Some RCFT indices are effective Performance Validity Test (PVTs) during neuropsychological evaluations. A combination score that includes the copy score, true positive recognition, and atypical errors has proven to be especially useful (see Lu et al, 2003). However, this score was derived from administration that deviated from protocols outlined by Meyers & Meyers (1995) in that the Recognition trial was administered after the 3-minute delay instead of the 30-minute delay. The current study examined the utility of the RCFT combination score as a performance validity test (PVT) when completing the recognition trial after the 30-minute delay.

This study utilized archival data from 298 Veterans who presented for a clinical neuropsychological evaluation at a southern Veterans Affairs Medical Center. The evaluation included up to nine PVTs and all trials of the RCFT (per Meyers & Meyers, 1995). Patients were considered credible if all PVT performance fell within normal limits. This resulted in 232 patients in the credible group (Mage = 52.9 years, SDage = 15.2, Medu = SDedu = 2.5, 88% male, 71.2% White, 28.3% Black/African American). Patients were considered non-credible if they failed >2 PVTs. This resulted in 66 patients in the non-credible group (Mage = 51.6, SDage = 13.79, Medu = SDedu = 2.4, 92.4% male, 56.1% White, 43.9% Black/African American). Group assignment was also clinically confirmed. Receiver operating characteristic (ROC) curve analyses were conducted to discriminate between credible and non-credible groups utilizing the established RCFT combination score.

RCFT combination scores distinguished groups, with credible participants scoring higher than non-credible participants (F[1, 296]=63.76, p<.001, d=1.11; M = 56.9, SD = 9.3 vs. M = 46.5, SD = 9.5, respectively). A ROC analysis indicated AUC = .800 (95% CI = .73 to .86). When specificity was set at >90%, a cut-score of <46.5 yielded sensitivity at 46.0%. The analogous cut-score from the Lu et al. (2003) study (i.e., <47) was associated with a specificity of 88.7 and sensitivity of 46.0% in the current study.

As the Lu et al. (2003) established the combination score of the RCFT with procedures that deviated from the standardized protocol outlined by Meyers and Meyers (1995), clinicians who opted to adhere to Meyers and Meyers’ full protocol may have concerns about using the combination score as a PVT. The current study established a similar cut-off score to what Lu et al., (2003) reported (i.e., <46.5 vs. <47) while following a different administration procedure of the RCFT. Also, the index was moderately sensitive in the current study (i.e., 45.5%) but less so than what Lu et al. reported when using a cut-score that had >90% specificity (i.e., 75.9% sensitivity). This suggests that the index may be robust to deviations in administration procedures. Difference in sensitivity could be related to difference between samples. As the current sample was derived from a clinical, VA setting, current findings extend the generalizability of the index. Future research would benefit exploring if any subgroups would benefit from adjusted cut-scores to reduce the risk of false positive identification.

Cognitive flexibility, typically measured using neuropsychological tasks of set-shifting, has been associated with mental and physical health, social relationships, resilience, and overall quality of life (Diamond, 2013; Chen et al., 2014; Davis et al., 2010; de Abreu et al., 2014; Genet et al., 2011). Previous research has found conflicting results regarding the relationship between set-shifting and various measures of functional outcomes in individuals with traumatic brain injury (Allanson et al., 2017). The present study examined the relationship between cognitive flexibility and adaptive functioning in individuals with acquired brain injuries (ABI).

Participants in this research are adults (n = 116) with severe, chronic ABI who completed a neuropsychological evaluation through Bancroft Neurorehab between 2012-2022. Participants ranged in age from 20.4 - 67.8 years (M = 45.8). Individuals included in data analysis completed Trails A and B, Wide Range Achievement Test, Fourth Edition (WRAT-4) Word Reading, and Texas Functional Living Scale (TFLS). Set-shifting ability was measured using Trails B and adaptive functioning was measured using the TFLS. Word reading ability, measured using the WRAT-4, was included as a covariate to account for the impact of word reading difficulties on Trails B performance.

A simple linear regression was conducted to examine if Trails B T-score (M = 24.7) and WRAT-4 Word Reading Standard Score (M = 87.8) predicted TFLS Total T-score (M = 35.8). The overall regression model was statistically significant (R2 = .351, F(2, 113) = 32.0, p < .001). It was found that lower performances on Trails B (ß = .272, p <.001) and WRAT-4 Word Reading (ß = .189, p <.001) both significantly predicted a lower TFLS Total T-score.

Set-shifting and word reading ability significantly predicted the overall adaptive functioning score on the TFLS which adds to a body of literature that suggests that the ability to think and behave flexibly affects functional aspects of everyday living. These findings are consistent with previous literature regarding the association between cognitive flexibility and adaptive functioning in the general population, and these results add to the growing body of research on cognitive flexibility in individuals with brain injury. Clinicians may use an individual’s set-shifting performance to estimate and further assess potential difficulties in completing activities of daily living. This information may assist in subsequent treatment planning and identifying treatment goals of cognitive rehabilitation consistent with rehabilitation psychology’s goals of increasing levels of adaptive functioning and quality of life (Division 22 of the American Psychological Association, n.d.). Future research may examine if certain domains of adaptive functioning are more or less affected by impairments in cognitive flexibility. Future research may also examine patterns of set-shifting performance, such as sequencing errors vs. set-loss errors, associated with specific areas of insult.

Although relationships between Fried frailty criteria (i.e., weakness, slowness, weight loss, exhaustion and low physical activity), cognitive decline, and adverse childhood experiences (ACEs) have been examined (Brigalo et al., 2015, Brown et al., 2022, Fabricio et al., 2020, & Tani et al., 2021), the moderating effect of age on the relationship between ACEs and frailty has yet to be explored. The present study examined whether age moderates the relationship between total number of ACEs and number of frailty criteria in older age.

