An abbreviated WISC-5 model for identifying youth at risk for intellectual disability in a mixed clinical sample.

OBJECTIVE: The correct "dosing" of neuropsychological assessment is of interest for the purposes of cost management and the personalization of medicine/assessment. In this context, embedded IQ screening, rather than routine comprehensive IQ testing, may be useful in identifying youth at risk for Intellectual Disability (ID) for whom further assessment is needed. This retrospective, cross-sectional study examined subtests from the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-5) needed to identify youth with Full Scale IQ (FSIQ) ≤75. METHOD: Data were obtained from a large pediatric clinically referred sample (N = 4,299; Mean Age = 10.7 years; Range = 6-16y; 66% male; 54% White; 29% receiving Public Insurance), divided into training (n = 2149) and test (n = 2150) samples. RESULTS: In the training sample, sequential and additive regression-based models for predicting FSIQ comprised of one (Block Design [BD]), two (BD + Similarities [SI]), three (BD + SI + Matrix Reasoning [MR]), and four (BD + SI + MR + Digit Span [DS]) subtests of the WISC-5 explained 61.3%, 82.7%, 88.5%, and 93.0% of FSIQ variance, respectively. Using a predicted FSIQ ≤ 80 as a cut score to identify persons with observed FSIQ ≤75, the two subtest (BD + SI) model showed strong sensitivity (83.4), specificity (90.5), and negative predictive value (96.2) in the test sample; however, positive predictive value was low (65.3%). Three and four subtest models provided incremental, but modest gains in classification metrics. CONCLUSIONS: Findings suggest the first several subtests of the WISC-5 can be used to identify clinically referred youth at risk for ID who subsequently require full administration of the WISC-5 for consideration of an ID diagnosis.

How much testing can a kid take? Feasibility of collecting pediatric patient experience ratings of neuropsychological and psychological assessment.

Parent-reported satisfaction is an important outcome measure in pediatric neuropsychology; however, self-report of patient experience following lengthy pediatric assessments has been under-investigated. Written at a first grade reading level and utilizing touch screen and read-aloud functionality, a set of 15 operationally-focused items were administered to evaluate pediatric patient experience of neuropsychological and psychological assessment. One-hundred ninety-seven clinically-referred patients (M age = 11.74, SD = 3.17, range = 5.86-19.02 years, 56% male) answered the post-assessment survey. The majority of patients (n = 167; 84.77%) accurately completed the initial two validity items, even though many had parent-reported ratings of reading difficulty. More than a third of patients indicated that the assessment made them tired (39%), but fewer patients reported feeling bored (13%) or worried (7%) during testing. Moreover, most patients reported having fun (66%) and many indicated that testing was preferable to other activities typically performed at that same time (i.e., school, homework). Responses to items assessing the child's interactions with the clinician and the child's effort provided little variation and were answered in a socially desirable manner. Items that focused upon the child's personal response to the assessment appointment (e.g., boredom, worry), however, elicited greater variance in patient responding. In general, patient responses did not suggest that assessment was an aversive experience. Overall, these proof of concept findings suggest that most referred pediatric patients, even those with learning issues, may be capable of independently navigating and completing self-report questionnaires while providing differential responses to items assessing clinical experience. Self-report questionnaires appear to be a feasible method for acquiring pediatric patient-reported experiences of assessment.

The Role of the Cerebellum in Repetitive Behavior Across Species: Childhood Stereotypies and Deer Mice.

