Gerald Goldstein

The Profile of Memory Function in Children With Autism

A clinical memory test was administered to 38 high-functioning children with autism and 38 individually matched normal controls, 8-16 years of age. The resulting profile of memory abilities in the children with autism was characterized by relatively poor memory for complex visual and verbal information and spatial working memory with relatively intact associative learning ability, verbal working memory, and recognition memory. A stepwise discriminant function analysis of the subtests found that the Finger Windows subtest, a measure of spatial working memory, discriminated most accurately between the autism and normal control groups. A principal components analysis indicated that the factor structure of the subtests differed substantially between the children with autism and controls, suggesting differing organizations of memory ability.

The Pattern of Intact and Impaired Memory Functions in Autism

A battery of tests of auditory and visual memory was used to investigate memory function in 52 high-functioning adolescents and young adults with autism and 40 group-matched normal controls. It was hypothesized that memory dysfunction is present in autism but is not modality specific and is produced by poor utilization of organizing strategies. It was therefore hypothesized that memory impairment in autism would become more prominent as task complexity was increased. The participants with autism performed as well as controls on short-term memory and paired-associate learning tasks, but performed significantly less well than controls on a list learning task. They also performed significantly more poorly on immediate and delayed recall of a story and of a complex geometric figure. On a maze learning task, their performance became progressively worse relative to controls as the complexity of the maze increased. On a series of span tasks, they did not differ from controls on letter span, but did significantly worse on word span and sentences of increasing complexity. These findings indicate a lack of modality specificity and a failure to initiate organizing strategies as evidenced by inefficiency in new learning, poor utilization of contextual cues in story and complex pattern recall, and greater impairment with increasing complexity of the material.

Neuropsychologic functioning in children with autism: further evidence for disordered complex information-processing.

A wide range of abilities was assessed in 56 high-functioning children with autism and 56 age- and IQ-matched controls. Stepwise discriminant analyses produced good group discrimination for sensory-perceptual, motor, complex language, and complex memory domains but lower agreement for the reasoning domain than previously obtained for adults. Group discrimination did not occur for attention, simple language, simple memory, and visuospatial domains. Findings provide additional support for a complex information-processing model for autism, previously based on adult data, demonstrating a pattern across domains of selective impairments on measures with high demands for integration of information and sparing when demands were low. Children as compared to adults with autism exhibited more prominent sensory-perceptual symptoms and less pronounced reasoning deficits reflecting brain maturation.

Neuropsychological heterogeneity in schizophrenia: A consideration of abstraction and problem-solving abilities

The study examines heterogeneity in abstraction and problem-solving abilities among schizophrenic patients through a cluster analysis of scores from the Halstead Category Test, the Tactual Performance Test, Part B of the Trail Making Test and the Wisconsin Card Sorting Test obtained from 136 male schizophrenic inpatients. Extensive heterogeneity was noted among the five clusters extracted, marked by differences in both level and pattern of performance. Efforts were made to find associations between cluster membership and age, education, general intelligence, neurological comorbidity, and medication status. Such associations were noted in all cases, but the role of medication was viewed as equivocal. It was concluded that (i) there is extensive heterogeneity in both pattern and level of performance of schizophrenics on tests of abstraction and problem solving; and (ii) Some, but not all of this heterogeneity is associated with variations in age, education, general intelligence, and neurological comorbidity.

Test-retest reliability of the halstead-reitan battery and the WAIS in a neuropsychiatric population

Abstract Data are presented concerning the test-retest reliability of the Halstead-Reitan battery and the WAIS in a heterogeneous neuropsychiatric sample of 150 patients. Relative reliability or stability of results was evaluated through use of Pearson r correlation coefficients, while absolute reliability, or sensitivity to change in clinical condition, was evaluated with paired sample t tests. Subgroups of alcoholic/trauma, schizophrenic, and vascular disease patients were extracted from the total sample in order to examine for the possibility of different reliability levels among different clinical groups. It was found that most of the components of the Halstead-Reitan battery had psychometrically satisfactory relative reliability levels. However, schizophrenics exhibited significantly lower levels of reliability than did the other subgroups. Differences in absolute reliability were characterized by a greater incidence of improved performance on second testing in the alcoholic/trauma subgroup than in t...

Sources of Heterogeneity in Schizophrenia: The Role of Neuropsychological Functioning

Although schizophrenia is often characterized as a heterogeneous disorder, efforts to validate stable and meaningful subtypes have met with limited success. Thus, the issue of whether schizophrenia reflects a continuum of severity or a number of discrete subtypes remains controversial. This review evaluates efforts to establish subtypes based upon a model that includes causes, characteristics, and course and outcomes of heterogeneity. Emphasis is placed on empirical classification studies utilizing cognitive tests or symptom rating scales, sometimes in conjunction with neuroimaging procedures. Results of recent cluster analytic studies are reviewed that produced evidence of four or five clusters, varying in level and pattern of performance. Although this research typically generated meaningful subtypes, it was often the case that there was little correspondence between subtyping systems based upon cognitive function and those based upon symptom profile. It was concluded that there may be different mechanisms for producing cognitive and symptomatic heterogeneity, and that diversity in presentations of schizophrenia reflects a combination of continuities in severity of the disorder with a number of meaningful and stable subtypes.

