Abstracts for the 2015 AACN Scientific Poster Session.

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Abstracts for the 2015 AACN Scientific Poster Session Published online: 15 May 2015.

Click for updates To cite this article: (2015) Abstracts for the 2015 AACN Scientific Poster Session, The Clinical Neuropsychologist, 29:3, 308-393, DOI: 10.1080/13854046.2015.1040457 To link to this article: http://dx.doi.org/10.1080/13854046.2015.1040457

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The Clinical Neuropsychologist, 2015 Vol. 29, No. 3, 308–393, http://dx.doi.org/10.1080/13854046.2015.1040457

Abstracts for the 2015 AACN Scientific Poster Session


SECTION 1: ADULT EMPHASIS Adult and Geriatric Neuropsychological Assessment Neuroimaging Traumatic Brain Injury and Concussion Symptom and Performance Validity Aging and Dementia Medical Disorders Psychiatric Disorders SECTION 2: PEDIATRIC EMPHASIS Autistic Spectrum Disorder Pediatric Neuropsychological Assessment Pediatric Oncology Attention, Learning, and Executive Functioning Pediatric Neurology Traumatic Brain Injury and Concussion

SECTION 1: ADULT EMPHASIS (Student first-authored papers identified by “S” after poster number.) Adult and Geriatric Neuropsychological Assessment #1 S COTHRAN, T.P., LARSON, E.B., & HUTMAN, P. The Relationship Between Subjective Psychomotor Slowing and Sustained Complex Attention Performance: A Three-Level Hierarchical Linear Model Fatigue appears to be related to psychomotor slowing, reduced energy, and sleep disturbance. The effects of fatigue on cognition tend to manifest when sustained effort is exerted over time. This exploratory chart review study investigated the relationship between slopes of performance across a sustained attention task and self-reports of psychomotor slowing, reduced energy, and sleep disturbance. One hundred and twenty outpatients completed the Paced Auditory Serial Addition Task (PASAT), the processing speed (PSI) and working memory (WMI) subtests of the Wechsler Adult

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AACN SCIENTIFIC POSTERS: ABSTRACTS

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Intelligence Scale-Fourth Edition, and provided clinical interview data. A three-level hierarchical model was used to test person-level predictors affecting slopes of performance across the PASAT. In this model, repeated measures of PASAT scores were nested within the four series of PASAT trials, which were nested within persons. Additionally, a quadratic term was entered into level 1 to model curvature in overall performance across the entire test. After controlling for WMI and PSI, persons who endorsed psychomotor slowing in the clinical interview evidenced significantly greater decline across the PASAT (t = −2.80, p = 0.006). Self-report of sleep disturbance and reduced energy were not significant predictors. Confirmatory research of this new model is warranted. #2 S HOLT, H., ALIOTO, A.G., HOYMAN, L.C., & ZEINER, H.K. The Clinical Utility of the Advanced Clinical Solutions Test of Premorbid Functioning Word reading tests are commonly used to estimate premorbid functioning. Advanced Clinical Solutions (ACS) Test of Premorbid Functioning (TOPF) extends this technique by including complex demographic variables to improve prediction accuracy. Research on the utility of word reading tests is inconsistent and little research has examined the TOPF in particular. The current study examines the accuracy of the TOPF by comparing estimates of overall intellectual functioning as measured by the Wechsler Adult Intelligence Scale-IV (WAIS-IV) full scale IQ (FSIQ). The sample consisted of veterans (N = 59) in an outpatient neuropsychology clinic. It is expected that the TOPF estimates will exceed WAIS-IV FSIQ, as comparison with estimated baseline scores should indicate stability or decline in cognitive functioning. However, results indicated that 14% of actual TOPF (not demographically corrected) were lower than FSIQ scores. When using the predicted TOPF (demographically corrected) an even greater percentage of scores (29%) were lower than FSIQ. Furthermore, eight percent of the overall sample’s predicted TOPF scores were a full standard deviation or more below FSIQ scores. The TOPF likely underestimates premorbid functioning and accuracy was not increased by including complex demographic information. Rather, including these variables resulted in less accurate prediction. #3 S THOMPSON, D.A., MOSES, J.A., & ENG, M.E. Verbal and Non-Verbal Mediation of Benton Serial Digit Learning Test 8-Digit Version Exploratory factor analyses were conducted using archival data of 137 Veterans at the Palo Alto Veterans’ Affairs Hospital. A two-factor solution of Benton Serial Digit Learning Test 8-digit Version (SDL-8), showing independent performance on early and late trials (Romero, 2008), was combined with patient age and education. Performance on the early trials of SDL-8 loaded with education while performance on the late trials loaded with age. These two factors were analyzed with Wechsler Adult Intelligence Scale-III (WAIS-III) to determine construct validity, explaining 84.77% of the shared variance. The four-factor solution showed that the early trial component loaded with

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raw scores of Verbal Comprehension (VC) and Working Memory (WM) while the late trial component loaded with raw scores of Processing Speed (PS) and Perceptual Organization (PO). The results show that performance on early trials of SDL-8 are mediated verbally while late trials are mediated non-verbally.


#4 S LAI, J.K., MOSES, J.A., HAN, S.S., & MARINO, C.E. Analysis of Copy Error Scores of the Benton Visual Retention Test The effects of demographic variables on Benton Visual Retention Test (BVRT) Copy error scores were examined, and the pattern of performance was categorized using the Wechsler Adult Intelligence Scales-Third Edition (WAIS-III). Factor analysis of the six types of BVRT Copy errors yielded two loadings of Major or Minor perceptual errors. Age was found to be correlated with Major errors (Component 1) while years of education loaded with Minor errors (Component 2). A third analysis of these component variables with the four indices of WAIS-III in a sample of 129 diagnostically mixed neuropsychiatric patients found that Component 1 had loadings with Perceptual Organization and Processing Speed Indices, Component 2 loaded solely on Verbal Comprehension Index, and Working Memory Index was unrelated to either components (total variance explained = 85.17%). Our findings suggested that number of Major Copy errors are likely to increase with age, poorer perceptual reasoning abilities, and slower cognitive processing, while number of Minor Copy errors result from a breakdown in acquired strategies that are verbally mediated. Working memory abilities appear to be unrelated to BVRT Copy performance. Overall there appears to be a verbal component involved in BVRT Copy performance although it is traditionally considered a visual-motor test. #5 S GARCIA, A.M., TROCHE, J., & COHEN, R. The Importance of Concreteness, Similarity, and Association for Semantic Knowledge Recent work has questioned the necessity of dichotomizing semantic knowledge into concrete and abstract categories. Troche and colleagues (2014) proposed a unitary semantic space, which is instead based on the relative importance of three factors: exogenous information, endogenous information, and magnitude. The current study investigated the importance of similarity and association in predicting distance between word pairs in this unitary semantic space. Participants (N = 234, Mage = 36.5) were asked to rate 551 word pairs on a 7-point Likert scale for their association and similarity. Regressions examined the relative importance of similarity and association for concrete, abstract, and concrete-abstract word pairs separately. These found a robust effect of similarity, such that more similar words were closer in semantic space (Abstract β = −.26, p < .05; Concrete β = −.43, p < .01; Mixed β = −.57, p < .01). However, association only significant predicted distance for mixed abstract-concrete word pairs (β = −.24, p < .05). This finding suggests that words may be overwhelmingly defined by their overarching word class. However, everyday language largely reflects the use of both abstract and concrete words in context. Thus, association between words is relatively more important for our typical semantic processing.


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#6 S SANTOS, O.A., SUNDERARAMAN, P., SCHWARZ, L., MAHMOOD, Z., BLOCK, C., & THAMES, A.D. Are We There Yet? Preparation and Doctoral-Level Training in Cross-Cultural Neuropsychology With advancements in online learning, web-based seminars (i.e. webinars) are increasingly popular as they facilitate real-time communication in an interactive environment. A recent webinar, hosted by the Society for Clinical Neuropsychology’s Ethnic Minority Affairs and Association of Neuropsychology Students in Training, provided training and practice recommendations in cross-cultural neuropsychology (CCN) to 994 viewers worldwide, demonstrating the utility of this technology for neuropsychological education and training. A follow-up survey was conducted, with 96% of respondents being doctoral students or completed a doctorate. Importantly, 57% reported minimal preparation in CCN tantamount to one course or less, which is consistent with a recent study showing the need for appropriate education and training in CCN to adequately serve ethnic/racial minorities (Elbulok-Charcape et al., 2014). Unsurprisingly, only 24% of respondents reported confidence with CCN services/consultation, which is similar to previous results showing that 83% of neuropsychologists reported feeling inadequately prepared to work with Hispanics (Echemendia et al., 1997). Over half (54%) of respondents endorsed having “learned a great deal” from this webinar. Overall, a high level of satisfaction (4.53/5.00) was reported. Results are discussed in the context of this technology’s potential use in neuropsychological education and training as well as recommendations for future webinars. #7 S WILSON, M.D., TESTA, S.M., & SAWYER, R.J. Use of The Calibrated Neuropsychological Normative System (CNNS) in the Assessment of Neurocognitive Performance Among Minority Populations Use of ethnicity-based norms in the analysis of neuropsychological test data has faced some controversy. Ethnicity is used frequently as a proxy for a number of sociocultural factors, such as socioeconomic status, quality of education, and health issues. Such an approach may confound test result interpretation of examinees from minority populations. This raises questions about the validity of using such norms. The purpose of the present analysis was to understand how calibration of test scores with and without race as a predictor variable impacts test score interpretation. The files of 130 Veterans referred for neuropsychological evaluation were examined. Neurocognitive data included the Wechsler Adult Intelligence Scale Digit Span subtest, Trail Making Test (TMT) parts A and B, Hopkins Verbal Learning Test-Revised (HVLT-R), Brief Visuospatial Memory Test-Revised (BVMT-R), and the Boston Naming Test (BNT). All data were interpreted using the CNNS. Results demonstrate that inclusion of ethnicity as a normative factor results in higher T-score values for African American Veterans and lower values for Caucasian Veterans than when ethnicity is not included. In particular, the scores of African American Veterans increased to new interpretative categories on TMT Part A and BVMT-R Total Recall. Overall, these results suggest that inclusion of ethnicity as a normative factor may alter the manner in which neurocognitive test

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scores are interpreted. More research is needed to understand the variables that account for these interpretive differences.


#8 S JAYAKAR, R., TONE, E.B., & NAHMIAS, E. Self-Reported Social Anxiety Predicts Mutual Cooperation for Caucasian Individuals but not for Non-Caucasian Individuals During the Prisoner’s Dilemma (PD) game, in which mutual cooperation increases long-term gain and is thus considered an adaptive behavior, social anxiety has been linked to distinct behavior patterns in largely Caucasian samples. Findings on neural underpinnings of social anxiety and associated behavioral outcomes are sparse for ethnic minorities; also, behavioral results are mixed regarding whether self-reported social anxiety symptoms are consistent across different ethnic backgrounds. Therefore, we examined the role of social anxiety when predicting mutual cooperation in Caucasian (n = 34) and non-Caucasian (n = 23) participants (46% female; age M = 20.54) separately. We used the Liebowitz Social Anxiety Scale (LSAS) and behavioral data (earnings) from the PD game. Linear regression showed that lower LSAS Anxiety subscale scores were associated with higher Caucasian participant earnings (β = −.34, p < .05, SE = .07), accounting for 9% of the variance in earnings when the co-player was believed to be human. LSAS Anxiety did not predict non-Caucasian earnings (β = −.19, p = .39, SE = .09). Further, LSAS Anxiety did not predict earnings for any individuals when the co-player was believed to be a computer. Results suggest that it is important to include non-Caucasian samples in neuroimaging and neuropsychological research on adaptive social functioning because social anxiety could manifest differently across ethnic backgrounds. #9 ZOMBOR, R., RICHARDS, N., DRAGOVIC, M., PESTELL, M., & BRONSON, M. Improved Access to Neuropsychology Results in Decreased Health Utilization and Cost Savings* There is emerging evidence that outpatient neuropsychological assessment can decrease health care utilization. This evaluation considered whether improved access to neuropsychology might also result in decreased hospital utilization in a group of very long stay general medical inpatients (range 15–202 days in hospital). During a 15 month period 13 general medical inpatients were referred to a community clinic for neuropsychological assessment, as there was no onsite service. These patients waited an average of 21 days to be seen (SD = 13), at significant cost to the hospital (over $1,000 per patient, per day). A neuropsychologist commenced onsite, with patients (n = 22) being seen much more quickly (M = 3 days after referral, SD = 3, p = 0.001). Analysis showed that improved access to neuropsychology input significantly decreased hospital utilization with concomitant savings to the health service. Specifically, overall length of stay was significantly shorter for patients assessed onsite decreasing from an average of 129 days (SD = 44) to 50 days (SD = 40, p = 0.001). Further, readmission rates also decreased significantly (p = 0.001). The results of this analysis were used to permanently establish the neuropsychology position within the hospital. This evaluation adds further support


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to the capacity for neuropsychological evaluation to decrease hospital utilization and potentially result in savings for health care services. *Funded by the American Academy of Clinical Neuropsychology Foundation (AACNF)


#10 S SHIRAZI, T., SUMMERS, A., KAPETANOVIC, S., SMITH, B., NATH, A., & SNOW, J. Performance-Based, but Not Self-Report Based, Measures of Everyday Function are Related to Neuropsychological Status Diagnostic algorithms for many neurocognitive disorders, such as HIV-Associated Neurocognitive Disorder, include assessment of everyday functioning (EF). However, the added diagnostic value of EF measures has not been systematically investigated. We hypothesized that in order for measures of EF to have added value, a group of neuropsychologically impaired individuals should manifest more EF difficulties than nonimpaired individuals. HIV+ and HIV− participants (n = 118) completed the CHARTER neuropsychological battery and received a diagnosis of neuropsychologically impaired (n = 26) or unimpaired (n = 92) according to established criteria. Additionally, they completed the self-report based Patient’s Assessment of Own Functioning and the performance-based Texas Functional Living Scale (TFLS). The proportion of individuals self-reporting EF impairment did not vary by neuropsychological status (p = 0.40). ANOVAs revealed a significant main effect of neuropsychological status on TFLS scores (p = 0.001), but no significant main effect of self-reported impairment on TFLS scores (p = 0.61). Self-reported impairment was not correlated with Global Deficit Scores (GDS), mean T-scores, or TFLS scores (ps > 0.05). TFLS scores, however, were significantly correlated with mean T-scores and GDS (ps < 0.001). The discordance of self-reported impairment with neuropsychological status and other measures of EF casts doubt upon the clinical utility of incorporating subjective EF measures in the diagnosis of neurocognitive disorders. #11 S SANTOS, O.A., FINMAN, V.K., PETERS, E.R., NEUMANN, K.L., MIRKOVIC, T., & OSMON, D.C. Concurrent Validity of Elementary Cognitive Tasks to Measure Executive Functions Elementary cognitive tasks (ECTs) to assess perceptual-motor processes and executive functions (EF) offer several advantages: a precise definition of EF, a clear differentiation between non-EF and EF abilities, levels of complexity according to bits of information, and a mathematical model using a ratio level of measurement among others. This study tested the concurrent validity of four ECTs (0- & 1-bit non-EF tasks and 1-bit & 2-bit EF tasks) by examining their relationship with nine subtests from the Delis–Kaplan Executive Function System that constitute three EF factors: Switching, Updating, and Inhibition. Tasks were administered to 133 undergraduates (mean = 22.08, SD = 4.40), and the three EF factors were used to predict performance on the ECTs. For both the 0-bit and 1-bit non-EF tasks, only Switching was predictive (R2adj = .06 & .15, p < .005 & .01, respectively). For the 1-bit EF task, both Updating and Inhibition were

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predictive, although Updating predominated (Importance = .767 & .233, respectively; R2adj = .16, p < .005 & .01, respectively). Contrarily, for the 2-bit EF task, Inhibition predominated compared to Updating (Importance = .699 & .301, respectively; R2adj = .19, p < .0001 & .02, respectively). Results are discussed in terms of Miyake et al.’s (2012) unity/diversity framework of EF as well as of other studies using latent variable analysis. #12 S COTHRAN, T.P., & LARSON, E.B. Psychometric Properties of the First Series of The Paced Auditory Serial Addition Test: An Item Response Theory Evaluation In the Paced Auditory Serial Addition Test (PASAT), the examinee sums successive dyads of numbers that are presented at a set rate, which increases in a stepwise fashion across four series. The PASAT is a test of complex attention, working memory, and processing speed but other factors are believed to impact performance. Often patients report anxiety associated with the successive increases in rate. Similarly, increases in error rate within each series have raised concerns that fatigue affects items later in each series. In the present study, to determine if items in the first series load on a single factor, binary item-level data were coded for 123 outpatients who underwent neuropsychological evaluation. Mean total correct was 38.21 (SD = 7.55). The suitability of item response theory one-parameter (1PL) and two-parameter (2PL) logistic models were assessed. The data were better suited to the 1PL model (χ2 = 56.34, df = 48, p = 0.31). The marginal reliability for the 1PL model response pattern was 0.87. The effects of fatigue are thought to be evident over time. These psychometric properties suggest suitability for Rasch modeling which would be ideal in a longer version for the study of fatigue. #13 S MORGAN, K.N., SCOTT, B.J., SHEAN, M., ALVAREZ, G., & SHADA, K. Convergent Validity of Lumosity’s Brain Performance Test Measures with Conventional Neuropsychological Tools Lumosity is an online program designed to improve cognitive functioning with the use of brain-training games. To help subscribers gage improvement in cognitive functioning, Lumosity developers created a battery of computerized tests based on conventional neuropsychological measures; however, no psychometric data has been published for these tests. The current pilot study aimed to explore relationships between measures used in Lumosity and traditional neuropsychological practice. A total of 15 neurologically healthy adults between the ages of 18 and 35 completed the Lumosity test battery, including Digit-Symbol Coding, Divided Visual Attention, Memory Span/Reverse Memory Span, Progressive Matrices, and Wordy Equations subtests. Examiners also administered standard neuropsychological measures, including Trail Making Test parts A and B, Digit Span, Symbol Span, Spatial Span, Matrix Reasoning, and Math Fluency. Spearman’s rho correlations were calculated between scaled scores for functionally similar Lumosity and conventional measures. of 14 relationships analyzed, only Memory Span/Spatial Span forward and Trails B were significantly correlated (p < 0.01). Therefore, based on this pilot sample, many of the Lumosity subtests may


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not accurately determine changes in cognitive functioning when compared to psychometrically valid measures used in traditional neuropsychology. A larger study is planned to further investigate.