Recent studies suggest that the cerebellum may have a significant role in repetitive behaviors. In primary complex motor stereotypies, typically developing children have repetitive movements usually involving rhythmic flapping/waving arm/hand movements. Similarly, the deer mouse animal model exhibits inherited repetitive behaviors, with increased frequencies of spontaneous jumping and rearing. In this study, data from both children with motor stereotypies and deer mice were used to investigate the role of the cerebellum in repetitive behaviors. The 3.0-T MRI volumetric imaging of the cerebellum was obtained in 20 children with primary complex motor stereotypies and 20 healthy controls. In deer mice, cerebellar volume (n = 7/group) and cell counts (n = 9/group) were compared between high- and low-activity animals. Levels of cerebellar neurotransmitters were also determined via HPLC (n = 10/group). In children with stereotypies, (a) there were a statistically significant reduction (compared to controls) in the white matter volume of the posterior cerebellar lobule VI-VII that negatively correlated with motor control and (b) an 8% increase in the anterior vermis gray matter that positively correlated with motor Stereotypy Severity Scores (SSS). In deer mice, (a) there was a significant increase in the volume of the anterior vermal granular cell layer that was associated with higher activity and (b) dentate nucleus cell counts were higher in high activity animals. Similar increases in volume were observed in anterior vermis in children with stereotypies and a deer mouse model of repetitive behaviors. These preliminary findings support the need for further investigation of the cerebellum in repetitive behaviors.

Aberrant prefrontal cortical-striatal functional connectivity in children with primary complex motor stereotypies.

Motor stereotypies are rhythmic, repetitive, prolonged, predictable, and purposeless movements that stop with distraction. Although once believed to occur only in children with neurodevelopmental disorders such as autism, the presence and persistence of complex motor stereotypies (CMS) in otherwise typically developing children (primary CMS) has been well-established. Little, however, is known about the underlying pathophysiology of these unwanted actions. The aim of the present study was to use resting-state functional magnetic resonance imaging to evaluate functional connectivity within frontal-striatal circuits that are essential for goal-directed and habitual activity in children with primary complex motor stereotypies. Functional connectivity between prefrontal cortical and striatal regions, considered essential for developing goal-directed behaviors, was reduced in children with primary CMS compared to their typically developing peers. In contrast, functional connectivity between motor/premotor and striatal regions, critical for developing and regulating habitual behaviors, did not differ between groups. This documented alteration of prefrontal to striatal connectivity could provide the underlying mechanism for the presence and persistence of complex motor stereotypies in otherwise developmentally normal children.

Capturing cognitive and behavioral variability among individuals with Down syndrome: a latent profile analysis.

BACKGROUND: There is a high degree of inter- and intra-individual variability observed within the phenotype of Down syndrome. The Down Syndrome Cognition Project was formed to capture this variability by developing a large nationwide database of cognitive, behavioral, health, and genetic information on individuals with Down syndrome, ages 6-25 years. The current study used the Down Syndrome Cognition Project database to characterize cognitive and behavioral variability among individuals with Down syndrome. METHODS: Latent profile analysis was used to identify classes across a sample of 314 participants based on their cognition (IQ and executive functioning), adaptive and maladaptive behavior, and autism spectrum disorder symptomatology. A multivariate multinomial regression model simultaneously examined demographic correlates of class. RESULTS: Results supported a 3-class model. Each class demonstrated a unique profile across the subdomains of cognition and behavior. The "normative" class was the largest (n = 153, 48%) and displayed a relatively consistent profile of cognition and adaptive behavior, with low rates of maladaptive behavior and autism symptomatology. The "cognitive" class (n = 109, 35%) displayed low cognitive scores and adaptive behavior and more autism symptomatology, but with low rates of maladaptive behavior. The "behavioral" class, the smallest group (n = 52, 17%), demonstrated higher rates of maladaptive behavior and autism symptomatology, but with cognition levels similar to the "normative" class; their adaptive behavior scores fell in between the other two classes. Household income and sex were the only demographic variables to differ among classes. CONCLUSIONS: These findings highlight the importance of subtyping the cognitive and behavioral phenotype among individuals with Down syndrome to identify more homogeneous classes for future intervention and etiologic studies. Results also demonstrate the feasibility of using latent profile analysis to distinguish subtypes in this population. Limitations and future directions are discussed.

A Genotype-Phenotype Study of High-Resolution FMR1 Nucleic Acid and Protein Analyses in Fragile X Patients with Neurobehavioral Assessments.