137 older adults were recruited from University of Miami clinics and surrounding community care centers. Collected data included demographic information, number of frailty criteria met, and number of ACEs endorsed. Participants were primarily Hispanic-White (64.2%) and female (56.9%), with a mean age of 73.62 years (SD=6.252). Data were initially analyzed using descriptive statistics. A hierarchical linear regression was run to test the effect of ACE score on number of frailty criteria met. A simple moderation analysis using the PROCESS macro was then performed with total number of medical conditions included as a covariate to address any potentially confounding effects. To avoid multicollinearity issues, number of ACEs endorsed and age were mean centered and an interaction term between the two was produced.

Scores on the ACE did substantially effect the total number of frailty criteria met by participants in this study (f=2.37, p=0.028, ΔR2=0.023), independent of number of medical conditions. The overall moderation model was significant (f=2.99, p=0.022, R2=0.103), and the addition of the interaction effect resulted in a statistically significant change to the model (f=4.08, p=0.045, ΔR2=0.035). Taken together, support for a moderating effect was found, specifically within the lower age group (65 - 71years), but not older (greater than 72 years) with ACE score positively predicting the number of frailty criteria met (b =0.230, t=2.62, p=0.010).

Results largely support the positive effect of ACE endorsement on the number of frailty criteria met in later life. Age acted as a moderating effect, for the younger old population, such that as number of ACEs endorsed increased, so too did the number of frailty criteria met. This finding highlights the importance of early intervention among those in younger late life who have experienced trauma. Given the positive relationship between frailty and cognitive decline in late life (Brigalo et al., 2015 & Fabricio et al., 2020), these findings also support the need for a better understanding of how childhood adversity impacts physical well-being over the life course.

Pediatric brain tumor survivors treated with proton radiation therapy (PRT) prior to 4 years of age are at high risk for poor cognitive and developmental outcomes. This cross-sectional study examined developmental outcomes and educational service utilization at follow-up in a cohort of pediatric survivors treated with PRT before the age of 4 years.

A total of 46 patients (58.7% female, 93.5% White) were assessed using age-appropriate measures for executive, behavioral, and adaptive functioning. Mean age at PRT was 2.4 years (SD=0.9, range 1.0-3.9 years); mean age at follow-up was 7.0 years (SD=4.8, range 2.0-18.6 years). Mean follow-up interval was 4.57 years (SD=4.52, range 0.9-16.2 years). Diagnoses included ependymoma (n=26, 54.2%), medulloblastoma (n=7, 14.6%), craniopharyngioma (n=4, 8.3%), and a few other tumor types. Infratentorial tumors were most common (69.6%). Treatment included prior surgical resection (93.5%) and chemotherapy (60.9%). Posterior fossa syndrome was present in 10.9% (n=5). PRT field consisted of focal (n=41, 89.1%) or craniospinal irradiation (CSI) (n=5, 10.9%). The impact of demographic, diagnostic, and treatment-related factors was examined, including age at PRT, gender, time interval since PRT, radiation field, and tumor location, on intelligence quotient (IQ), adaptive skills, and executive functioning. Rates of impairment (T-scores >65) were calculated. The utilization of educational services was determined.

Mean IQ (SS = 97.6, SD=16.3), as well as mean global executive functioning (Mean T=53.4, SD=11.1) and adaptive skills (Mean SS = 92.5, SD=21.4), as assessed by parent rating scales (BRIEF; SIB), were in the average range. Despite mean scores being within the average range, a large proportion of patients demonstrated difficulties with social withdrawal (28.3%) and activities of daily living (28.3%) (BASC), and global executive dysfunction (17.4%) (BRIEF). Younger age at PRT was associated with lower global adaptive skills at follow-up (r=.39, p=.005), better activities of daily living (r=.53, p<.001), lower social skills (r=.43, p=.002), and more hyperactivity (r=-.37, p=.008), but not aggression, anxiety, depression, somatization, atypical behaviors, withdrawal, or attention problems. Longer follow-up interval was correlated with better activities of daily living (r=.46, p<.001), but more anxiety (r=.39, p=.006). Gender, SES, radiation field, history of hydrocephalus, and location of tumor were not significantly related to primary outcome variables. Posterior fossa syndrome was associated with lower adaptive skills (t=2.90, p=.003) and IQ (t=2.02, p=.026). Of those enrolled in school, 59% received special education services and/or accommodations (IEP n=18, Early Intervention n=6; 504 Plan n=3).

Overall, PRT before age 4 years was associated with difficulties with withdrawal, adaptive skills, and executive functioning. Younger age at PRT was associated with lower adaptive functioning, lower social skills, and higher hyperactivity, but not with IQ, attention, mood, or anxiety. While a longer time interval since treatment was associated with improvement in activities of daily living, anxiety was increased, suggesting some late emotional effects. Furthermore, posterior fossa syndrome after surgery was related to lower adaptive skills and IQ. Attention problems were not indicated. Approximately half received school services/accommodations. Young children treated with PRT require proactive support and services to foster their developmental outcomes.

All premenopausal women who survive traumatic brain injury (TBI) will eventually experience menopause. Challenges experienced by women with TBI are superimposed on challenges associated with hormonal changes in midlife. Some women with stressful life contexts such as TBI are more vulnerable to the added burdens of the menopause transition, potentiating its effects. Although it may be argued that TBI research correctly overrepresents the male experience given disparities in injury rates (4:1), there are important differences in how females and males age, their specific health needs, and the psychosocial context of midlife. Development of evidence-based interventions begins with understanding the experience of menopause after TBI, including where and when key problems may emerge.

All participants were women 40-60 years old, not taking hormones (i.e., replacement therapy or other systematic hormones), with intact ovaries. Women with TBI were > 2 years post injury, whose menstrual period returned after injury, and were living in the community. Severity of injury ranged from complicated-mild to severe TBI. Pre/peri and postmenopausal status was determined by presence/absence of menstrual period in previous 6 months, respectively. Eighteen common menopause symptoms (vasomotor, somatic, psychological, and cognitive) were assessed for presence and frequency (rarely-always), along with Quality of Life in Neurological Disorders (Neuro-QOL) Sleep Disturbance and Traumatic Brain Injury Quality of Life (TBIQOL) Anxiety, Depression, and Fatigue scales.