#14 S RITCHIE, K.A., VOGT, E.M., WASISCO, J.E., & HOELZLE, J.B. How Low Do They Go? Rates of Impaired Delis–Kaplan Executive Function System Scores in a Collegiate Sample Monte-Carlo simulations suggest it is common to observe impaired Delis–Kaplan Executive Function System (D-KEFS; Delis et al., 2001) scores in a normal sample. This project investigated the frequency of impaired D-KEFS Color-Word Interference and Trail Making scores in college students [N = 93; M age = 19.12 (1.06); WTAR M = 114.35 (8.51)]. Utilizing Crawford’s (2007) software, expected frequencies of impaired scores were generated for three primary achievement scores (Trails Condition 4, Color-Word Interference Conditions 3 and 4) for groups of individuals 1) aged 19 and below (n = 68) and 2) 20 and above (n = 25). It was expected that 16% of each group would obtain one scaled score ≤ 5. In the older group one impaired score was observed (4.0%), whereas in the younger group three impaired scores (4.4%) were observed. Noteworthy, one significantly impaired score (scaled score ≤ 3) was observed in the older group (4.0%), which is consistent with prediction (4.0%). While high functioning young adults do obtain impaired scores, the rates are lower than predicted based upon simulation studies using normative samples. This information should be kept in mind while evaluating individuals with strong premorbid abilities. Additional clinical and methodological implications will be discussed. #15 S HAN, C.S., MOSES, J., LAI, J., & MARINO, C. An Investigation of Language Dimensions and Their Relationships to Intellectual Functioning Assessment of language abilities has mainly focused on evaluating the level of performance on expressive and receptive language tasks, while limited attention has been directed to the investigation of specific language dimensions and their relationships to general intelligence. The current study examined 107 diagnostically mixed neuropsychiatric patients to explore how dimensions of spoken language, as measured by the Multilingual Aphasia Examination (MAE), relate to each modular factor of the Wechsler Adult Intelligence Scales-Third Edition (WAIS-III). Four interactive factors of spoken language (confrontation naming, auditory comprehension, repetition, and verbal fluency) were identified using principal component analysis of total scores of MAE subtests. A model in which the four language components were independent was then created. These four components were found to be uniquely associated with the four modular factors derived from the raw scores of WAIS-III (total variance explained = 70%). In specific, confrontation naming was associated with Verbal Comprehension; auditory comprehension was grouped with Perceptual Organization; repetition was associated with Working Memory; and verbal fluency was grouped with Processing Speed. Results supported the notion that confrontation naming, auditory

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comprehension, repetition, and verbal fluency are distinct linguistic constructs, and that they also are uniquely associated with specific factors of intellectual functioning.


#16 RANI, P., RAO, S.L., & CHANDRAMOULI, B.A. Development of Emotion Perception Test in India Dearth of scientifically developed and culturally relevant tests of emotions could have contributed to the slow progress of the affective neuroscience field in India. Facial expression emotion perception tests are few and do not have strong scientific basis. Further, there are no prosody emotion perception tests in India. Present study aimed to develop a test of emotion perception through facial expression and prosody. Photographs and audio sounds (meaningful as well as non-meaningful sentences) depicting neutral and six basic emotions were recorded from actors. These items were judged by 18 experts (clinical psycholigists and actors). Items with greater than 75% consensus were incorporated in the preliminary test. The preliminary test consisted of 363 items. This test was administered on 96 normals. Item analysis was carried out on the obtained data. Based on the results of item analysis, 84 items (14 items in each of the six subtests) were selected for the final test. The final test, NIMHANS Emotion Perception Test (NEPT), was thus developed. NEPT is a compact, time-effective, cost-effective, easy to administer, scientificaly sound, and culturally relevant test for the Indian population to assess perception of emotions across facial expression and prosody communication channels. #17 S BENSON, L.M., YOUNG, M.A., & PLISKIN, N.H. Does The Boston Naming Test-2 Function Equivalently for Men and Women? The Boston Naming Test-2 (BNT-2) is widely used for detecting naming deficits. However, few studies have investigated its item-level psychometric properties with regard to gender. The present study examined the BNT-2 for gender-based differential item functioning (DIF) in a sample of 744 men and women of diverse cognitive ability, recruited from a neuropsychology outpatient clinic. Using a two-parameter Item Response Theory (IRT) framework, difficulty and discriminability estimates were generated for items 11 through 60. DIF was detected for 6 items (“stethoscope,” “pyramid,” “latch,” “sphinx,” “yoke,” and “palette”), indicating that these items do not function equivalently in men and women. Post hoc analyses found that age, years of education, and literacy provided partial explanations for the DIF, although none could entirely account for observed findings. The IRT-estimated rank ordering of item difficulty was similar in both groups, and comparable to those initially assigned by Kaplan, Goodglass, and Weintraub (2001). Correlations between BNT-2 scale scores and IRT-based scale scores were very high, suggesting that the overall scoring of the BNT-2 was not substantially biased by gender, despite the identified DIF and small fluctuations in item rankings. Future consideration should be given to revision or omission of items identified as having DIF.


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#18 S BRADEN, L.M. Has The Boston Naming Test Reached Its Expiration Date? The 60-item Boston Naming Test (BNT) is one of the most frequently used visual confrontation naming tests. Most early work with the BNT found either no differences based on age or that picture-naming accuracy declined with age. The purpose of the present evaluation was to determine if a sample of older adults (65 years or older) performed differently on the BNT when compared to a younger adult cohort (18–30 year olds). Archival records of 565 patients that were referred for an evaluation from 2012 through 2014 were reviewed and of those 110 met criteria for inclusion in the study. There were 25 older adults and 85 younger adults. The groups were demographically matched (n = 8) in terms of gender, education and ethnicity. The total BNT score for the older adult cohort (mean = 57.375, SD = 2.1) was significantly better than the younger adult population (mean = 49.125, SD = 7.4) at a level of (p = 0.01). When the sample was examined by age without additional demographic corrections the scores remained significantly higher for older subjects (mean = 54.4, SD = 5.0) compared to younger adults (mean = 51.8, SD = 5.2). These results suggest the possible obsolescence of the BNT and that the test may no longer measure what it was intended to measure. #19 S ROSADO, D.L., PIPER, L.E., FEIGON, M., LUU, H., BOTBOL, E., GONZALES, M., ZALIZNIAK, K., CARRIÓN, C., LEON, A., GREIF, T., RAO, J., BUEHLER, S., & PLISKIN, N. Impact of Feedback Services Following Neuropsychological Evaluation Evidence-based outcome research regarding the clinical utility of neuropsychological evaluation is essential due to health care reform. The objective of the current study was to examine the relationship between understanding of testing, condition, and coping abilities in patients utilizing neuropsychology services. This study included 37 patients presenting for evaluation and feedback services. Patients completed questionnaires on the evaluation day and again 6–8 weeks later via structured phone interviews. The questionnaires assessed quality of life (QOL), personal mastery (PM), stress and clinical utility items. Correlation analyses revealed significant relationships between change in understanding of testing with change in understanding of condition (r = .40, p = .01) and change in coping ability (r = .52, p = 10 voxels) in SPM8 was used. We found a significant increase of FC of bilateral superior frontal gyrus and posterior cingulate in stroke controls when compared to patients with depression or anxiety. Our findings suggest that DMN alterations are associated with post stroke depression and anxiety symptoms. #38 SUNDARAM, S.E., HUBBARD, N.A., TURNER, M.P., OASAY, L.MK., REMINGTON, G., BARKER, R., DAVIS, S., FROHMAN, E., FROHMAN, T., HART JR., J., & RYPMA, B. Functional Reorganization of Resting Neural Networks are A Function of Disease Duration in Relapsing-Remitting Multiple Sclerosis Relapsing-remitting multiple sclerosis (RRMS) is characterized by acute, inflammatory central nervous system attacks. These attacks (i.e. exacerbations) continue periodically across the lifetime in individuals with RRMS. Few studies have been conducted to determine the impact of disease duration on functional reorganization of neural connectivity. The purpose of this study was to assess changes in the functional organization of resting neural networks as disease duration progressed in RRMS patients. We hypothesized distinct changes to resting state functional connectivity as a function of disease duration. Twenty-two (N = 22) patients with RRMS not currently experiencing an exacerbation underwent structural and functional magnetic resonance imaging (fMRI). Functional reorganization was examined by assessing how individual differences in disease duration related to the centrality of each voxel in the resting network as measured by average connectivity. Increased disease duration was associated with decreased centrality in visual and cerebellar cortices, but increased centrality in association areas (i.e. middle frontal gyrus and angular gyrus; all ps corrected FWER < .05). Results suggest that centrality in resting networks shifts from perceptual and motor regions to higher order association areas as a function of disease duration in RRMS. #39 S JAMES, K.A., GRACE, L.K., THOMAS, K.G., WARTON, C.M.R., & COMBRINCK, M.I. Apolipoprotein E4, Cognition, and Hippocampal Volumes in South African Older Adults Allelic frequencies of Apolipoprotein (APOE) E4 are high in indigenous populations of southern Africa. Few neuro-imaging studies have been performed in low- and middleincome countries. We explored relationships between APOE-E4, cognition and hippocampal volumes (HV) in South African older adults. APOE genotyping, cognitive testing and structural magnetic resonance imaging were performed in 14 cognitively healthy controls and 21 patients with possible or probable Alzheimer’s disease (AD). A manual tracing technique was used to obtain volumetric hippocampal measurements. APOE-E4 allelic frequency was 0.14 in controls and 0.26 in AD patients. AD patients had smaller mean HV than controls: right HV, t(33) = 5.22, p < .0001; left HV, t(33) = 5.36, p < .0001; total HV, t(33) = 5.44, p < .0001. Presence of APOE-E4 had an

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independent effect on HV (total, left and right) in AD patients, F(3, 12) = 5.14, p = .04, d = 0.30. In all participants, across a range of healthy and impaired cognitive functioning, cognitive scores were positively correlated with right, left and total HV. This is the first quantitative neuro-imaging study performed in South African older adults. These findings concur with studies performed in high-income countries demonstrating the effect of APOE-E4 on hippocampal volumes.


Traumatic Brain Injury and Concussion #40 S GRIMES, K.M., JEFFAY, E., & ZAKZANIS, K.K. Relationship Between Apathy and Real-World Disability in Patients with Mild Traumatic Brain Injury While most persons recover soon after a mild traumatic brain injury (mTBI), protracted neuropsychological impairment (i.e. more than three months post-injury) is evident in many patients. The mediating role of apathy has yet been examined as a possible explanation for this impairment. Moreover, there is growing concern regarding the ecological validity of neuropsychological test measures and their ability to predict realworld disability. To this end, we sought to elucidate the relationship between apathy, neuropsychological impairment, and disability as it pertains to real-world function. We employed a battery of neuropsychological, psychological, and performance validity measures in 104 litigating patients with neuropsychological complaints: 38 patients were cognitively impaired but not disabled (defined by the ability to return to work) and 66 were cognitively impaired and disabled (the inability to return to work). An overall deficit in neuropsychological functioning was not indicative of real-world disability. Specific deficits in verbal fluency, memory, and information processing, however, did predict real-world disability. Apathy was not found to differ between these two groups, suggesting that psychological factors may play less of a mediating role than specific neuropsychological factors. In conclusion, we need to be mindful that not all neuropsychological test measures are predictive of real world disability. #41 BELANGER, H.G., SILVA, M.A., DONNELL, A., LAMBERTY, G., & VANDERPLOEG, R. The Concurrent and Predictive Validity of The Neurobehavioral Symptom Inventory (NSI): A VA Traumatic Brain Injury Model System Study The Neurobehavioral Symptom Inventory (NSI) is a measure of postconcussion symptoms (PCS) used within the Veterans Health Administration (VHA) in TBI screening and evaluation and as an outcome measure. There are no studies of its validity beyond factor analytic studies. Many cross-sectional studies have found significant overlap with anxiety measures. The purpose of this study was to examine the concurrent and predictive validity of the NSI in TBI patients after controlling for demographic variables (age, gender, ethnicity, marital status), TBI severity, time since injury, and PTSD symptoms (PTSD Checklist, PCL). In a sample of mixed severity (Mild TBI n = 59; Moderate to Severe TBI n = 570), NSI collected during inpatient rehabilitation admission was not


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significantly related to any concurrently administered measures of functioning (Functional Independence Measure or FIM, Disability Rating Scale or DRS, Participation Scale or PART of the Mayo-Portland Adaptability Inventory), p > 0.05. Similarly, baseline NSI was not predictive of any future functional measures at one year follow-up, p > 0.18. However, NSI administered at one year follow-up was significantly related to concurrent functional measures including FIM, ΔF = 8.0, p < .005, such that greater PCS severity was associated with worse functioning (r = −0.3) and satisfaction with life, ΔF = 5.6, p < .02, such that greater PCS severity was associated with less satisfaction (r = −0.5). #42 S GREEN, D.L., STRICKER, N.H., LIPPA, S.M., MCGLYNN, S.M., MILBERG, W.P., & MCGLINCHEY, R.E. Similar Rates of Neuropsychological Impairment in Veterans with and without Mild TBI in the Absence of Psychiatric Comorbidities Psychiatric diagnoses account for considerable variance in the neurocognitive effects of remote, military mild traumatic brain injury (mTBI) but are not excluded from studies given their high rate of comorbidity. This study investigated neuropsychological test performance and rate of clinical impairment in Veterans of the recent conflicts in Iraq and Afghanistan with (n = 17) and without (n = 62) history of military mTBI after excluding psychiatric comorbidities. 302 non-treatment-seeking veterans were recruited to the VA Boston TBI Center of Excellence. Exclusion criteria included prior neurological illness, moderate/severe TBI, posttraumatic stress disorder, depression and other mood disorders, substance use disorders and failure on performance validity measures. Groups were matched for age, education, IQ, gender and ethnicity. Individuals with mTBI showed equivalent rates of impairment in all domains assessed, i.e. attention, processing speed, executive functioning and memory, at several clinical cutoffs (−1, −1.5 and −2SD). Multivariate analysis of variance comparing group performances on 16 neuropsychological measures was nonsignificant. These findings are consistent with the civilian literature demonstrating the vast majority of individuals with mTBI recover postinjury without persisting cognitive impairment. Studying this elusive population may identify protective factors in Veterans who experience mTBI but show no post-acute neurocognitive effects, possibly informing development of prevention/intervention measures #43 FURGER, R.E., NELSON, L.D., LERNER, E.B., & MCCREA, M.A. Predictors of Recovery Time After Mild Traumatic Brain Injury in a Community Emergency Department Sample Identifying risk factors for prolonged recovery from mild traumatic brain injury (mTBI) may help providers identify at-risk individuals and direct them to appropriate psychoeducation and early intervention. While prior work has examined the relationship between select factors and recovery from mTBI, none have jointly considered the predictive value of a comprehensive set of neurobiopsychosocial variables. In this study, we evaluated subjects who presented to an emergency department (ED) with uncomplicated