Fragile X syndrome (FXS) is caused by silencing of the FMR1 gene, which encodes a protein with a critical role in synaptic plasticity. The molecular abnormality underlying FMR1 silencing, CGG repeat expansion, is well characterized; however, delineation of the pathway from DNA to RNA to protein using biosamples from well characterized patients with FXS is limited. Since FXS is a common and prototypical genetic disorder associated with intellectual disability (ID) and autism spectrum disorder (ASD), a comprehensive assessment of the FMR1 DNA-RNA-protein pathway and its correlations with the neurobehavioral phenotype is a priority. We applied nine sensitive and quantitative assays evaluating FMR1 DNA, RNA, and FMRP parameters to a reference set of cell lines representing the range of FMR1 expansions. We then used the most informative of these assays on blood and buccal specimens from cohorts of patients with different FMR1 expansions, with emphasis on those with FXS (N = 42 total, N = 31 with FMRP measurements). The group with FMRP data was also evaluated comprehensively in terms of its neurobehavioral profile, which allowed molecular-neurobehavioral correlations. FMR1 CGG repeat expansions, methylation levels, and FMRP levels, in both cell lines and blood samples, were consistent with findings of previous FMR1 genomic and protein studies. They also demonstrated a high level of agreement between blood and buccal specimens. These assays further corroborated previous reports of the relatively high prevalence of methylation mosaicism (slightly over 50% of the samples). Molecular-neurobehavioral correlations confirmed the inverse relationship between overall severity of the FXS phenotype and decrease in FMRP levels (N = 26 males, mean 4.2 ± 3.3 pg FMRP/ng genomic DNA). Other intriguing findings included a significant relationship between the diagnosis of FXS with ASD and two-fold lower levels of FMRP (mean 2.8 ± 1.3 pg FMRP/ng genomic DNA, p = 0.04), in particular observed in younger age- and IQ-adjusted males (mean age 6.9 ± 0.9 years with mean 3.2 ± 1.2 pg FMRP/ng genomic DNA, 57% with severe ASD), compared to FXS without ASD. Those with severe ID had even lower FMRP levels independent of ASD status in the male-only subset. The results underscore the link between FMR1 expansion, gene methylation, and FMRP deficit. The association between FMRP deficiency and overall severity of the neurobehavioral phenotype invites follow up studies in larger patient cohorts. They would be valuable to confirm and potentially extend our initial findings of the relationship between ASD and other neurobehavioral features and the magnitude of FMRP deficit. Molecular profiling of individuals with FXS may have important implications in research and clinical practice.

Reduced striatal GABA in unmedicated children with ADHD at 7T.

Attention-deficit hyperactive disorder (ADHD) is characterized by inattention and increased impulsive and hypermotoric behaviors.Despite the high prevalence and impact of ADHD, little is known about the underlying neurophysiology of ADHD. The main inhibitory and excitatory neurotransmitters γ-aminobutyric acid (GABA) and glutamate are receiving increased attention in ADHD and can be measured using Magnetic Resonance Spectroscopy (MRS). However, MRS studies in ADHD are limited. We measured GABA and glutamate in young unmedicated participants, utilizing high magnetic field strength. Fifty unmedicated children (26 with ADHD, 24 controls) aged 5-9 years completed MRS at 7T and behavioral testing. GABA and glutamate were measured in dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), premotor cortex (PMC), and striatum, and estimated using LCModel. Children with ADHD showed poorer inhibitory control and significantly reduced GABA/Cr in the striatum, but not in ACC, DLPFC, or PMC regions. There were no significant group differences for Glu/Cr levels, or correlations with behavioral manifestations of ADHD. The primary finding of this study is a reduction of striatal GABA levels in unmedicated children with ADHD at 7T. These findings provide guidance for future studies or interventions. Reduced striatal GABA may be a marker for specific GABA-related treatment for ADHD.

Efficacy of Parent-Delivered, Home-Based Therapy for Tics.

