The construct validity of the Tower of LondonDX as a measure of the executive functioning of ADHD children.

Currently, there are a limited number of measures that have been developed to assess childhood executive planning and problem-solving abilities. The present study represents ongoing efforts to determine the psychometric properties of the newly developed Tower of London Drexel (TOLDX), a measure of executive functions. Specifically, the construct-related validity of the TOLDX was investigated with a sample of attention-deficit hyperactivity disorder (ADHD) children (N = 129), 7 to 15 years of age. The performance of the children on a neuropsychological battery of measures sensitive to executive abilities, psychometric intelligence, and memory was subjected to maximum-likelihood factor analysis. A four-factor solution was extracted that best fit the selected variables. The TOLDX was found to produce the highest loading on an Executive Planning/Inhibition factor comprised of other executive measures. The Executive Planning/Inhibition measure was separate from factors of Executive Concept Formation/Flexibility, Psychometric Intelligence, and Memory. Moreover, the two executive factors were found to be correlated (r = .42) suggesting that each assesses, to varying degrees, related executive dimensions. The neuropsychological construct structure of the TOLDX is discussed in relationship with the temporal organization of behavior and frontal lobe functioning.

The Tower of London(DX): a standardized approach to assessing executive functioning in children.

In the current study, the Tower of London (Shallice, 1982) was modified to enhance its clinical utility as a measure of childhood executive functioning. The Tower of London-Drexel (TOL(DX)) was administered to normal control (NC; N = 56) and attention-deficit hyperactivity disorder (ADHD; N = 99) children (ages 7 to 12) to determine whether age-related changes in performance were evident, to gather normative data, and to evaluate the test-retest reliability and criterion-validity of the measure. The results revealed age-related changes in score performance, age-group normative data, an acceptable level of reliability and significant differences in performance of NC and ADHD subjects. Further, discriminant analysis classification rates determined that the TOL(DX) was sensitive and highly specific to ADHD. Implications and limitations of the study are discussed.

MMPI-2 profiles of battered women in transition.

Domestic violence is a widespread problem in our society that has not been extensively studied using psychological assessment tools. In this investigation, the psychological functioning of battered women in transition was examined through the use of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Thirty-one women (M age = 30 years, M education = 11.5 years) were evaluated as residents in a confidential shelter operated by Women Against Abuse. All subjects were asked to complete the MMPI-2 as well as information on their history of length, severity, and types of abuse (i.e., physical and/or psychological). Results indicated elevated MMPI-2 profiles in 90% of the subjects with the most frequent code type being a combination of Scales F, 4, 6, and 8. Scales 2 and 7, which are often associated with depression, anxiety, and other forms of subjective distress, were not consistently elevated. Supplementary MMPI-2 scales revealed elevations on scales MAC-R, Mt, PK, and PS. Regression analysis indicated significant relationships between length and severity of psychological forms of abuse and overall levels of psychological distress (i.e., F scale and average clinical T-score). Age and physical forms of abuse were not related to MMPI indices of psychological disturbance. Theoretical issues of domestic violence, intervention strategies with battered women, and the dangers of misdiagnosis are discussed.

The effects of unilateral and multifocal lesions on the WAIS-R: a factor analytic study of stroke patients.

An exploratory maximum likelihood factor analysis of the inter-correlations among the 11 subtests of the WAIS-R was undertaken for 167 patients who had a primary diagnoses of cerebrovascular accident (right hemisphere, n = 79; left hemisphere, n = 55; diffuse or multifocal, n = 33). On the WAIS-R, this sample performed below normative standards (average scaled score = 7.1), but demonstrated a pattern of variability among subtests similar to the normative groups. Interestingly, VIQ-PIQ discrepancy analyses revealed V > P profiles for patients with lesions in either or both hemispheres. The best fit for the WAIS-R matrix was an oblique two-factor model comprised of the Verbal and Performance subtests. This factor solution, which was moderately correlated (.52), accounted for 58.8% of the total variance. The stability of a two-factor structure in this neurologic impaired population suggests that the WAIS-R is a robust measure, even when used within such a rehabilitation population. Only two of the eleven subtests (i.e., Comprehension and Picture Arrangement), however, were related to lesion site. Rehabilitation settings may need to rely more on neuropsychological procedures that measure the more "fluid" areas of neurocognitive ability, in contrast to the WAIS-R which appears less sensitive to the neurological impairment associated with stroke.

