W.D. Gouvier

Postconcussion symptoms and daily stress in normal and head-injured college populations.

The postconcussion syndrome is a term invoked to describe a constellation of cognitive (decreased memory and concentration), emotional (increased irritability and nervousness or anxiety), and physical (increased headaches and dizziness) changes that are commonly reported following minor or severe head injuries. The first section presents the development and validation of the Postconcussion Syndrome Checklist. The second section describes the daily changes in symptom reports as a function of daily stress levels. A population of head-injured subjects and controls monitored postconcussion symptoms and stress across a 6-week period. The frequency, intensity, and duration of symptoms reported were correlated with daily stress levels as measured by the Daily Stress Inventory for both groups. Yet, the number of symptoms reported by our head-injured group did not vary significantly from the normal subjects. The data support models which predict that postconcussion syndrome varies with stress, but the evidence for a reduction in the cerebral reserve capacity after head injury was not supported with this population. Explanations for this finding are presented and implications of this research and directions for future research are outlined.

Base rates of post-concussional symptoms

Several cognitive, physical and psychological symptoms have been reported as common sequelae of head injury. However, these data have been reported largely in absence of established base rates. This study employed self-report and relative report questionnaires to assess base rates of these symptoms in uninjured subjects. Chi square analysis was used to compare the rate of symptoms reported by head injured subjects, relatives of head injured subjects, uninjured subjects and relatives of uninjured subjects. In most cases, no significant difference was found between the symptoms reported by the head injured group and the uninjured group. These results demonstrate the importance of establishing base rates of symptoms in non-clinical populations prior to drawing conclusions about symptoms in clinical populations.

Ability of college students to simulate ADHD on objective measures of attention.

Objective: The authors examined the ability of college students to simulate ADHD symptoms on objective and self-report measures and the relationship between knowledge of ADHD and ability to simulate ADHD. Method: Undergraduate students were assigned to a control or a simulated ADHD malingering condition and compared with a clinical AD/HD group. The authors used several clinical attentional measures and symptom validity tests to differentiate experimental groups via a series of multivariate procedures. Results: Simulators successfully feigned ADHD symptoms on a retrospective self-report measure. Moreover, knowledge of ADHD was unrelated to objective attentional measure performance. Overall, participants who simulated ADHD on some objective measures (i.e., specific Wechsler Adult Intelligence Scale—III [WAIS-III] subtests) showed similar performance to the clinical ADHD comparison sample. Conclusion: The implications of these findings highlight the importance of relying on multiple vectors of information, be it objective, observational, self-report, or reports by others, when diagnosing ADHD and assessing factors related to potential secondary gain. (J. of Att. Dis. 2010; 13(4) 325-338)

Continuous Performance Test (CPT) of College Students With ADHD, Psychiatric Disorders, Cognitive Deficits, or No Diagnosis:

Objective/Method: The Conner’s Continuous Performance Test (CPT) was administered to four groups of adult college students who self-referred for comprehensive psychoeducational evaluation and received either no diagnosis (n = 30) or a diagnosis of ADHD (n = 26), a psychiatric disorder (n = 17), or various cognitive deficits (n = 22). Results: The groups did not differ with respect to age, sex, race, or IQ. Although the ADHD group made more CPT errors of omission, had longer response times, and showed greater variability in responding than the other three groups, these differences did not reach statistical significance when analyzed parametrically using standard scores. But when the pattern of scores across the groups was analyzed nonparametrically, significant and interpretable results emerged. Conclusion: The CPT reliably differentiated between individuals with ADHD and both normal college students and individuals with psychiatric diagnoses but not persons with learning/cognitive disorders.

The Myer-Megargee Inmate Typology Dynamic or Unstable?

The Megargee and Dorhout (1977) classificatory rules were applied to 181 MMPI profiles from inmates at a Level 4 Federal Correctional Institution, in Memphis, Tennessee. Unambiguous classification was easily obtained for 92% of these inmates. The dispersion of these inmates among the 10 Megargee types was comparable to that previously reported at other levels of the Federal Prison System. Fifty of these inmates were retested (mean test-retest interval = 10.16 months) and reclassified. Only 14 of these 50 inmates retained their original type designation upon retesting. Thus, although the Megargee and Dorhout (1977) typology may be easily applied to inmate MMPI profiles in a Federal Level 4 facility, the rather marked instability of this system suggests that considerable caution should be exercised if it is to be used in the classification process.

Utility of the UFOV test with mild traumatic brain injury.

Driving skills are socially important, easily disrupted by brain injury, and potentially risky and difficult to evaluate afterward. The Useful Field of View test has seen successful use with severe traumatic brain injury (TBI), but its use with mild TBI victims has not been examined. This study shows its ecological insensitivity among persons with mild TBI or no impairment and suggests its use be limited to more severely impaired persons.

Partial cross-validation of the Wechsler Memory Scale-Revised (WMS-R) General Memory-Attention/Concentration Malingering Index in a nonlitigating sample.

The Wechsler Memory Scale-Revised (WMS-R) malingering indices proposed by Mittenberg, Azrin, Millsaps, and Heilbronner [Psychol Assess 5 (1993) 34.] were partially cross-validated in a sample of 200 nonlitigants. Nine diagnostic categories were examined, including participants with traumatic brain injury (TBI), brain tumor, stroke/vascular, senile dementia of the Alzheimers type (SDAT), epilepsy, depression/anxiety, medical problems, and no diagnosis. Results showed that the discriminant function using WMS-R subtests misclassified only 6.5% of the sample as malingering, with significantly higher misclassification rates of SDAT and stroke/vascular groups. The General Memory Index-Attention/Concentration Index (GMI-ACI) difference score misclassified only 8.5% of the sample as malingering when a difference score of greater than 25 points was used as the cutoff criterion. No diagnostic group was significantly more likely to be misclassified. Results support the utility of the GMI-ACI difference score, as well as the WMS-R subtest discriminant function score, in detecting malingering.

Sex differences in visual information processing following right cerebrovascular accidents

This study examined whether males and females who had sustained right CVAs but did not show gross asymmetries in processing left- and right-sided visual information would demonstrate visual hemiimperception when tested with more demanding evaluation procedures. Testing involved tasks of reaction time, oral reading and searching for embedded words and figures. Males and females differed in their response patterns for tasks involving searching for embedded target stimuli; specifically, males required greater lengths of time to locate stimuli in left hemispace, while females showed no such pattern of results. This suggests that closer attention must be paid to screening procedures used to detect hemispatial visual imperceptions, particularly among males.

Group Psychotherapy with Brain-Damaged Adults and Their Families

In the past, cognitive and behavioral sequelae of neurological insult were thought to contraindicate psychotherapeutic intervention with brain-damaged adults. Recently, however, the cultivation of awareness of deficits, self-appraisal techniques, and adaptive skills have become important objectives for postacute rehabilitation of such patients. Meeting these objectives can be a critical obstacle to successful community reentry. In this context, psychotherapy is becoming a viable therapeutic tool (Rosenthal, 1989).

Behavioral assessment and treatment of acquired visuoperceptual disorders

Visuoperceptual deficits are common sequelae of damage to either hemisphere of the brain, but are typically more pronounced following injuries involving the right cerebral hemisphere. Common visuoperceptual disorders include visual field cuts, hemi-inattention and hemi-spatial neglect, hemi-perceptual deficits, and gaze and visual pursuit disturbances. A number of behavioral interventions have been developed to teach patients to compensate for acquired visual deficits. Studies addressing assessment and treatment issues in this area are reviewed, and future directions for research are outlined.