Amy Heffelfinger

Glucocorticoid effects on memory function over the human life span

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

Visual attention in preschool children prenatally exposed to cocaine: Implications for behavioral regulation

The presence of cocaine during the prenatal period disrupts the development of neural systems involved in mediating visual attention; therefore, it is possible that prenatal cocaine exposure results in impairments in visual attention in early childhood. In the current study we hypothesized that preschool children with prenatal cocaine exposure would exhibit difficulties in the disengagement operation of visual attention and in sustaining attention, particularly for targets presented in the right visual field. Fourteen cocaine-exposed children and 20 control children between 14 and 60 months of age were assessed on measures of visual attention, cognition, and behavior. Cocaine-exposed children had slower reaction times on disengagement trials in the second half of our attention task, supporting our hypotheses that impairments in disengagement and sustained attention are associated with prenatal cocaine exposure. There was a trend for slower reaction times to targets presented in the right visual field, but not to targets presented in the left visual field. Cocaine-exposed children also exhibited greater difficulties in behavioral regulation. Overall, our findings suggest that children with prenatal cocaine exposure demonstrate specific impairments in visual attention and behavioral regulation.

Differential Performance of the MacArthur HBQ and DISC-IV in Identifying DSM-IV Internalizing Psychopathology in Young Children

OBJECTIVE Three sites collaborated to evaluate the differential performance of the MacArthur Health and Behavior Questionnaire (HBQ) and the Diagnostic Interview Schedule for Children Version IV (DISC-IV) in identifying DSM-IV psychopathology in young children. METHOD A sample of 120 four- to eight-year-old nonreferred (community) (n = 67) and referred (clinical) (n = 53) children was examined. Mothers reported on their childs mental health symptoms using the HBQ (a dimensional measure with a clinical cutoff score) and the DISC-IV. Teachers independently reported on the childs symptoms and impairment in school using the teacher HBQ. Children self-reported on their symptoms using the companion Berkeley Puppet Interview. RESULTS On the basis of its derived clinical cutoff scores, the HBQ identified significantly more children with clinical symptoms of DSM-IVinternalizing psychopathology than the DISC-IV in both referred and nonreferred groups. There was a high level of agreement between the two measures in the identification of externalizing psychopathology. Children identified as having internalizing psychopathology by the HBQ were also rated as highly symptomatic and impaired by teachers. CONCLUSION The findings support the general validity of the parent HBQ for the assessment of young child psychopathology and the hypothesis that it captures more internalizing psychopathology than the DISC-IV in this population.

The relationship of neuropsychological functioning to adaptation outcome in adolescents with spina bifida

Adolescents with spina bifida (SB) vary in their ability to adapt to the disease, and it is likely that numerous risk and protective factors affect adaptation outcomes. The primary aim was to test neuropsychological impairment, exemplified herein by executive dysfunction, as a risk factor in the Ecological Model of Adaptation for Adolescents with SB. Specific hypotheses were that: (1) executive functioning predicts the adaptation outcome of functional independence in adolescents with SB; (2) executive functioning mediates the impact of neurological severity on functional independence; and (3) family and adolescent protective factors are related to functional independence and moderate the relationship between executive functioning and functional independence. Forty-three adolescents aged 12-21 years completed neuropsychological measures and an interview that assessed risk, adolescent and family protective factors, and functional independence. Age, level of lesion, executive functioning, and the protective factor adolescent activities were significantly correlated with the functional independence outcome. In hierarchical regression analysis, the model accounted for 61% of the variance in functional independence outcomes. Executive functioning mediated the impact of neurological severity on functional independence.

A Description of Preschool Neuropsychological Assessment in the P.I.N.T. Clinic after the First 5 Years

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

Neuropsychological characterization of three adolescent females with anti-NMDA receptor encephalitis in the acute, post-acute, and chronic phases: an inter-institutional case series

