Rayna B. Hirst

Adherence to Validity Testing Recommendations in Neuropsychological Assessment: A Survey of INS and NAN Members

Objective The National Academy of Neuropsychology (NAN) has published recommendations for best validity testing practices, as has the American Academy of Clinical Neuropsychologists (AACN) in their review of critical issues in the field. However, surveys show not all neuropsychologists follow these recommendations consistently. Examiner characteristics (e.g., training history) and current practice characteristics (e.g., type of practice setting) may affect systematic adherence to these recommendations. Further, previous surveys focused on distinct countries or continents rather than an international sample. This study sought to provide better understanding of examiner factors that contribute to recommendation adherence and identify opportunities for improving validity testing training and practice. Method A sample of 654 NAN and International Neuropsychological Society (INS) neuropsychologists responded to online survey questions about their demographic, training, and practice characteristics, as well as validity testing practices. Results Findings indicate that neuropsychologists from other countries generally adhere to NAN and AACN recommendations as closely as United States neuropsychologists. Across all neuropsychologists, those who work with pediatric and geriatric populations do not follow recommendations as consistently as those who work with adults, despite research supporting that recommendations should be followed with all patients. Neuropsychologists who have been practicing longer were also less likely to adhere to recommendations, suggesting that continuing education would be beneficial even for more experienced neuropsychologists. Conclusions Results highlight the need for continued training on the importance of validity testing practices across different countries and all assessment settings, and identify groups of neuropsychologists to whom training could be targeted to maximize effectiveness.

Subjective, but Not Objective Sleep is Associated with Subsyndromal Anxiety and Depression in Community-Dwelling Older Adults

OBJECTIVE To examine the relationship between subclinical anxiety and depressive symptoms and objective sleep architecture measures and subjective sleep reports in older adults. METHODS Community-dwelling older adults (N = 167) self-rated their current severity of anxiety symptoms, depressive symptoms, daytime sleepiness, and global sleep quality. Participants received overnight ambulatory polysomnography to assess sleep architecture. Multivariate linear regression models examined associations between anxiety and depressive symptoms and objective and subjective sleep measures. RESULTS Significant findings emerged for subjective sleep, with higher depression and anxiety scores associated with worse global sleep quality and greater anxiety scores associated with greater daytime sleepiness. No significant associations were observed between subclinical levels of anxiety or depressive symptoms with sleep architecture. CONCLUSION Subclinical levels of late-life anxiety and depression have distinct associations with subjective sleep disturbance. Findings implicate subjective measures of sleep quality and daytime sleepiness as stronger trait markers for subthreshold psychiatric symptoms than objective sleep biomarkers.

Anorexia nervosa and bulimia nervosa: A meta-analysis of executive functioning

Objective Research investigating the link between eating disorder (ED) diagnosis and executive dysfunction has had conflicting results, yet no meta‐analyses have examined the overall association of ED pathology with executive functioning (EF). Method Effect sizes were extracted from 32 studies comparing ED groups (27 of anorexia nervosa, 9 of bulimia nervosa) with controls to determine the grand mean effect on EF. Analyses included effects for individual EF measures, as well as an age‐based subgroup analysis. Results There was a medium effect of ED diagnosis on executive functioning, with bulimia nervosa demonstrating a larger effect (Hedges’s g = −0.70) than anorexia nervosa (g = −0.41). Within anorexia nervosa studies, subgroup analyses were conducted for age and diagnostic subtype. The effect of anorexia nervosa on EF was largest in adults; however, subgroup differences for age were not significant. Conclusions Anorexia and bulimia nervosa are associated with EF deficits, which are particularly notable for individuals with bulimia nervosa. The present analysis includes recommendations for future studies regarding study design and EF measurement. HighlightsIndividuals with anorexia nervosa show small to moderate impairments in executive functioning.Individuals with bulimia nervosa show moderate to large impairments in executive functioning.Both sets of studies demonstrated homogeneity in outcomes.Neither age nor diagnostic subtype subgroup analyses of anorexia nervosa were significant.

