Cheryl H. Silver

Ecological validity of neuropsychological assessment in childhood traumatic brain injury.

Empirical investigation of the degree to which testing predicts childrens real-world functioning following traumatic brain injury (TBI) is sparse. This article reviews the research in neuropsychology, which offers only moderate correlations between test scores and everyday functioning. This line of research is hindered by several methodological issues: difficulty translating performance on standardized testing into real-world capacities, measurement of real-world functioning, developmental factors, and the influence of intervening variables in the natural environment. Ecologically valid assessment may require multiple data sources. More research is needed to respond effectively to questions about childrens everyday functioning after traumatic brain injury.

Stability of Arithmetic Disability Subtypes

Cross-sectional research has identified subtypes of children with learning disabilities who may have distinctive cognitive ability patterns. This study examined the stability over 19 months of academic subtyping classifications for 80 children ages 9 to 13 representing four subtypes of arithmetic disabilities (AD), using three criteria for learning disability identification. Approximately half of the sample retained AD regardless of identification method. Children with pervasive deficits in arithmetic, reading, and spelling displayed the greatest subtype stability. Only one third of the children with the other subtypes, including those with isolated arithmetic deficits, retained their original subtypes. Thus, drawing conclusions and making recommendations based on academic subtyping at a single point in time may be unwise.

Attention Training for School-Aged Children with ADHD: Results of an Open Trial.

Objective: The article discusses a feasibility study conducted to examine whether Pay Attention!, an intervention training sustained, selective, alternating, and divided attention, could be utilized in a clinical setting with children diagnosed with ADHD, and whether children who received the intervention made attention and executive functioning gains. Method: After a diagnostic and baseline evaluation, 23 school-aged children with ADHD participate in up to 16 sessions of Pay Attention! and the outcomes are evaluated. Results: Results show the intervention is feasible to administer and acceptable to participants. Parents and clinicians rate fewer ADHD symptoms following the intervention and report improvements in executive function. Child performance on neuropsychological tests showed improvements in fluid reasoning and cognitive flexibility and working memory. Conclusion: The findings suggest that a randomized clinical trial of Pay Attention! is warranted to investigate its viability as a treatment for attention and executive functioning deficits in ADHD. (J. of Att. Dis. 2010; 14(1) 86-94)

Sources of data about children's executive functioning: review and commentary.

Accurate measurement of a child’s executive functioning (EF) is important for diagnosis, description of functional impairment, and treatment planning. EF assessment typically consists of administration of a battery of performance-based tests involving abilities such as attention, inhibition, reasoning, planning, and mental flexibility. In recent years, observer (e.g., parent) rating scales have been added to the typical EF battery. However, research has revealed that performance-based tests and parent rating scales are not highly correlated. In other words, level of impairment indicated by one source of data often does not match level of impairment indicated by the other source of data. This disagreement places the clinician in a difficult situation when attempting to interpret evaluation results. The profession of pediatric neuropsychology needs to provide guidance about handling this disagreement. Using the current assessment tools, specific EF subdomains may need to be examined systematically to identify precisely where the disagreements lie. Perhaps the relative validity of the two data sources can be determined, and decisions can be made about what to emphasize and what/when to interpret cautiously. Alternatively, perhaps the goal should be to develop and/or refine measurement tools to increase agreement in order to improve accuracy and validity of test interpretation. At this time, the results of performance-based tests and rating scales of EF are being used together but are not being integrated. Evidence-based practice requires that more work be done to enhance the use of these two sources of data.

Relationship between parenting stress and ratings of executive functioning in children with ADHD

Executive functioning is important to assess in children with attention deficit/hyperactivity disorder (ADHD). Parent report is used to obtain information about a child’s executive functioning; however, parent report can be influenced by many factors. This study’s hypothesis was that higher ratings of children’s executive dysfunction are associated with parenting stress. Parents of 32 children (ages 8-12 years) with ADHD completed the Parenting Stress Index and two executive function rating scales, the BRIEF and CEFS. Stress produced by child and family system characteristics was significantly correlated with composite scores and subscales from the executive function rating scales. Findings suggest that parent ratings of their children’s executive functioning appear related to the stress they experience being parents, particularly with regard to their children’s challenging behaviors.

Introduction to the NAN 2001 Definition of a Clinical Neuropsychologist. NAN Policy and Planning Committee.

At the request of the membership, and at the direction of the President, Dr. Barbara Uzzell, and the Board of Directors (BoD), the National Academy of Neuropsychology (NAN) Policy and Planning Committee has developed the following 2001 Definition of a Clinical Neuropsychologist, as part of NAN’s White Paper series on Professional Policy and Practice. The entire NAN membership has had an opportunity for input to this definition, and it has been clearly endorsed by our membership and the BoD. We believe that the 2001 NAN Definition incorporates the best aspects of the previous work on Definitions of a Clinical Neuropsychologist, if one keeps in mind that the intent is to provide information to managed care and third party payers regarding general neuropsychological practice and minimal educational, experiential, and licensure requirements. An inclusive, expanded, and updated definition referencing the 1989 and 1984 definition articles, published by Division 40 (Clinical Neuropsychology) of the American Psychological Association (APA) was considered necessary as an internal NAN reference document. This 2001 NAN Definition of a Clinical Neuropsychologist underwent three major Policy and Planning Committee revisions, one full membership review and one membership vote (81% endorsement out of 789 votes), and two NAN BoD comprehensive discussions, resulting in unanimous approval by a formal vote of the Board of Directors on May 5, 2001.

