Validation study of the Roberts Apperception Test for Children (RATC) in an adolescents' forensic sample.

The Roberts Apperception Test for Children (RATC) is a projective method developed by McArthur and Roberts (1982) to assess children and adolescents' behavioural, social and emotional functioning, concerns, conflicts and emotional management strategies through their perceptions of common interpersonal situations of everyday life. The aim of the present study is to contribute to the validation of the RATC in a forensic sample (N = 75) [constituted by a group of juvenile delinquents detained in educational centres (n = 40, 12-17 years old, 1-10 years of schooling) and a group of maltreated adolescents integrated in residential care (n = 35, 11-16 years old, 5-10 years of schooling)], studying its psychometric properties, such as reliability and criterion validity (convergent and discriminant validity), considering the results obtained in other instruments as external validation criteria: Wechsler Intelligence Scale for Children - Third Edition (WISC-III) and Youth Self-Report (YSR). It also aims to search for some indicators based on means and standard deviations to interpret the scores obtained in RATC for these forensic contexts, through the comparisons within forensic groups and the comparisons of the forensic groups with a community sample. The RATC showed minimally acceptable reliability and adequate validity indices, considering that this instrument is a projective method. This limitation is compensated by the clinical value of the data obtained from the projection of individuals' thoughts, concerns, conflicts and problem-solving styles, which are useful to assess their emotional and behavioural characteristics and psychological functioning. The results also show statistically significant differences between the two forensic groups on RATC scales, as well as between them and the community sample, as expected, underlining their different characteristics.

Healthcare decision-making capacity in old age: A qualitative study.

Objectives: Research about decision-making capacity has been growing in the last decades. That relates to more concerns regarding patients' autonomy, and an increase in diseases that can negatively impact capacity. This research aims to: explore perceptions, legal aspects, and assessment procedures related to healthcare decision-making capacity in older adults with cognitive impairment; and study the first version of a new assessment instrument of this capacity. Method: Nine focus groups were conducted, including healthcare, law and justice, nursing home professionals, institutionalized older adults, and dwelling older adults. Focus group discussions followed semi-structured interview scripts, specifically developed for each group. After group discussions, the assessment instrument was presented, and participants were asked to evaluate each item relevance and comprehensibility. Qualitative coding of the transcriptions was performed with resource to MAXQDA, using direct content analysis. Results: Six primary themes emerged from the qualitative analysis: Decision-making capacity features; Abilities implied in decision-making; Factors influencing decision-making; Obstacles to decision-making; Legal aspects; and Assessment procedures. Discussion: Results corroborate previous theoretical formulations of capacity. Generally, research results have implications for clinical and assessment practices, as well as preventive strategies that can improve older adult's decision-making capacity. Assessment procedures of capacity should include a thorough protocol for the assessment of cognition, functionality, depressive symptoms, and decision-making abilities. In this respect, the need for an assessment tool that can provide valid information during evaluation processes is highlighted. Concerning the strategies to promote decision-making capacity, these rely on improving older adult's health literacy and healthcare providers communication skills, as well as conduct actions to reduce stigma toward people with dementia.

Evidências de validade e fidedignidade da Escala Internacional de Inteligência Leiter-R para crianças dos 6 aos 8 anos / Validity and Reliability of the Leiter International Performance Scale - Revised for children of 6 to 8 years

RESUMO Este estudo verificou os parâmetros psicométricos da escala não-verbal de inteligência Leiter-R. Esta foi administrada em 213 crianças com idade entre 6 e 8 anos. Análise fatorial exploratória e índices de ajustes confirmatórios mostraram adequação da estrutura interna para dois fatores conforme a versão original do instrumento. Foi verificada estabilidade temporal, com correlações de magnitude moderada a alta entre teste e re-teste. Coeficientes de Kuder-Richardson e Spearman-Brown variaram entre os subtestes em função das diferentes idades. Maiores valores foram observados nos subtestes Sequências e Padrões Repetidos para todas as idades. Aumento significativo dos escores ocorreu apenas dos 6 para os 7 e 8 anos. Foram verificadas evidências de validade convergente com a WISC-III e as Matrizes Progressivas Coloridas de Raven.