Trying to remember: Effort mediates the relationship between frequency of cannabis use and memory performance

ABSTRACT Introduction: While many studies suggest that regular cannabis use leads to deficits in cognitive functioning, particularly in memory, few have measured effort put forth during testing, and none have examined this as a potential mediator. Both age of onset of regular cannabis use and frequency of use have been linked to increased risk of memory deficits. The present study sought to determine whether effort mediated the relationship between frequency or age of onset of cannabis use and learning and memory performance. Method: Sixty-two participants (74% male, mean age = 19.25 years) who met criteria for chronic cannabis use (four or more days per week for at least 12 months) completed a neuropsychological battery including the California Verbal Learning Test-II (CVLT-II) and the Rey Complex Figure (RCF) as measures of learning and memory, and the Word Memory Test (WMT) as a measure of effort put forth during neuropsychological assessment. Results: Participants who more frequently used cannabis exhibited poorer effort (as measured by WMT performance; p < .01). Bootstrapping yielded 95% confidence intervals for indirect effects and revealed that effort significantly mediated the relationship between frequency of cannabis use and CVLT-II Learning (Sum of Trials 1–5), CVLT-II Delayed Recall, and RCF Delayed Recall, but not RCF Immediate Recall. Age of onset of cannabis use was not significantly related to effort. Conclusions: Findings indicate that effort mediates the relationship between frequency of cannabis use and performance on learning and memory measures, suggesting that effort performance should be measured and controlled for in future studies assessing cognition in frequent cannabis users.

The D-KEFS Trails as performance validity tests.

This study was designed to examine the potential of the Delis-Kaplan Executive System (D-KEFS) version of the Trail Making Test (TMT) as a performance validity test (PVT). Data were collected from a mixed clinical sample of 157 consecutively referred outpatients (49% male, MAge = 47.1, MEducation = 13.6) undergoing neuropsychological assessment at an academic medical center in the northeastern United States. Sensitivity and specificity of the D-KEFS Trails to psychometrically defined invalid responding was calculated across various cutoffs and criterion PVTs. The D-KEFS Trails produced classification accuracy comparable to the original version of the TMT, hovering around the “Larrabee limit” (.50 sensitivity at .90 specificity). Different cutoffs (age-corrected scaled score ⩽5 on Trails 1–3, ⩽4 on Trails 4 and ⩽8 on Trails 5) were needed to achieve the same classification accuracy across the five trials. Combining multiple cutoffs improved the signal detection performance. The study provides preliminary evidence of the utility of D-KEFS Trails as a PVT. Embedded PVTs are valuable, because they make a multivariate approach to validity assessment feasible. Combining validity indicators is superior to relying on single cutoffs.

Bell Ringers: Factors Related to Concussive Events in Children Playing Tackle Football

INTRODUCTION Sports-related concussion is a significant pediatric health risk, given the number of children involved in sports and the vulnerability of developing brains. Although most research has focused on high school/college athletes, these findings may not be applicable to younger athletes. METHOD A mixed-methods analysis examined concussion incidence and sequelae in a cohort of 8- to 13-year-old males (N = 31) playing youth football and their parents. Parents provided background information and completed mood/behavioral questionnaires, and each athlete completed a neuropsychological battery. RESULTS Eight athletes (26%) had a history of concussion before assessment. Concussion risk was related to lack of medical evaluation in prior concussions, tackling exposure (in both offensive and defensive positions), and multisport participation. There were no cognitive or psychological differences based on concussion history. DISCUSSION Findings identify factors that may contribute to concussion risk in children and show the need for further research in this understudied population.

