Tisha J. Ornstein

Neuropsychological performance in childhood OCD: A preliminary study

Background: Neuropsychological deficits have often been found in studies of adults with obsessive compulsive disorder (OCD). However, few studies have examined such impairment in children with OCD and of those studies published, the results are mixed. Methods: In the present study, 14 OCD children were compared to 24 healthy developing children of similar age and intellectual ability on a series of neuropsychological tests that assess response inhibition, abstract reasoning and problem solving, planning ability, verbal and nonverbal fluency, working memory, attention and information processing speed, and visual and verbal memory and learning. Results: No significant differences emerged between the children with OCD and healthy controls for working memory, verbal fluency, attention, information processing speed, concept formation/abstraction, and response inhibition. We observed some deficits and a trend toward performance differences between the groups for psychomotor speed and attention, cognitive flexibility, nonverbal fluency, planning ability, and verbal memory and learning. Results are partially consistent with those found in adults with OCD. Findings were not related to depressive symptoms or self‐report feeling of anxiety. Conclusions: This preliminary survey indicates that OCD children may have deficits for cognitive flexibility and planning ability and differ from adults with OCD in not presenting with poor response inhibition or memory deficits. Larger, multi‐site studies are warranted to help delineate the neurocognitive deficits associated with childhood OCD. Depression and Anxiety, 2010.

Performance monitoring in children following traumatic brain injury

BACKGROUND Executive control deficits are common sequelae of childhood traumatic brain injury (TBI). The goal of the current study was to assess a specific executive control function, performance monitoring, in children following TBI. METHODS Thirty-one children with mild-moderate TBI, 18 with severe TBI, and 37 control children without TBI, of comparable age and sex, performed the stop signal task, a speeded choice reaction time task. On occasion, they were presented with a signal to stop their responses. Performance monitoring was defined as the extent of slowing in go-task reaction time following failure to stop responses. RESULTS The TBI group as a whole demonstrated less post-error slowing than did controls. This finding suggested impaired error monitoring performance. In addition, time since injury and socioeconomic status predicted less slowing after stopped responses. CONCLUSIONS We suggest that alterations in performance monitoring expressed as the inability to notice, regulate and adjust behavior to changing situations are an effect of TBI in children.

The Manifestation of Anxiety Disorders after Traumatic Brain Injury: A Review

The development of anxiety disorders after a traumatic brain injury (TBI) is a strong predictor of social, personal, and work dysfunction; nevertheless, the emergence of anxiety has been largely unexplored and poorly understood in the context of TBI. This article provides an overview of the limited published research to date on anxiety disorders that are known to develop after TBI, including post-traumatic stress disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, specific phobia, and social anxiety disorder. This review also examines diagnostic criteria, the epidemiology of each disorder, and the factors that influence the expression of these conditions, including injury-related and psychosocial variables. Putative neural correlates will be reviewed where known. A discussion of current treatment options and avenues for further research are explored.

Response inhibition in children with and without ADHD after traumatic brain injury

Children with attention-deficit hyperactivity disorder (ADHD) and traumatic brain injury (TBI) show deficient response inhibition. ADHD itself is a common consequence of TBI, known as secondary ADHD (S-ADHD). Similarity in inhibitory control in children with TBI, S-ADHD, and ADHD would implicate impaired frontal-striatal systems; however, it is first necessary to delineate similarities and differences in inhibitory control in these conditions. We compared performance of children with ADHD and those with TBI without pre-injury ADHD on a stop signal, response inhibition task. Participants were 274 children aged 6-14 years. There were 92 children with ADHD, 103 children with TBI, and 79 typically developing children who served as controls. Among the TBI participants, injury severity ranged from mild to severe. Children with ADHD and TBI showed deficient inhibition. The deficit in children with ADHD was as great as or greater than that in children with TBI, regardless of degree of TBI severity or the presence of S-ADHD. The finding indicates that TBI results in deficient inhibition regardless of the development of S-ADHD.