Overall, women with TBI (n = 68) showed greater presence and frequency of symptoms than women without TBI (n = 153), with fewer within-group differences by menopausal status. Among pre/peri-menopausal women, TBI and non-TBI groups did not significantly differ and showed small effect sizes on symptoms associated with changes in estrogen during menopause, including hot flashes, night sweats, bowel and bladder sequelae, and breast tenderness. However, pre/peri-menopausal women with TBI also endorsed body aches and headaches, as well as troubles with memory, focus, fatigue, cognitive concerns, sleep, and anxiety significantly more than their pre/peri-menopausal counterparts (all medium effect sizes). Among postmenopausal women, those with TBI had significantly greater frequency of hot flashes, crying spells, poor memory, worry, moodiness, panic attacks, sleep disturbance, and anxiety than women without TBI. Within TBI, only hot flashes and breast tenderness were greater in postmenopausal versus pre/peri-menopausal women. Within non-TBI, postmenopausal status was associated with significantly greater hot flashes, night sweats, restlessness, poor memory, irritability, sleep disturbance, and anxiety, with greater fatigue but not significantly.

The findings support a model of TBI and menopause in which symptoms most closely associated with estrogen decline in pre/peri-menopause are generally similar between women with and without TBI, and symptoms that overlap with common TBI sequelae were generally more often present and frequently experienced among women with TBI versus non-TBI. We did not observe a synergistic or potentiating effect of TBI on menopause symptoms in post-menopause. These findings offer insight that contextualizes the experience of menopause symptoms among women with TBI. Such insights are essential for the development of treatment approaches that maximize health and wellbeing during the menopause transition for women with TBI.

Multiple Sclerosis (MS) affects up to 500,000 adults in the United States, with cognitive impairment present in 45%-65% of people. Studies showed hippocampal atrophy in MS, but the underlying mechanisms remain unknown. Inflammation has been proposed to play a significant role, and associations between systemic inflammatory biomarkers and hippocampal atrophy have been shown in other neurological conditions. However, research exploring serum biomarker and volumetric associations in MS are lacking. Given that conventional imaging methods lack resolution for hippocampal internal architecture (HIA), new protocols were developed. We used the High-Resolution Multiple Image Co-Registration and Averaging (HR-MICRA) method to visualize the HIA subfields. We investigated the relationship between subfield volumes generated from HR-MICRA scans and systemic serum biomarkers in MS.

Patients with MS were recruited (N= 34, mean age= 54.6, 35.3% Black) underwent Magnetic Resonance Imaging (MRI), and serum biomarkers were obtained, specifically chosen for their potential role in MS. Inflammatory biomarkers included; granulocyte colony stimulating factor (G-CSF), interleukin-10 (IL-10), matrix metalloproteinase-9 (MMP-9), tumor necrosis factor- a (TNF- a), and growth factors; vascular endothelial growth factor (VEGF); insulin-like growth factor-1 (IGF-1), and brain derived growth factor (BDNF). Imaging was performed in a Siemens Prisma 3T scanner with a 64-channel head coil using the HR-MICRA method. Hippocampal subfields were calculated using the Automated Segmentation of Hippocampal Subfields (ASHS) package. We used the Magdeburg Young Adult 7T Atlas for sub-hippocampal structures and Penn Temporal Lobe Epilepsy T1-MRI Whole Hippocampus ASHS Atlas for general hippocampal structure and segmentation. Pearson's product-moment analyses provided correlations between biomarkers and hippocampal subfield volumes for each cerebral hemisphere. A statistical significance level of p < 0.05 was used for all analyses.

Correlations emerged between left hemisphere Cornu Ammonis (CA) 2 and G-CSF (r = -.384; p = .025); IL-10 (r = -.342; p = .048); VEGF (r = -.371; p= .031); and CA3 with IL-10 (r = -.488, p = .003); G-CSF (r = -.386; p= .024); VEGF (r = -.352; p= .041). Dentate gyrus correlated with MMP-9 (r =.416; p=.014); IL-10 (r = -.365; p =.034). BDNF was correlated with right hemisphere CA1 (r = -.417, p = .014), CA2 (r = -.497; p= .003) and CA3 (r = -.451; p=.007).

In our sample of persons with MS, left hemisphere hippocampal subfield volumes were negatively correlated with inflammatory biomarkers, supporting previous reports linking inflammation to reduced brain volumes in other neurological conditions. In the right hemisphere, we found negative correlations between HIA and BDNF, suggesting a neuroprotective function for BDNF in this neurodegenerative disease. These findings in a representative sample of patients with MS highlight the need for further research exploring the relationship between HIA and systemic serum biomarkers in MS.

Ensuring test-taking validity is a crucial part of any neuropsychological evaluation. While all batteries ought to include well established test-taking validity measures regardless, it can still be helpful to be aware of an increased chance of poor performance validity prior to initiating testing. Studies repeatedly demonstrate that it is very difficult to predict which patient, particularly those without any clear incentive for poor test performance, will have invalid test performances based purely on subjective clinical judgment. Therefore, there is a need for an objective predictor of poor test taking validity. This study examines if a high endorsement of cognitive symptoms can indicate likely failure on test-taking validity measures.

All patients at an outpatient neurological clinic completed an intake background form prior to testing. On this form, patients were asked to endorse in which, if any, of nine cognitive areas they may be experiencing difficulty (memory, attention/concentration, word finding, etc.). Patients who endorsed at least eight out of the nine clinical symptoms on the intake form were included in the current study (N=7; age range 36-43 years). All patients were clinically referred for a comprehensive neuropsychological evaluation with a variety of conditions (e.g., stroke, memory concerns, and post-COVID-19 syndrome). Importantly, none of these patients were referred within a forensic context, and therefore, they did not have any clear external motivation or secondary gain. In addition to a battery of individual neuropsychological measures, each patient was administered performance validity tests (Test of Memory Malingering, Reliable Digits, and CVLT-3 Forced Choice).

