducting orthogonal vector matrix comparisons (Barrett, 2005 ), and a robust 2-factor structure reliably emerged across samples. The invariant RBANS 2-factor structure primarily emphasized memory and visuospatial functioning. This finding offered further support for a 2-factor RBANS structure identified in previous studies and additionally provided empirical documentation of replication across diverse samples. Due to the expansive use of the RBANS, this psychometric knowledge has significant clinical implications. It should facilitate accurate interpretation of test data and allow clinicians to make more informed decisions regarding whether the instrument is appropriate to use in various clinical settings.

The impact of failing to identify suspect effort in patients undergoing adult attention-deficit/hyperactivity disorder (ADHD) assessment.

[Correction Notice: An Erratum for this article was reported in Vol 28(10) of Psychological Assessment (see record 2016-22725-001). In the article, the penultimate sentence of the abstract should read "These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (62%)." All versions of this article have been corrected.] This retrospective study examines how many adult patients would plausibly receive a diagnosis of attention-deficit/hyperactivity disorder (ADHD) if performance and symptom validity measures were not administered during neuropsychological evaluations. Five hundred fifty-four patients were extracted from an archival clinical dataset. A total of 102 were diagnosed with ADHD based on cognitive testing, behavior rating scales, effort testing, and clinical interview; 115 were identified as putting forth suspect effort in accordance with the Slick, Sherman, and Iverson (1999) criteria. From a clinical decision-making perspective, suspect effort and ADHD groups were nearly indistinguishable on ADHD behavior, executive function, and functional impairment rating scales, as well as on cognitive testing and key clinical interview questions. These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (62%) [corrected]. This research makes clear that it is essential to evaluate task engagement and possible symptom amplification during clinical evaluations.

The Interchangeability of CVLT-II and WMS-IV Verbal Paired Associates Scores: A Slightly Different Story.

We investigated the similarity of the Wechsler Memory Scale-Fourth Edition (WMS-IV) Auditory Memory Index (AMI) scores when California Verbal Learning Test-Second Edition (CVLT-II) scores are substituted for WMS-IV Verbal Paired Associates (VPA) subtest scores. College students (n = 103) were administered select WMS-IV subtests and the CVLT-II in a randomized order. Immediate and delayed VPA scaled scores were significantly greater than VPA substitute scaled scores derived from CVLT-II performance. At the Index level, AMI scores were significantly lower when CVLT-II scores were used in place of VPA scores. It is important that clinicians recognize the accepted substitution of CVLT-II scores can result in WMS-IV scores that are inconsistent with those derived from standard administration. Psychometric issues that plausibly contribute to these differences and clinical implications are discussed.

Neuropsychological outcomes of U.S. Veterans with report of remote blast-related concussion and current psychopathology.

This study explored whether remote blast-related MTBI and/or current Axis I psychopathology contribute to neuropsychological outcomes among OEF/OIF veterans with varied combat histories. OEF/OIF veterans underwent structured interviews to evaluate history of blast-related MTBI and psychopathology and were assigned to MTBI (n = 18), Axis I (n = 24), Co-morbid MTBI/Axis I (n = 34), or post-deployment control (n = 28) groups. A main effect for Axis I diagnosis on overall neuropsychological performance was identified (F(3,100) = 4.81; p = .004), with large effect sizes noted for the Axis I only (d = .98) and Co-morbid MTBI/Axis I (d = .95) groups relative to the control group. The latter groups demonstrated primary limitations on measures of learning/memory and processing speed. The MTBI only group demonstrated performances that were not significantly different from the remaining three groups. These findings suggest that a remote history of blast-related MTBI does not contribute to objective cognitive impairment in the late stage of injury. Impairments, when present, are subtle and most likely attributable to PTSD and other psychological conditions. Implications for clinical neuropsychologists and future research are discussed. (JINS, 2012, 18, 1-11).

A brief review of cognitive assessment in neurotoxicology.

Among commercial and industrial chemicals, cosmetics, food additives, pesticides, and medicinal drugs, there are more than 50,000 substances distributed. Neurotoxic insults to the brain can manifest in many different ways, especially involving cognition. Given many possible differences in the pathophysiology of neurotoxic exposure and related cognitive sequelae, a systematic method of cognitive assessment is important for appropriate management of neurotoxic exposure. In the context of Neurotoxicology, this article briefly reviews the contemporary literature and the utility of cognitive assessment tools that are used in neuropsychology.

Self-report of psychological function among OEF/OIF personnel who also report combat-related concussion.

