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11 The Psychometric Characteristics of a Novel Metamemory Questionnaire for Children
- Mary Godfrey, Samantha van Terheyden, Gabriel Loud, Jack Wiese, Maxine Reger, Christopher Vaughan, Gerard Gioia
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 529-530
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Objective:
Metamemory is a component of metacognition that includes both the knowledge of factors that affect memory (i.e., declarative metamemory) and knowledge and application of factors in one's own learning and recall performance (i.e., procedural metamemory; Kreutzer et al., 1975). Previous researchers have examined children's metamemory through interviews and found that metamemory abilities are positively associated with age and performance on memory measures (see Godfrey et al., 2022 for review). However, there is not yet a standardized measure to evaluate children's metamemory. The current study aimed to examine the psychometric characteristics of a declarative metamemory questionnaire, the Measure of Metamemory (MoM-10), for children ages 6-12 years old. Based on previous research, we hypothesized that performance on the MoM-10 would not be associated with sex but would be positively associated with age and learning and memory performance.
Participants and Methods:A total of 75 English-speaking typically developing children between the ages of 6 to 12 years old were recruited for the current study (M age=9.1+1.92; females 49%). Participants completed the MoM-10 which assessed declarative metamemory via 10 multiple choice questions (accuracy score of 0 or 1 points per question) and required participants to provide an explanation for their multiple-choice answer (explanation score of 0, 1, or 2 points per question). The metamemory questionnaire provided two outcome variables: an Accuracy score of 10 possible points, and an Explanation score of 20 possible points. Additionally, participants completed a 3-trial pictorial learning/memory task which provided an Immediate Recall score and Delayed Recall score.
Results:As hypothesized, there were no sex differences on the MoM-10 Accuracy scores (t(73)=0.71, p=0.48) or Explanation scores (t(73)=-73, p=0.47). Consistent with our hypothesis, age was significantly associated with Accuracy (r=0.31, p<0.01) and Explanation scores (r=0.79, p<0.001). Internal consistency of the MOM-10 was moderate for the Explanation score (Cronbach's alpha=0.68) and low for the Accuracy score (KR-20=0.54). Lastly, after controlling for age, participants' MoM-10 Accuracy score was significantly associated with Immediate Recall (r=0.32, p<0.01) on the learning/memory task and the Explanation scores were significantly associated with the Immediate Recall (r=0.36, p<0.01) and Delayed Recall scores (r=0.32, p<0.01) on the learning/memory task.
Conclusions:The current study presents an initial review of psychometric properties of a metamemory questionnaire for children ages 6 to 12 years old. Additionally, as hypothesized, these results suggest the MOM-10 performance is significantly positively associated with participants' age and immediate and delayed recall performance on a pictorial learning/memory task. These associations provide lines of evidence for convergent validity given the expected maturation of metamemory with both age and with improvements in actual memory performance. However, based on the low internal consistency of the accuracy scores, further refinement will be explored including possibly rephrasing questions from the current item set or perhaps excluding current items in future use of the scale.
12 The Development of a Pediatric Metamemory Questionnaire and Scoring Procedure
- Jack Wiese, Mary Godfrey, Samantha van Terheyden, Gabriel Loud, Maxine Reger, Gerard Gioia, Christopher Vaughan
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 530-531
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Objective:
To create a standardized scoring procedure to evaluate open-ended responses as part of a novel questionnaire (Measure of Metamemory; MoM) designed to assess declarative metamemory in youth. Metamemory is an aspect of metacognition that is one’s knowledge of the factors related to storage and retrieval of information (Flavell 1971; Kreutzer et al., 1975), and includes both declarative metamemory (i.e., one’s knowledge about factors influencing memory) and procedural metamemory (i.e., one’s understanding of their own memory performance).
Participants and Methods:Fourteen short vignettes related to memory were administered to 100 participants (age 6-12) with questions such as, “Two children hear a story they must remember. The first person is 5 years old. The second person is 12 years old. Who is most likely to remember it best?” After answering, they were then prompted to explain their answer (i.e., “Why?”) and their responses were recorded verbatim. To develop standardized and objective criteria for each of the 14 open-ended responses, responses from a subsample of 20 youth were collectively examined by the study team and a scoring structure similar to open-ended items on common intelligence tests (e.g., WISC-V/WAIS-IV) was created. Two points (full credit) were awarded for complete and thorough understanding of memory processes related to the question; 1 point was given for partially accurate or incomplete understanding of the related memory process; and 0 points for an inability to correctly express an understanding of relevant memory concepts. This scoring guide was then applied independently by each of the six raters to an additional 25 participants (ages 6-12 mean age (SD)). To assess the interrater reliability of this 3-point ordinal scoring system, we examined both Fleiss’ kappa and 2-way random-effects, single-rater, absolute agreement Intra-Class Correlations (ICC).