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mild traumatic brain injury (mTBI) at various time points post-injury (M = 39 hours and days 8, 15, and 45 post-injury). A number of psychosocial, neurocognitive, and injury-related variables predicted symptom duration at a univariate level. In multivariate regression analyses, the best fitting model (Model R-squared = .51) in which all predictors added incrementally to the prediction of symptom duration included the following predictors: loss of consciousness (standardized beta = .29), initial post-concussive symptom score (beta = .18), number of non-head injuries (beta = .22), whether or not narcotics were administered in the ED (beta = .28), and reported injury-related litigation (beta = .24). This model might be used to identify mTBI patients at risk of prolonged recovery and direct future research efforts on recovery from civilian mTBI. #44 S KEENAN, P.T., EICHENBAUM, E., & LAMBERTY, G.J. The Effects of Psychiatric Symptom Overreporting on Neurobehavioral Symptom Inventory (NSI) Scores The Neurobehavioral Symptom Inventory (NSI; Cicerone & Kalmar, 1995) was developed to assess symptoms observed following mild TBI and is incorporated into the VA’s Comprehensive Traumatic Brain Injury Evaluation (CTBIE). Recent work examining the psychometric properties of the NSI has suggested that it does not adequately distinguish postconcussive and psychiatric symptoms. The present study examined the relationship between psychiatric overreporting and NSI scores in veterans seen for a CTBIE. The sample included veterans who completed a Minnesota Multiphasic Personality Inventory – Restructured (MMPI-2-RF) within one year of NSI/CTBIE administration. Cases with content nonresponsive MMPI-2-RF profiles or self-reported moderate/severe brain injury were excluded. Remaining cases were separated into valid, overreporting, and invalid groups based on interpretive guidelines for Infrequency Responses (F-r) and Infrequency Psychopathology Responses (Fp-r) scales. One-way ANOVAs revealed that invalid groups had significantly higher NSI scores than valid (p < 0.01, F-r d = 0.77, Fp-r d = 0.86) and overreporting groups (p < 0.01; F-r d = 0.48, Fp-r d = 0.65). Consistent with previous literature, somatic symptom overreporting (Fs) was also associated with significantly higher NSI scores (p < 0.01, d = 0.64–1.21). These results suggest that psychiatric distress, psychiatric overreporting, and somatic overreporting can all significantly affect NSI scores and cannot be assumed to be related primarily to a history of mild TBI. #45 COLE, W.R., ARRIEUX, J.P., IVINS, B.J., SCHWAB, K., DALE, M.A., & QASHU, F.M. A “Head to Head” Comparison of Four Neurocognitive Assessment Tools in Service Members with and without Mild Traumatic Brain Injury The rising awareness regarding concussions, especially in athletes and service members, has given rise to the development of numerous computerized neurocognitive assessment tools (NCATS) to efficiently evaluate individuals with mild TBI (mTBI). This study sought to evaluate the ability of four commonly used NCATS (ANAM, CNS Vital Signs; CNSVS, CogState, and ImPACT) to distinguish between military service members with and without mTBI. The sample included 139 healthy enlisted US Army



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soldiers and 216 enlisted soldiers within seven days of a medically documented mTBI. Two randomly selected NCATs were administered in random order to each soldier. Independent samples t-tests were used to compare the commonly interpreted scores from each NCAT, expecting controls to perform better than the mTBI group. Only participants putting forth adequate effort were included in analyses with alpha at.05. Results revealed significant differences for 7 of 8 ANAM subtests, all 12 of the CNSVS scores, 4 of 5 CogState scores, and 1 of 4 ImPACT scores. Effect sizes for significant differences were generally small to moderate (d < .80), though CogState had two subtests with large effect sizes. The data suggest these NCATs have utility, though to varying degrees, in identifying soldiers at risk for mTBI-related cognitive issues. Disclaimer: THE VIEWS EXPRESSED HEREIN ARE THOSE OF THE AUTHOR(S) AND DO NOT REFLECT THE OFFICIAL POLICY OF THE DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE, OR THE U.S. GOVERNMENT. #46 COLE, W.R., ARRIEUX, J.P., & IVINS, B.J. Performance On Neuropsychological Testing by Soldiers with and without Mild Traumatic Brain Injury Concussion is a large health concern in the military, and neuropsychological tests are often administered as part of routine care after a service member has sustained a mild TBI (mTBI). This study evaluated the difference between neuropsychological test scores of soldiers with mTBI and healthy controls. The sample was a predominantly male, all enlisted active duty US Army soldier population of 187 healthy soldiers and 132 soldiers within seven days of a medically documented mTBI. Six commonly used neuropsychological tests were administered: Test of Premorbid Functioning (TOPF), WAIS-IV, Continuous Performance Test, Second Edition (CPT-II), CVLT-II, Delis Kaplin Executive Functioning System (DKEFS), and Rey Complex Figure Test (RCFT). Independent samples t-tests were used to evaluate differences between the control and mTBI groups on 26 scores from the test battery. 20 of 26 scores were statistically different (p < .05) with the exception of TOPF predicted IQ, short delay verbal memory (CVLT-II), recognition memory (CVLT-II and RCFT), and CPT-II reaction time. However, effect sizes (Cohen’s d) were generally small with 11 scores 3 resulted in low sensitivity (.16), high specificity (.99) and positive predictive power (PPP; .93), and moderate negative predictive power (NPP; .68). An alternative cut-off of >0 resulted in moderate-high sensitivity (.67), specificity (.86), PPP (.71), and NPP (.83). For the ES, no cut-off had adequate specificity and PPP. These findings support the use of the EI, but not the ES, to identify poor effort in mild TBI patients in conjunction with other PVTs. #51 SULLIVAN, K.A., EDMED, S.L., ALLAN, A.C., KARLSSON, L., & SMITH, S.S. Postconcussion Symptoms After Mild TBI (mTBI): Influence of Pre-Morbid and Current Sleep-Wake Disturbances. To examine the relationship between self-reported pre-morbid and current sleep disturbance and persistent postconcussion symptoms (PPCS). Participants were 58 community-dwelling individuals (Mage = 24.16; SD = 8.40; 53.4% female) tested 1-6


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months post-injury. The data were cross-sectional and collected via online self-report measures, including: a single item rating of pre-morbid sleep quality (1 = very poor to 5 = very good); the PROMIS® Sleep-Related Impairment (PROMISa) and Sleep Disturbance (PROMISb) 8-item short forms; and, the Insomnia Severity Index (ISI). The dependent measure was a modified Neurobehavioral Symptom Inventory (NSI) with the sleep-items removed. A two-step hierarchical regression analysis was conducted. First, pre-morbid sleep quality was entered; it was not a significant predictor of PPCS, F(1, 56) = 3.18, p = .080, R2 = 5.4%. Second, current sleep disturbance was entered (i.e. ISI, PROMISa, PROMISb); it significantly predicted PPCS, R2 = 30%, F (3, 53) = .19, p < .001. One of three current sleep disturbance measures, the PROMISa, made a significant (p = .003) and unique contribution to outcome (accounting for 11.9% of the variance). When premorbid sleep quality is controlled, current sleep disturbance, particularly sleep-related impairment, contributes to PPCS report. Targeting sleep impairment post-mTBI might help to reduce PPCS. #52 S BIEU, R.K., RINALDI, A.R., KULAS, J.F., DEVIVA, J.C., & MCCARTHY, E. Cognitive-Behavioral Therapy for Insomnia in a mTBI Veteran Population Despite high rates of complaints of poor sleep among Veterans who have suffered an mTBI and the potential costs associated with failure to adequately treat sleep disturbance, multicomponent non-pharmacological sleep treatments are poorly utilized and under-researched in mTBI populations. The present study examined the effectiveness of group administered CBTI in a Veteran mTBI sample (N = 17). Following completion of a weekly, six-session intervention, significant improvement was realized in self-reported insomnia symptoms on the Insomnia Severity Index from pre-treatment (M = 17.24, SD = 5.33) to post-treatment (M = 10.82, SD = 6.32), t(16) = 4.62, p < .001. There was also a significant increase in sleep efficiency (M = 75.09%, SD = 13.51, improving to 82.96%, SD = 12.36, t(16) = −2.31, p < .05), and significant decreases in sleep onset latency (M = 36.67 mins, SD = 33.45, improving to 23.43 mins, SD = 20.98, t(16) = 2.72, p < .05) and time in bed (M = 7.58 hrs, SD = 1.39, decreasing to 6.83 hrs, SD = .92, t(16) = 2.44, p < .05) noted by self-report using sleep diaries. While wake after sleep onset (WASO) was reduced, this was not significant and there was no change in total sleep time. These results provide preliminary evidence that CBTI can benefit a Veteran mTBI population when delivered in a group format. #53 S ROZEK, D., WAN, R., YARLING, C., SULLIVAN, K.D., TRIGGER, C., & CONTARDO, C. Mental Health History Increases Self-Report of Concussion Symptoms The role of mental health (MH) symptoms on the presentation and recovery of concussion is a topic of emerging clinical significance. MH history has been shown to be more predictive of initial presentation and symptom resolution time than physical injury characteristics (McClean et al 2009). The current study retrospectively examined a sample of 165 patients (36% female, mean age = 20.53, 67% sport injuries) in a community-based outpatient clinic to investigate the impact of MH history on self-reported concussion symptoms. All had uncomplicated concussions with no


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significant differences in injury characteristics (as diagnosed by a physician and board certified neuropsychologist). 27% of patients reported a history of diagnosis, or treatment, for a non-psychotic MH disorder which was confirmed via clinical interview. Preliminary results show patients with a MH history endorsed increased levels of symptoms (Post Concussion Syndrome Checklist, PCSC, Gouvier et al., 1992) at initial and follow-up appointments (F(2, 140) = 3.219, p = .043, and F(2, 127) = 3.451, p = .035, respectively), not attributable to demographics. In this clinic, MH history increases self-report of concussion symptoms and prolongs symptoms. Results suggest MH history is a factor in self-reported symptoms and should be considered when evaluating and rehabilitating this injury. #54 S KANDAH, C., CICCONE, D., BAIR, J., SWAMINATHAN, B., & SCIMECA, L. Neuropsychological Performance of Military Personnel with Blast and Non-Blast Related mTBI and PTSD Blast trauma exposure is related to the development of mild traumatic brain injuries (mTBI) and posttraumatic stress disorder (PTSD). When the blast occurs, TBIs are typically caused by trauma to the head from shrapnel and PTSD is caused by witnessing, hearing about, or direct exposure to the blast. Yet, the shockwave alone can force blood up through the carotid arteries potentially yielding a distinct type brain damage to the cerebral-vasculature and the subcortical areas of the brain. The purpose of this study was to examine if blast exposure in military personnel influences their performance on a brief neuropsychological examamination. Each group contained a mixture of pure mTBI, PTSD, and healthy individuals. A total of 23 individuals with a history of blast injury (Mage = 42.17, SD = 13.98) and 22 individuals with no history of blast exposure (Mage = 44.36, SD = 15.72) was examined. No differences were found between groups for age (t(43) = .48, p > .05) and education (t(43) = .08, p > .05). Results show that blast exposure does not lead to a specific type of neuropsychological performance, which is largely supported by the previous literature. Nevertheless, future endeavors might examine how the number of blast exposures and the average distance from the blast relates to performance on a full neuropsychological battery. #55 S SEMLA, M., PARIKH, S., WHITESIDE, D.M., LUU, H., RICE, L., & BASSO, M. Assessment of Psychiatric Symptoms with The Personality Assessment Inventory (PAI) in Mild Traumatic Brain Injury (mTBI) Patients with Credible Performance Patients with mild traumatic brain injury (MTBI) often have higher elevations on Personality Assessment Inventory (PAI) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical scales compared to severe traumatic brain injury (STBI) or psychiatric (PSYCH) patients (Kweon & Rho, 2005), but secondary gain issues could influence these results. Further, research examining personality functioning incredible performance MTBI patients is sparse. This study evaluated whether credible performance MTBI patients (N = 106, age = 43.95 [SD = 12.70], education = 13.19 [SD = 2.50]) would have higher PAI somatization (SOM) scale elevations compared to credible performance STBI (N = 44, age = 44.9 [SD = 12.19], education = 12.61 [SD = 2.13]) and PSYCH (N = 142, age = 48.80 [SD = 15.63], education = 13.70

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[SD = 2.54]) patients. Participants were consecutive outpatient referrals for neuropsychological evaluations that completed the PAI and passed all performance validity tests. One way ANOVAs indicated only SOM scale and its subscales (SOM-C [Conversion], SOM-S [Somatization], and SOM-H [Health Concerns]) were significantly different between the MTBI, STBI and PSYCH groups. Post-hoc analyses indicated that SOM and its subscales were significantly higher in MTBI than the STBI and PSYCH groups. The findings provided support for somatization symptoms in even credible MTBI patients and also provided further support for the validity of the PAI in TBI patients. #56 PFALLER, A.Y., NELSON, L.D., LAROCHE, A.A., & MCCREA, M.A. Division III College Football Teams with Better Win-Loss Records Have Fewer Concussions and Faster Recovery Time Football has come under increased scrutiny about concussions, concussion reporting, and concussion treatment. To our knowledge, no studies have examined the relationship between team performance and concussion incidence or reporting in football. This study looked at incidence and self-reported recovery from concussion as a function of team performance, as measured by end of season winning percentage. N = 749 athletes (960 player seasons) from four Division III college football teams participated in this study in 2013 and 2014 (eight team seasons). Concussion incidence had a large negative correlation with team winning percentage (r = −.89, p = .003). In concussed athletes, team winning percentage was negatively correlated with total duration of self-reported symptoms (r = −.28, p = .027), total time lost from sports participation after injury (r = −.32, p = .016), and number of days completely symptom free before return to sports (r = −.30, p = .025). Teams with better records had lower concussion rates and shorter recovery times from concussion. Numerous explanations may account for these findings including practice methods, playing style and technique, program attitudes about concussions, motivation to report concussions, and motivation to return to play after concussion. #57 S SCOTT, K., STRONG, C., GORTER, B., & DONDERS, J. The Utility of a Neuropsychologist in a Post-Concussion Rehabilitative Program At Three-Month Follow-Up As part of a larger prospective study evaluating the efficacy of a post-concussion rehabilitation program, the incremental value of a neuropsychologist’s involvement in this program was investigated in a sample of 50 participants (62% female, median age 40 years, median time post injury 63 days). As a routine standard of care, participants completed an established assessment instrument, the Mayo-Portland Adaptability Inventory, Fourth Edition (MPAI-4) at treatment initiation as well as three months following the completion of their treatment. Pre-treatment, they were also administered standardized measures, including the Beck Depression Inventory-II (BDI-II) and the Trail Making Test, and were interviewed to gather information about their history by a neuropsychologist. Regression analysis revealed that, after controlling for baseline MPAI-4 scores, BDI-II scores predicted a significant amount of additional variance in three-month follow-up MPAI-4 Ability scores (F[5, 44] = 5.58, p < .01; Table 1) and


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psychiatric history predicted a significant amount of additional variance in three-month follow-up MPAI-4 Adjustment scores (F[5, 44] = 7.01, p < .01; Table 2). These results support the incremental value of a neuropsychological screening in a post-concussion rehabilitation program.


#58 S LUU, H., WHITESIDE, D.M., PARIKH, S., SEMLA, M., RICE, L., & BASSO, M. The Relationship Between Cognitive and Emotional Functioning in Severe Traumatic Brain Injury Severe TBI has both significant emotional and cognitive sequelae (Bay et al., 2012), but the relationship between cognition and emotion is not well studied. The goal of this study was to evaluate the relationship between cognitive and emotional variables in STBI patients who passed all performance validity tests. Mild TBI (MTBI) and psychiatric patients (PSYCH) patients were studied as comparison groups. Participants were patients with STBI (N = 44; mean age = 44.9.8, SD = 12.2), MTBI (N = 106; mean age = 44.0, SD = 12.7), and psychiatric disorders (N = 142; mean age = 48.8, SD = 15.6). Correlations between the Personality Assessment Inventory (PAI; Morey, 1996) and Conner’s Continuous Performance Test (CPT; omissions), Rey Complex Figure Test (RCFT; Copy Trial raw score), Boston Naming Test (BNT; total raw score), and Verbal Fluency Test (FAS; total raw score) were calculated. The STBI group had significant correlations (p < .01) between CPT and several PAI scales, including SCZ (r = .51), INF (r = .49), NIM (r = .43), and SOM (r = .41). RCFT had large magnitude correlations with scales NIM (r = −.42), ANX (r = −.41), SCZ (r = −.45), BOR (r = −.46), ALC (r = −.38), DRG (r = −.48), SUI (r = −.41), and RXR (r = .45). However, there were almost no significant correlations in the psychiatric and MTBI groups. These findings indicated that distress is significantly related to cognition in STBI but not in non-neurological samples. #59 PARMENTER, B., RAU, H., PESKIND, E., & PAGULAYAN, K. Self-Reported Working Memory Difficulties in Veterans with Multiple BlastRelated Mild Traumatic Brain Injury Many Veterans of the conflicts in Iraq and Afghanistan who sustained multiple mild traumatic brain injuries (mTBI) report a range of cognitive and emotional symptoms for years post-injury. This study evaluated factors associated with self-reported working memory difficulties among OIF/OEF/OND Veterans with a history of repeated blast-related mTBI (N = 24) and without a history of TBI (deployed controls; N = 16). Participants completed the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A), WAIS-III Letter Number Sequencing Test (LNS), Symbol Digit Modalities Test (SDMT), TOMM, Patient Health Questionnaire-9 (PHQ-9), PTSD Checklist-Military (PCL-M), and Pittsburgh Sleep Quality Inventory (PSQI). mTBI participants endorsed significantly higher working memory (WM) difficulties on the BRIEF-A than deployed controls (p < 0.05). Within the mTBI group, participants with clinically elevated subjective WM difficulties (T scores ≥ 65; n = 16) performed significantly worse on the SDMT and reported poorer sleep quality (PSQI; p < .05). Although not significant, these participants also performed worse on LNS and endorsed

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more PTSD and depression symptoms. These results suggest that self-reported memory difficulties in Veterans with a history of repeated blast-related mTBI may be related to multiple factors, including both objectively reduced information processing speed and increased mental health difficulties.