BACKGROUND: Although behavioral therapy is an effective approach to reduce tics in children and adults, there is an insufficient availability and accessibility of behavioral therapy in the community. OBJECTIVE: The goal of the study was to test the clinical efficacy of home-based, parent-provided behavioral therapy in children with Tourette syndrome aged seven to 13 years. METHOD: An instructional habit reversal training-based video and guide was developed for use by parents. Eligible families, in this 10-week study, were enrolled in either a home-based therapy (DVD) group (received disk and written instructions) or an in-person therapist group (had scheduled visits with the therapist). Outcome scales included the Yale Global Tic Severity Scale, both the total Tic Severity Score and total Global Severity Score, and the parent report of Clinical Global Impressions of Improvement. RESULTS: Forty-four children (mean age = 10.21 ± 1.69 years) were enrolled into either the DVD (n = 33) or in-person therapist (n = 11) groups. Eighteen completed the study-eight in the DVD and 10 in the in-person therapist group. Outcome measures showed significant reductions in Yale Global Tic Severity Scale change ratios: mean improvement on the Tic Severity Score was DVD 32.4% (P < 0.001) and in-person therapist 26.6% (P = 0.01); and for the Global Severity Score, DVD 33.7% (P < 0.001) and in-person therapist 26.7% (P < 0.001). CONCLUSIONS: Home-based, parent-administered habit reversal training behavioral therapy is efficacious for reducing tics in children. Telephone contacts early in the DVD treatment course might reduce the number of dropouts.

American Academy of Clinical Neuropsychology consensus conference statement on uniform labeling of performance test scores.

Objectives: Descriptive labels of performance test scores are a critical component of communicating outcomes of neuropsychological and psychological evaluations. Yet, no universally accepted system exists for assigning qualitative descriptors to scores in specific ranges. In addition, the definition and use of the term "impairment" lacks specificity and consensus. Consequently, test score labels and the denotation of impairment are inconsistently applied by clinicians, creating confusion among consumers of neuropsychological services, including referral sources, trainees, colleagues, and the judicial system. To reduce this confusion, experts in clinical and forensic neuropsychological and psychological assessment convened in a consensus conference at the 2018 Annual Meeting of the American Academy of Clinical Neuropsychology (AACN). The goals of the consensus conference were to recommend (1) a system of qualitative labels to describe results from performance-based tests with normal and non-normal distributions and (2) a definition of impairment and its application in individual case determinations. Results: The goals of the consensus conference were met resulting in specific recommendations for the application of uniform labels for performance tests and for the definition of impairment, which are described in this paper. In addition, included in this consensus statement is a description of the conference process and the rationales for these recommendations. Conclusions/Importance: This consensus conference is the first formal attempt by the professional neuropsychological community to make recommendations for uniform performance test score labels and to advance a consistent definition of impairment. Using uniform descriptors and terms will reduce confusion and enhance report comprehensibility by the consumers of our reports as well as our trainees and colleagues.

Premorbid functioning as a predictor of outcome in pediatric brain tumor: An initial examination of the normalcy assumption.

BACKGROUND: Research on neurodevelopmental outcome in survivors of pediatric brain tumor (BT) is often based on the assumption of normal development up to the onset of overt symptoms. We sought to verify the "normalcy assumption" and to investigate corollary issues including challenges inherent to the measurement of premorbid neurobehavioral functioning. PROCEDURE: The Brain Radiation Investigative Study Consortium (BRISC) is a prospective longitudinal multisite study of 58 children diagnosed with BT. Premorbid functioning was assessed via retrospective parent report on standardized rating scales and detailed questionnaires. Findings were examined for the sample as a whole and in patients grouped by tumor histology (embryonal and non-embryonal). RESULTS: Mean age at diagnosis was 9.84 years (range, 3-16). The overall sample showed low proportions of pre/postnatal risk factors and delays in development. The proportion of children with clinically significant premorbid attention (18%) problems based on the BASC-2 exceeded expectation of that in healthy children (6.68%). Similar findings were obtained for somatization (18%) and anxiety (14%). Delays in talking were significantly more common in children with embryonal than non-embryonal tumors (P = 0.02). The non-embryonal tumor group had significantly higher overall rates of premorbid psychosocial problems than the embryonal tumor group (P < 0.001). CONCLUSIONS: We describe a rigorous approach to estimating premorbid developmental status in pediatric BT. The findings suggest mixed support for the "normalcy assumption" and highlight the complexity of this concept and need for further investigation. Our results also suggest the need for further study of potential premorbid correlates with tumor histology.