ABSTRACT This study verified psychometric parameters of the Leiter-R, a nonverbal intelligence scale. The scale was administered to 213 children between 6 and 8 years. Exploratory factor analysis and confirmatory indexes showed adequacy for a two factor structure according to the original version. Moderate and high correlations between test-retest measures indicated the stability of the test scores. The values of Kuder-Richardson and Spearman-Brown coefficients varied between subtests according to the age of the children. In all age groups the highest values were observed for the subtests Sequential Order and Repeated Patterns. Significant increase in scores occurred only from 6 to 7 and 8 years. Evidence of convergent validity was obtained between the Leiter-R with the WISC-III and the Raven Colored Progressive Matrices.

Relação entre habilidades cognitivas não-verbais e variáveis presentes no contexto educacional / Relationship between non-verbal cognitive abilities and variables in the educational context / Relación entre habilidades cognitivas no-verbales y variables presentes en el contexto educacional

O objetivo deste estudo foi verificar a relação entre habilidades cognitivas não-verbais avaliadas pela Escala Internacional de Inteligência Leiter-R e variáveis presentes no contexto educacional. A Leiter-R foi administrada em 213 crianças com idades entre 6 e 8 anos, pertencentes a escolas públicas e particulares, juntamente com o Teste de Competência de Leitura de Palavras e Pseudopalavras e a Prova de Aritmética. Os alunos de escolas particulares alcançaram uma pontuação superior aos de escolas públicas nos 6 subtestes da Leiter-R, sendo que essas diferenças também foram observadas na faixa etária de 6 anos. No entanto, aos 7e 8 anos, as diferenças foram apenas em 2 subtestes. As correlações entre a Leiter-R e os testes de desempenho acadêmico foram positivas, significativas e de magnitude moderada. As análises de regressão linear indicaram predição das habilidades cognitivas em 24,2% do desempenho em aritmética e 30,6% do desempenho de leitura.(AU)

The aim of this study was to investigate the relationship between non-verbal cognitive skills evaluated by the Leiter-R Intelligence International Scale and variables in the educational context. The Leiter-R was administered to 213 children aged between 6 and 8 years old, belonging to public and private schools, along with the Reading Competence Test of words and pseudo words and Proof of arithmetic. Students of private schools reached a higher score to the public schools in six subtests of the Leiter-R, and these differences were also observed in the age group for six years. However, between the ages of 7 and 8 years, the differences were only in two subtests. The correlations between the Leiter-R and academic achievement tests were positive, significant and of moderate magnitude. The linear regression analyzes indicated prediction of cognitive abilities in 24.2% of the arithmetic performance and 30.6% of the read performance.(AU)

El objetivo de este estudio fue verificar la relación entre habilidades cognitivas no-verbales evaluadas por la Escala Internacional de Inteligencia Leiter-R y variables presentes en el contexto educacional. Se administró la Leiter-R a 213 niños con edades entre 6 y 8 años, pertenecientes a escuelas públicas y particulares, juntamente con el Test de Competencia de Lectura de Palabras y Pseudo-palabras y la Prueba de Aritmética. Los alumnos de escuelas particulares alcanzaron una puntuación superior a los de escuelas públicas en los 6 sub-testes da Leiter-R, siendo que esas diferencias también fueran observadas en la etapa etaria de 6 años. Sin embargo, a los 7 y 8 años, las diferencias fueron sólo en 2sub-testes. Las correlaciones entre la Leiter-R y los testes de desempeño académico fueron positivas, significativas y de magnitud moderada. Los análisis de regresión linear indicaron predicción de las habilidades cognitivas e nel 24,2% del desempeño en aritmética y el 30,6% del desempeño de lectura.(AU)

Relação entre habilidades cognitivas não-verbais e variáveis presentes no contexto educacional / Relationship between non-verbal cognitive abilities and variables in the educational context / Relación entre habilidades cognitivas no-verbales y variables presentes en el contexto educacional