Results:Across the six independent raters, reliability coefficients for each of the 14 items ranged from (Fleiss') k =. 277 to .792 (ICC ranged from .481 to .880). Of these 14 items, the kappa value was classified (using interpretation rules for Cohen’s kappa) as “substantial” for 10 items, “moderate” for 3 items, and “fair” for 1 item. Based on these lower inter-rater reliabilities, two items were subsequently removed from the measure to create the 12-item open-ended measure of metamemory, the MoM-12, with reliable scoring for youth as young as 6 years old.
Conclusions:A consensus process established a quantifiable scoring procedure to assess open-ended responses related to youth’s knowledge of memory (e.g., metamemory). Reliability metrics identified acceptable interrater reliabilities in 12 of the 14 original items. Further examination of psychometric properties, including internal consistency and lines of evidence for validity is needed. The successful crafting of a scoring procedure is a first step towards developing a psychometrically sound measure (the MoM) to evaluate and study metamemory concepts objectively and reliably in youth.
4 Extending the 5P Clinical Decision Rule Predicting Concussion Recovery Using an Evidence-Based Assessment Model
- Dean R Allen, Peter K Isquith, Roger Zemek, Gerard A Gioia
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 603
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Objective:
Construction of predictive algorithms of concussion symptom recovery at 4 and 12 weeks post-injury using an evidence-based assessment (EBA) model to guide clinical decision-making, extending the 2016 5P decision rule.
Participants and Methods:Children and adolescents, ages 8-18 (n=1,551; mean age=12.78; 62% male), followed over 12 weeks in the prospective multicenter cohort study (Predicting Persistent Post-Concussive Problems in Pediatrics, 5P; Zemek et al., 2016). The age-specific PostConcussion Symptom Inventory (PCSI) (8-12, 17 items; 1318 years, 20 items) was completed at six timepoints from the ED and at 1, 2, 4, 8, and 12-weeks post-injury. Logistic regression analysis was applied to the set of key variables including the PCSI Total Retrospective-Adjusted PostInjury Difference (RAPID) scores, patient demographics and pre-injury history, and injury characteristics to predict participant recovery status (Recovered, Not Recovered) at the 4- and 12-week endpoints. The resulting recovery-predictive equations identified the significant sets of variables with symptom scores at four successive post-injury timepoints (ED, 1, 2, 4 weeks). Logistic Regression Threshold values were established at the 90th CI against which individual patient data was applied to determine recovery status. Participants with sub-threshold sums were deemed recovered at the target endpoint (4- or 12-weeks post-injury).
Results:A total of 19 predictive equations were generated for the two age groups across the recovery timeline. Four sets of equations were developed to predict symptom recovery status at 4-weeks post-injury for the two age groups (8-12 AUC=0.679-0.884; 13-18 AUC=0.752-0.909). Prediction of symptom recovery status at 12-weeks post-injury yielded six equations for the 8-12 age group (AUC=0.723-0.825), and five equations for the 13-18 age group (AUC=0.724-0.887). Total PCSI RAPID score was identified as a significant variable in each of these 19 equations. Participant sex was identified as significant in 18 of the 19 constructed equations. Other variables that were identified as significant at varying timepoints included age, pre-injury history of learning disability and migraines, and an early post-injury sign in the ED (answering questions more slowly than usual). Examples of the equations include: Week 1 predicting symptom recovery status at 4-weeks: 8-12 yr group-(Sex*.802)+(week 1 Total RAPID Score*.142)+(Age2* .053)+(-3.851) with AUC=0.808; 13-18 yr group-(Sex*.980)+(Week 1 Total RAPID Score*.071)+(-3.261) with AUC=0.861.
Conclusions:Clinicians’ management of the concussion recovery of children and adolescents can benefit from EBA guidance. The 5P dataset (Zemek et al., 2016) provides an important window into “typical” and “atypical” recovery trajectories, establishing an initial predictive decision rule for a 4-week recovery endpoint, at the ED timepoint only, reporting AUC=0.69. The current study extends the prediction modeling using successive post-injury timepoints reflecting a typical management timeline. Symptom reports from both 1- and 2-weeks post injury with patient demographics/ history predicted symptom recovery status at 4- and 12-weeks post-injury, significantly improve predictive accuracy over the ED timepoint alone. These predictive equations, when applied to the individual patient, can serve to assist the clinician’s understanding of the patients’ recovery trajectory, i.e., on track for a typical or atypical recovery, further informing the intervention strategy.