Concordance of the Children’s Executive Functions Scale With Established Tests and Parent Rating Scales

An increase can be seen in the number of tests designed to assess executive dysfunction in children, but few address ecological validity by attempting to measure functioning in the natural environment. This study examined the utility of the Children’s Executive Functions Scale (CEFS), a 99-item parent-report measure. The CEFS was designed to measure a variety of behaviors related to executive functioning, including social appropriateness, inhibition, problem solving, initiative, and motor planning. A sample of 59 children was evaluated with the CEFS, established tests of executive functioning, Child Behavior Checklist, and Conners’ Rating Scale. Correlations between the CEFS and the test variables were modest and produced a pattern slightly different from correlations obtained for the other parent report measures. The CEFS was significantly correlated with the other parent report measures; however, the magnitude of the coefficients suggests that the CEFS is providing unique information.

Test Security: Official position statement of the National Academy of Neuropsychology

A major practice activity of neuropsychologists is the evaluation of behavior with neu-ropsychological test procedures. Many tests, for example, those of memory or ability to solve novel problems, depend to varying degrees upon a lack of familiarity with the test items. Hence, there is a need to maintain test security to protect the uniqueness of these instruments. Test Security), which specify that these procedures are to be used only by psychologists trained in the use and interpretation of test instruments (APA Principles 2.01, 2.06, Unqualified Persons). In the course of the practice of psychological and neuropsychological assessment, neuropsychologists may receive requests from attorneys for copies of test protocols, and/or requests to audio or videotape testing sessions. Copying test protocols, video and/or audiotaping a psychological or neuropsychological evaluation for release to a non-psychologist violates the Ethical Principles of Psychologists and Code of Conduct (APA, 1992), by placing confidential test procedures in the public domain (APA Principle 2.10), and by making tests available to persons unqualified to interpret them (APA Principles 2.02, 2.06). Recording an examination can additionally affect the validity of test performance (see NAN position paper on Third Party Observers). Such requests can also place the psychologist in potential conflict with state laws regulating the practice of psychology. Maintaining test security is critical, because of the harm that can result from public dissemination of novel test procedures. Audio-or video-recording a neuropsychological examination results in a product that can be disseminated without regard to the need to maintain test security. The potential disclosure of test instructions, questions, and items by replaying recorded examinations can enable individuals to determine or alter their responses in advance of actual examination. Thus, a likely and foreseeable consequence of uncontrolled test release is widespread circulation, leading to the opportunity to determine answers in advance, and to manipulation of test performance. This is analogous to the situation in which a student gains access to test items and the answer key for a final examination prior to taking the test. Threats to test security by release of test data to non-psychologists are significant.The Policy and Planning committee wishes to acknowledge the important contribution of Mr. John Craver for his careful analysis and helpful comments on this project.

American parent perspectives on quality of life in pediatric cochlear implant recipients.

Objectives: Cochlear implantation influences not only communication but also psychosocial outcomes in children with severe to profound hearing loss. Focusing on issues specific to cochlear implantation (e.g., self-reliance, social relations, education, effects of implantation, and supporting the child) may provide a more accurate and relative view of functional status of pediatric cochlear implant (CI) recipients. The present study analyzes parental perspectives of CI-specific health-related quality of life (HRQoL) in children with CIs to determine (a) if parents differentially rate their child’s quality of life according to psychosocial domain (e.g., communication, self-reliance, education); (b) if associations exist between quality of life domains specific to cochlear implantation in pediatric implant recipients; and (c) if demographic variables (i.e., chronologic age, age at cochlear implantation, duration of device experience) mediate parent ratings of quality of life in pediatric CI recipients. Design: Parents of 33 children with CIs (mean age, 9.85 years; mean age of CI activation, 2.47 years; mean device experience, 7.47 years) completed a validated condition-specific questionnaire, Children With Cochlear Implants: Parental Perspectives. Results: Parents positively rated most HRQoL domains, although education and effects of implantation received significantly less positive ratings (p < 0.01). Three domains (communication, self-reliance, and well-being) significantly correlated with at least 5 other domains, suggesting that positivity in one domain co-occurs with positivity in other domains. Demographic variables (chronologic age, CI activation age, and duration of CI use) did not correlate significantly with psychosocial outcomes; rather, parents reported positive HRQoL and successful functional use of CI across demographic variables. Conclusions: Parents of children and adolescents with CIs rate overall HRQoL positively across psychosocial domains. Significantly less positive ratings of education and effects of implantation may result from limited access to CI-related accommodations and varying parent expectations, warranting further exploration to maximize psychosocial and performance outcomes in pediatric CI users.

Voices of leadership: wisdom from women leaders in neuropsychology

Abstract Objective: Inspired by panel discussions at various neuropsychology conferences, the aim of this paper is to share wisdom that women in neuropsychology acquired from their leadership experiences. Method: We identified 46 women leaders in governance and academic research through reviews of organizational websites and journal editorial boards, and requested their response to brief questions via email. Twenty-one leaders provided responses to three questions formulated by the authors. Results: This paper summarizes the primary themes for the following questions: (1) What advice would you give to a woman neuropsychologist who is seeking to move into a leadership role? Responses included: increase visibility, make connections, know yourself, be confident, and gather information. (2) What leadership style(s) works best? No respondents endorsed a ‘best’ leadership style; however, they suggested that leaders should know their own personal style, be open and transparent, find a shared mission, and most importantly – use a collaborative approach. (3) What helps a woman earn respect as a leader in neuropsychology? Respondents recommended that leaders should: get involved in the work, demonstrate integrity, do your homework, be dependable, and keep meetings focused. Conclusions: It is the authors’ intent that by gathering and distilling advice from successful women leaders in neuropsychology, more women may be catalyzed to pursue leadership roles in our profession.