Symptom and Performance Validity #60 PECK, C.P., MITCHELL, E., VARGA, C.M., & MASSE, A.J. The Repeatable Battery for the Assessment of Neuropsychological Status Effort Index on an Epilepsy Monitoring Unit The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a widely accepted measure frequently used with inpatient populations. In 2007, Silverberg et al. developed the Effort Index (EI) for the RBANS. The EI has shown great promise for detecting insufficient effort in a number of diagnostic groups; however, several studies have documented high false positive rates in geriatric populations. This construct is untested in an epilepsy population. As such, we examined the accuracy of the RBANS EI on an epilepsy-monitoring unit. Seventy-three consecutive patients were administered the Test of Memory Malingering (TOMM) and the RBANS. Using a TOMM Trial 1 cutoff of 2 EI cutoff produced 80% specificity and 62% sensitivity, while >3 cutoff resulted in 87% specificity and 62% sensitivity. Acceptable specificity levels were not achieved until the EI cutoff was raised to >4 (92% specificity and 38% sensitivity). Interestingly, the EI produced higher false-positive rates in the epileptic seizure group than the psychogenic non-epileptic group. Findings from this study suggest that caution should be employed when using the RBANS EI on epilepsy monitoring units. #61 S YANIS, Z., SMALL, S.K., & MACCIOCCHI, S.N. Performance on Embedded Performance Validity Metrics Following Acute Moderate-Severe TBI Our study examined the performance of 362 persons hospitalized following moderatesevere traumatic brain injury (TBI) using the California Verbal Learning Test-II Forced Choice (CVLT-II FC) metric, 2 Reliable Digit Span (RDS) metrics and measures of executive, attention, language and memory functioning. Participants mean age and education was 34 and 13.1 respectively. Mean time since injury was 50.6 days. The sample overall test battery mean (OTBM) was T = 32.98 (SD = 7.79). RDS was computed using 2 methods: maximum digits passed with one failed trial (RDS-1) and maximum digits passed with zero failed trails (RDS-0). Participants performance was not impaired on any metric CVLT-FC = 15.62 (SD = 6.13), RDS-1 = 8.22 (SD = 1.92) and RDS-0 = 8.31 (SD = 2.11). Different RDS scoring methods yielded highly similar findings. Our data can be used to derive expectations for CVLT-II and RDS performance in persons being examined in inpatient and outpatient settings. The RDS-0 scoring method may yield fewer type II errors in clinical practice. Implications of


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OTBM, orientation, CVLT-II FC and RDS scoring methods on clinical practice are discussed.


#62 S RAI, J.K., ERDODI, L.A., & FLARO, L. Wisconsin Card Sorting Test Embedded Validity Indicators Developed for Adults can be Extended to Children Clinically Referred for Neuropsychological Assessment Previous research has found that a certain combination of scores from the Wisconsin Card Sorting Test (WCST) adequately distinguish malingering from non-malingering undergraduates and suspected malingerers from brain-injured controls (Suhr & Boyer, 1999). The present study aimed to investigate whether the WCST can provide effective embedded validity indicators in a pediatric sample. Data were analyzed from 569 clinically referred children with a wide range of diagnoses. Raw scores on Failure to Maintain Set (FMS) and a discriminant function involving both FMS and categories completed (S-BDF) were evaluated against established performance validity tests as reference. An FMS cut-off of ≥4 produced acceptable overall specificity (.89–.90) but low sensitivity (.06–.17), whereas a cut-off of ≥4.69 on the S-BDF produced acceptable overall specificity (.88–.92) and variable sensitivity (.05–.57). FMS and S-BDF covaried with gender (rxy = −.12; rxy = −.13), while S-BDF was also correlated with age (rxy = −.18) and intellectual functioning (rxy = −.20 to .27). Results support the use of FMS and S-BDF as measures of performance validity in a mixed clinical sample of children. #63 S STELMOKAS, J., FLAHERTY, J.M., KITCHEN ANDREN, K., LINK, J., SPENCER, R., & BIELIAUSKAS, L. Measurement of Performance Validity Using the Stroop Test in a VA Polytrauma/ TBI Clinic The Stroop Color and Word Test manual (Golden & Freshwater, 2002) suggests that “low” Word and Color naming scores may provide an additional measure of invalid performing. The aim of the current study was to evaluate the sensitivity of the manual guidelines and establish optimal cut-off scores defined by 90% specificity using the Test of Memory Malingering (TOMM) failure (i.e. Trial 1 1.10) were present. Theoretically, multidimensional IRT modeling of a more complex scoring protocol may bolster the precision demonstrated here and derive indices of multiple cognitive domains. #87 S FANALE, C.M., COURTNEY, M., ROBERTSON, K.K., & SCHMITTEREDGECOMBE, M. Diet and Exercise Improve Performance On Naturalistic Task Efficiency The positive effects of exercise and diet on cognitive functioning measured by standardized tests are well understood. However, few studies have measured the effects of diet and exercise on goal-directed behavior for daily tasks. We assessed participants’ task accuracy and efficiency on the Night Out Task (NOT), a naturalistic task conducted in the lab setting. Participants were 36 healthy older adults. The NOT required participants to prioritize, organize, initiate, and complete a number of subtasks to prepare for a night out (e.g. gather ingredients to bake a dessert, determine and gather change for a movie). Participants also completed a questionnaire that assessed health behaviors (e.g. regular meals, exercise, etc.). Eating regular meals was related to higher task accuracy (r = .492, p = .002) and more efficient subtask completion (r = .482, p = .017). Regarding exercise, task completion time for the NOT was faster for individuals who were less sedentary (r = .420, p = .015), and engaged in more moderate sport activities (r = .518, p = .002) and muscle strengthening exercises (r = .440, p = .008). Overall, better diet and exercise showed positive associations with more efficient performance on a naturalistic, laboratory-based everyday tasks. This study provides an applied approach to understanding the importance of diet and exercise on cognition used for everyday tasks. #88 S PIPER, L.E., ROSADO, D., LEE, C., GUIDOTTI BRETING, L., & SWEET, J.J. Factor Structure of the Behavioral Dyscontrol Scale-II in an Outpatient Dementia Sample Previous analyses of the Behavioral Dyscontrol Scale (BDS) factor structure have generally indicated a three-factor solution across various samples (e.g. TBI, dementia) (e.g. Leahy et al., 2003; Hall & Harvey, 2007). Shura and colleagues (2015) found a two-factor solution for the BDS-II in a sample of veterans. The present study evaluated the factor structure of the BDS-II in a civilian dementia sample. Participants were 109 outpatients who underwent neuropsychological evaluation (M age = 74.84 years, SD = 10.12), and were subsequently diagnosed with a dementia of vascular,

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Alzheimer’s, mixed, or unknown etiology. Exploratory factor analysis (EFA) was run on the nine BDS-II items using Kaiser’s criterion, principal components extraction, and direct oblimin rotation. The analysis yielded a three-factor solution which accounted for 58.9% of the variance. Factor 1 was labeled “motor sequencing and inhibition” due to high loadings on items three through six. Factor 2 was labeled “bilateral motor programming” due to high loadings on items one and two. Factor 3 was labeled “self-monitoring” due to high loadings on items seven through nine. Unlike Shura and colleagues (2015), a two-factor solution was indicated; however, the pattern of item loadings differed. Results suggest the BDS-II factor structure may differ across clinical samples, which warrants further study.

Medical Disorders #89 LIM, S.H., SUL, B., KM, J.S., HONG, B.Y., LEE, K.B., & HWANG, W.S. The Recovery of Aphasia Related with Stroke Lesion Although studies have demonstrated that several specific brain lesions are related to the severity of aphasia, the effects of specific brain lesions on recovery of aphasia are not yet clear. This study investigated the effects of the lesions for stroke, on aphasia recovery. Fifteen aphasia subjects with stroke were assessed and completed at least two sets of language assessment using Korean version of the Western Aphasia Battery at subacute and chronic stage. Brain lesions and size were evaluated using MRIcron, SPM8, and Talairach Daemon software. Subtracting the lesion overlap map for those who showed more than thirty percent improvement of the Aphasia Quotient (AQ) by the time of their chronic stage after stroke (n = 9) from the lesion overlap map for those who did not (n = 6) revealed strong relationship with Broca’s area, inferior prefrontal gyrus, premotor cortex. Subtracting the lesion overlap map for those whose subsequent AQ in their chronic stage after stroke was equal to or higher than 50 (n = 6) from the lesion overlap map for those whose subsequent AQ was less than 50 (n = 9) revealed strong relationship with Broca’s area, superior temporal gyrus. These results should be useful for planning of aphasia treatment. #90 S KRISHNAN, K., MACHULDA, M.M., BUTTS, A.M., DUFFY, J.R., STRAND, E.A., WHITWELL, J.L., LOWE, V., & JOSEPHS, K.A. Clinical and Neurocognitive Profiles of Two Differing Hypometabolism Patterns in Individuals with Logopenic Primary Progressive Aphasia The diagnostic specificity of Logopenic Primary Progressive Aphasia (lvPPA) is unclear due to symptom overlap with Alzheimer’s disease and varying patterns of hypometabolism observed on fluorodeoxyglucose 18-F positron emission tomography (FDG-PET). This study aimed to investigate differences in clinical and neurocognitive profiles in a subset of individuals diagnosed with lvPPA with atypical hypometabolism in the superior parietal region compared to the typical left inferior temporoparietal pattern. Based on a comprehensive speech and language evaluation, 60 subjects were diagnosed with lvPPA and a neurological and neuropsychological evaluation was conducted. PET scans


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were qualitatively assessed by 5 investigators and reliably classified into the 2 groups (Kappa = 0.7, p < 0.001). Forty-four patients were classified as temporoparietal and 16 as superior parietal. There were no significant differences on demographic measures. The superior parietal group demonstrated significantly higher behavioral dyscontrol, lower recall and recognition on memory measures, and more impaired cognitive flexibility (FDR = 0.05). There are differences in clinical features and neurocognitive dysfunction in the superior parietal variant of lvPPA that supports prior research regarding the heterogeneity in phenotypical presentation among individuals diagnosed with lvPPA. The distinguishing features of the superior parietal subtype warrant further review to aid in the nosology of lvPPA diagnosis. #91 SCHOENBERG, M.R., EICHSTAEDT, K.E., SOBLE, J.R., CLIFTON, W.E., BENBADIS, S.R., BOZORG, A.M., RODGERS-NEAME, N.T., MATTINGLY, M.L., & VALE, F.L. Predicting Verbal Memory Outcome Following Selective Amygdalohippocampectomy for Localization-Related Temporal Lobe Epilepsy Neuropsychological assessment is a required component of preoperative evaluation for epilepsy surgery in order to identify patients at greatest risk for postoperative neurocognitive decline. This study examined the utility of several neuropsychological variables in predicting postoperative performances on the Rey Auditory Verbal Learning Test (RAVLT) trial 7, a measure with known sensitivity to TLE-related verbal memory deficits. Participants included nine left TLE (LTLE) and 15 right TLE (RTLE) patients who achieved Engel Class I surgical outcome. Predictor variables included preoperative scores on the following measures: Green’s Word Memory Test Free Recall subtest (WMT FR), Wechsler Memory Scale, 4th Ed., Logical Memory II, Rey Complex Figure Test 30-minute delay (RCFT), and Boston Naming Test (BNT). WMT FR performance most highly correlated with RAVLT (r = .91, p = .01), and Logical Memory II also correlated with RAVLT (r = .47, p = .02). Neither RCFT nor BNT correlated with RAVLT, with p = .28 and .83, respectively. Linear regression with WMT FR performance as the sole independent variable predicted postoperative RAVLT (beta = .91, p = .01; overall model fit R2 = .83). These data add to the evidence base of neuropsychology in the context of epilepsy surgical planning. #92 LEE-WILK, T., DUX, M.C., TYNER, C., RYAN, P., WALLIN, M., CULPEPPER, W.J., & BEVER, C. Motor and Neurocognitive Functioning in a Sample of Veterans with Multiple Sclerosis This study compared motor/cognitive functioning in a sample of predominantly male, African-American veterans diagnosed with Multiple Sclerosis (MS) with published samples of primarily Caucasian women with MS (Benedict, 2006, 2011). Seventy patients enrolled in a longitudinal VA study were studied cross-sectionally. They were administered: 25 Foot Walk, 9-Hole Peg Test, and the Minimal Assessment of Cognition in MS, and rated on the Expanded Disability Status Scale (EDSS). Participants were 70% male, 53% Black/African-American, aged 46.3 + 9.3, with

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14.6 + 2.1 years of education. Mean EDSS scores of this sample was 4.69 + 1.92. In contrast, the published sample (N = 291) was 78% female, 95% Caucasian, 45.4 + 8.9 years old, with 14.4 + 2.4 years of education, with a mean EDSS score of 3.0 + 1.8. The VA sample evidenced significantly lower test score performance (p < .05) across a number of domains, including upper/lower motor functioning, verbal/visual learning and memory, processing speed, executive functioning, and working memory. Differences across samples may partially be explained by greater overall neurologic impairment in the VA sample. Other factors including demographic differences may contribute to findings. Providers should be aware of disparities in symptom presentation in diverse groups, as previous findings may not be generalizable. #93 S MCGOLDRICK, K.D., OROCZO, A., HUTCHINSON, K.S., VIGGIANI, S., & DILKS, L. Effects of Guillain-Barré Syndrome and West Nile Virus on Cognitive Functioning Guillain–Barré Syndrome (GBS) causes the body’s immune system to attack the peripheral nervous system though demyelination. West Nile Virus (WNV), a mosquito-borne virus, can result in central nervous system infection. Research on the cognitive effects from these disorders is limited, while even less is known on the comorbid presentation of GBS and WNV. This case study presents a clinical snapshot of a post-acute patient with GBS and WNV. A standard neuropsychological battery was administered on a 67-year-old, male in an inpatient rehabilitation unit. He displayed rapid progression of neurological symptoms, including back pain and weakness in bilateral upper and lower extremities requiring maximal assistance. He possessed average intelligence, with impairment in attention and working memory. Executive functioning demonstrated mild impairment in planning and verbal fluency. Bilateral grip strength and left finger motor speed were also impaired with greater weakness on the left side. Although, little is still known about the comorbid effects of GBS and WNV on cognitive functioning, this case presentation appeared to follow the pattern of WNV, impairment in two neuropsychological domains, and is suggestive of cognitive impairment secondary to GBS and WNV. This case study contributes to accumulating knowledge of GBS and WNV sequelae. #94 BROWN, L.N., WOELSTAD, A., ZHANG, Y., & METZ, L.M. Neuropsychological Measures Associated with Corpus Callosum Integrity may be Sensitive to Minimal Cognitive Impairment in Multiple Sclerosis Although neuropsychological measures correlate better with MRI-T2 lesion burden than the Expanded Disability Status Scale (EDSS) in multiple sclerosis (MS), T2 lesion volume has not been a robust marker for neuropsychological impairment. Impaired verbal memory, processing speed, sustained attention, and executive dysfunction are often impaired in the early stages of MS. We present the MRI and neuropsychological findings of a 29 year-old woman with Relapsing Remitting MS and an EDSS score of 2.5 (minimal disability). Neuroimaging revealed high bilateral T2 lesion burden and whereas corpus callosum (CC) volume was normal and decreased CC fractional anisotropy confirmed structural abnormalities. Our neuropsychological tests included the


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Paced Auditory Serial Addition Test (PASAT), the Minimal Assessment of Cognitive Function in MS (MACFIMS) battery, and the Purdue Pegboard Test. Results revealed diminished performance only in tests associated with interhemispheric transfer including the 3-second PASAT (SD = −1.18), Purdue Pegboard (Bilateral: SD = −1.80), and phonemic fluency (SD = −1.42). These results support the reported subclinical degradation of CC efficiency (i.e. interhemispheric transfer) in early MS and indicate that neuropsychological measures associated with CC function may be sensitive in detecting brain injury that are functionally significant, even when other measures of cognition are normal. #95 DUX, M.C., LEE-WILK, T., TYNER, C., CULPEPPER, W.J., WALLIN, M., BEVER, C.T., & ROYAL III, W. Cognitive Function at Different Levels of Neurologic Disability in Veterans with Multiple Sclerosis The degree to which cognitive and neurologic impairment covary among individuals with multiple sclerosis (MS) is poorly understood. The Expanded Disability Status Scale (EDSS) is a well-accepted measure of neurologic impairment, with a cutoff score of 6 (“cannot walk without a cane”) indicating significant disease progression. Given the widespread use of this scoring cutoff as a disability marker in research and clinical practice, we examined performance across multiple cognitive domains of demographically-matched Veterans with MS who had an EDSS score of ≥6 (EDSS+; n = 31) versus those with scores of .02), but were negatively correlated with total QOLIE-31 score (r = −.54, p < .001), and several subscales: overall quality of life (r = −.51, p < .001), emotional well-being (r = −.64, p < .001), energy/fatigue (r = −.34, p = .01), and cognitive functioning (r = −.38, p = .004). These results suggest depression does not impact neurocognitive performance in TLE, but negatively correlates with reported quality of life and perceived cognitive functioning. #104 S ALI, J.S., & ADAMSON, A.M. Neuropsychological Sequelae of Repeated Carbon Monoxide Poisoning: A Sibling Case Study Carbon monoxide (CO) is a leading cause of unintentional poisoning among children in the United States. Continuous CO exposure reduces the delivery of oxygen to cells leading to nausea, dizziness, and loss of consciousness. Delayed effects of CO poisoning include difficulties with attention, memory, and executive functioning. Despite the increased risk of CO poisoning to children compared to adults, limited neuropsychological data exists on the effects of repeated exposure. This study presents test data from two brothers with prolonged exposure to smaller amounts of CO, as well as two acute exposures to very large amounts of CO. These data illustrate the prototypical profile of repeated CO poisoning, while also demonstrating that variability can exist among