Perceptions of the cognitive effects of cannabis use: A survey of neuropsychologists’ beliefs

ABSTRACT Introduction: Research evaluating the neuropsychological effects of cannabis has yielded mixed findings, with some studies finding cognitive deficits in cannabis users (primarily in learning and memory) and others finding no significant effects. It is important to understand how clinicians perceive this discrepancy in the empirical literature. However, no studies have assessed neuropsychologists’ beliefs regarding the effects of cannabis on cognitive functioning. Thus, this study sought to evaluate how patient and cannabis-use factors influence neuropsychologists’ perceptions of cannabis’s cognitive effects. Method: Neuropsychologists (N = 261) read eight vignettes, each depicting cannabis users varying in age, gender, and cannabis-use history (frequency, duration, and recreational/medicinal use). Respondents rated the anticipated effects of cannabis in each vignette on nine cognitive domains. Mixed effects linear regression modeled the ratings of cognitive abilities as a function of neuropsychologist, neuropsychologists’ training, vignette, patient age, gender, and frequency/duration/type of cannabis use, and treated neuropsychologist and vignette as random effects. Results: Duration of use had the most notable effect on neuropsychologists’ ratings, with a small (0.1 to 0.2 SDs) yet statistically significant (p < .001) negative effect on each cognitive domain. Male gender and medicinal use also predicted lower cognitive ratings. Differences in ratings between neuropsychologists accounted for 73% of the total variability in each domain, whereas variability due to vignette alone was negligible (<1%). Conclusions: Results suggest that neuropsychologists believe that cannabis use results in broad but mild cognitive deficits, consistent with meta-analytic findings of active chronic cannabis users, particularly for males and for individuals using cannabis for medicinal purposes. Interestingly, neuropsychologists expected fewer cognitive effects in recreational cannabis users. Further, duration of use (rather than frequency) was believed to be the primary factor contributing to cognitive deficits.

Embedded performance validity indicator for children: California Verbal Learning Test – Children’s Edition, forced choice

ABSTRACT Performance validity testing in children undergoing neuropsychological testing is a growing research area. Accurate identification of performance validity is necessary to avoid invalid assessment conclusions. In the present research, a forced choice (FC) trial was created for the California Verbal Learning Test – Children’s Edition (CVLT-C), modeled after the established California Verbal Learning Test – Second Edition (CVLT-II) FC trial. Distractor words were taken directly from the CVLT-II FC Standard Form, with about half being concrete (n = 8) and half abstract (n = 7). The order of the items was organized similarly to the CVLT-II FC to ensure that items from within the same category were not sequential. The Test of Memory Malingering was administered for comparison, and three embedded measures that have previously been validated in adults were also calculated. The CVLT-C FC trial was administered to 40 children, aged 6–16 (M = 12.08, SD = 3.13). Average full scale IQ was 97.3 (SD = 12.41, range = 71–123). Ninety-three percent of examinees performed perfectly on the CVLT-C FC, suggesting high specificity, which is similar to findings for the CVLT-II FC normative group (90%). Results from other embedded measures are also presented.

Motivation in Chronic Cannabis Use

Abstract Although a commonly associated stereotype of chronic cannabis users is a lack of motivation, sometimes referred to as the “amotivational syndrome,” the empirical evidence is contradictory, with many studies finding no evidence to support it. In this chapter, the authors will examine the evidence for and against motivational deficits in chronic cannabis users through studies assessing self-report, educational and occupational achievement, and laboratory measures of motivation. Methodological variability likely contributes to the conflicting evidence demonstrated, and limitations of research designs will be described. Further, a distinction must be made between research examining the acute effects of cannabis use, and the long-term effects on those who use regularly but are not currently intoxicated. Finally, the authors describe the importance of measuring motivation in users within the research design, and suggest a unique method for enhancing the motivation of chronic cannabis users during research participation.

Longitudinal association of delta activity at sleep onset with cognitive and affective function in community-dwelling older adults

This investigation sought to determine whether delta activity at sleep onset (DASO) in the sleep electroencephalography of older adults represents normal variation or is associated with clinical pathology. To this end, we examined its longitudinal associations with cognitive and affective function in older adults without dementia.