When theory met data: Factor structure of the BRIEF2 in a clinical sample.

Objective: The BRIEF2 is the recent revision of a frequently employed measure of executive behaviors; however, no research has yet addressed the validity of the new measure's theoretical design.Method: The present study examined the factor structure of the BRIEF2 in 5212 clinically referred youth (66% male, 5-18 years) via exploratory (EFA) and confirmatory (CFA) factor analyses of item-level responses.Results: Results from the EFA suggested the BRIEF2 has fewer factors than would be suggested by the nine theoretically derived scales. While the theoretical CFA model, that omitted item-level information, demonstrated the best fit, when the item-level information was employed there was a decrement in model fit statistics and several extremely high loadings suggested scale-level redundancy in measurement. When the scales were omitted, and the items were loaded directly onto the indices, there was very little change in item-level factor loadings.Conclusions: Findings suggest fewer than nine scales are needed and that clinical interpretation of the BRIEF2 may be more appropriate at the index, rather than scale, level.

Parent versus teacher ratings on the BRIEF-preschool version in children with and without ADHD.

Caregiver rating scales represent an important component of comprehensive child neuropsychological assessments for conditions such as Attention-deficit/Hyperactivity Disorder (ADHD); however, low inter-rater reliability (parent vs. teacher) often complicates interpretation. It has been challenging to identify the factors contributing to inter-rater variability, particularly when parents and teachers complete slightly different versions of the same rating scale. The present study examined the associations between parent- and teacher-reported executive functions in 84 children, ages 4-5 years, with and without symptoms of ADHD, using the Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P). Use of the BRIEF-P allows for direct comparison of symptom ratings because parents and teachers complete the exact same measure. Significant associations between raters were observed on 4 of 5 BRIEF-P subscales when rating children with ADHD, but on only 1 subscale when rating typically developing (TD) children. The Shift scale in particular displayed low, non-significant inter-rater association in both groups. Significant group-by-rater interactions were observed for Working Memory and Plan/Organize scales, and driven by larger inter-rater T-score discrepancies in the TD group, such that teachers rated children as having more symptoms than parents. Conversely, examination of raw scores reflected no significant rater differences in the TD group, but significant or nearly significant differences on multiple scales in the ADHD group, such that parents rated more symptoms than teachers. Inter-rater associations for the BRIEF-P appear to vary based on who is being rated (i.e., children with or without ADHD), the specific subscales, and whether standardized or raw scores are analyzed.

[Formula: see text] Reliable change in pediatric brain tumor: A preliminary investigation.

Children treated for brain tumor show evidence of declines in general intellectual abilities (i.e., IQ). Group-level data indicate subtle declines over time on average, but no study has utilized a clinical criterion to identify and describe a reliable change in survivors of pediatric brain tumor (PBT). In this study, we discuss the utility of reliable change index (RCI) methodology to supplement group-level analysis (e.g., repeated measures ANOVA). This pilot sample consisted of 22 children (M age = 10.47 years) treated for PBT who completed initial and follow-up assessments (M interval = 23.58 months). Cognitive data included composite scores from the WISC-IV. An RCI z-score was calculated for each participant on each composite score based on two different test-retest reliability coefficients. As a group, survivors of PBT did not demonstrate a statistically significant change from initial to follow-up on any WISC-IV composite score. When RCI was calculated based on reliability coefficients with shorter test-retest intervals provided by the test publisher, 77% of survivors demonstrated a reliable change in performance on at least one measure. The frequency of RCI decreases in working memory was significantly higher than expected. In contrast, only 32% of survivors showed reliable changes on at least one measure when RCI was based on a reliability coefficient derived from a clinical sample with a longer retest interval. This study demonstrates that highly divergent results may be obtained with RCI and the importance of the source of reliability estimates.