O objetivo deste estudo foi verificar a relação entre habilidades cognitivas não-verbais avaliadas pela Escala Internacional de Inteligência Leiter-R e variáveis presentes no contexto educacional. A Leiter-R foi administrada em 213 crianças com idades entre 6 e 8 anos, pertencentes a escolas públicas e particulares, juntamente com o Teste de Competência de Leitura de Palavras e Pseudopalavras e a Prova de Aritmética. Os alunos de escolas particulares alcançaram uma pontuação superior aos de escolas públicas nos 6 subtestes da Leiter-R, sendo que essas diferenças também foram observadas na faixa etária de 6 anos. No entanto, aos 7e 8 anos, as diferenças foram apenas em 2 subtestes. As correlações entre a Leiter-R e os testes de desempenho acadêmico foram positivas, significativas e de magnitude moderada. As análises de regressão linear indicaram predição das habilidades cognitivas em 24,2% do desempenho em aritmética e 30,6% do desempenho de leitura.

The aim of this study was to investigate the relationship between non-verbal cognitive skills evaluated by the Leiter-R Intelligence International Scale and variables in the educational context. The Leiter-R was administered to 213 children aged between 6 and 8 years old, belonging to public and private schools, along with the Reading Competence Test of words and pseudo words and Proof of arithmetic. Students of private schools reached a higher score to the public schools in six subtests of the Leiter-R, and these differences were also observed in the age group for six years. However, between the ages of 7 and 8 years, the differences were only in two subtests. The correlations between the Leiter-R and academic achievement tests were positive, significant and of moderate magnitude. The linear regression analyzes indicated prediction of cognitive abilities in 24.2% of the arithmetic performance and 30.6% of the read performance.

El objetivo de este estudio fue verificar la relación entre habilidades cognitivas no-verbales evaluadas por la Escala Internacional de Inteligencia Leiter-R y variables presentes en el contexto educacional. Se administró la Leiter-R a 213 niños con edades entre 6 y 8 años, pertenecientes a escuelas públicas y particulares, juntamente con el Test de Competencia de Lectura de Palabras y Pseudo-palabras y la Prueba de Aritmética. Los alumnos de escuelas particulares alcanzaron una puntuación superior a los de escuelas públicas en los 6 sub-testes da Leiter-R, siendo que esas diferencias también fueran observadas en la etapa etaria de 6 años. Sin embargo, a los 7 y 8 años, las diferencias fueron sólo en 2sub-testes. Las correlaciones entre la Leiter-R y los testes de desempeño académico fueron positivas, significativas y de magnitud moderada. Los análisis de regresión linear indicaron predicción de las habilidades cognitivas e nel 24,2% del desempeño en aritmética y el 30,6% del desempeño de lectura.

The Visual Word Form Area remains in the dominant hemisphere for language in late-onset left occipital lobe epilepsies: A postsurgery analysis of two cases.

Automatic recognition of words from letter strings is a critical processing step in reading that is lateralized to the left-hemisphere middle fusiform gyrus in the so-called Visual Word Form Area (VWFA). Surgical lesions in this location can lead to irreversible alexia. Very early left hemispheric lesions can lead to transfer of the VWFA to the nondominant hemisphere, but it is currently unknown if this capability is preserved in epilepsies developing after reading acquisition. In this study, we aimed to determine the lateralization of the VWFA in late-onset left inferior occipital lobe epilepsies and also the effect of surgical disconnection from the adjacent secondary visual areas. Two patients with focal epilepsies with onset near the VWFA underwent to surgery for epilepsy, with sparing of this area. Neuropsychology evaluations were performed before and after surgery, as well as quantitative evaluation of the speed of word reading. Comparison of the surgical localization of the lesion, with the BOLD activation associated with the contrast of words-strings, was performed, as well as a study of the associated main white fiber pathways using diffusion-weighted imaging. Neither of the patients developed alexia after surgery (similar word reading speed before and after surgery) despite the fact that the inferior occipital surgical lesions reached the neighborhood (less than 1cm) of the VWFA. Surgeries partly disconnected the VWFA from left secondary visual areas, suggesting that pathways connecting to the posterior visual ventral stream were severely affected but did not induce alexia. The anterior and superior limits of the resection suggest that the critical connection between the VWFA and the Wernicke's Angular Gyrus cortex was not affected, which is supported by the detection of this tract with probabilistic tractography. Left occipital lobe epilepsies developing after reading acquisition did not produce atypical localizations of the VWFA, even with foci in the close neighborhood. Surgery for occipital lobe epilepsy should take this into consideration, as well as the fact that disconnection from the left secondary visual areas may not produce alexia.