In this sample, 57% of patients who endorsed all - or nearly all - cognitive symptoms on an intake form failed test-taking validity measures. Patients who failed validity measures did not meet passing criteria on two or more embedded or independent performance validity tests. This signifies a much higher rate than the typically observed base rates (∼15%) of test-taking invalidity across non-forensic clinical settings.

Preliminary findings suggest that those who indicate having cognitive problems in all (or nearly all) listed domains fail validity measures at a higher than expected rate, supporting the use of responses on a background from to indicate likely poor performance validity. Identification of high rates of symptomatic complaints, particularly symptoms that may extend beyond the initial referral question, should prompt practitioners to keenly evaluate performance validity and consider the results within the context of the patient’s presentation.

Research has established the importance of early identification and intervention for children with developmental disorders and delays. In striving toward earlier recognition and treatment of developmental concerns, it is crucial to have a universal system to monitor infant and toddler development over time. This system should comprehensively assess the desired areas of development, be based on normative data from large samples, and have strong psychometric properties. While a few developmental monitoring tools are currently in use, they lack many of the aforementioned qualities. The current study reports on the cross-sectional psychometric properties of PediaTrac, which is a novel caregiver-report measure of infant and toddler development. Specifically, this study focuses on psychometric properties of PediaTrac’s social/communication/cognition (SCG) domain during the first 9 months of life.

The current sample included 571 caregiver-infant dyads recruited into term (n=331) and preterm (n=240) groups. Participants were from the PediaTrac multisite, longitudinal study and were socioeconomically (41.9% below median income) and racially (33.6% Black, 47.6% White, 11.0% multiracial/other) diverse. Data included caregiver reports of infant development from the SCG domain of PediaTrac at 5 sampling periods (newborn, 2, 4, 6, and 9 months). Item response theory (IRT) graded response modeling was used to estimate theta, an index of the latent trait, social/communication/cognition. Exploratory factor analysis (EFA) was used to further examine the underlying structure of the SCG domain.

Mean theta values could be reliably estimated at all time periods and followed a linear trend consistent with development. At 9 months, theta values were statistically different between the term and preterm groups, indicating that term infants demonstrated more advanced SCG abilities. Item parameters (discrimination and difficulty) could be modeled at each time period across the range of ability. Reliability of the SCG domain ranged from 0.97 to 0.99. Results of the EFA suggested a two-factor solution (affect/emotional expression, social responsiveness) at the newborn period accounting for 43% of the variance, a three-factor solution (affect/emotional expression, social responsiveness, imitation/emerging communication) at the 2-, 4-, and 6-month periods accounting for 43%, 34%, and 34% of the variance, respectively, and a four-factor solution (affect expression, social responsiveness, imitation/communication, nonverbal/gestural communication) at the 9-month period accounting for 34% of the variance.

The PediaTrac SCG domain has strong psychometric properties, including reliability estimates higher than other existing caregiver-report measures of SCG abilities. EFA analyses demonstrated that the structure of affect/emotional expression and social responsiveness remains relatively stable and may reflect affective and regulatory aspects of temperament. Conversely, the quality and type of communication continually develops and becomes more differentiated throughout the time periods of interest. Notably, parents appear to be capable of observing and reliably reporting on their infants’ abilities in these areas. The use of a universal screening tool developed with rigorous psychometric methods, such as PediaTrac, could transform the way that clinicians identify infants in need of early intervention.

Empirical support for inclusion of performance validity testing (PVTs) in neuropsychological assessment continues to grow (Sweet et al., 2021). However, considerable validation is still needed to understand the impact of culturally mediated factors on the reliability of current, commonly used PVTs to accurately classify effort among various cultural groups. This study sought to contribute to the literature by examining the utility of several PVTs in a non-clinical, community-dwelling sample in Kampala, Uganda.

Participants included 52 residents (25 Female, 27 Male) who were born between 1953-2003 from the Wabigalo community of central Kampala. Individuals were recruited by community leaders and volunteered to participate. All 52 participants were administered the Dot Counting Test (DCT; Boone et al., 2002), Test of Memory Malingering (TOMM; Tombaugh, 1997), and Rey 15-Item Memorization Test (Rey 15; Lezak, 1995). Twenty-five participants also completed Green’s Non-Verbal Medical Symptom Validity Test (NV-MSVT; Green, 2006). Data from three participants was excluded due to suspected memory concerns. Instructions for all tests were translated into Luganda by a professional translator with experience in Luganda and were administered by Luganda-speaking individuals.

Using test manual-derived cut scores, 71.4% (n = 35) participants scored in the invalid range on the DCT, 10.2% (n = 5) produced total combined scores in the invalid range on Rey 15, 6.1% (n = 3) failed TOMM Trial 2, and one participant (4.3%) exceeded cut-offs on Green’s NV-MSVT.

In this non-clinical sample, manual cutoffs for DCT contributed to a high type-1 error rate. These findings suggest that culturally mediated factors may contribute to differences in engagement or performance on DCT. Future studies should explore these factors and continue to examine the utility of widely used tests in diverse samples.

Early life exposures to lead, mercury, polychlorinated biphenyls (PCBs), polybromide diphenyl ethers (PBDEs), organophosphate pesticides (OPPs), and phthalates have been associated with diminished IQ scores in children. Some studies suggest that these neurotoxicants impact boys and girls differently. We conducted a systematic review and meta-analysis to identify and quantify sex differences in IQ deficits from pre- and post-natal exposures to these developmental neurotoxicants.