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exposed children. Consistent with literature, both brothers demonstrated attention and executive functioning difficulties, suggesting that these domains of cognitive functioning are often impacted in individuals exposed to CO. The brothers also demonstrated significant differences in their performances on tasks assessing visual motor integration, fine motor speed/dexterity, verbal and visual memory, and parent ratings of emotional and behavioral functioning. Results of this case study suggest that even when genetic and environmental variables are similar, variability can exist in the neuropsychological profiles of children exposed to CO. #105 S IKANGA, J.N., MACDONALD, D., GESS, J.L., & STRINGER, A.Y. Cluster Analytic Approach to Defining Hemi-Neglect Hemi-neglect occurs in 23–52% of acute stroke admissions (Pedersen et al., 1997; Zoccolloti et al., 1989). The variability in incidence is partly due to the lack of clear diagnostic criteria defining hemi-neglect syndromes. Empirical criteria are lacking for the commonly recognized clinical subtypes of hemi-neglect, including hemi-inattention, hemi-extinction, and hemi-spatial neglect (Stringer, 1996). Cluster analysis of a sample of 330 patients all tested for hemi-neglect using unilateral and bilateral simultaneous visual, auditory, and tactile stimulation and a line bisection test, identified clusters of patients presenting with hemi-inattention; mild, moderate, and severe hemi-extinction; left hemi-spatial neglect; and mild, moderate, and severe right hemi-spatial neglect. Smaller clusters representing differences in severity of the same subtype were combined, and each resulting cluster differed significantly (p < .05 to p < .001) from groups not showing the same hemi-neglect syndrome. Cutoff scores were established for each hemi-neglect subtype. Use of cutoff scores resulted in high average sensitivity (0.88), specificity (0.89), and positive (.74) and negative predictive value (.97) when applied to the same sample. However, results need to be replicated with a second, independent sample in order to establish their diagnostic accuracy and utility. #106 S LEON, A., & PLISKIN, N.H. The Neuropsychological Correlates of Neurodegenerative Disease: A Case Study of Capgras Syndrome Capgras syndrome is a delusional misidentification disorder associated with psychiatric and neurodegenerative disease that is characterized by the belief that someone familiar has been replaced by an imposter, despite contrary evidence. Studies regarding Capgras syndrome in neurodegenerative disease have generally focused on its clinical features and neuroanatomical correlates, which reveal diffuse cerebral atrophy and/or pathology in the right cerebral hemisphere (Devinsky, 2009). However, few studies have examined the neuropsychological performance of patients with Capgras in the context of neurodegenerative disease. The purpose of this case study is to expand on the literature of this rare disorder, exploring its potential effects on neuropsychological testing. This is the case of a 67-year-old, Hispanic female presenting for neuropsychological testing with complaints of worsening memory, communication difficulties, and episodes of confusion following a left parieto-occipital stroke. On several occasions, she had expressed the belief that her husband was replaced with an imposter, but had no difficulty


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recognizing other familiar individuals. Neuropsychological testing indicated impairments in memory, executive functioning, and abstract reasoning, with prominent impairments in visuo-spatial abilities, suggestive of a mixed vascular/Alzheimer’s dementia. The clinical features of Capgras syndrome, and their potential impact on neuropsychological testing of patients with co-occurring neurodegenerative disease, are explored. #107 S WONG, A.L., PERSAD, C.C., CHOU, K.L., & PATIL, P.G. The Relationship Between Executive Functioning and Behavioral Changes in Patients with Parkinson’s Disease Post Deep Brain Stimulation Surgery Cognitive and behavioral changes have been observed in Parkinson’s disease (PD) patients following deep brain stimulation surgery; however, not much is known about the interrelationship between these changes. Cognitive data from 26 PD patients and behavior rating forms completed by patients and caregivers were gathered pre- and post-surgery. Change scores on executive functioning measures and the Frontal Systems Behavior Scale (FrSBe) were calculated. Results revealed that change scores on the FrSBe Executive Dysfunction subscale (caregiver form) were significantly correlated with Wisconsin Card Sorting Test (WCST) performance change scores, including perseverative errors, r = .51, p = .02, and total correct, r = −.52, p = .02. Repeated-measures ANOVA showed that patients with clinically significant behavioral changes as rated by caregivers had more perseverative errors on the WCST than those patients with no behavioral changes, F = 6.92, p = .01. No significant correlations were found between caregiver ratings on the FrSBe Apathy or Disinhibition subscales and any of the executive functioning measures. There also were no significant correlations between changes in the patient’s behavioral self-ratings and executive functioning performance. Results from the present study suggest that caregivers may be more acutely aware of declines in aspects of the patient’s executive functioning abilities than the patients themselves. #108 HANNA-PLADDY, B., CHOI, H., HERMAN, B., MACKAY, A., & SCHOOMER, E. Neural Basis of Movement Synchronization to Acoustic Cues in Rehabilitation Neurorehabilitation typically includes intervention designed to improve functional skills through repetition. However, acoustic events can access spatiotemporal action features and improve skilled movements without practice. To investigate how actions are coded by modality, we compared healthy controls (n = 124) to left hemisphere stroke patients (n = 45) on spatiotemporal features of object action across verbal, auditory, visual and multisensory (audiovisual) conditions. Significant latencies were identified for verbal cues (F = 162.4, p < .0001) and for left cortical patients (F = 15.6, p < .0001) relative to other groups (controls, subcortical, and cortical-subcortical patients). There was also a condition by group interaction (F = 6.6, p < .0001), revealing that cortical lesions exclusively had greater latencies to auditory cues compared to visual and multisensory conditions. Frontal, temporal and parietal lesions delayed movement initiation in response to both verbal and auditory non-linguistic cues. Temporal lesion location predicted movement initiation in visual and multisensory conditions. Acoustic access to movement synchronization relies on a left fronto-temporal-parietal cortical network

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similar to verbally initiated action. However, the delay in movement retrieval to linguistic cues emphasizes the preparatory time required to generate self-paced movements and access spatiotemporal features, consistent with greater reliance on frontal lobes. Conversely, acoustic cues provide both external pacing and salient semantic features to facilitate movement synchronization.


#109 S HUDSON, M.C., BONNELL, M., MYERS, A., & HAINES, M.E. Neuropsychological Functioning, Pre- and Post-Placement of Left Ventricular Assist Device Left ventricular assist devices (LVADs) serve as a necessary treatment for individuals with advanced heart failure (AHF). Extended periods of cerebral hypoperfusion place those in AHF at increased risk for cognitive dysfunction. Research examining the cognitive impacts of LVAD placement, which is known to improve cerebral perfusion, is sparse. During a pilot study (n = 7), findings were not statistically significant. The purpose of the current follow-up study was to assess the impact of an increased sample (n = 12) and additional follow-up testing. We compared cognition pre- and post-LVAD placement across time points (A: 3–6 months; B: 6–12 months; C: 2 years) for individuals using Paired-Samples t-tests. Individuals were administered the Repeatable Battery for the Assessment of Neuropsychological Status and the Trail Making Test. Statically significant improvement in cognition was evident on measures assessing verbal memory (Pre to A, p = .044; Pre to B, p = .032) and visual memory (B to C, p = .050). Findings are consistent with limited extant research showing modest improvements in cognition and provide further understanding of the effects of LVAD placement on neurocognition. #110 S TRAN, K., STELMOKAS, J.E., & BIELIAUSKAS, L.A. Detection of Delirium in an Inpatient Sub-Acute Rehabilitation Hospital Delirium may be underdiagnosed or go undetected in medical settings, despite screening positive on a cognitively-based delirium severity measure (Memorial Delirium Assessment Scale (MDAS); Anderson, Gabel, & Bieliauskas, 2014). This study reviewed medical records of inpatients at a VA sub-acute rehabilitation setting to evaluate whether individuals with a positive MDAS screen differed from medically-identified delirium in cognitive functioning, and medical (Charlson Index) or psychiatric history. The studied sample included 266 inpatients with an average age of 66 (SD = 11); 237 screened negative for delirium by both (MDAS and physician diagnosis); 10 were diagnosed by physician only; 19 patients screened positive by MDAS only. of those with a positive MDAS, only 31.6% (n = 6) were identified as delirious by both. Individuals with a positive MDAS but no physician-identified delirium had higher Charlson Index scores overall (median = 9, SD = 3.15; U = 5.5, p = .003), and higher rates of cancer (Fisher’s exact test, p = .018), solid tumors (Fisher’s exact test, p = .011), and chronic obstructive pulmonary disease (Fisher’s exact test, p = .018). Psychiatric and cognitive factors were not statistically different between groups. Results indicate that the MDAS may aid physician diagnosis for patients with high rates of medical comorbidities, particularly for individuals with delirium due to secondary treatment effects.


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#111 S BAULDRY, R.M., ADAMS, S.W., GOMEZ, I.B., KIM, Y., LOBDELL, D., WRIGHT, C.W., & BOWLER, R.M. Associations Between Neuropsychology and Neurological Finger Tapping Tests in Adult Residents Environmentally Exposed to Manganese Psychomotor speed slowing is a frequently reported adverse effect of manganese (Mn) exposure. This environmental epidemiologic study reports the relationship between the Finger Oscillation Test (FOT) and Unified Parkinson’s Disease Rating Scale (UPDRS) Finger Tapping (FT) scores in adult residents exposed to elevated air-Mn in two Ohio towns (n = 186) and one unexposed town (n = 90). The two exposed towns were combined for analyses. Air-Mn concentrations for the exposed residents were estimated over 10 years using the USEPA’s AERMOD dispersion model. Linear regression analyses investigated the relationship between modeled air-Mn and scores on the FOT and UPDRS FT. Comparing FOT and UPDRS FT raw scores by exposure group, exposed had lower mean FOT dominant (t[273] = 2.32, p = .02) and nondominant (t[273] = 2.35, p = .02) scores than unexposed. Exposure group was also associated with higher scores on UPDRS FT dominant (χ2 = 6.01, V = .145, p = .03) and non-dominant hand (χ2 = 4.44, V = .129, p = .03) using Fisher’s exact test. In exposed residents, higher modeled air-Mn concentrations predict lower FOT dominant (β = −0.270, R2 = .068, p < .001) and non-dominant (β = −0.164, R2 = .021, p = .03) scores (age, education, gender adjusted) but not scores for the UPDRS FT. This suggests FOT is a more sensitive test of motor function than the UPDRS FT. #112 S BURKAUSKAS, J., BROZAITIENE, J., MICKUVIENE, N., & BROZAITIENE, J. Cognitive Functioning is Associated with Triiodothyronine Concentrations in Patients with Coronary Artery Disease Decrease in thyroid hormone free triiodothyronine (FT3) is a strong predictor of poor prognosis of cardiac patients. The aim of this study was to determine whether cognitive functioning of coronary artery disease (CAD) patients is associated with FT3 concentrations. In sum, 278 patients were enrolled in the study; 206 men (74.1%, mean age 58 ± 9). Cognitive functioning tests battery comprised the Mini-Mental State Examination (MMSE), Digit Span Test, Digit Symbol Test, and Trail Making Test. Patients were also evaluated for socio-demographic and clinical CAD characteristics. Depressive symptoms were measured by Hospital Anxiety and Depression scale (HADS). In univariate analysis almost all cognitive functions were associated with FT3 concentrations. After adjusting for age, gender, education, left ventricular ejection fraction, New York Heart Association NYHA class, arterial hypertension, body mass index, smoking, nitrates and beta-blockers use, and depressive symptoms, higher triiodothyronine concentrations were independently associated with better Digit symbol test raw scores (β = .122, p = .035), less time which individuals took to complete the digit symbol test (β = −.141, p < .010) and less time to complete Trail Making Test A (β = −.151, p < .011). Overall, higher FT3 concentrations are associated with better cognitive functioning in CAD patients, independently from socio-demographic and clinical CAD characteristics, as well as depressive symptoms.

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#113 S EICHSTAEDT, K.E., SEVER, R.W., RUM, R., KAMPER, J.E., SOBLE, J.R., BROWN, C.D., FOSTER, S.M., BENBADIS, S.R., & SCHOENBERG, M.R. Asking for More: Baseline Data of A Randomized Controlled Trial to Evaluate Neuropsychology Outcome within a Comprehensive Epilepsy Clinic Epilepsy patients are seldom referred for neuropsychological evaluation outside of the pre-surgical context, despite the known neurocognitive sequelae of epilepsy syndromes. As initial baseline data for a randomized controlled trial to assess whether neuropsychological consultation improves care for patients with medically-managed epilepsy, we collected survey data on 23 patients presenting for outpatient neurology/epileptology visits who had not undergone neuropsychological evaluation. Twenty-six percent of respondents endorsed at least one epilepsy-related emergency department visit within the last six months. Almost half (47.8%) were at least somewhat concerned about their cognitive functioning. Similarly, 47.8% believed they did not know enough about their epilepsy. A majority (68.2%) desired to talk more to a health care provider about their epilepsy, of whom 75% indicated a specific desire to talk to a neuropsychologist, relative to 52.9% indicating “yes” for neurologist and 50% for general clinical psychologist or psychiatrist. Treating neurologists/epileptologists rated 27.2% of the sample as having less than optimal treatment compliance. These initial data support neuropsychology services’ potential to improve standards of care for nonsurgical epilepsy patients. An expanded evidence base in this area is needed to further validate neuropsychology as an essential component of epilepsy-related medical care.

Psychiatric Disorders #114 S LEE, C., GUIDOTTI BRETING, L.M., ROSADO, D., PIPER, L.E., & SWEET, J.S. Gender Moderates The Relation Between Depressive Symptoms and Performance On The Hopkins Verbal Learning Test-Revised (HVLT-R) Depression, particularly in older adults, has been associated with cognitive deficits in the domains of executive functioning, attention, processing speed, and the acquisition and retrieval of new information. It has also been proposed that depression may be a prodromal symptom or risk factor for the development of dementia. Despite the relative strength of the relation between depression and cognitive impairment, findings continue to be mixed, perhaps due to the multidimensional nature of mood disorders. Gender differences in depression have been widely studied, showing higher prevalence, incidence, and severity in females than males. However, gender differences in the cognitive impact of depression have not been explored. The current study examined the effect of gender on depressive symptoms and performance on a list-learning task. Multiple regression analyses indicated that gender moderated the relation between depressive symptoms on the Beck Depression Inventory-II and the HVLT-R immediate and delayed recall trials, as well as percent retention, and discriminability on recognition. In females (n = 162), self-reported depression was significantly related to better performance. In males (n = 126), self-reported depression was related to worse performance, but the


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association was not significant. Moving forward, research on the cognitive deficits of depression should explore the effects of gender.


#115 S CARRATHERS, T., AMSBAUGH, H., ROSEBERRY, J., NELSON, C., BUCHHOLZ, A., & HILL, S. Performance for Paced and Unpaced Serial Order Recall in Schizophrenia Prior reports indicate a specific deficit in schizophrenia when output for serial order was externally paced, but not when participants were allowed to respond at their own pace. The present study was designed to evaluate paced and unpaced serial order output in a larger independent sample of 22 patients and 28 demographically similar healthy controls. A significant interaction was observed between output type (paced and unpaced) and diagnosis [F(2.45, 117.38) = 5.89, p < .01]. Overall, patients performed worse than controls across tasks, but controls showed more variability as a function of working memory load. Specifically, healthy controls showed reduced accuracy for modest working memory loads (3 item sequences), but only when responding was externally paced. Accuracy was more consistent when the task was more challenging (reproducing 4 item sequences) and when output was self-paced. Although previous research indicated select serial order processing deficits in schizophrenia patients the present findings indicate more robust deficits. This implicates working memory systems more broadly for developing pharmacological treatment targeting cognition and suggests tailoring clinical treatments to cognitive/behavioral strategies to enhance functional status. #116 S WILLIAMSON, E.S., DUNCANSON, H., & O’CONNOR, M. Relationship of Local Processing Bias On The Rey-Osterrieth Complex Figure Drawing to The Proposed Hypermasculinization of The Adult Female Autistic Brain Studies show individuals with Autism Spectrum Disorder (ASD) have visuospatial processing deficits limiting capacity to appreciate gestalt images. This tendency to favor local processing might be due to hypermasculinization of the brain (Baron-Cohen, 2002). In this study we investigate the role of gender in organizational approach using the Rey-Osterrieth Complex Figure (ROCF) to test 26 ASD adults (10 females, 26 males) and 33 age- and IQ-matched adult controls (13 females, 20 males). We expect an inverse relationship between gestalt processing and hypermasculinization and predict ASD females will show greater deficits similar to those of ASD males and male controls, while female controls will show greatest gestalt processing. A two-way ANOVA was conducted to explore the impact of gender and diagnostic group on organization efficiency. The interaction effect between gender and diagnostic group was not statistically significant (F(1, 54)0.47, p = 0.49), and differences between the means were very small (partial η2 = 0.009). There was no significant main effect of gender (F(1, 54)0.97, p = 0.33, partial η2 = 0.01) or diagnostic group (F(1, 54)2.04, p = 0.16, partial η2 = 0.04). In this preliminary investigation the lack of support for gender-based differences in ROCF approach likely relate to small sample size or to restricted range of metric used to assess organization.