Memory functioning in children with epilepsy: frontal lobe epilepsy, childhood absence epilepsy, and benign epilepsy with centrotemporal spikes.

Specific cognitive deficits have been identified in children with epilepsy irrespective of results on intelligence tests. Memory deficits are traditionally attributed to temporal lobe epilepsy, whereas the impact of frontal lobe epilepsy on memory functions has remained controversial. The aim of this study was the examination of memory abilities in other childhood common epilepsy syndromes (frontal lobe epilepsy (FLE), childhood absence epilepsy (CAE), and benign epilepsy with centrotemporal spikes (BECTS)) and the influence of epilepsy-related variables. Memory was examined in 90 children with epilepsy (each epilepsy group consisted of 30 children), aged 6-15, and compared with 30 control children. Children with FLE showed significant deficits in verbal and visual memory. In addition, type of epilepsy, earlier age at epilepsy onset, and longer active duration of epilepsy were associated with memory problems. Seizure frequency and treatment, however, did not influence memory performance. This study indicates that children with FLE show greater risk of developing memory deficits than children with CAE or BECTS, thus highlighting the importance of assessing also memory functions in frontal lobe epilepsy.

Intellectual functioning in children with epilepsy: frontal lobe epilepsy, childhood absence epilepsy and benign epilepsy with centro-temporal spikes.

PURPOSE: The purpose of our study is to describe intellectual functioning in three common childhood epilepsy syndromes - frontal lobe epilepsy (FLE), childhood absence epilepsy (CAE) and benign epilepsy with centro-temporal spikes (BECTS). And also to determine the influence of epilepsy related variables, type of epilepsy, age at epilepsy onset, duration and frequency of epilepsy, and treatment on the scores. METHODS: Intellectual functioning was examined in a group of 90 children with epilepsy (30 FLE, 30 CAE, 30 BECTS), aged 6-15 years, and compared with a control group (30). All subjects obtained a Full Scale IQ ≥ 70 and they were receiving no more than two antiepileptic medications. Participants completed the Wechsler Intelligence Scale for Children - Third Edition. The impact of epilepsy related variables (type of epilepsy, age at epilepsy onset, duration of epilepsy, seizure frequency and anti-epileptic drugs) on intellectual functioning was examined. RESULTS: Children with FLE scored significantly worse than controls on WISC-III Verbal IQ, Full Scale IQ and Processing Speed Index. There was a trend for children with FLE to have lower intelligence scores than CAE and BECTS groups. Linear regression analysis showed no effect for age at onset, frequency of seizures and treatment. Type of epilepsy and duration of epilepsy were the best indicators of intellectual functioning. CONCLUSION: It is crucial that children with FLE and those with a longer active duration of epilepsy are closely monitored to allow the early identification and evaluation of cognitive problems, in order to establish adequate and timely school intervention plans.