Influences on cognitive heterogeneity in schizophrenia

A study was conducted of diagnostic reliability, clinical, demographic, iatrogenic, and neurological comorbidity influences on heterogeneity in cognitive function among schizophrenic patients. Comparisons were made between a previously described (Goldstein, 1990) retrospective sample of clinically diagnosed schizophrenic patients and a new sample based on a prospective study of patients meeting strict DSM-III-R diagnostic criteria for schizophrenia. A cluster analysis of a brief battery of cognitive tests suggested a four cluster solution in both samples. The cluster pattern was found to be similar in both samples, indicating that diagnostic unreliability is unlikely to be strongly associated with heterogeneity. Age, general intelligence, and education were found to have significant influences on cluster membership, with length of illness and hospitalization having less robust influences. It was concluded that heterogeneity has a relatively mild relationship with the various influences studied, but a great deal of the diversity in level and pattern of cognitive function found among schizophrenic patients is likely to be a function of heterogeneity within the disorder itself.

Cognitive rehabilitation of chronic alcohol abusers.

The current literature suggests that individuals who chronically abuse alcohol exhibit a wide variety of cognitive deficits resulting from cerebral dysfunction that is either directly or indirectly related to their alcohol consumption history. Cognitive deficits have been hypothesized as having implications for standard alcohol treatment efficacy as they may directly affect cognitively impaired individuals’ abilities to utilize various treatment modalities. Although evidence is accumulating that suggests this is actually the case, the majority of alcohol treatment programs neither directly consider the impact cognitive deficits have on treatment efficacy nor do they employ cognitive rehabilitation treatment strategies to remediate identified cognitive deficits. Few studies exist that investigate the remediability of neurobehavioral deficits or the efficacy of integrating cognitive rehabilitation strategies into more traditional treatment programs. Empirical investigations conducted to date indicate that some cognitive deficiencies secondary to alcoholism are amenable to cognitive rehabilitation and this remediation is generalizable. Rigorous well-controlled treatment outcome investigations are needed in order to determine the efficacy of cognitive rehabilitation techniques in naturalistic settings using ecological outcome measures. Also, emphasis should be placed on integrating cognitive rehabilitation techniques with proven efficacy into traditional alcoholism treatment programs.

language comprehension in schizophrenics and their brothers

Disturbances in language functioning may be associated with familial vulnerability to schizophrenia. Language comprehension, measured by the Luria-Nebraska Relational Concepts Factor Scale, was evaluated in 36 schizophrenic probands and their nonschizophrenic adult brothers (n = 41), and in 18 normal controls. Language comprehension performance was a function of psychiatric diagnosis in the brothers. Brothers who met criteria for schizophrenia-spectrum disorders showed significantly reduced language performance compared with unaffected brothers and normal controls. Moreover, abnormal language performance was exhibited by significantly more probands and spectrum-disordered brothers than by the normal controls and the brothers without schizophrenia-spectrum disorders. Finally, language performance was not significantly different for 31 pairs of schizophrenic probands and their brothers. Impaired language comprehension appeared comparatively specific in this sample of relatives, as groups were not significantly different on measures of nonlinguistic concept formation (Wisconsin Card Sorting Test) and general intellectual functioning (WAIS-R Information and Block design). Results suggest that impaired language comprehension is associated with familial vulnerability to schizophrenia, and that this disturbance may be most severe in relatives diagnosed with schizophrenia-spectrum disorders.

Factor structure of neurologic examination abnormalities in unmedicated schizophrenia.

The heterogeneity and uncertain significance of neurologic exam abnormalities in schizophrenia prompted us to evaluate their factor structure. We administered a modified version of the Neurological Evaluation Scale (NES) to 103 unmedicated patients with schizophrenia. Data were distilled by combining right- and left-side scores, and by eliminating superfluous, rarely abnormal and unreliable items from the analysis. Exploratory principal components analysis yielded four factors: repetitive motor tasks (fist-ring, fist-edge-palm, alternating fist-palm, dysdiadochokinesis); cognitive-perceptual tasks (memory, audiovisual integration, right-left orientation, face-hand test, rhythm tapping reproduction); balancing tasks (Romberg, tandem gait); and the palmomental reflex. Evaluation of the relationship between these factors and clinical and demographic variables revealed a robust correlation between the cognitive-perceptual factor and full-scale IQ score. This analysis is a step toward developing empirical subscales of a modified NES, which may provide insights into the nature of neurologic impairment in schizophrenia and may prove clinically useful.