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#117 STRICKER, N.H., GREEN, D.L., LIPPA, S.M., MCGLYNN, S.M., MILBERG, W.P., & MCGLINCHEY, R.E. Elevated Rates of Clinical Impairment On Neuropsychological Testing in PTSD Studies investigating the neurocognitive effects of PTSD routinely find “deficits” in various domains including attention, processing speed, memory and executive functioning. However, the rate of clinical impairment in individuals with PTSD remains unclear, as studies have focused on null hypothesis testing and inferring patterns of impairment rather than empirically determining the rate of clinical impairment in this sample. This study examined rates of clinical impairment based on neuropsychological test performance in non-treatment-seeking Operation Enduring Freedom/Operation Iraqi Freedom/ Operation New Dawn service members and Veterans with (n = 92) and without (n = 79) Posttraumatic Stress Disorder (PTSD) who passed a performance validity measure and were matched on age, education, estimated IQ and ethnicity. Subjects were consecutively recruited to the VA Boston TBI Center of Excellence. Individuals with PTSD showed higher rates of impairment in memory at various clinical cutoffs (−1, −1.5 and −2 SD) relative to controls, but equivalent rates of impairment in attention, processing speed and executive functioning. Impairment in any domain was also more prevalent in PTSD (−1, −1.5 and −2 SD cutoffs). Investigation of individual profiles of clinical impairment partially supports past results based on null hypothesis testing suggesting impaired cognition in PTSD, with elevated rates of impairment in memory. #118 S BAYAN, S.M., AGUILAR, C., KAMINETSKAYA, M., NITCH, S., & KINNEY, D. An Exploratory Analysis of CVLT-II Forced-Choice Recognition Base Rate for Forensically-Committed, Psychotic-Disordered Inpatients: Implications On Clinical Decision Making Within the inpatient forensic setting, requests for a neuropsychological evaluation are common to determine cognitive strengths and weaknesses. However, variable effort is a prominent issue in a criminal forensic setting that includes patients with severe psychosis. Thus, assessment of effort becomes an essential component of a neuropsychological evaluation. The California Verbal Learning Test, 2nd Edition (CVLT-II) is a widely utilized cognitive measure in the inpatient setting. In the context of effort, a major strength of this test is the inclusion of an embedded effort measure. The purpose of this exploratory study is to establish the local base rate and predictive ability of the CVLT-II Forced-Choice Recognition (FCR) measure in an attempt to gain a better understanding of how it functions in a forensic inpatient setting. Participants included 56 forensically-committed, psychotic-disordered inpatients who completed the CVLT-II FCR. Using the Test Validation Summary (TVS), the estimated local base rate for a positive FCR score was 8%. This resulted in 97% negative predictive power and 50% positive predictive power. Given its low sensitivity and predictive power, the results suggest that much more confidence can be placed in negative FCR results (i.e. above the cut-off score) as opposed to positive findings (i.e. below the cut-off score).


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#119 S BOUCHARD, A.B., GALLEGOS, Y.E., & SPAULDING, W.D. Relationship Between Psychiatric Symptoms and Neuropsychological Test Performance in Individuals Diagnosed with Schizophrenia Neurocognitive impairments are known mediators of social functioning and treatment outcome for individuals diagnosed with schizophrenia. Likewise, positive and negative symptoms have been linked to social and occupational functioning for this population; however, relatively less is known regarding the relationships among specific cognitive domains, clinical symptoms, and functional outcomes. The current study examines the relationships among psychiatric symptoms (as measured by the Brief Psychiatric Rating Scale; BPRS) and performance on commonly used neuropsychological tests. The BPRS, Trail Making Test (TMT), Controlled Oral Word Association Test (COWAT), and WAIS-IV Letter Number Sequencing (LNS) were administered to 23 outpatients diagnosed with schizophrenia. Overall performance fell in the lower end of the average range on TMT A (mean t-score = 41.98, SD = 14.12) and LNS (mean = 8.02; SD = 3.59). The sample demonstrated overall borderline impairment on TMT B (mean t-score = 37.62, SD = 13.62) and FAS (mean t-score = 39.81, SD = 11.27). BPRS ratings were not significantly correlated with performance on FAS, LNS, or TMT B; however, 6 items were significantly negatively correlated with performance on Trails A. Overall, results suggest a link between clinical symptoms and performance on TMT A, providing a possible explanation for the low reliability of TMT A for individuals with schizophrenia. #120 S BOUCHARD, A.B., CAPOZZOLI, M.C., & SPAULDING, W.D. The Clinical Utility of The Neuropsychological Assessment Battery Screening Module for Schizophrenia-Spectrum Disorders Neurocognitive dysfunction is pervasive in schizophrenia-spectrum disorders and has been implicated in various functional impairments. Consequently, cognitive functioning is increasingly considered a key treatment target in this population, making neuropsychological assessment essential for monitoring progress. A challenge in real-world settings is to utilize clinically useful measures that are feasible considering limited time and staffing resources. The purpose of the present study was to evaluate the utility of the Neuropsychological Assessment Battery Screening Module (S-NAB) for assessing cognitive functioning in this population. Adults diagnosed with a schizophreniaspectrum disorder (N = 280) were administered the S-NAB Screener. Performance on the Attention Domain (S-ATT; M = 74.97, SD = 19.16) reflected mild impairment, consistent with the expected performance level for this population. However, overall performance was slightly higher than anticipated for all other screener domains: Language (S-LAN; M = 93.99, SD = 16.97), Memory (S-MEM; M = 86.99, SD = 17.29), Spatial (S-SPT; M = 91.34, SD = 16.02), and Executive Functions (S-EXE; M = 90.72, SD = 17.69). Considering the test authors’ recommendations, full administration of corresponding NAB modules was indicated in 84% of S-LAN administrations, 70% of S-MEM administrations, 81% of S-SPT administrations, and 72% of S-EXE

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administrations. These proportions are high enough to substantially limit the utility of the S-NAB as a screening measure for schizophrenia-spectrum disorders.


#121 S AGUILAR, C., KAMINETSKAYA, M., BAYAN, S.M., KINNEY, D., & NITCH, S. Performance On The Repeatable Battery for The Assessment of Neuropsychological Status (RBANS) Between Long-Term and Short-Term Patients with Psychotic Spectrum Disorders in a Forensic Psychiatric Hospital Schizophrenia and other psychotic disorders are highly prevalent disorders in inpatient state hospitals. While evidence suggests inpatients committed to state psychiatric hospitals have high rates of neuropsychological risk factors, little research has examined the neuropsychological functioning of these individuals. Understanding the neurocognitive limitations of psychiatric inpatients is essential to provide rehabilitation services that are appropriate for their cognitive functioning. This study assessed cognition in two types of forensic inpatients in a state hospital: (1) short-term patients (STPs) deemed incompetent to stand trial (Mean Stay = .86 years), and (2) long-term patients (LTPs) found Not Guilty By Reason of Insanity (Mean Stay = 11.2 years). The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a widely used, brief measure of neurocognitive functioning. Participants included 240 STPs and 138 LTPs with a primary psychotic disorder who were given the RBANS as part of routine, clinical care. LTPs performed significantly better (p < .05) than STPs on overall cognitive functioning, and in the domains of immediate/delayed memory, visuospatial/constructional, language, and attention. Perhaps this finding suggests that LTPs have benefitted from rehabilitation services for a longer period of time and have therefore become more psychiatrically and cognitively stable. Further possible implications will be discussed in the poster. #122 ERHAN, H., EISENACH, D., & SHAYEVITZ, C. Case Study: Are Life Long Attention Problems Indicative of Comorbidity of ADHD and Bipolar Disorder? Treatment Implications Potential comorbidity of Bipolar Disorder and Attention Deficit/Hyperactivity Disorder (ADHD) has significant treatment implications. A patient with Bipolar I Disorder, treated with Lamictal, was referred for neuropsychological assessment due to self reports of prominent inattention impairing daily functioning. Cognitive findings inconsistent with ADHD included: (1) superior to high average range index scores on the Wechsler Adult Intelligence Scale – Fourth Edition, except for average range Working Memory Index (secondary to documented hearing loss), (2) high average range Visual Working Memory Index on the Wechsler Memory Scale – Fourth Edition, (3) high average range freedom from distractibility on the Delis Kaplan Executive Function System (DKEFS) Color Word Interference Test, (4) high average range visual motor tracking on the DKEFS Trail Making Test, (5) Continuous Performance Test – Second Edition performance revealing 89.7 percent confidence that the test profile was more consistent with a non ADHD than an ADHD population and (6) executive skills ranging from the very superior to the average range. A twelve week course of Cognitive


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Behavioral Therapy was offered to address concerns regarding ADHD symptoms as a low risk alternative to pharmacologic intervention.


#123 S LUU, H., WHITESIDE, D.M., KEALEY, T., SEMLA, M., RICE, L., & BASSO, M. Construct Validity of The Verbal Fluency Test in Neurological and Psychiatry Patients Phonemic and semantic fluency are conceptualized as executive functioning (EF; Lezak, 2012) measures. However, Whiteside et al. (2013) used exploratory factory analysis (EFA) and found that verbal fluency (VF) loaded significantly onto Language factor in a mixed neuropsychological sample. This study examined whether neurological and psychiatric populations produced different factor structures for VF. The participants were consecutive referrals who met study criteria with either primary psychiatric diagnoses (N = 141, mean age = 43.25, SD = 14.77, mean education = 13.18, SD = 2.15, 42% male, 95% Caucasian) or neurological diagnoses (N = 128 mean age = 47.91, SD = 14.03, mean education = 13.41, SD = 2.00, 51% male, 97% Caucasian). Language measures, including COWAT, Animal Fluency (AF), Boston Naming Test (BNT), Vocabulary (WAIS-III), and EF measures including Wisconsin Card Sorting Test (WCST; perseverative responses), and Trailmaking Test, Part B (TMT-B) were administered. EFA for the psychiatric participants indicated a two-factor solution that very similar to Whiteside et al. (2013). The neurological participants produced a one-factor solution with high loadings for FAS, AF, BNT, and Vocabulary, and low loadings for the EF measures (WCST and TMT-B). These findings suggest that the relationship between VF and language processing and EF differs depending upon patient population, but that language is an important component of VF regardless of diagnosis. #124 MAUCIERI, L.P., TIMKO, A., & AASE, D.M. The Relationship Between Social Perception and Crystallized Intelligence in Individuals with Alcohol Use Disorders The literature documents social perception deficits in individuals with prior alcohol use disorders. However, the relationship between social perception and other cognitive functions in these individuals is not yet well understood. The purpose of this investigation was to explore the association between aspects of social perception and crystallized intellect, as operationalized by the Wechsler Test of Adult Reading (WTAR). A sample of 30 individuals (10 women, 20 men) participating in an inpatient treatment program for alcohol use disorders was administered the WTAR and the Wechsler ACS Social Perception subtests. Each subject had a primary alcohol diagnosis and had completed detoxification. An average of 28.5 days (Range = 17–60) had elapsed since their last drink. The Social Perception subtest measures facial emotional recognition (Affect Naming), emotional cueing based on vocal tone (Prosody), and correct descriptions of emotions, including recognition of sarcasm (Pairs). A backward elimination multiple regression was run with Affect Naming, Prosody, and Pairs as predictors of crystallized intelligence (WTAR FSIQ). The model yielded a strong linear relationship between Prosody and WTAR FSIQ score (R = .57, Adjusted R2 = .30, p = .001) over three

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model iterations. The possible reasons for these results and the implications for further research are discussed.


#125 S GERTSBERG, A.G., & KLORMAN, R. Modulating Emotional Memories and Event Related Potentials in Humans Using A Reconsolidation Update Mechanism The present work tested the adaptive role of reconsolidation as a window of opportunity to modify memories by pairing an experimentally specified meaning to aversive emotional stimuli and measuring the change with event-related potentials (ERPs). The hypothesis was that a cognitive intervention during the reconsolidation phase would impact the acquisition and consolidation of memories. This study examined differences in responses to negative affective stimuli in individuals with and without elevated anxiety, and the effectiveness of a brief cognitive intervention to impact the long-term memory formation and recall in these individuals. Participants were 81 adults with varying levels of trait anxiety. Task participation occurred across two laboratory sessions, held 5–10 days apart. Differences in cognitive processing of emotional stimuli were found as early as ERPs peaking at 100 ms through 2 seconds. ERPs evoked by affectively negative images suggest that emotional memories are in fact malleable and modifiable, which was demonstrated by varying ERP amplitudes across time and conditions. Finally, higher levels of trait anxiety moderated this effect, a pattern that is consistent with a greater bias for affectively negative stimuli in anxious persons. These results help to delineate the mechanism and time-course of memory formation and have important implications for the treatment and assessment of memory functions, especially in individuals with trait anxiety.

SECTION 2: PEDIATRIC EMPHASIS (Student first-authored papers identifeid by “S” after poster number.)

Autistic Spectrum Disorder #126 S KLAVER, J.M., & DILALLA, L.F. Psychological and Genetic Contributions to The Development of Social Cognition in Children with and without Autism Spectrum Disorder This study examined the development of social cognition in children with and without autism spectrum disorder (ASD) and the influence of behavioral and molecular genetics on higher order cognitive abilities. It was hypothesized that children with ASD would perform more poorly on all social cognitive tasks compared with typically developing peers, that typically developing children who performed better on a simpler social cognitive task in preschool would perform better at follow-up, and that the presence of risk alleles in either or both of the dopamine receptor-D4 (DRD4) and the serotonin


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transporter-linked polymorphic region (5-HTTLPR) polymorphisms would decrease performance. The sample included 62 families of twins/triplets and 25 children with ASD. Significant group differences were found for children’s performance on all of the social cognitive tasks. Results showed that some areas of social cognition (i.e. theory of mind, non-literal language) are more influenced by genetic factors than are other cognitive skills. Results from the molecular genetic analyses suggest that basic social cognitive skills (e.g. theory of mind) may be influenced by underlying biological factors in the serotonergic and dopaminergic pathways. The present study provided useful information on how psychological and genetic factors influence the development of social cognitive abilities in young children. #127 S JASHAR, D.T., BRENNAN, L., ROBINS, D., BARTON, M., & FEIN, D. Diagnostic Stability in Toddlers Who Lose An Autism Diagnosis in DSM-5 In a study conducted by the current authors, 29% of toddlers (Time1; age range = 16–30 months) who met DSM-IV-TR ASD criteria no longer did so under DSM-5 (DSM-IV-only group). The current study examined the Time2 (age range = 41 to 91 months; M = 52.56, SD = 7.98) DSM-IV-TR diagnosis and cognitive skills (Mullen Scales of Early Learning) of the DSM-IV-only group (N = 41) and compared them to toddlers who met DSM-5 ASD criteria (DSM-5 group; N = 101) and to toddlers who did not meet ASD criteria under either system (Non-ASD group; N = 43). As expected, a large percentage (88%) of the DSM-5 group continued to meet DSM-IV-TR ASD criteria at Time2. Of note, a little over 75% of children in the DSM-IV-only group continued to meet DSM-IV-TR ASD criteria at Time2. of the Non-ASD group, 7% met DSM-IV-TR ASD criteria. The DSM-5 group scored significantly lower than the DSM-IV-only and Non-ASD groups in all Mullen domains; the DSM-IV-only and Non-ASD group did not significantly differ. The results suggest that the majority of the DSM-IV-only group continued to experience significant social and communication impairments at Time2. Their higher cognitive skills indicate they may benefit greatly from autism-specific intervention services, which they likely will not receive without a DSM-5 ASD diagnosis. #128 S ZOLTOWSKI, A., HEINRICH, K., KTIRI, M., BADALY, D., & HODGES, E. Social Cognition Measures and Their Relationship to Ratings of Social Problems in Autism Spectrum Disorder Measures of social cognition are often used in evaluations for autism spectrum disorder (ASD) along with parent and teacher ratings of social deficits. Few studies have examined associations between social cognition and ratings of these symptoms. The purpose of the present study was to examine the extent to which objective measures of social cognition, including measures of affect recognition and theory of mind, relate to parent and teacher ratings of social problems. Participants included 99 children referred for a multidisciplinary consensus evaluation of ASD (mean age = 9.32 years, males = 79%). Sixty-seven percent of the sample was given a consensus diagnosis of ASD. We used multivariate multiple regression to examine associations between NEPSY-II Theory of Mind and Affect Recognition Total scores and parent and teacher ratings of peer

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relationship problems from the Conners-3, controlling for patients’ age and IQ. Though the ASD group was rated as having more peer relationship problems, social cognition scores were not related to parent [F(1, 49) = .904, p = .48] and teacher ratings [(1, 49) = 1.96, p = .10]. Though objective measures of social cognition were not predictive of peer problems in this sample, further research with larger sample sizes is needed.