Distúrbio específico de linguagem: caracterização neuropsicológica / Trastorno especifico del desarrollo del lenguaje: caracterizacion neuropsicologica / Specific language impairment: A neuropsychological characterization

O presente estudo pretende caracterizar o funcionamento neuropsicológico de crianças com Distúrbio Específico de Linguagem (DEL) nas áreas da memória visual e verbal, atenção/funções executivas e funções visuopercetivas. A amostra é constituída por 28 crianças com DEL e 28 crianças sem DEL, sendo ambos os grupos equiparáveis em termos de idade, género, ano de escolaridade e nível socioeconómico. Para o efeito, recorreu-se a testes da Bateria de Avaliação Neuropsicológica de Coimbra e os dados foram analisados através de testes estatísticos paramétricos e não paramétricos. De um modo geral, os resultados obtidos diferenciam os desempenhos das crianças com DEL dos observados em crianças sem DEL. Em concreto, e comparativamente ao grupo de controlo, o grupo de crianças com DEL apresentou resultados significativamente inferiores na memória visual e memória verbal, na atenção seletiva e sustentada, nas funções executivas, na fluência verbal semântica, nas funções visuopercetivas e na velocidade de processamento.(AU)

Este estudio trata de caracterizar el funcionamiento neuropsicológico de niños con Trastorno Específico del Desarrollo del Lenguaje (TEDL) en las áreas de la memoria visual y verbal, atención/funciones ejecutivas y funciones visuoperceptivas. La muestra abarcó a 28 niños con TEDL y 28 niños sin TEDL, ambos grupos equiparables en términos de edad, género, nivel de escolaridad y nivel socioeconómico. Para tal efecto, se aplicó los test de la Batería de Valoración Neuropsicológica de Coimbra y los datos fueron analizados con testes estadísticos paramétricos y no paramétricos. En general, los resultados obtenidos diferencian los desempeños de los niños con y sin TEDL: el grupo de niños con TEDL presentaba resultados significativamente inferiores en la memoria visual y verbal, en la atención selectiva y sustentada, en las funciones ejecutivas, en la fluidez verbal semántica, en las funciones visuoperceptivas y en la velocidad de procesamiento.(AU)

This study's objective was to characterize the neuropsychological functioning of children with Specific Language Impairment (SLI), in the areas of visual and verbal memory, attention/executive functions, and visual-perceptual functions. The sample consisted of 28 children with SLI and 28 children without SLI. Both groups were comparable in terms of age, gender, school grade and socioeconomic level. The assessment instruments used are part of Coimbra's Neuropsychological Assessment Battery and data were analyzed through parametric and nonparametric statistical tests. In general, the results differentiate the performances of children with SLI from those observed in children without SLI. In comparison to the control group, the group of children with SLI obtained poorer results in visual memory and verbal memory, selective and sustained attention, executive functions, semantic verbal fluency, visual-perceptual functions and processing speed.(AU)

Distúrbio específico de linguagem: caracterização neuropsicológica / Trastorno especifico del desarrollo del lenguaje: caracterizacion neuropsicologica / Specific language impairment: A neuropsychological characterization

O presente estudo pretende caracterizar o funcionamento neuropsicológico de crianças com Distúrbio Específico de Linguagem (DEL) nas áreas da memória visual e verbal, atenção/funções executivas e funções visuopercetivas. A amostra é constituída por 28 crianças com DEL e 28 crianças sem DEL, sendo ambos os grupos equiparáveis em termos de idade, género, ano de escolaridade e nível socioeconómico. Para o efeito, recorreu-se a testes da Bateria de Avaliação Neuropsicológica de Coimbra e os dados foram analisados através de testes estatísticos paramétricos e não paramétricos. De um modo geral, os resultados obtidos diferenciam os desempenhos das crianças com DEL dos observados em crianças sem DEL. Em concreto, e comparativamente ao grupo de controlo, o grupo de crianças com DEL apresentou resultados significativamente inferiores na memória visual e memória verbal, na atenção seletiva e sustentada, nas funções executivas, na fluência verbal semântica, nas funções visuopercetivas e na velocidade de processamento.