MMPI-2 RF profiles of 128 U.S. soldiers and veterans with history of concussion were examined. Participants evaluated in forensic (n = 42) and clinical (n = 43) settings showed significantly higher validity and clinical elevations relative to a research group (n = 43). In the full sample, a multivariate GLM identified main effects for disability claim status and Axis I diagnosis across numerous MMPI-2 RF scales. Participants with co-morbid PTSD and concussion showed significant Restructured Clinical and Specific Problem scale elevations relative to those without Axis I diagnosis. Participants with PTSD and active disability claims were especially prone to elevate on FBS/FBS-r and RBS. Implications for neuropsychologists who routinely administer the MMPI-2/RF in the context of combat-related concussion are discussed.

Neuropsychological evaluation of blast-related concussion: illustrating the challenges and complexities through OEF/OIF case studies.

BACKGROUND/OBJECTIVE: Soldiers of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) sustain blast-related mild traumatic brain injury (concussion) with alarming regularity. This study discusses factors in addition to concussion, such as co-morbid psychological difficulty (e.g. post-traumatic stress) and symptom validity concerns that may complicate neuropsychological evaluation in the late stage of concussive injury. CASE REPORT: The study presents the complexities that accompany neuropsychological evaluation of blast concussion through discussion of three case reports of OEF/OIF personnel. DISCUSSION: The authors emphasize uniform assessment of blast concussion, the importance of determining concussion severity according to acute-injury characteristics and elaborate upon non-concussion-related factors that may impact course of cognitive limitation. The authors conclude with a discussion of the need for future research examining the impact of blast concussion (particularly recurrent concussion) and neuropsychological performance.

Comparison of Wechsler Memory Scale-Fourth Edition (WMS-IV) and Third Edition (WMS-III) dimensional structures: improved ability to evaluate auditory and visual constructs.

Dimensional structures underlying the Wechsler Memory Scale-Fourth Edition (WMS-IV) and Wechsler Memory Scale-Third Edition (WMS-III) were compared to determine whether the revised measure has a more coherent and clinically relevant factor structure. Principal component analyses were conducted in normative samples reported in the respective technical manuals. Empirically supported procedures guided retention of dimensions. An invariant two-dimensional WMS-IV structure reflecting constructs of auditory learning/memory and visual attention/memory (C1 = .97; C2 = .96) is more theoretically coherent than the replicable, heterogeneous WMS-III dimension (C1 = .97). This research suggests that the WMS-IV may have greater utility in identifying lateralized memory dysfunction.

Evaluation context impacts neuropsychological performance of OEF/OIF veterans with reported combat-related concussion.

Although soldiers of Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) encounter combat-related concussion at an unprecedented rate, relatively few studies have examined how evaluation context, insufficient effort, and concussion history impact neuropsychological performances in the years following injury. The current study explores these issues in a sample of 119 U.S. veterans (OEF/OIF forensic concussion, n = 24; non-OEF/OIF forensic concussion, n = 20; OEF/OIF research concussion, n = 38; OEF/OIF research without concussion, n = 37). The OEF/OIF forensic concussion group exhibited significantly higher rates of insufficient effort relative to the OEF/OIF research concussion group, but a comparable rate of insufficient effort relative to the non-OEF/OIF forensic concussion group. After controlling for effort, the research concussion and the research non-concussion groups demonstrated comparable neuropsychological performance. Results highlight the importance of effort assessment among OEF/OIF and other veterans with concussion history, particularly in forensic contexts.

Updated meta-analysis of the MMPI-2 symptom validity scale (FBS): verified utility in forensic practice.

Clinical research interest in the symptom reporting validity scale currently known as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Symptom Validity Scale (FBS) has continued to be strong, with multiple new publications annually in peer-reviewed journals that publish psychological and neuropsychological assessment research. Related to this growth in relevant literature, the present study was conducted to update the Nelson, Sweet, and Demakis (2006b) FBS meta-analysis. A total of 83 FBS studies (43 new studies) were identified, and 32 (38.5%) met inclusion criteria. Analyses were conducted on a pooled sample of 2218 over-reporting and 3123 comparison participants. Large omnibus effect sizes were observed for FBS, Obvious-Subtle (O-S), and the Dissimulation Scale-Revised (Dsr2) scales. Moderate effect sizes were observed for the following scales: Back Infrequency (Fb), Gough's F-K, Infrequency (F), Infrequency Psychopathology (Fp), and Dissimulation (Ds2). Moderator analyses illustrate that relative to the F-family scales, FBS exhibited larger effect sizes when (1) effort is known to be insufficient and (2) evaluation is conducted in the context of traumatic brain injury. Overall, current results summarize an extensive literature that continues to support use of FBS in forensic neuropsychology practice.