Elisabeth M. S. Sherman

Diagnostic Criteria for Malingered Neurocognitive Dysfunction: Proposed Standards for Clinical Practice and Research

Over the past 10 years, widespread and concerted research efforts have led to increasingly sophisticated and efficient methods and instruments for detecting exaggeration or fabrication of cognitive dysfunction. Despite these psychometric advances, the process of diagnosing malingering remains difficult and largely idiosyncratic. This article presents a proposed set of diagnostic criteria that define psychometric, behavioral, and collateral data indicative of possible, probable, and definite malingering of cognitive dysfunction, for use in clinical practice and for defining populations for clinical research. Relevant literature is reviewed, and limitations and benefits of the proposed criteria are discussed.

Neuropsychological outcomes after epilepsy surgery: systematic review and pooled estimates

Purpose:  Epilepsy surgery is a safe surgical procedure, but it may be associated with cognitive changes. Estimates of the risk of decline in specific neuropsychological domains after epilepsy surgery would assist surgical decision making in clinical practice. The goal of this study was to conduct a systematic review to derive pooled estimates of the rate of losses and gains in neuropsychological functions after epilepsy surgery, using empirically based methods for quantifying cognitive change.

ADHD, neurological correlates and health-related quality of life in severe pediatric epilepsy.

Summary:  Purpose: ADHD is reported as a frequent comorbidity in pediatric epilepsy. We aimed to clarify the prevalence of ADHD, its neurological correlates and the role of ADHD in health‐related quality of life (HRQOL) in children with severe epilepsy.

Hemispheric Surgery in Children with Refractory Epilepsy: Seizure Outcome, Complications, and Adaptive Function

Summary:  Purpose: To describe seizure control, complications, adaptive function and language skills following hemispheric surgery for epilepsy.

NEPSY-II: A Developmental Neuropsychological Assessment, Second Edition

The NEPSY-II consists of 32 subtests for use in a neuropsychological assessment with preschoolers, children, and adolescents. This test review provides an overview of the NEPSY-II for clinicians and researchers, including descriptions of the subtests, changes from the original NEPSY, reliability and validity evidence, strengths, and limitations.

Frequency of Scale Elevations and Factor Structure of the Behavior Rating Inventory of Executive Function (BRIEF) in Children and Adolescents With Intractable Epilepsy

The Behavior Rating Inventory of Executive Function (BRIEF) is a standardized rating scale that provides information about the nature and extent of executive function deficits displayed by children and adolescents in daily life. BRIEF protocols completed by parents of 80 children with intractable epilepsy were evaluated with respect to prevalence and severity of scale elevations in the sample, and also with respect to factor structure. Overall, the sample was rated as having significantly more executive function problems than healthy children in the BRIEF standardization sample; elevations on the Working Memory and Plan/Organize scales were most frequently seen. Fully 36% of the sample had four or more significantly elevated scales. However, 31% of the sample had no clinically elevated scales, indicating that executive difficulties, though frequent, are not necessarily characteristic of all children with severe epilepsy. As in the validation studies reported in the manual, a two-factor solution emerged from a principal factor analysis of BRIEF scales. However, the factor structure as given in the manual was not entirely replicated; specifically, the Monitor scale was found to load equivalently on both factors. The results of this study suggest that a substantial proportion of children with intractable epilepsy display significant executive function deficits in daily life. Research into the relationship of BRIEF scores to other measures of executive functioning in children with epilepsy is needed to further clarify its clinical utility.

Executive Dysfunction Is a Significant Predictor of Poor Quality of Life in Children with Epilepsy

Summary:  Purpose: Based on prior research indicating poor health‐related quality of life (HRQOL) in children with attention‐deficit/hyperactivity disorder, we investigated (1) whether executive functioning deficits were related to poor HRQOL in children with epilepsy, (2) how important these variables were in comparison to known predictors of HRQOL such as neurological factors, and (3) the extent to which clinical‐level impairments in executive dysfunction predispose children to low HRQOL.

Social skills problems in children with epilepsy: Prevalence, nature and predictors

To determine the prevalence, nature, and predictors of social skills impairment in children with epilepsy, 101 parents completed the Social Skills Rating System, the Child Behavior Checklist, a general health questionnaire for both their child with epilepsy (aged 3-17) and his or her sibling, a quality-of-life assessment for the child with epilepsy, and Family Assessment Measure III. Epilepsy-specific variables were recorded for each case. Although children with epilepsy had poorer social skills (P<0.05) and were less assertive (P<0.006) than their siblings, the proportion with clinically significant social skills deficits was low and did not differ between groups (13% vs 7%, P=0.12). Neurological factors were related to social skills, but only presence of a learning disability (odds ratio=8.64, 95% CI=1.87-39.98) and abnormal family function (odds ratio=8.75, 95% CI=1.42-53.83) were strongly predictive of social skills impairment. Lower social skills were moderately correlated with epilepsy-specific and global quality of life (P<0.001).

Identifying Cognitive Problems in Children and Adolescents with Depression Using Computerized Neuropsychological Testing

Depression in children and adolescents can negatively impact cognitive functioning, social development, and academic performance. The purpose of this study was to determine whether a computerized battery of neuropsychological tests could detect neurocognitive difficulties in children and adolescents with depression. Participants included 30 children and adolescents between the ages of 9 and 17 years (M = 14.6, SD = 2.1) with a clinical diagnosis of depression. Healthy control participants were individually matched on age, education, sex, race, primary language, handedness, and self-reported computer familiarity. All participants completed the Central Nervous System Vital Signs computerized battery. This battery of seven tests yields 23 test scores and 5 domain scores (Memory, Psychomotor Speed, Reaction Time, Complex Attention, and Cognitive Flexibility). Children and adolescents with depression performed worse on the Memory (Cohens d = .43) and Complex Attention domains (d = .58) than matched controls. On the individual test scores, children and adolescents with depression performed worse on delayed verbal memory (d = .63), delayed visual memory (d = .34), measures of reaction time (d = .34–.53), and accuracy/inhibition on complex attention tasks (d = .49–.65). When considering the five domain scores simultaneously, children and adolescents with depression were more likely to have two or more scores at or below the 5th percentile (p = .05). Children and adolescents with depression have problems with reduced processing speed, memory for verbal information, and executive functioning on this computerized battery of tests, which represents a feasible method for neuropsychological screening.

Deterioration in Cognitive Function in Children With Benign Epilepsy of Childhood With Central Temporal Spikes Treated With Sulthiame

The purpose of this study was to determine if reduction in spike frequency in children with benign epilepsy of childhood with centrotemporal spikes treated with sulthiame correlates with improved neuropsychologic function. Six untreated children (5 boys, 1 girl) with a mean (standard deviation) age of 9.1 years (1.5 years) underwent overnight ambulatory electroencephalograph recording and neuropsychologic evaluation at baseline and after 6 months of sulthiame monotherapy. The Reliable Change Index was used to determine whether a statistically reliable change in neuropsychologic function occurred. All children continued receiving sulthiame monotherapy (dose range, 8.0-9.3 mg/kg per day) for the study period without further seizures. Although spike frequency was reduced in all 6 children (3 showing a decrease to less than 10% of baseline), they all demonstrated significant deterioration in their reading ability, 5 had significant declines in general memory, and more than half had reduction in attention skills and mathematics ability. Although sulthiame was effective at seizure control and significantly reduced spike frequency in children, it was also associated with deterioration in cognitive function.