We used PubMed and PsychINFO to screen abstracts of articles published between January 1, 1950 and December 31, 2021 for empirical studies of six neurotoxicants [lead, mercury, PCBs, PBDEs, OPPs, and/or phthalates] that (1) used an individualized biomarker; (2) measured exposure during the prenatal period or within the first six years of life; and (3) provided different effect estimates on children's intellectual abilities by sex. We assessed each study for risk of bias using Navigation Guide (Woodruff & Sutton, 2014). For studies with combinable data, we performed separate random effects meta-analyses for boys and girls with subgroup analyses by neurotoxicant. To homogenize the magnitude of effect observed in each study, we recalculated results to be expressed as the absolute change in intellectual abilities for a relative change of 1.5 times (i.e., 50% increase) in the exposure variable.

Of 3205 studies screened, 53 met inclusion criteria: 34 evaluated prenatal exposure, 11 postnatal exposure, and 8 both pre- and post-natal exposure. We generally rated these studies as "low" to "probably low" risk of bias. Among the studies examining prenatal exposure, 27 reported no significant differences between the sexes, 7 found negative associations in boys, 4 found negative associations in girls, 5 found negative nonsignificant associations in boys and positive nonsignificant associations in girls, and 3 found no clear pattern, where differences by sex depended on the specific phthalate compound or outcome measurement. Among the studies examining postnatal exposure, 14 reported no significant differences between the sexes, 1 found a negative association in boys, 2 found negative associations in girls, and 2 found positive associations for either boys or girls. In our meta-analysis of 16 studies (4 lead, 4 mercury, 2 PBDEs, 2 OPPs, 4 phthalates), we found that prenatal exposure to developmental neurotoxicants was associated with decreased full-scale intelligence in boys (B = -0.26; 95% CI: -0.45, -0.08), but not girls (B = 0.09; 95% CI: -0.14, 0.31). In subgroup analyses by neurotoxicant, prenatal exposure to lead (B = -1.07; 95% CI: -1.63, -0.52), and ZPBDEs (B = -0.57; 95% CI: -1.14, -0.01) were associated with decreased full-scale intelligence in boys, whereas the girls' effect sizes were consistently near zero.

During fetal development, boys appear to be more vulnerable than girls to IQ deficits from neurotoxic exposures, and especially from lead and PBDEs. More research is needed to examine the nuanced sex-specific effects found for postnatal exposures to toxic chemicals.

Children with post-acute sequelae of COVID-19 (PASC) often report fatigue, attention problems, anxiety, and low mood. Sluggish cognitive tempo (SCT) is a constellation of behavioral symptoms (e.g., drowsiness, moving slowly, mental fogginess, daydreaming, confusion, or inattention) often associated with but distinct from attention-deficit/hyperactivity disorder (ADHD), executive function deficits and depressive symptoms. Given the apparent overlapping symptoms of PASC and SCT, this retrospective chart review aimed to 1) characterize SCT symptoms among pediatric patients with PASC relative to published normative and clinically referred samples, and 2) examine associations between subscales of SCT with ADHD symptoms, depression, anxiety, and functional impairment in this clinical sample.

This study included retrospective data from 25 patients with PASC (17 females; Mean age=13.73 years, SD=2.07, range=8-19) who were referred for a neuropsychological evaluation following a multidisciplinary visit at a post-COVID-19 rehabilitation clinic within an academic medical center. Patients’ caregivers completed the SCT Scale, ADHD Rating Scale 5 (ADHD-RS-V),

Conners Comprehensive Behavior Rating Scale (CBRS), and Impairment Rating Scale (IRS). Higher scores on the SCT, CBRS, and IRS total reflect more problems in the specified area. Welch’s t-tests were utilized to compare SCT scores from our cohort of pediatric patients with PASC relative to a normative community sample (Penny et al., 2009) and a heterogeneous clinically-referred sample (Koriakin et al., 2015). Bivariate correlations were computed to examine associations between SCT (Daydreamy, Low Initiation, Sluggish/Sleepy), ADHD (Inattention and Hyperactivity subscales from the ADHD-RS-V), affective symptoms (Major Depressive Episode (MDE) and Generalized Anxiety Disorder (GAD) scales from the CBRS), and functional impairment (average score from IRS). Multiple linear regressions were used to determine whether SCT factors independently contribute to variance in functional deficits after accounting for age of evaluation, low mood, and anxiety.

Sluggish/Sleepy and Low Initiation were elevated in our cohort with PASC as compared to normative and mixed clinical samples from Penny et al. and Koriakin et al. (t>4.36, p<0.001). Patients with PASC had lower scores on the Daydreamy SCT scale than the clinically referred cohort (t=2.06, p=0.049), but similar to the normative sample (t=1.48, p=0.15). After controlling for age of testing, of the SCT subscales, only Low Initiation was associated with MDE (r=0.62, p=0.005), GAD (r=0.56, p=0.01) and overall Functional Impairment (r=0.48, p=0.04). Low Initiation was not correlated with Inattention or Hyperactivity. Notably, multiple regressions revealed Low Initiation scores were not associated with functional impairment when accounting for depression and anxiety symptoms(Low Initiation: ß=0.48, p=0.04; Low Initiation when depression and anxiety are included in independent regression models: ßs=0.13 and 0.29, ps=0.58 and 0.27 respectively).

Children and adolescents with PASC demonstrate more sluggish/sleepy presentation and difficulties with initiating activities or directing effort, as compared to normative and mixed clinically referred samples. Low initiation was associated with symptoms of MDE and GAD and functional impairment, but not with symptoms of ADHD. Depression and anxiety may moderate the association between poor initiation with functional impairment, highlighting the importance of psychological interventions to address mental health among youth with PASC and behavioral/cognitive concerns.

Machine learning studies of PTSD show promise for identifying neurobiological signatures of this disorder, but studies to date have largely excluded Black American women, who experience disproportionately greater trauma and have relatively higher rates of PTSD. PTSD is characterized by four symptom clusters: trauma reexperiencing, trauma avoidance, hyperarousal, and anhedonia. A prior machine learning study reported successful PTSD symptom cluster severity prediction using functional MRI data but did not examine white matter predictors. White matter microstructural integrity has been related to PTSD presence and symptoms, and unexplored metrics such as estimates of tract shape may provide unique predictive utility. Therefore, this study examines the relationship between white matter tract shape and PTSD symptom cluster severity amongst trauma-exposed Black American women using multiple machine learning models.