#129 S LUDWIG, N.N., ABRAMS, D.N., FEIN, D., ADAMSON, L.B., & ROBINS, D.L. The Utility of Early Autism Spectrum Disorder (ASD) Screening Tools in Predicting The Presence of ASD Symptoms and Symptom Severity The Modified Checklist for Autism in Toddlers (-Revised; M-CHAT(-R)) screens for risk of autism spectrum disorder (ASD). Some studies have considered the M-CHAT (-R) total score in diagnostic decisions and in predicting social-cognitive outcomes. Since the M-CHAT(-R) was not developed as a diagnostic measure, we asked whether the M-CHAT(-R) total scores predict ASD symptoms and severity. Toddlers who screened positive on the M-CHAT (n = 341, M = 26.35mos, SD = 4.44) or M-CHAT-R (n = 115, M = 24.92mos, SD = 4.90) received a comprehensive diagnostic evaluation. Results indicated that the M-CHAT was moderately related to total DSM-IV-TR symptoms (predicting 24.8% of the variance; r = .50, p < .001), Autism Diagnostic Observation Schedule severity scores (19.2%; r = .44, p < .001), and Childhood Autism Rating Scale-2 total scores (17.2%; r = .41, p < .001), whereas the M-CHAT-R, despite its improved psychometrics (Robins et al., 2014), had a weak relationship (predicting 10.1%, r = .32, p = .001; 6.8%, r = .26, p = .005, and 6.4%; r = .25, p = .006, respectively). These findings highlight the limitations of using a screening tool to predict ASD symptoms and severity. Future research will explore alternative M-CHAT(-R) algorithms that may better predict diagnostic outcomes.

Pediatric Neuropsychological Assessment #130 S PAULRAJ, S.R., DUONG, P.H., GANNON, C.E., JHINGON, G., & GOMEZ, R.G. Rate of Infant Cognitive Development Predicts Adolescent Intelligence in Low-Income African Americans This study investigated the rate of infant cognitive development and its impact on intelligence in adolescence. African-American infants (N = 102) at high risk for academic failure due to poverty, low maternal IQ, or low parental education, were given the Bayley Scales of Infant Development (BSID) at 3, 6, 9, and 12 months, and the Wechsler Intelligence Scale for Children-Revised (WISC-R) at 15 years. The average rate of change on the BSID was calculated as the mean of rates of change between measurement points. Participants were randomly assigned to day care treatment or control groups at three months. After controlling for mother’s IQ and treatment effects, the average rate of change on the BSID from 3–12 months explained 4.4% of the variance of IQ at 15 years, F(3, 98) = 8.99, p = .02, R2 = .04. Children with positive rates of change (mean = 95.65, SD = 9.95) had higher IQ scores at 15 years compared with children with negative or no rate of change (mean = 90.84, SD = 10.37), F(1, 99) = 4.2,


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p = .04. The rate at which cognitive development occurs in the first year of life may impact intelligence in adolescence. This finding has implications for cognitive assessment and intervention in infancy and an investigation of factors that impact rate of infant cognitive development


#131 HOLLER, K., KAVANAUGH, B., DUPONT-FRECHETTE, J., TELLOCK, P., MAHER, I., & HAISLEY, L. The Problem of Bias in Neurocognitive Assessment of Inpatient Children: The Impact of Neighborhoods On Outcomes There is a growing literature on the impact of culture on neuropsychological outcomes in adult populations. In contrast, very little is understood in terms of test bias in children based on culture or other extra-normative considerations. To investigate the effect of socio-economic status (SES) on neurocognitive assessment, retrospective chart reviews were conducted on 146 children ages 6 to 13 consecutively referred for neuropsychological screening within an inpatient children’s psychiatric program between 2010 and 2014. Zip codes with mean income ratings were selected as a surrogate for SES; groups were divided by mean income above and below $39,000. Comparisons were made on measures of IQ, memory, visual-spatial functions, and executive control. Correlation, ANOVAs, and regression analyses identified significant group differences on individual and composite scores on tests including general intellect (FSIQ r = .204, p = .007) with differences on Similarities (r = .203, p = .009) and Vocabulary (r = .264, p = .001). In addition, specific associations with discrete executive sets were evident including Trails A Errors (r = −.190, p = .015) and Continuous Performance Test (CPT) hit rate (r = −.227, p = .011). More surprising, significant differences were apparent on a supposedly culture-free test, the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI r = .193, p = .015). Implications for neuropsychological evaluation and interpretation in extra-normative populations are discussed. #132 S MALAMUD OZER, Y.M. Proposing and Evaluating A Model of Multicultural Pediatric Neuropsychological Assessment This study proposes a model of multicultural factors that can be considered within pediatric neuropsychological assessment (NPA) of children with neurodevelopmental disabilities. Multiple cultural factors relate to accuracy of diagnosis and appropriateness of treatment plans. Assessment is complicated when children are members of a linguistic or cultural minority, immigrants, or have encountered severe hardships (e.g. homelessness, domestic violence, or other trauma). Assessment may occur within organizations that have limited resources to appropriately assess children from minority language and cultural groups. NPA instruments may be culturally biased or lack ecological validity, and normative samples may not comprise representative minority samples. This qualitative study examines the utility of a multicultural pediatric NPA (MPNPA) model. The MPNPA model was developed from a pilot study utilizing interviews with NPA professionals that explored factors relevant to MPNPA. The current research interviews 17 NPA professionals about the utility of the MPNPA model. A

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qualitative approach is utilized to explore the complex interaction of multicultural factors, the utility of the model, and possible applications of the model. This study may provide a basis for multicultural NPA training and inform development of guidelines that in turn could lead to more accurate diagnoses and more appropriate treatment plans.


#133 S VOGT, E.M., DOLAN, B., & HOELZLE, J. 5, 4, 3, 2, 1? WISC-V Factor Structure The construct validity of the recently published Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V; Wechsler, 2014) was investigated using exploratory factor analysis (EFA). The WISC-V Technical Manual proposes a five factor structure determined through confirmatory factor analysis (CFA). Principal components analysis (PCA) with oblique rotation was conducted with the overall sample and each of the separate 11 normative age groups. Empirically supported component retention criteria: Horn’s parallel analysis (PA), and Velicer’s minimal average partial (MAP) procedure, suggested that one or two factors should be retained in most samples. Orthogonal vector matrix comparisons supported an invariant two component solution across age groups and Tucker’s congruency coefficients confirmed an invariant one component solution. The two component solution included dimensions primarily reflecting (1) verbal, nonverbal and working memory abilities and (2) processing speed. PCA models consisting of five, four, or three factors exhibited a broad first component (g), a second processing speed component, and the remaining components were poorly defined with low to trivial loadings. These findings converge with an emerging literature that suggests over-factoring of recently published cognitive tests. Additional clinical implications will be discussed.

Pediatric Oncology #134 S FOURNIER-GOODNIGHT, A.S., ASHFORD, J.M., CLARK, K.N., MARTINELBAHESH, K., HARDY, K.K., MERCHANT, T.E., JEHA, S., OGG, R.J., & CONKLIN, H.M. Investigation of Fidelity of Computerized Working Memory Training Across Coaches Cogmed is a computerized intervention directed at improving working memory (WM). This program emphasizes the role of coaches in remotely monitoring performance and providing feedback to participants and their families. Coaches receive standardized instruction in analyzing training indices and tailoring feedback. This study investigated intervention fidelity across Cogmed coaches. Participants were pediatric cancer survivors (acute lymphoblastic leukemia n = 20; brain tumor n = 10) with attention or WM deficits who completed Cogmed training. Measures of WM (Wechsler Intelligence Scale for Children, Fourth Edition [WISC-IV] Integrated Spatial Span; WISC-IV working memory index [WMI]) and attention/executive functions (e.g. Conners Third Edition, Parent [Conners 3-P]) were administered before and after training. Patient


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characteristics did not differ across coaches (t-tests: diagnosis p = 0.297; treatment intensity p = 0.311; enrollment age p = 0.417; time since treatment p = 0.498; abbreviated intellectual ability p = 0.825) with the exception of gender (p = 0.430). Training adherence was similar across coaches (sessions completed p = 0.389; training duration p = 0.904), and there were no differences for outcome variables between coaches (change scores for Spatial Span Backward p = 0.994; WMI p = 0.961; Conners 3-P Inattention p = 0.823; Conners 3-P Executive Function p = 0.436). Findings indicate very high training fidelity with no significant differences with respect to adherence or training efficacy across coaches, highlighting the disseminability of this intervention. #135 S JONES, K.E., RANE, S., & JACOBSON, L.A. The Contribution of Sluggish Cognitive Tempo to Executive Functioning in Survivors of Pediatric Brain Tumors Sluggish cognitive tempo (SCT) describes symptoms of under-activity, poor initiation, and slowness. SCT is related to, yet separable from, inattention. Neurocognitive late effects in brain tumor (BT) survivors have been characterized similarly to ADHD symptoms, but slowed processing may relate to white matter injury secondary to treatment. The present study examined contributions of SCT to executive functioning (EF) in BT survivors, controlling for verbal ability and inattention. Participants included 59 clinically-referred BT survivors, ages 4–20, with parent ratings of inattention (ADHD Rating Scale-IV) and SCT (subscales: Sleepy/Sluggish, Daydreamy, Low Initiation) and performance-based speeded measures of speeded cognitive functioning. SCT, particularly Daydreamy SCT (β = −.905, p = .005), added to prediction of speeded inhibition (DKEFS Color-Word, NEPSY-II Inhibition) after controlling for verbal ability and inattention (ΔR2 = .339, p = .014). However, SCT did not predict rapid naming (DKEFS Color Naming, NEPSY-II Inhibition-Naming) or motor speed (Coding, Pegs). Daydreamy SCT accounted for significant additional variance in EF, above and beyond parent-reported inattention. Daydreamy SCT, as distinct from ADHD inattention, was associated only with speeded EF and not measures of basic verbal or motor speed. Findings suggest that survivors of pediatric brain tumors may experience executive difficulties on more complex timed tasks, secondary to sluggish cognitive tempo symptoms. #136 S HAUT, J.M., MCCLAIN, M.B., & KATZENSTEIN, J.M. Neurocognitive Late Effects Following Proton Beam Radiation Therapy in Two Pediatric Craniopharyngioma Patients Less than 1% of pediatric brain tumors are craniopharyngiomas often treated with radiation therapy, and more recently, proton beam radiation therapy. As a result of treatment, children are at risk for late neurocognitive effects. The purpose of the current study is to report two unique cases of neurocognitive late effects of an 8 year, 9 month old female and 6 year, 11 month old female status-post proton beam radiation therapy and partial resection for craniopharyngioma. MRI findings revealed bilateral globus pallidus hyperintensity in both patients. Following treatment, patients demonstrated similar declines across areas of neurocognitive functioning, one patient demonstrating more

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significant symptoms consistent with Kluver-Bucy like-symptoms and the other patient exhibiting similar traits, including decreased language, decreased motor skill, behavior changes, and hyperorality. Both patients presented for an initial neuropsychological evaluation with similar symptoms and a comprehensive neuropsychological evaluation was completed with each. Results of each neuropsychological evaluation will be presented, as well as follow up neuropsychological evaluations following therapies. The current study adds to the existing literature regarding two unique cases of neurocognitive late effects with bilateral globus pallidus hyperintensity. The findings of these two cases suggest significant neurocognitive dysfunction following proton beam radiation for craniopharyngioma. #137 S OLSON, K.J., HOLCOMBE, B.D., HARDY, K.K., HARDY, S.J., & WALSH, K.S. Serum Calcium As A Potential Biomarker for Working Memory Deficits Among Children Treated for Brain Tumor Childhood cancer survivors carry risk for accelerated aging and demonstrate neuropsychological profiles similar to older adults with dementia. Lower calcium levels are associated with greater executive dysfunction in the elderly. We examined pre-treatment serum calcium and post-treatment executive function (EF) in pediatric brain tumor survivors. Retrospective data was available for 26 patients (65% female), with average age at diagnosis of 7.12 years (SD = 4.54). We found a significant correlation between pre-treatment calcium and post-treatment EF on the Behavior Rating Inventory of Executive Function (BRIEF) Working Memory (WM) subscale (r = −.477, p = .014) and Metacognition Index (r = −.433, p = .030). The relationship between WM and calcium remained significant after controlling for age at diagnosis (r = −.495, p = .012) and radiation treatment (r = −.504, p = .101). Multiple regression entering pre-treatment calcium, age at diagnosis, and radiation on WM scores was statistically significant [F (3, 22) = 3.070, p = .049)]. Calcium uniquely explained 27% of the variance; radiation uniquely explained 4%. Kruskal-Wallis test revealed a significant difference in WM across calcium level groups [normal, high, low; χ2 (2, n = 26) = 6.245, p = .044] such that lower pre-treatment calcium was associated with poorer post-treatment WM (T > 65). Lower pre-treatment calcium may be an independent risk factor for impaired WM in pediatric patients following treatment for a CNS tumor. #138 S HAMILTON, J.R., SCHREIBER, J.E., PALMER, S.L., SWAIN, M., CHAPIESKI, M.L., & MABBOTT, D.J. Stability of Family Functioning in a Prospective, Longitudinal Study of Pediatric Medulloblastoma Children treated for medulloblatoma are at risk for poor neurobehavioral outcomes. Positive family functioning is associated with better neurobehavioral outcomes in other pediatric populations. The present study examines stability of family functioning over time using the Family Environment Scale (FES) in 160 patients (100 males) treated for pediatric medulloblastoma on a longitudinal, multi-institution study. Mean age of patient at diagnosis was 9.12 years. Caregivers completed questionnaires at baseline and at 12- and 36-months post-diagnosis. Linear mixed-effect modeling indicated that



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estimated mean scores remained within the average range over time on FES scales (cohesion, expressiveness, conflict, independence, organization, and control). Longitudinal latent profile analysis identified discrete patterns of family functioning for each scale. On the cohesion scale, 79% stayed within the average range over time; 13% who were below average at baseline increased to the average range; and 8% who were average at baseline decreased to below average. On the remaining scales, families generally displayed stable profiles of higher, moderate, or lower functioning over time. Results suggest that family functioning largely remains stable over time following treatment for medulloblastoma. Intervention or support for lower functioning families may be warranted. Future analyses will examine associations among family functioning profiles and neurobehavioral outcomes. #139 S HAUT, J.M., & KATZENSTEIN, J.M. Examining The Neurocognitive Outcomes of Preschool-Age Children with Brain Tumors Following Radiation, Chemotherapy, and Stem Cell Transplant Children undergoing treatment for brain tumors are at-risk for neurocognitive late effects. Preschool-aged children are at a greater risk. The purpose of this study was to examine the intellectual, adaptive, and behavioral outcomes of preschool-age children who underwent radiation, chemotherapy, and stem cells treatment. Eight children diagnosed (3 medulloblastoma, 1 ependymoma, 1 glioblastoma, 1 JPA, 1 DNET, &1 ATRT) participated in an initial clinical neuropsychological evaluation. At the time of the evaluation (M age = 4.56, SD = 0.70), all patients were treated with chemotherapy and radiation and 3 received stem cell transplant. Detailed results from the neuropsychological evaluation will be presented. Post-treatment, children demonstrated overall average verbal and performance IQ on the WPPSI-III (VIQ M = 94.2, SD = 17.35, p = ns; PIQ M = 99.67, SD = 20.34, ns). Visual motor integration skills also fell within the average range (M = 92.29, SD = 14.10, p = ns). Overall ABAS-II scores following treatment fell below age expectation (M = 69.71, SD = 24.42, t(7) = 5.36, p < 0.001). Seven of the eight patients were rated as demonstrating clinically significant behavioral and emotional concerns (e.g. depression, hyperactivity, etc.), seven of the eight patient’s caregivers endorsed mild concerns with behavioral/emotional symptoms (BASC-2). Adaptive behavior ratings may be sensitive to outcomes of brain tumor treatment in preschool-age children. #140 S MCCURDY, M.D., TURNER, E., BARAKAT, L.P., HOBBIE, W., DEATRICK, J., & HOCKING, M.C. Processing Speed Mediates The Relationship Between Radiotherapy Exposure and Executive Functioning in Young-Adult Survivors of Childhood Brain Tumor Childhood brain tumors (BT) and their treatments pose substantial risks to neurological development. Survivors transitioning into young-adulthood may experience longstanding neuropsychological deficits in both basic (processing speed; PS) and higher order (executive functioning; EF, Working Memory; WM) cognitive domains. Research using theoretical models of neuropsychological development suggests that more basic processing abilities may underlie these higher order cognitive skills. The present study