Subtle Motor Signs and Executive Functioning in Chronic Paediatric Traumatic Brain Injury: Brief Report.

Background: Children with traumatic brain injury (TBI) are reported to have persistent deficits in executive functioning and subtle motor functionsAim: This study examined the relationship between subtle motor signs and executive functioning in children with TBIMethods: Eighteen children aged 13-18 years with mild to severe TBI at least one year before study participation and 16 age-matched typically-developing controls were examined using the Revised Physical and Neurological Examination of Subtle Signs (PANESS), a simplified Go/No-go task, portions of the Delis-Kaplan Executive Function System Verbal Fluency and Trail Making tests, and a Wechsler Coding testResults: There were significant associations between PANESS scores and executive functioning measures in children with TBI but not in controls. Conclusion: Results suggest that assessment of subtle motor signs may provide broader information regarding functioning after pediatric TBI.

Initial Examination of the BRIEF2 in Clinically Referred Children With and Without ADHD Symptoms.

Objective: Clinical utility of the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) was examined in 1,381 clinically referred youth (62.5% male, 5 to 18 years) with and without ADHD symptoms. Method: Participants included children with restricted inattentive symptoms (IA only), restricted hyperactivity/impulsivity symptoms (HI only), symptoms in both domains (Combined), and non-ADHD clinical comparison. Results: Greater hyperactivity (Combined, HI only) was associated with higher Behavior Regulation (BRI) and Emotion Regulation (ERI) scores, whereas greater inattentiveness (IA only, Combined) was associated with higher Cognitive Regulation scores. Effect sizes were largest for Inhibit, Working Memory, and Organization of Materials scales; these scales discriminated children with and without ADHD symptoms and restricted inattentive and hyperactive presentations. Conclusion: The BRIEF2 distinguishes associated features of ADHD and the day-to-day executive impact. Sensitivity was consistently poorer than specificity. The referred nature of the sample and examination of restricted presentations suggest additional work is needed to examine whether ERI and BRI are dissociable.

Multivariate genome-wide association study of rapid automatised naming and rapid alternating stimulus in Hispanic American and African-American youth.

BACKGROUND: Rapid automatised naming (RAN) and rapid alternating stimulus (RAS) are reliable predictors of reading disability. The underlying biology of reading disability is poorly understood. However, the high correlation among RAN, RAS and reading could be attributable to shared genetic factors that contribute to common biological mechanisms. OBJECTIVE: To identify shared genetic factors that contribute to RAN and RAS performance using a multivariate approach. METHODS: We conducted a multivariate genome-wide association analysis of RAN Objects, RAN Letters and RAS Letters/Numbers in a sample of 1331 Hispanic American and African-American youth. Follow-up neuroimaging genetic analysis of cortical regions associated with reading ability in an independent sample and epigenetic examination of extant data predicting tissue-specific functionality in the brain were also conducted. RESULTS: Genome-wide significant effects were observed at rs1555839 (p=4.03×10-8) and replicated in an independent sample of 318 children of European ancestry. Epigenetic analysis and chromatin state models of the implicated 70 kb region of 10q23.31 support active transcription of the gene RNLS in the brain, which encodes a catecholamine metabolising protein. Chromatin contact maps of adult hippocampal tissue indicate a potential enhancer-promoter interaction regulating RNLS expression. Neuroimaging genetic analysis in an independent, multiethnic sample (n=690) showed that rs1555839 is associated with structural variation in the right inferior parietal lobule. CONCLUSION: This study provides support for a novel trait locus at chromosome 10q23.31 and proposes a potential gene-brain-behaviour relationship for targeted future functional analysis to understand underlying biological mechanisms for reading disability.

Processing speed in children treated for brain tumors: effects of radiation therapy and age.