Neuropsychological Performance of Youth with Secondary Attention-Deficit/Hyperactivity Disorder 6- and 12-Months after Traumatic Brain Injury

The present study compared executive dysfunction among children with attention-deficit/hyperactivity disorder (ADHD) after traumatic brain injury (TBI), also called secondary ADHD (S-ADHD), pre-injury ADHD and children with TBI only (i.e., no ADHD). Youth aged 6-16 years admitted for TBI to five trauma centers were enrolled (n=177) and evaluated with a semi-structured psychiatric interview scheduled on three occasions (within 2 weeks of TBI, i.e., baseline assessment for pre-injury status; 6-months and 12-months post-TBI). This permitted the determination of 6- and 12-month post-injury classifications of membership in three mutually exclusive groups (S-ADHD; pre-injury ADHD; TBI-only). Several executive control measures were administered. Unremitted S-ADHD was present in 17/141 (12%) children at the 6-month assessment, and in 14/125 (11%) children at 12-months post-injury. The study found that children with S-ADHD exhibited deficient working memory, attention, and psychomotor speed as compared to children with pre-injury ADHD. Furthermore, the children with S-ADHD and the children with TBI-only were impaired compared to the children with pre-injury ADHD with regard to planning. No group differences related to response inhibition emerged. Age, but not injury severity, gender, or adaptive functioning was related to executive function outcome. Neuropsychological sequelae distinguish among children who develop S-ADHD following TBI and those with TBI only. Moreover, there appears to be a different pattern of executive control performance in those who develop S-ADHD than in children with pre-injury ADHD suggesting that differences exist in the underlying neural mechanisms that define each disorder, underscoring the need to identify targeted treatment interventions.

The effect of emotion-focused orientation at retrieval on emotional memory in young and older adults

This study examines how emotion-focused orientation at retrieval affects memory for emotional versus neutral images in young and older adults. A total of 44 older adults (ages 61–84 years, M=70.00, SD=5.54) and 43 young adults (ages 17–33 years, M=20.58, SD=3.72) were tested on their free recall and forced-choice recognition of images. At retrieval the emotion-focused orientation was manipulated by instructing participants to focus on emotion-related information (i.e., emotional content of images and the emotional reactions evoked by the images). In the control conditions participants were either instructed to focus on visual information or not provided any specific orientation instruction. In free recall but not forced-choice recognition, the emotion-focused orientation increased young adults’ positivity bias and thus wiped out their superior negativity bias. However, the emotion-focused orientation did not affect older adults’ emotional memory. The data suggest that young adults activate and prioritise emotional goals in response to external demand during intentional information processing whereas older adults seem to spontaneously tune themselves to emotional goals.

Assessing accident phobia in mild traumatic brain injury: The Accident Fear Questionnaire.

PURPOSE Despite a documented prevalence of accident phobia in almost 40% of motor vehicle accident (MVA) survivors, the onset of accident phobia after traumatic brain injury (TBI) remains poorly understood. There is currently a body of knowledge about posttraumatic stress disorder (PTSD) in patients with TBI, but less is known about accident phobia following TBI, particularly in cases of mild TBI (mTBI). Accident phobia can impede safe return to driving or motor vehicle travel, inhibiting return to daily functioning. In addition, pain complaints have been found to correlate positively with postinjury anxiety disorders. METHOD The present study sought to determine the reliability and validity of the Accident Fear Questionnaire (AFQ), a measure used to assess accident phobia, in 72 patients with mTBI using secondary data analysis and the subsequent development of accident phobia postinjury. Furthermore, we sought to examine the impact of pain, anxiety, and depression complaints on the AFQ. RESULTS Results reveal convergent validity and reliability in mTBI populations. Additionally, pain, anxiety, and depression measures were significantly correlated with scores on the AFQ. CONCLUSIONS Psychometrically, the phobia avoidance subscale of the AFQ is a reliable measure for use with mTBI populations, although some limitations were found. In particular, the accident profile (AP) subscale was not found to be reliable or valid and could be eliminated from the AFQ. Collectively, the present study contributes to the small body of published literature evaluating accident phobia in patients with mTBI and the impact of pain on the development of postinjury anxiety disorders. (PsycINFO Database Record

Cognitive Fluctuations and Cognitive Test Performance Among Institutionalized Persons With Dementia

Objective: To examine the nature and frequency of cognitive fluctuations (CFs) among institutionalized persons with dementia. Method: A clinical interview and a medical chart review were conducted, and 55 patients were assigned a specific dementia diagnosis. The Severe Impairment Battery (SIB) was administered to assess cognitive function, and the Dementia Cognitive Fluctuation Scale (DCFS) was administered to each patient’s primary nurse to determine the presence and severity of CFs. Results: A simple linear regression model was conducted with DCFS as the predictor variable and SIB total score as the dependent variable. The overall model was significant, suggesting that score on the DCFS significantly predicted SIB total score. Additionally, greater severity of CFs predicted poorer performance in the areas of orientation, language, and praxis. Conclusions: Results suggest that CFs exert a clinically significant influence over patients’ cognitive abilities and should be considered as a source of excess disability.

Outcomes of Cognitive Fluctuations in Dementia Patients

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