Wechsler Verbal-Performance IQ discrepancies among psychiatric inpatients: implications for subtle neuropsychological dysfunctioning.

One hundred seventy-nine psychiatric inpatients were administered the WAIS-R and several neuropsychological and academic achievement tests. All subjects were assigned to three groups based on their WAIS-R's VIQ-PIQ discrepancy scores: (i) Low Verbal (Verbal IQ < Performance IQ. by at least 13 points); (ii) Low Performance (Performance IQ < Verbal IQ by at least 13 points); and (iii) Equal (Verbal IQ-Performance IQ within 13 points). The Low Verbal group made significantly more errors on the Speech Sounds Perception Test, demonstrated lower spelling scores, evinced more aphasic signs, and had had more special education placements than did the Equal or Low Performance groups. The Low Performance subjects demonstrated significantly more signs of constructional dyspraxia and performed more poorly on the Grooved Pegboard test. The neuropsychiatric patients who had Verbal-Performance IQ discrepancies of at least one standard deviation may be at risk for specific, subtle neuropsychological deficits.

Comparison of two cognitive bedside screening instruments in nursing home residents: a factor analytic study.

The Mini-Mental State Examination (MMSE) and the Blessed Orientation-Memory-Concentration test (BOMC) were each administered to 110 nursing home residents. The correlation between the MMSE and BOMC's total score was -.79. Maximum likelihood factor analysis revealed a two-factor structure, consisting of memory-attention and verbal-comprehension factors that were highly correlated (.69). The results suggest that the somewhat longer MMSE may be preferred for bedside mental status testing, as it clearly measures an additional dimension of cognitive ability, while the BOMC is primarily a unidimensional test. The theoretical and clinical implications of bedside mental status testing of elderly patients are discussed.

Measurement and prediction of hearing loss in a nursing home.

The purpose of this study was to evaluate the abilities of three paper-and-pencil tests to predict pure-tone hearing loss of nursing home residents. The three tests used were the staff version of the Nursing Home Hearing Handicap Index and two tests of mental status, the Mini Mental State and the Short Orientation-Memory-Concentration Test. Testing was done on the residents (n = 122) of a long-term, intermediate-care nursing home. In general, the residents who passed the hearing test (using a 40 dB HL criterion) performed better on all three tests than did the residents who failed the hearing test and the residents who could not be tested. The results of discriminant analyses showed that the factor of age predicted hearing loss with a sensitivity of 93% and a specificity of 35%. The factor of age in combination with question 4 of the SOMCT and question 10 of the NHHI improved specificity to 53%.

Mood states in the volunteer blood donor.

Mood changes across time were evaluated as they applied to the process of volunteer blood donation. Measures of mood (from the Mood Adjective Check List) were taken before and at three different intervals after blood donations by 245 college students. Anxiety scores were significantly higher before blood donation, and elation scores showed a significant increase following donation. Veteran donors experienced significantly less discomfort before donation. These findings imply that blood donations can be viewed as an "opponent-affective process," in which initial, mildly aversive feelings lead to positive aftereffects. Current findings suggest that blood donation can be explained, in part, by a self-serving, addictive process.

Rorschach records of Nazi war criminals: a reanalysis using current scoring and interpretation practices.