Abstract Objective: Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is an acute, immune-mediated paraneoplastic syndrome that often presents with psychobehavioral changes, abnormal movements, autonomic instability, seizures, and cognitive dysfunction. While the disease continues to be more readily identified and appropriately treated, the course of cognitive deficits from the acute to post-acute to chronic phase has not been well described, particularly in the pediatric population. This case series describes the neuropsychological functioning of three adolescent females with anti-NMDA receptor encephalitis from its early presentation to long-term follow-up.Method: All three cases are adolescent females with antibody-confirmed anti-NMDA receptor encephalitis. A review of the literature is provided summarizing the disorder and its known cognitive sequelae, pathophysiology, treatment, and prognostic factors, as well as each patient’s relevant history, symptom presentation, and disease course. Neuropsychological functioning of each patient was evaluated from her initial inpatient hospitalization to long-term follow-up (3.5–12 months after acute evaluation).Results: All three patients demonstrated clear improvement in cognitive functioning during the course of their recovery, though selected deficits in executive functioning, fine motor dexterity, language, and memory were observed at long-term follow-up in some of our patients.Conclusions: Findings are consistent with studies in adults that found cognitive deficits following anti-NMDA receptor encephalitis. Though gradual recovery was noted over time, all three patients reported no clinically significant difficulties during their final evaluation, despite showing mild impairment in some areas, emphasizing the importance of ongoing neuropsychological follow-up.

Associations Among Parent-Child Relationships and Cognitive and Language Outcomes in A Clinical Sample of Preschool Children

Abstract Objective: To examine associations among parent–child relationship characteristics and child cognitive and language outcomes. Methods: Preschool children (n = 72) with early neurological insult completed assessments of cognitive and language functioning and participated in a parent–child semi-structured interaction. Results: Quality of the parent–child relationship accounted for a significant amount of unique variance (12%) in predicting children’s overall cognitive and language functioning. Impact of neurological insult was a significant predictor. Conclusions: Caregiver–child interactions that are harmonious and reciprocal as evidenced by affective and/or verbal exchanges support children’s cognitive and language development. Observations of interactions can guide providers in facilitating child- and family-centered interventions.

Taxonomy for Education and Training in Clinical Neuropsychology: past, present, and future

Abstract Objective: Historically, the clinical neuropsychology training community has not clearly or consistently defined education or training opportunities. The lack of consistency has limited students’ and trainees’ ability to accurately assess and compare the intensity of neuropsychology-specific training provided by programs. To address these issues and produce greater ‘truth in advertising’ across programs, CNS, with SCN’s Education Advisory Committee (EAC), ADECN, AITCN, and APPCN constructed a specialty-specific taxonomy, namely, the Taxonomy for Education and Training in Clinical Neuropsychology. The taxonomy provides consensus in the description of training offered by doctoral, internship, and postdoctoral programs, as well as at the post-licensure stage. Although the CNS approved the taxonomy in February 2015, many programs have not adopted its language. Increased awareness of the taxonomy and the reasons behind its development and structure, as well as its potential benefits, are warranted. Methods: In 2016, a working group of clinical neuropsychologists from the EAC and APPCN, all authors of this manuscript, was created and tasked with disseminating information about the taxonomy. Group members held regular conference calls, leading to the generation of this manuscript. Results: This manuscript is the primary byproduct of the working group. Its purpose is to (1) outline the history behind the development of the taxonomy, (2) detail its structure and utility, (3) address the expected impact of its adoption, and (4) call for its adoption across training programs. Conclusions: This manuscript outlines the development and structure of the clinical neuropsychology taxonomy and addresses the need for its adoption across training programs.

Never, Ever Shake a Baby: Pass It On

At that moment, the sun stopped shining and our happy, carefree world came crumbling down. We were told our healthy 4½-month-old baby boy was in critical condition and could die. Our son, Jeremy, had just learned to smile about a week before, and now his smile was gone.

Secondary conditions in adolescents and young adults (AYA) with spina bifida (SB) in Four US Programs

Background Spina bifida affects one out of every 1200 to 1400 live births each year in the United States. Secondary conditions related to the level of the SB lesion (LOL) such as incontinence, skin breakdown, obesity, pain, and orthopedic problems (e.g., scoliosis) are common. The purpose of this presentation is to address the following questions: 1) What is the frequency of key secondary conditions (bowel/bladder status, skin breakdown, UTIs, pain, overweight, scoliosis, latex allergy)? 2) Are select secondary conditions related to LOL, school, peer or employment activities? 3) How satisfied are participants with their bowel/bladder program and is satisfaction related to clinical variables?