67 Extending Evidence of Validity for Symptom Severity Classification of the PostConcussion Symptom Inventory (PCSI)
- Dean R Allen, Roger Zemek, Pediatric Emergency Research Canada (PERC), Gerard A Gioia
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 171
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Objective:
External validation of symptom severity classification levels for the PostConcussion Symptom Inventory (PCSI).
Participants and Methods:Two distinct samples of parents and children, ages 8-18, participated from a: (1) prospective multicenter cohort study (Predicting Persistent Post-concussive Problems in Pediatrics, 5P) (Zemek et al., 2016), including parents (n=2,852), adolescents (n=1,087; mean age=15.13; 54% male), and children (n=1,271; mean age=10.70; 65% male) and (2) published clinic sample at Children’s National Hospital (CN) including parents (n=1,197; adolescents, n=835; children, n=326) (Gioia et al., 2019). Participants completed the age-specific Post-Concussion Symptom Inventory (PCSI): Mean time postinjury = 8 hours (5P), 6 days (PCSI2), generating a post-pre-injury difference (RAPID) score. The distribution of the RAPID scores for the Total Symptom and 4 subscales (physical, emotional, cognitive, sleep/fatigue) were examined to define 4 symptom severity classification levels (minimal - within the CI for recovered, low <20th %tile, moderate 21-79th %tile, high >80th %tile) for the respective samples. These severity distributions were compared between the two distinct datasets.
Results:ANOVAs were performed to examine group differences in the mean scores for each of the 4 classification levels. No significant differences were found for all the RAPID score distributions with minimal effect sizes (<.1% variance) for the parents, adolescents and children. PCSI RAPID Total Score ranges for the severity classifications were as follows: Minimal-Parent and adolescent groups 5P<=5, Clinic <=5; Children: 5P<=3, Clinic<=3; Low- Parents 5P 6-15, Clinic 6-13; Adolescents 5P 6-19, Clinic 6-16; Children: 5P 4-7, Clinic: 4-7; Moderate-Parents 5P 16-49, Clinic 14-47; Adolescents 5P 20-56, Clinic 17-51; Children 5P 8-17, Clinic: 818; High- Parents: 5P>=50, Clinic >=48; Adolescents 5P >=57, Clinic >=52; Children 5P >=18, Clinic >=19).
Conclusions:Our findings reveal a parallel distribution of RAPID scores in the two distinct 5P and Clinic patient populations, yielding nearly identical severity classification level parameters across all five PCSI symptom domains (total score, physical, cognitive, emotional, and sleep/fatigue). The present investigation provides evidence of validity for the use of these severity classification levels across the ED and specialty clinic settings.
40 Metamemory performance of children with ADHD in comparison to typically developing children.
- Samantha van Terheyden, Mary Godfrey, Gabriel Loud, Jack Wiese, Maxine Reger, Christopher Vaughan, Gerard Gioia
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 647-648
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Objective:
Metamemory is an aspect of metacognition that is one's knowledge of memory and understanding of their own memory performance (Kreutzer et al., 1975). Executive function skills are foundational skills required for the development of metamemory in early school-age children (Lockl & Schneider, 2007; Lecce et al., 2015). Previous studies have suggested children with Attention-Deficit/Hyperactivity Disorder (ADHD) may have weaker study and organizational strategies, suggesting weaker metamemory skills (O'Neill & Douglas, 1991; Voelker et al., 1989). The current study aimed to examine the metamemory knowledge of typically developing (TD) children and children with ADHD on a novel declarative metamemory questionnaire. We hypothesized that the ADHD group would have worse metamemory performance than the TD group and that executive functioning skills would be significantly associated with metamemory for all groups.
Participants and Methods:The current study recruited a total of 93 English-speaking children between the ages of 6 to 12 years old, including 70 typically developing (TD) children (M age=9.1+1.92; females 49%), and 23 children with diagnoses of ADHD (M age=9.56+1.27; females 57%). Fifty-seven percent of the ADHD group reported daily use of stimulant medication, but no participants took medication on the day of testing. The participant groups did not significantly differ regarding age or sex. Participants completed the Measure of Metamemory (MoM-10) which included 10 multiple choice questions (i.e., Accuracy) and asked participants to explain their multiple-choice answer (i.e., Explanation). This provided three scores: Accuracy (max 10 points), Explanation (max 20 points), and Total (max 30 points). Additionally, participants' parents completed the 12-item Behavior Rating Inventory of Executive Function, 2nd Edition (BRIEF-2) Screening form, evaluating the child's executive functioning, which provided a percentile based on age and sex.