Participants included 45 Black American women with PTSD (Mage=40.4(12.9)) and 89 trauma-exposed controls (Mage=39.8(11.6)). Shape and diffusion metrics for the cingulum, corpus callosum, fornix, inferior longitudinal fasciculus, superior longitudinal fasciculus, and uncinate fasciculus were calculated using deterministic tractography. Current symptom severity was calculated using the PTSD Symptom Scales. Input features included tract metrics, questionnaire responses, and age. The following regression models were generated: least absolute shrinkage and selection operator (LASSO), ridge, elastic net, and gaussian process (GPR). Additionally, two forms of latent-scale GPR, one without (lsGPR) and with (sp-lsGPR) node selection via spike and slab priors, were calculated. The performance of regression models was estimated using mean square error (MSE) and R2.

sp-lsGPR performed at or above other models across all symptom clusters. LASSO models were comparable to sp-lsGPR for avoidance and hyperarousal clusters. Ridge regression and GPR had the weakest performance across clusters. Scores for sp-lsGPR by cluster are as follows: reexperiencing Mmse =0.70(0.17), Mr2=0.56(0.13); avoidance Mmse =0.75(0.17), Mr2= 0.51(0.13); hyperarousal Mmse =0.57(0.18), Mr2=0.66(0.12); anhedonia Mmse =0.74(0.27), Mr2=0.57(0.13). The top three ranked posterior inclusion probabilities for white matter tracts across sp-lsGPR models include four sections of the cingulum, three sections of the corpus callosum, the right fornix, the left inferior longitudinal fasciculus, the first segment of the right superior longitudinal fasciculus, and the right uncincate fasciculus. The greatest posterior inclusion probability value for the sp-lsGPR models was the left frontal parahippocampal cingulum for the hyperarousal cluster.

Results support the combined predictive utility of white matter metrics for brain imaging regression models of PTSD. Results also support the use of sp-lsGPR models, which are designed to balance interpretable linear models and highly-flexible non-linear models. The sp-lsGPR model performance was similar across clusters but was relatively better for the hyperarousal cluster. This finding contrasts with prior machine learning work using functional data which was unable to predict hyperarousal scores above chance (MR2=0.06). These diverging findings highlight the importance of examining both functional and structural data in PTSD populations. Differing findings may also be related to sample characteristics as the prior study was conducted in China. Black American women and Chinese individuals have unique lived experiences that may differentially impact brain structure and function. Future work should continue to include diverse research samples to account for such experiences.

Neurocognitive deficits commonly occur following pediatric stroke and can impact many neuropsychological domains. Despite awareness of these deleterious effects, neurocognitive outcome after pediatric stroke, especially hemorrhagic stroke, is understudied. This clinical study aimed to elucidate the impact of eight factors identified in the scientific literature as possible predictors of neurocognitive outcome following pediatric stroke: age at stroke, stroke type (i.e., ischemic vs. hemorrhagic), lesion size, lesion location (i.e., brain region, structures impacted, and laterality), time since stroke, neurologic severity, seizures post-stroke, and socioeconomic status.

Ninety-two patients, ages six to 25 and with a history of pediatric stroke, chose to participate in the study and were administered standardized neuropsychological tests assessing verbal reasoning, abstract reasoning, working memory, processing speed, attention, learning ability, long-term memory, and visuomotor integration. A standardized parent questionnaire provided an estimate of executive functioning. Statistical analyses included spline regressions to examine the impact of age at stroke and lesion size, further divided by stroke type; a series of one-way analysis of variance to examine differences in variables with three levels; Welch’s t-tests to examine dichotomous variables; and simple linear regressions for continuous variables.

Lesion size, stroke type, age at stroke, and socioeconomic status were identified as predictors of neurocognitive outcome in our sample. Large lesions were associated with worse neurocognitive outcomes compared to small to medium lesions across neurocognitive domains. Exploratory spline regressions suggested that ischemic stroke was associated with worse neurocognitive outcomes than hemorrhagic stroke. Based on patterns shown in graphs, age at stroke appeared to have an impact on outcome depending on the neurocognitive domain and stroke type, with U-shaped trends suggesting worse outcome across most domains when stroke occurred at approximately 5 to 10 years of age. Socioeconomic status positively predicted outcomes across most neurocognitive domains. Participants with seizures had more severe executive functioning impairments than youth without seizures. Youth with combined cortical-subcortical lesions scored lower on abstract reasoning than youth with cortical and youth with subcortical lesions, and lower on attention than youth with cortical lesions. Neurologic severity predicted scores on abstract reasoning, attention, processing speed, and visuomotor integration, depending on stroke type. There was no evidence of differences on outcome measures based on time since stroke, lesion laterality, or lesion region defined as supra-versus infratentorial.

The current study contributed to the scientific literature by identifying lesion size, stroke type, age at stroke, and socioeconomic status as predictors of neurocognitive outcome following pediatric stroke. Future research should examine other possible predictors of neurocognitive outcome that remain unexplored. Multisite collaborations would provide larger sample sizes and allow teams to build models with better statistical power and more predictors. Enhancing understanding of neurocognitive outcomes following pediatric stroke is a first step towards improving appraisals of prognosis.

Findings are clinically applicable as they provide professionals with information that can help assess individual expected patterns of recovery and thus refer patients to appropriate support services.

Research has shown that social support has protective effects against cognitive decline in older adults. No study to date has examined the relationship between social support and cognition in older adults with Multiple Sclerosis (MS). Advances in treatments for MS have resulted in a growing number of aging individuals with MS, making it imperative to identify modifiable risk factors that affect cognition, such as social support. Therefore, this study was designed to examine the association between social support and cognition in older adults with MS and healthy controls.