Este estudio trata de caracterizar el funcionamiento neuropsicológico de niños con Trastorno Específico del Desarrollo del Lenguaje (TEDL) en las áreas de la memoria visual y verbal, atención/funciones ejecutivas y funciones visuoperceptivas. La muestra abarcó a 28 niños con TEDL y 28 niños sin TEDL, ambos grupos equiparables en términos de edad, género, nivel de escolaridad y nivel socioeconómico. Para tal efecto, se aplicó los test de la Batería de Valoración Neuropsicológica de Coimbra y los datos fueron analizados con testes estadísticos paramétricos y no paramétricos. En general, los resultados obtenidos diferencian los desempeños de los niños con y sin TEDL: el grupo de niños con TEDL presentaba resultados significativamente inferiores en la memoria visual y verbal, en la atención selectiva y sustentada, en las funciones ejecutivas, en la fluidez verbal semántica, en las funciones visuoperceptivas y en la velocidad de procesamiento.

This study's objective was to characterize the neuropsychological functioning of children with Specific Language Impairment (SLI), in the areas of visual and verbal memory, attention/executive functions, and visual-perceptual functions. The sample consisted of 28 children with SLI and 28 children without SLI. Both groups were comparable in terms of age, gender, school grade and socioeconomic level. The assessment instruments used are part of Coimbra's Neuropsychological Assessment Battery and data were analyzed through parametric and nonparametric statistical tests. In general, the results differentiate the performances of children with SLI from those observed in children without SLI. In comparison to the control group, the group of children with SLI obtained poorer results in visual memory and verbal memory, selective and sustained attention, executive functions, semantic verbal fluency, visual-perceptual functions and processing speed.

Montreal cognitive assessment: validation study for mild cognitive impairment and Alzheimer disease.

The Montreal Cognitive Assessment (MoCA) was recently proposed as a cognitive screening test for milder forms of cognitive impairment, having surpassed the well-known limitations of the Mini-Mental State Examination (MMSE). This study aims to validate the MoCA for screening Mild Cognitive Impairment (MCI) and Alzheimer disease (AD) through an analysis of diagnostic accuracy and the proposal of cut-offs. Patients were classified into 2 clinical groups according to standard criteria: MCI (n=90) and AD (n=90). The 2 control groups (C-MCI: n=90; C-AD: n=90) consisted of cognitively healthy community dwellers selected to match patients in sex, age, and education. The MoCA showed consistently superior psychometric properties compared with the MMSE, and higher diagnostic accuracy to discriminate between MCI (area under the curve=0.856; 95% confidence interval, 0.796-0.904) and AD patients (area under the curve=0.980; 95% confidence interval, 0.947-0.995). At an optimal cut-off of below 22 for MCI and below 17 for AD, the MoCA achieved significantly superior values in comparison with MMSE for sensitivity, specificity, positive predictive value, negative predictive value, and classification accuracy. Furthermore, the MoCA revealed higher sensitivity to cognitive decline in longitudinal monitoring. This study provides robust evidence that the MoCA is a better cognitive tool than the widely used MMSE for the screening and monitoring of MCI and AD in clinical settings.

Anxiety and depression in sarcoma patients: emotional adjustment and its determinants in the different phases of disease.

PURPOSE: Sarcoma patients are a particularly debilitated group and vulnerable to the development of significant psychosocial difficulties. In this study we examine the prevalence and levels of anxiety and depression in different phases of disease and we analyse the determinants of sarcoma patients' emotional adjustment. METHOD: One hundred and forty two sarcoma patients in different phases of the cancer experience were recruited from three Portuguese Cancer Care Units and completed the Portuguese version of HADS. RESULTS: The majority of sarcoma patients, in the different phases of disease, reported normal or mild levels of anxiety and depression but, for a significant minority, the emotional distress was clinically relevant. In general, anxiety and depression scores were below the cut-off "caseness" threshold of 11 and, with the exception of depression levels for patients in treatment phase, no differences were found between groups on the outcome measures. Age, gender, presenting status and time since the termination of treatments were found to be significant determinants of anxiety and depression. CONCLUSIONS: In the different phases of the disease an important number of patients may show significant psychological distress and, therefore, psychosocial interventions adapted to each period of the illness trajectory and to the demographic and clinical contexts are needed for this type of cancer.