Results:Within the ADHD group, BRIEF-2 percentiles and MoM-10 scores did not differ between those who were medicated and those who were not. As previous literature has shown, the TD and ADHD groups significantly differed on the BRIEF-2 screening score percentiles (t(91)=-5.78, p<0.001; TD M=52.89+26.1; ADHD M=85.26+13.82). The TD and ADHD groups did not significantly differ on either the MoM-10 Accuracy (p=0.13; TD M=7.22+1.84; ADHD M=7.87+1.32), the Explanation (p=0.08; TD M=9.34+3.80; ADHD M=10.57+2.92), or Total (p=0.13). There was a trend towards a significant correlation between the Explanation scores and BRIEF-2 for TD participants (r=-0.23, p=0.06), but there was no significant correlation between Explanation, Accuracy, or Total scores and the BRIEF-2 for the ADHD group.
Conclusions:Our results tentatively suggest a possible association between metamemory and parent reported executive functioning for TD children, supporting the expected association between the development of executive functioning and the development of metamemory. However, there was no association between metamemory and executive functioning for children with ADHD, likely due to the restricted range of executive functioning scores for this group (i.e., M=85.25+13.82; Range 55-99). Additionally, metamemory did not significantly differ between diagnostic groups. Children with ADHD may have comparable metamemory knowledge to TD children as a result of executive functioning instruction and support they have received. Rather, there may be group differences in the application of metamemory judgement and strategies.
Test–Retest Reliability of a Semi-Structured Interview to Aid in Pediatric Traumatic Brain Injury Diagnosis
- Danielle C. Hergert, Veronik Sicard, David D. Stephenson, Sharvani Pabbathi Reddy, Cidney R. Robertson-Benta, Andrew B. Dodd, Edward J. Bedrick, Gerard A. Gioia, Timothy B. Meier, Nicholas A. Shaff, Davin K. Quinn, Richard A. Campbell, John P. Phillips, Andrei A. Vakhtin, Robert E. Sapien, Andrew R. Mayer
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- Journal:
- Journal of the International Neuropsychological Society / Volume 28 / Issue 7 / August 2022
- Published online by Cambridge University Press:
- 11 August 2021, pp. 687-699
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Objective:
Retrospective self-report is typically used for diagnosing previous pediatric traumatic brain injury (TBI). A new semi-structured interview instrument (New Mexico Assessment of Pediatric TBI; NewMAP TBI) investigated test–retest reliability for TBI characteristics in both the TBI that qualified for study inclusion and for lifetime history of TBI.
Method:One-hundred and eight-four mTBI (aged 8–18), 156 matched healthy controls (HC), and their parents completed the NewMAP TBI within 11 days (subacute; SA) and 4 months (early chronic; EC) of injury, with a subset returning at 1 year (late chronic; LC).
Results:The test–retest reliability of common TBI characteristics [loss of consciousness (LOC), post-traumatic amnesia (PTA), retrograde amnesia, confusion/disorientation] and post-concussion symptoms (PCS) were examined across study visits. Aside from PTA, binary reporting (present/absent) for all TBI characteristics exhibited acceptable (≥0.60) test–retest reliability for both Qualifying and Remote TBIs across all three visits. In contrast, reliability for continuous data (exact duration) was generally unacceptable, with LOC and PCS meeting acceptable criteria at only half of the assessments. Transforming continuous self-report ratings into discrete categories based on injury severity resulted in acceptable reliability. Reliability was not strongly affected by the parent completing the NewMAP TBI.
Conclusions:Categorical reporting of TBI characteristics in children and adolescents can aid clinicians in retrospectively obtaining reliable estimates of TBI severity up to a year post-injury. However, test–retest reliability is strongly impacted by the initial data distribution, selected statistical methods, and potentially by patient difficulty in distinguishing among conceptually similar medical concepts (i.e., PTA vs. confusion).
Impact of Self-Efficacy and Affective Functioning on Pediatric Concussion Symptom Severity
- Kesley A. Ramsey, Christopher Vaughan, Barry M. Wagner, Joseph F. McGuire, Gerard A. Gioia
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- Journal:
- Journal of the International Neuropsychological Society / Volume 27 / Issue 9 / October 2021
- Published online by Cambridge University Press:
- 14 January 2021, pp. 875-882
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Objective:
The purpose of this study was to examine whether self-efficacy predicted pediatric concussion symptom severity and explore whether affective mood states (e.g., depression) influenced this relationship.