Participants were older adults with MS (N = 70; M age = 64.71, SD + 3.86 years; 62.9% female) and community-residing older adults (N = 74; M age = 68.42, SD + 5.96 years; 58.1% female). Perceived social support was assessed using the Medical Outcomes Study Modified Social Support Survey (MSSS), which measures emotional/informational support, tangible support, affectionate support, and positive social interaction. Cognition was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which measures immediate and delayed memory, attention, language, and visuospatial abilities. Linear regressions stratified by group status (MS vs. control) assessed the association between perceived social support and cognition.

Linear regressions controlling for age, gender, education, and medical comorbidities showed that higher total MSSS scores were related to higher RBANS scores in the MS group (β = 0.243, p = .046) and marginally in the control group (β = 0.239, p = .053). Examination of MSSS domains showed that emotional/informational support (β = 0.246, p = .044) and positive social interaction (β = 0.279, p = .023) were significant predictors of RBANS performance in the MS group. Positive social interaction (β = 0.262, p = .011) was a significant predictor of RBANS performance in the control group. Analyses that further adjusted for depression scores showed that positive social interaction remained a significant predictor of RBANS performance in the control group (β = 0.361, p = .005). In contrast, depression scores attenuated associations between all aspects of social support and RBANS performance in the MS group (p > .05).

Among older adults, the association between social support and cognition varied as a function of MS status. Overall perceived social support, emotional/informational support, and positive social interaction were significantly associated with cognition in the MS group. However, depressive symptoms attenuated these associations. In contrast, positive social interaction was the key driver of the association between social support and cognition among the healthy controls, and notably, this association remained significant even after adjusting for depressive symptoms.

Delayed speech and language development is one of the main diagnostic criteria for autism spectrum disorders (ASD) and is found almost in all children with ASD. Language development in children with ASD may differ from the norm both quantitatively (delayed speech development, reduced vocabulary, scarcity of speech and limitation in its use) and qualitatively (echolalias, violation of speech grammatical structure, difficulties in the communicative use of speech). Studying different aspects of language development in ASD is very important as it provides opportunities for finer diagnostics, as well as for targeted correction of communication disorders.

The study included 34 primary-school-aged children, who were diagnosed ASD using ADOS-2, diagnostic groups included “autism” (24 children) and “autism spectrum” (8 children). Speech development was assessed using the “Korablik” test on 9 parameters: distinguishing sounds; understanding and generating nouns, verbs and syntax; text understanding; sentences repetition. Kaufman test battery (KABC-II) and the Wechsler test (WISC-III) were used to assess non-verbal intelligence. The sample was divided into two subgroups according to an educational program recommended by PMPC (Psychological, Medical and Pedagogical Commission). Group 1 included 15 children, attending program 8.1, which is recommended for children with ASD who reach developmental milestones before starting study. Group 2 included 19 children attending program 8.2, which is recommended for children with ASD who do not reach developmental milestones before starting study.

In general, all children were the best successful in understanding and generating nouns, understanding verbs, and the least successful in understanding text and searching for sound in the word. Comparing subgroups using Mann-Whitney test revealed significant differences in all measured speech parameters, except for word repetition and noun generation. Group 2 demonstrated uneven results for separate subtests - minimum scores in some subtests coexisted with maximum in others. The group also showed uneven scores distribution inside the subtests, for example, half of the children did not cope with the task to determine a sound in a word, while the rest successfully completed at least 83% of the task. A significant positive correlation between all speech subtests was found in the group. Correlation analysis for parameters of speech development, severity of autistic manifestations and non-verbal intelligence revealed a significant direct relationship between the total scores of impressive and expressive speech and IQ and an inverse relationship with the severity of autistic manifestations and disorders of social and communicative behavior. No relationships like described above were found for group 1.

Obtained results indicate variability of reasons for delayed development of various language aspects in children with ASD.

Because cognitive resources are limited, models of cognitive control predict that additional control is engaged only if it improves task performance. Increased response caution, which occurs when individuals increase the threshold of information needed before making a decision, is one example of cognitive control adaptation. While previous studies have measured increased response caution via increased reaction time, the diffusion model can be used to derive a boundary separation parameter that directly indexes response caution and eliminates capturing alternative influences on reaction time. This study aims to determine if school-aged children, either with or without ADHD, show adaptive changes in response caution during a set-shifting task. These groups have demonstrated mixed results when analyzing reaction time, so this study utilizes diffusion modeling to measure response caution more directly. The set-shifting task presents switches in a random order such that they cannot be predicted; therefore, increasing response caution is only adaptive following errors, called post-error slowing (PES), but not following switch trials. It is predicted that children will show increased response caution only when adaptive. If child with ADHD adapt their response caution fundamentally differently, then there will be individual differences in change in boundary separation.

Children ages 8-12 with (n=193) and without (n=70) ADHD completed the Navon set-shifting task. Participants saw one of four global shapes made up of local shapes and were asked to identify one or the other based upon the background color. Of the 144 trials, 70 presented a switch between global and local. Trials were presented in the same randomized order for all participants, self-paced, and followed by feedback on correctness. The diffusion model parameters boundary separation (a), drift rate (v), and nondecision time (Ter) were estimated by condition, including a) post-error versus after correct and b) post-switch versus post-same. For PES analyses, only participants with a sufficient number of errors for modeling were included (ADHD n=113, control n=19).

Participants were slower on trials immediately following errors (F(1, 130)=119.76, p<.001, n2=.48) and switches (F(1, 261)=154.93, p<.001, n2=.37). In PES, slowing was attributable to increased boundary separation, F(1, 130)=16.11, p<.001, n2=.11, as well as slower drift rate and longer nondecision time (both p<.01, n2 >.05). However, as predicted, post-switch slowing was only attributable slower drift rate and longer nondecision time (both p<.001, n2 >.10), not increased boundary separation, F(1, 261)=0.77, p=.38, n2<.01. Overall, children with ADHD had slower drift rates (F(1, 261)=4.63, p<.001, n2=.10) and narrower boundary separation (F(1, 261)=10.56, p=.001, n2=.04). However, there were no ADHD x trial-type interactions for PES or post-switch (both p>.33, n2<.01).