The current study examined processing speed in children two years post-treatment for brain tumors (BT) with radiation therapy (RT) compared to those treated with without RT. Participants included 59 children (4-17 years) with BT assessed as part of the Brain Radiation Investigative Study Consortium (BRISC). Processing speed was assessed at two time points: Time1 (3-9 months post-surgery) for 26 children who received whole brain or focal RT (RT group) and 33 treated without RT (no-RT group), and again two years later (Time2) for 42 participants (17 RT, 25 no-RT). Linear mixed effects (LME) regression analyses examined differences in cognitive and motor speed between groups and across visits, with age at Time1 (age1) treated as a moderating variable, and sex and primary tumor size as covariates. No effects for treatment group or visit were found for motor speed (Pegboard) or mean reaction time (Attention Network Task). On the Wechsler Processing Speed Index (PSI), the no-RT group performed better than the RT group, with a group-by-age interaction such that across visits, the difference between the no-RT and RT groups was larger among children who were older at initial treatment (≥10 years) than among those who were younger (<10 years). Cumulative brain injury earlier in life (tumor, surgery, plus RT) may result in greater impact on more complex tasks of cognitive efficiency. Children receiving RT showed reduced processing speed over time, with a larger group difference among those who were over 10 years at treatment.

Sluggish Cognitive Tempo Predicts Academic Fluency, Beyond Contributions of Core Academic Skills, Attention, and Motor Speed.

OBJECTIVE: Sluggish Cognitive Tempo (SCT) is a distinct behavioral phenotype characterized by such symptoms as being slow to complete tasks, appearing drowsy or sleepy, and lacking initiative. Subcomponents of SCT appear differentially associated with inattention symptoms and child outcomes. Much of the work in this area has examined associations between SCT symptoms and ratings of behavior; few studies have examined associations with child performance. METHOD: We examined associations between SCT and timed reading and math skills in 247 referred youth (M age = 11.55, range = 6-20; 67.6% male), controlling for the untimed academic skills, inattention, and graphomotor speed. RESULTS: SCT consistently predicted timed academic fluency, after controlling for other component skills, for both reading (SCT ΔR2 = .039, p = .001) and math (ΔR2 = .049, p = .001). CONCLUSION: Results provide initial evidence for the unique association of SCT with timed academic performance. Understanding associations of SCT with actual child performance may allow for greater specificity in targeting interventions to address speed of performance.

Causal Attribution Profiles as a Function of Reading Skills, Hyperactivity, and Inattention.

The causes that individuals attribute to reading outcomes shape future behaviors, including engagement or persistence with learning tasks. Although previous reading motivation research has examined differences between typical and struggling readers, there may be unique dynamics related to varying levels of reading and attention skills. Using latent profile analysis, we found 4 groups informed by internal attributions to ability and effort. Reading skills, inattention, and hyperactivity/impulsivity were investigated as functional correlates of attribution profiles. Participants were 1,312 youth (8-15 years of age) of predominantly African American and Hispanic racial/ethnic heritage. More adaptive attribution profiles had greater reading performance and lower inattention. The reverse was found for the least adaptive profile with associations to greater reading and attention difficulties. Distinct attribution profiles also existed across similar-achieving groups. Understanding reading-related attributions may inform instructional efforts in reading. Promoting adaptive attributions may foster engagement with texts despite learning difficulties and, in turn, support reading achievement.

Does Increased Consolidated Nighttime Sleep Facilitate Attentional Control? A Pilot Study of Nap Restriction in Preschoolers.

OBJECTIVE: The aim of this study is to understand the impact of a 5-day period of nap restriction on sleep patterns and cognitive function in typically developing preschoolers, aged 3 to 4 years. METHOD: Following 1 week of baseline assessment, 28 children were randomly assigned to either a "napping as usual" group ( n = 15) or a 5-day period of nap restriction ( n = 13). Sleep was assessed with sleep logs and actigraphy; cognition was assessed at baseline and at the end of the intervention week. RESULTS: No group differences in sleep or cognitive function were observed at baseline. For the no-nap group, the 5-day period of daytime nap restriction resulted in increased nighttime sleep. Children in the no-nap group also showed a significant improvement in attentional control compared with baseline, whereas no such changes were observed among children in the napping-as-usual group. CONCLUSION: In preschool children who typically take naps, short-term nap restriction is associated with increased nighttime sleep and may contribute to improved attentional function.