Method:Children (8–17 years) who were diagnosed with a concussion within 30 days of injury participated in the study (n = 105). Following a clinical assessment, participants and caregivers completed questionnaires that assessed overall concussion symptom severity and current depression symptoms. Participants also completed ratings capturing self-efficacy for managing concussion recovery.
Results:Linear regression models revealed that greater levels of self-efficacy predicted lower parent- (R2 = 0.10, p = .001) and youth-rated (R2 = 0.23, p < .001) concussion symptom severity. Interestingly, depression symptoms moderated the relationship between self-efficacy and concussion symptom severity.
Conclusions:Findings provide initial support for a relationship between self-efficacy and concussion outcomes and highlight the influence of depressive symptoms. Interventions that optimize youth’s self-efficacy have the potential to increase treatment adherence, reduce concussion symptom severity, and improve recovery prognosis.
Applying an Evidence-Based Assessment Model to Identify Students at Risk for Perceived Academic Problems following Concussion
- Danielle M. Ransom, Alison R. Burns, Eric A. Youngstrom, Christopher G. Vaughan, Maegan D. Sady, Gerard A. Gioia
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- Journal of the International Neuropsychological Society / Volume 22 / Issue 10 / November 2016
- Published online by Cambridge University Press:
- 01 December 2016, pp. 1038-1049
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Objectives: The aim of this study was to demonstrate the utility of an evidence-based assessment (EBA) model to establish a multimodal set of tools for identifying students at risk for perceived post-injury academic problems. Methods: Participants included 142 students diagnosed with concussion (age: M=14.95; SD=1.80; 59% male), evaluated within 4 weeks of injury (median=16 days). Demographics, pre-injury history, self- and parent-report measures assessing symptom severity and executive functions, and cognitive test performance were examined as predictors of self-reported post-injury academic problems. Results: Latent class analysis categorized participants into “high” (44%) and “low” (56%) levels of self-reported academic problems. Receiver operating characteristic analyses revealed significant discriminative validity for self- and parent-reported symptom severity and executive dysfunction and self-reported exertional response for identifying students reporting low versus high academic problems. Parent-reported symptom ratings [area under the receiver operating characteristic curve (AUC)=.79] and executive dysfunction (AUC=.74), and self-reported ratings of executive dysfunction (AUC=.84), symptoms (AUC=.80), and exertional response (AUC=.70) each classified students significantly better than chance (ps<.001). Hierarchical logistic regression indicated that, of the above, self-reported symptoms and executive dysfunction accounted for the most variance in the prediction of self-reported academic problems. Conclusions: Post-concussion symptom severity and executive dysfunction significantly predict perceived post-injury academic problems. EBA modeling identified the strongest set of predictors of academic challenges, offering an important perspective in the management of concussion by applying traditional strengths of neuropsychological assessment to clinical decision making. (JINS, 2016, 22, 1038–1049)
Functional Magnetic Resonance Imaging of Working Memory and Response Inhibition in Children with Mild Traumatic Brain Injury
- Lauren S. Krivitzky, Tresa M. Roebuck-Spencer, Robert M. Roth, Kaitlin Blackstone, Chad P. Johnson, Gerard Gioia
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- Journal:
- Journal of the International Neuropsychological Society / Volume 17 / Issue 6 / November 2011
- Published online by Cambridge University Press:
- 12 October 2011, pp. 1143-1152
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The current pilot study examined functional magnetic resonance imaging (fMRI) activation in children with mild traumatic brain injury (mTBI) during tasks of working memory and inhibitory control, both of which are vulnerable to impairment following mTBI. Thirteen children with symptomatic mTBI and a group of controls completed a version of the Tasks of Executive Control (TEC) during fMRI scanning. Both groups showed greater prefrontal activation in response to increased working memory load. Activation patterns did not differ between groups on the working memory aspects of the task, but children with mTBI showed greater activation in the posterior cerebellum with the addition of a demand for inhibitory control. Children with mTBI showed greater impairment on symptom report and “real world” measures of executive functioning, but not on traditional “paper and pencil” tasks. Likewise, cognitive testing did not correlate significantly with imaging results, whereas increased report of post-concussive symptoms were correlated with increased cerebellar activation. Overall, results provide some evidence for the utility of symptom report as an indicator of recovery and the hypothesis that children with mTBI may experience disrupted neural circuitry during recovery. Limitations of the study included a small sample size, wide age range, and lack of in-scanner accuracy data. (JINS, 2011, 17, 1143–1152)