School-aged children demonstrated increased response caution following errors, but not following switches. This demonstrates an adaptive use of cognitive control. The diffusion model was crucial in determining this, as reaction time slowed following switches for reasons unrelated to cognitive control. Additionally, although children with ADHD demonstrated slower drift rates and narrower boundary separation overall, they showed no differences when adapting response caution.

Sluggish cognitive tempo (SCT) is an attentional disorder characterized by excessive daydreaming, reduced alertness, slowed motor behavior, and mental fogginess. The purpose of the present study was to examine potential executive functioning group differences between children with high SCT symptoms versus those with low SCT symptoms. It was hypothesized that children with high SCT symptoms would have greater executive functioning deficits than children with low SCT symptoms, as reported by their teachers.

There were 32 children in this study, between the ages of 6 to 13 (M = 8.94; SD = 1.97). To measure the level of SCT symptomology, an average rating on four items from the Child Behavior Checklist (CBCL; Items 13, 17, 80, 102) and an average rating from five items from the Teacher's Report Form (TRF; Items 13, 17, 60, 80, 102) were acquired and averaged to produce a combined measure of SCT. The present study had fair to good reliability for CBCL and TRF with Cronbach alpha values of .71 and .82 respectively. Eighteen participants had SCT scores above the Garner et al. (2010) cutoff criteria for the CBCL (SCT over 0.67) or the TRF (SCT over 0.75) which placed them in the high SCT group. The 13 participants who did not meet criteria for high SCT were considered the low SCT group. To measure executive function, Behavior Rating Inventory of Executive Function (BRIEF) teacher ratings were used. A general linear model multivariate analysis was conducted on each measure of the BRIEF teacher reports with ADHD-Inattentive (ADHD-IN) and Verbal Comprehension Index (VCI) scores as covariates.

There were significant group differences between the BRIEF Teacher Global Executive Composite scores of the high SCT group (M = 60.81, SD = 7.78) versus the low SCT group (M = 50.31, SD = 6.87), F(1, 30) = 11.73, p < .001, np2 = .59. The high SCT group scored significantly higher than the low SCT group on the Initiate (p < .001), Working Memory (p < .001), Plan/Organize (p < .001), Monitor (p < .01), and Organization of Materials (p < .05) subscales. These findings indicate that the children in the high SCT group had greater executive functioning difficulties overall than the low SCT group.

Children with high SCT symptoms demonstrated greater executive functioning deficits than children with low SCT symptoms regarding metacognition but not behavioral regulation. This means that children with SCT likely struggle more with initiating tasks, planning, organization, memory, and monitoring their thinking and behaviors than children without SCT. These skills are important for learning, which may at least partially help explain why children with SCT experience problems in school.

Aging is associated with disruptions in functional connectivity within the default mode (DMN), frontoparietal control (FPCN), and cingulo-opercular (CON) resting-state networks. Greater within-network connectivity predicts better cognitive performance in older adults. Therefore, strengthening network connectivity, through targeted intervention strategies, may help prevent age-related cognitive decline or progression to dementia. Small studies have demonstrated synergistic effects of combining transcranial direct current stimulation (tDCS) and cognitive training (CT) on strengthening network connectivity; however, this association has yet to be rigorously tested on a large scale. The current study leverages longitudinal data from the first-ever Phase III clinical trial for tDCS to examine the efficacy of an adjunctive tDCS and CT intervention on modulating network connectivity in older adults.

This sample included 209 older adults (mean age = 71.6) from the Augmenting Cognitive Training in Older Adults multisite trial. Participants completed 40 hours of CT over 12 weeks, which included 8 attention, processing speed, and working memory tasks. Participants were randomized into active or sham stimulation groups, and tDCS was administered during CT daily for two weeks then weekly for 10 weeks. For both stimulation groups, two electrodes in saline-soaked 5x7 cm2 sponges were placed at F3 (cathode) and F4 (anode) using the 10-20 measurement system. The active group received 2mA of current for 20 minutes. The sham group received 2mA for 30 seconds, then no current for the remaining 20 minutes.

Participants underwent resting-state fMRI at baseline and post-intervention. CONN toolbox was used to preprocess imaging data and conduct region of interest (ROI-ROI) connectivity analyses. The Artifact Detection Toolbox, using intermediate settings, identified outlier volumes. Two participants were excluded for having greater than 50% of volumes flagged as outliers. ROI-ROI analyses modeled the interaction between tDCS group (active versus sham) and occasion (baseline connectivity versus postintervention connectivity) for the DMN, FPCN, and CON controlling for age, sex, education, site, and adherence.

Compared to sham, the active group demonstrated ROI-ROI increases in functional connectivity within the DMN following intervention (left temporal to right temporal [T(202) = 2.78, pFDR < 0.05] and left temporal to right dorsal medial prefrontal cortex [T(202) = 2.74, pFDR < 0.05]. In contrast, compared to sham, the active group demonstrated ROI-ROI decreases in functional connectivity within the FPCN following intervention (left dorsal prefrontal cortex to left temporal [T(202) = -2.96, pFDR < 0.05] and left dorsal prefrontal cortex to left lateral prefrontal cortex [T(202) = -2.77, pFDR < 0.05]). There were no significant interactions detected for CON regions.

These findings (a) demonstrate the feasibility of modulating network connectivity using tDCS and CT and (b) provide important information regarding the pattern of connectivity changes occurring at these intervention parameters in older adults. Importantly, the active stimulation group showed increases in connectivity within the DMN (a network particularly vulnerable to aging and implicated in Alzheimer’s disease) but decreases in connectivity between left frontal and temporal FPCN regions. Future analyses from this trial will evaluate the association between these changes in connectivity and cognitive performance post-intervention and at a one-year timepoint.