The Nuremberg trials focused worldwide attention on 22 Nazi war criminals. Rorschach Inkblot tests were administered to these Nazi leaders in an attempt to understand the Nazi personality. Past studies which have described and interpreted these Rorschach records have made at least two types of errors in their analyses. One is that of overinterpretation and excessive inference. A second common error has been the failure to detect meaningful distinctions between protocols that represent significant differences in personality style. This latter error is shown in repeated attempts to group all Nazi protocols into one distinct "Nazi personality." This investigation attempted to quantify the analysis of these Nazi Rorschach records, specifically those Nazi leaders who were sentenced to life imprisonment or execution for their war crimes against humanity, by utilizing Exner's (1985a) standardized Comprehensive Scoring System as well as computerized objective interpretation software based on the Exner system (1986). This modern analysis of the Rorschach records demonstrates that the Nazi war criminals cannot be grouped together into one specific mental disorder that would adequately characterize these diverse individuals. The varying degrees of psychopathology of the Nazi leaders are illustrated by analyses of individual Rorschach protocols.

WAIS factor pattern for neuropsychiatric inpatients.

The current study examines the factor pattern of the Wechsler Adult Intelligence Scale for a sample of 151 neuropsychiatric inpatients (97 men, 54 women). As expected, these patients performed less well on all 11 of the subtests and ranged from .60 to 1.54 SD below normative standards. These patients were neither more variable nor were the intercorrelations among the subtests lower than those of the normative group. As in previous research, maximum likelihood factor analyses revealed the presence of a Verbal Comprehension dimension and a Perceptual Organization dimension, factors that were moderately correlated (.60). The stability of a two-factor solution for the WAIS in this population and its implications for the inclusion of the WAIS as a component of a neuropsychological assessment paradigm are discussed.

Relationships between the WAIS and neuropsychological measures for neuropsychiatric inpatients.

The current study examines the sensitivity of the Wechsler Adult Intelligence Scale in predicting performance on a modified Halstead Neuropsychological Test Battery for lower-functioning neuropsychiatric inpatients (97 men, 54 women). Regression analyses support earlier-reported findings that the WAIS's subtests more accurately predict neuropsychological test performance than do the WAIS IQ's alone. The IQ's and scaled scores respectively predicted 27% and 39% of the variance in the Halstead's measures. The overall relationship between neurocognitive and WAIS indices is somewhat greater than previous reports and is apparently due to the fact that the lower the overall level of cognitive ability, the lower is neuropsychological functioning in general. However, since most of the variance in the modified Halstead Battery was not common with the WAIS's indices, these findings continue to support the practice of including both sets of measures as part of a comprehensive neuropsychological assessment paradigm for such patients. The importance of developing instruments and procedures which more precisely measure "fluid" neurocognitive abilities is underscored.

Neurobehavioral sequelae of subcutaneous injection with metallic mercury.

A 19 year old, white male, with nine years of education, attempted suicide by injection of metallic mercury (Hg) into the left forearm. CT scan findings suggesting mercury infiltration of the brain and results from urinalysis indicated clinically high levels of Hg excretion. Premorbid cognitive history was essentially normal, yet comprehensive neuropsychological assessment revealed significant impairment of higher cortical functioning beyond those expected of a moderately to severely disturbed psychiatric patient. Neuropsychological test results appear to offer a more sensitive, quantitative assessment of heavy metal toxicity.

Characteristics and correlates of MMPI change within an adult psychiatric inpatient setting.

This study investigated characteristics and correlates of MMPI change scores among 188 male and female inpatients who were assessed at admission and upon completion of a 9-week residential program. Predictor variables included admission scores from the standard 13 MMPI scales, the Internal-External Locus of Control Scale, the trait component of the State-Trait Anxiety Inventory, and Shipley-Hartford Verbal IQ scores, as well as demographic variables including factors that involved psychiatric history. Outcome variables consisted of change scores based on raw score values for each of the 13 MMPI scales. Results of a canonical correlation indicated a significant relationship between predictor and outcome variables, which cumulatively accounted for 27% of the variance of outcome change scores. Findings were discussed in terms of implications for research and theory in the areas of the measurement of psychological change through use of the MMPI.