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examined the indirect effects of radiotherapy (RT) exposure on EF and WM through PS in young-adult survivors of childhood BT. Thirty-four young-adult survivors (52.9% female) aged 18–30 (M = 23.5, SD = 3.4) were administered measures of PS (Processing Speed Index) and WM (Letter-Number Sequencing; Digit Span Backward) from the Wechsler Adult Intelligence Scale-4th Edition (WAIS-IV) and EF subtests (Tower Achievement; Number-Letter Switching) from the Delis–Kaplan Executive Function System (D-KEFS). Survivors treated with RT (n = 17) evidenced significantly worse performance on all neurocognitive measures compared to those without RT exposure (n = 17; ps < .01). Bootstrapping analyses revealed indirect effects of RT exposure on survivor EF/WM through PS. PS either partially (Letter-Number Sequencing; Tower Achievement) or fully (Digit Span Backward; Number-Letter Switching) mediated this relationship. Findings suggest that basic speed of information processing may underlie deficits in more complex executive skills in BT survivor populations treated with RT. #141 S VAN DER PLAS, E., GUGER, S., SCHACHAR, R.J., ITO, S., & SPIEGLER, B. Cognitive and Behavioral Impairments in Survivors of Childhood Acute Lymphoblastic Leukemia Survivors of acute lymphoblastic leukemia (ALL) in childhood often experience longterm neurocognitive effects of chemotherapy that affect executive functions. Using a large battery of measures, we sought to determine specific patterns of neurocognitive impairments among ALL survivors. Seventy-six survivors (46 males and 30 females) between 8 and 18 years of age were given measures of processing speed, working memory, executive function and academic achievement (WISC-IV; DKEFS; WIAT), parental questionnaires on behavioral attention and functioning in the home environment (Conners 3; BRIEF), and experimental tasks that measure working memory (nback) and response inhibition (stop signal task). ALL survivors significantly deviated from the norm on measures of processing speed, working memory, behavioral inattention and response inhibition, but verbal domains were mainly intact. There was substantial heterogeneity in neurocognitive function among ALL survivors (particularly males) that was not related to treatment factors or age at diagnosis. These results will help identify clusters of survivors that are differentiated in terms of severity and perhaps patterns of late effects. Ultimately, we expect that these clusters will enable us to find genetic risk factors that explain the heterogeneity in neurocognitive outcomes among ALL survivors. #142 S TURNER, E.M., MCCURDY, M.D., QUAST, L., KAZAK, A.E., BARAKAT, L.P., & HOCKING, M.C. The Association Between Neuropsychological Functioning and Cognitive Strategies for Learning in Pediatric Brain Tumor Survivors Childhood brain tumor (BT) survivors display deficits in executive functioning (EF) and working memory (WM). Neurocognitive impairments are suggested to result in decreased rates of learning, which in turn contributes to academic underachievement. Impairments in cognitive learning strategies are related to EF and WM in other cognitively-compromised pediatric populations. This study examined the relationship between EF, WM and cognitive learning strategies in 25 BT survivors (ages 10–16 years).



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Survivors were administered the Wechsler Intelligence Scale for Children-4th Edition (WISC-IV) Digit Span Backward and the Motivated Strategies for Learning Questionnaire (MSLQ). The MSLQ measures advantageous (organization, elaboration and critical thinking) and disadvantageous (rehearsal) cognitive learning strategies. Caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF) Metacognitive Index. Pearson correlations revealed that greater deficits in EF were related to increased use of rehearsal-based strategies (r = −0.52, p = 0.008). All other correlations were non-significant (ps > 0.05), although the association between EF and organization-based strategies approached significance (p = 0.058). Executive dysfunction in childhood BT survivors is related to increased use of rehearsal-based learning strategies. This may limit survivors’ ability to store and retrieve class material. Future research should investigate whether use of rehearsal-based learning strategies mediates the association between EF and academic achievement in pediatric BT survivors.

Attention, Learning, and Executive Functioning #143 S CARRTHERS, T., & HEIDEMAN, E. Differentiating Children with Attention Deficit/Hyperactivity Disorder From Those with Learning Disabilities Using Both Objective and Subjective Measures Clinically, parents of children who receive a diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) or Learning Disability (LD) often report similar deficits in executive functioning, thus making it difficult to distinguish between the groups. This study examined both objective and subjective measures of processing and executive functioning in ADHD and LD populations. Objective measures did not differentiate the two groups. When comparing 47 children with ADHD to 24 children with an LD, there were no differences in processing speed or working memory (p > .05), providing little diagnostic specificity. However, parent ratings on the Behavior Rating Inventory of Executive Function revealed significant group differences for multiple subscales including Initiate [F(1, 68) = 4.46, p < .05], Working Memory [F(1, 68) = 5.81, p < .05], Plan/Organize [F(1, 68) = 4.72, p < .05], Organization of Materials [F(1, 68) = 9.22, p < .01], Monitor [F(1, 68) = 7.31, p < .01], and Metacognition [F(1, 68) = 8.26, p < .01]. For all subscales, children diagnosed with ADHD were rated as having significantly more executive function deficits than children diagnosed with an LD. Similarly, teachers reported children with ADHD as having greater deficits on these subscales compared to their LD peers. The present study supports previous findings of greater reports of executive dysfunction in children with ADHD compared to other clinical groups. This provides clinicians with tools that are sensitive to differences between children with ADHD and LDs. #144 S FECHTER, B., O’DESKY, I., & MARKS, D. Executive Functioning As A Predictor of Attention-Deficit/Hyperactivity Disorder and Nonverbal Learning Disability Children with nonverbal learning disability (NLD) are often diagnosed with ADHD, inattentive type (ADHD-I). Research suggests, however, that attentional problems


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associated with NLD may result from visual perceptual and attentional deficits (Fine et al., 2008; Rourke, 2000) distinct from those of ADHD-I, so that executive functioning tasks could help differentiate between NLD and ADHD-I. This study hypothesized: (1) individuals meeting screening criteria for ADHD-I (CPT ≥ 75) differ from individuals screening positive for NLD (VCI-PRI discrepancy ≥ 15, Rey Copy ≤ 1st percentile) on four NEPSY-II executive functioning subtests; (2) visuospatial reasoning subtests predict NLD while auditory attention subtests predict ADHD-I. Participants included 164 children ages 6- to 12-years with 15 meeting screening criteria for ADHD-I and 17 for NLD. These two groups differed on the NEPSY-II Design Fluency task, t(28) = −2.41, p = .02, but no other executive functioning subtests. Logistic regression revealed NEPSY-II executive functioning subtests did not predict ADHD-I, χ2(4) = 6.66, p = .155, but did predict NLD, χ2(4) = 16.72, p < .01, with Design Fluency as a significant individual predictor β = −.242, p = .01. Findings suggest children with NLD display greater impairment on visuospatial tasks, and NEPSY-II Design Fluency may assist with NLD diagnosis. #145 S BELASCO, C.D., LAZAR, M., ROURKE, M., KLEIMAN, R., & GOLDBERG, K. Differences in The Behavioral Presentation and Neuropsychological Profile of Children with Attention Deficit Hyperactivity Disorder (ADHD) and Comorbid Internalizing Problems Prior research suggests that comorbidity may be the norm rather than the exception in children with ADHD (Takada et. al, 2012). This study assessed how the presence of internalizing problems relates to neuropsychological and behavioral functioning in children with ADHD. Archival data was analyzed from 85 children diagnosed with ADHD, who completed the Wechsler Intelligence Scale for Children (WISC-IV) and Wisconsin Card Sorting Test (WCST). Parents completed the Behavior Assessment Scale for Children (BASC-2). Children with comorbid internalizing problems learned more efficiently on the WCST (p = .001, r = .35), but earned statistically similar scores on all other neurocognitive measures. On the BASC-2, children with internalizing problems were reported to have significantly greater trouble with externalizing behavior (p = .002, r = .33), hyperactivity (p = .033, r = .23), aggression (p = .017, r = .26), conduct problems (p = .009, r = .28), and social withdrawal (p = .000, r = .40); and diminished adaptability (p = .000, r = .39) and adaptive skills (p = .003, r = .32). Results suggest that children with comorbid internalizing problems experience greater social and behavioral impairment, but do not exhibit weaker neurocognitive skills than children with ADHD alone. #146 S SIMONE, A.N., & HALPERIN, J.M. Preschool Working Memory Predicts Inattentive, But Not Hyperactive-Impulsive Symptoms At 8-Years-Old This study examined the degree to which preschool WM predicted school-aged ADHD. Preschool children’s [N = 156; mean age (SD) = 4.25 (.48) years] WM was assessed using the Sentence Repetition subtest from the Developmental Neuropsychological Assessment (NEPSY) and ADHD symptom severity was assessed via parent and teacher ratings using the Attention-Deficit/Hyperactivity Disorder-Rating Scale-Fourth



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Edition (ADHD-RS-IV). On average, 4.30 (.47) years later, at a mean (SD) age of 8.56 (.31), children’s parents completed a clinical interview to determine ADHD symptom severity. Data were analyzed via linear regression. Children’s socioeconomic status (SES) and time between evaluations were first entered into the model; next preschool ADHD-RS-IV scores were entered; school-age ADHD symptom severity was entered into the final block. SES and time between evaluations significantly predicted schoolage ADHD accounting for 4.7% of the variance (p = .013). Parent and teacher ratings of ADHD symptom severity accounted for an additional 36.7% of the variance (p < .001). Above and beyond preschool ADHD severity, preschool WM significantly predicted later inattentive symptoms (p = .022), accounting for an additional 2% of the variance, but not hyperactive-impulsive symptoms (p = .60). Preschool WM significantly predicted change in school-aged inattentive, but not hyperactive-impulsive symptom severity. #147 JONES, E.F., FERENC, L., & MAHONE, E.M. Longitudinal Analysis of ADHD Symptoms and Executive Functions From Preschool to School Age ADHD onset typically occurs in the preschool years; thus, it is critical to understand the trajectory of symptoms prior to school entry. Forty children (23 controls [13 boys]; 17 with ADHD [10 boys]) participated in a longitudinal study of brain development. Each participant was assessed on three occasions, one year apart, beginning at age 4 or 5 years. Repeated measures ANOVAs were used to examine longitudinal changes in ADHD symptoms (Conners’ Parent Rating) and performance-based executive function (EF) measures (auditory working memory-Woodcock-Johnson-3, inhibitory controlConflicting Motor Response). There were no significant group differences in sex distribution or age across visits. There were, however, significant group effects (favoring controls) for ADHD symptoms (p = 0.006), working memory (p = 0.041), and inhibitory control (p = 0.032). Additionally, there was a significant effect for time (improvement with age) for working memory (p < 0.001), but not for inhibitory control or ADHD symptoms. Importantly, the strength of association between EF performance and ADHD symptoms increased across visits, such that mean correlations were small in preschool (Time 1 r = −0.085), but increased at Time 2 (r = −0.241) and Time 3 (r = −0.390). In preschoolers, ADHD symptoms change minimally from age 4–7 years. EF performance better predicts ADHD symptoms at school age than in preschool #148 KORIAKIN, T.A., JONES, E., MCCURDY, M., & JACOBSON, L. Can Teacher Ratings Accurately Identify Students’ Learning Problems? Validation of The Academic Skills Rating Scale The present study examined utility of the Academic Skills Rating Scale (ASRS), a teacher-report screening of language/literacy and math skills, for predicting low achievement in a clinical sample. Children (preK-5th grade) referred for neuropsychological assessment were included in the sample if they had a completed ASRS and were administered standardized reading and/or math achievement measures. of those, 720 youth had reading ratings from a reading/general education teacher (M age = 8.65 ± 1.49 years, 64% male) and


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723 had math ratings from a math/general education teacher (M age = 8.19 ± 1.77, 64% male). Sensitivity, specificity, and receiver operating characteristic (ROC) curves were examined for reading (word reading, decoding, fluency, & comprehension) and math (calculation & problem-solving) difficulties (SS < 85). Reliability was high for ASRS reading and math scales across grade levels (αs > .94). Teacher ASRS ratings and achievement scores were well correlated (p < .01 for all). Selected cut-scores (scale mean = 2.0) maximized sensitivity (Reading: 79–90%; Math: 86–89%), with lower specificity (Reading: 44–56%, Math: 46%). AUC ranged from .70–.82 (Reading) and .78–.79 (Math). Findings suggest that the teacher-reported ASRS is a psychometrically-strong screening measure for reading and math difficulties in clinically-referred children; mean reading and math ratings ≥2.0 can be used to determine necessity of further academic assessment. #149 S DUPONT-FRECHETTE, J.A., TELLOCK, P., KAVANAUGH, B., MAHER, I., HAILSEY, L., & HOLLER, K. Childhood Maltreatment and Its Impact On Executive Functioning Within An Inpatient Setting Previous research has shown that child maltreatment can negatively impact brain development and neurocognitive systems for children, adolescents, and adults. However, there are no studies that have sought to understand the role of child maltreatment with psychiatrically hospitalized children. The current study examined a hierarchical and cumulative model of maltreatment with inpatient children (ages 6–14 years old) who had been maltreated (n = 111) to understand its impact on executive functioning skills, compared with a psychiatric outpatient sample (n = 166). Results using a hierarchical and cumulative model of maltreatment revealed that significant differences existed between the outpatient sample and children who had been maltreated on combined measures of general executive functioning, even after controlling for FSIQ. Group differences between the outpatient sample were found for those who had been sexually and physically abused, but not neglected on general executive functioning skills using a hierarchical model of maltreatment. The cumulative model revealed significant differences between the control group and those who had been exposed to three and four types of maltreatment. These findings extend previous research conducted with maltreated adolescents in an inpatient psychiatric setting, suggesting the type of maltreatment and number of maltreatment exposures, significantly impact different skills associated with executive functioning. #150 S SUDIKOFF, E.L., LORDO, D.N., STROUP, M.L., & KAUFMAN, D.A.S. Executive Control is Associated with Emotion Regulation in Typically Developing Children Childhood is a developmental period characterized by heightened emotional reactivity and immature top-down executive control. The earlier engagement of dysregulated affective processing systems may contribute to emotion regulation difficulties in children whose executive skills are not fully developed. The current study examined associations between executive functioning and emotion regulation in healthy, typically



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developing children using neuropsychological measures and standardized self- and parent-report inventories. Sixteen children completed the Emotion Regulation Index for Children and Adolescents (ERICA), How I Feel scale (HIF), and subtests from the Delis–Kaplan Executive Functions System (D-KEFS), while parents completed the Behavior Assessment System for Children – Second Edition (BASC-2) and Behavior Rating Inventory of Executive Function (BRIEF). Results indicated that better performance on the D-KEFS Verbal Fluency Category Switching task was significantly correlated with better parent-reported (BASC-2 Emotional Self-Control: r = −0.69; BRIEF Emotional Control: r = −0.62) and better self-reported emotion regulation (ERICA Emotional Self-Awareness: r = 0.78). Similarly, better performance on the D-KEFS Color-Word Interference Inhibition and Switching tasks was associated with better selfreported emotional functioning (Inhibition and ERICA Emotional Self-Awareness: r = −0.56, Switching and ERICA Situational Responsiveness: r = −0.60). Thus, heightened executive control appears to play a critical role in the regulation of emotions in healthy children. #151 S HAISLEY, L.D., DUPONT-FRECHETTE, J., KAVANAUGH, B., TELLOCK, P., MAHER, I., & HOLLER, K. Executive Functioning and Length of Stay in a Children’s Inpatient Psychiatric Population From 2000 to 2011 the number of child psychiatric hospitalizations increased, prompting an interest in factors contributing to a patient’s length of stay (LOS). Lengthy stays are taxing on the patient and the overarching social and medical systems. Previous research suggested that behavioral dysregulation, negative affect, past-trauma and more severe psychiatric symptomatology lengthen LOS. No studies to date have examined the implications of a child’s neuropsychological profile, specifically examiner-assessed executive functioning (EF), on LOS. A retrospective chart review of 182 children consecutively referred for a neuropsychological evaluation within an inpatient children’s psychiatric hospital was conducted. EF measures included Trails A /B, Stroop task, Verbal Fluency, Rey-O, CPT and Wisconsin Card Sorting Task. Length of stay ranged from 1 to 107 days (M = 20.93, SD = 16.65). Longer LOS was negatively associated with Verbal Fluency FAS (r = −.196, p = .014) and positively associated with commission errors on the CPT (r = .195, p = .028); together accounting for 14% of the overall variance in LOS. Although the contribution to overall variance is small, EF skills may interact with other factors such as psychiatric symptomatology to affect length of stay. Possible interactions are examined in the current poster #152 S ALTIS, K.L., HIGHLEY, E., & KATZENSTEIN, J. Intellectual Abilities, Academics, and Behavioral Functioning Following International Adoption Children who are internationally adopted are at significant risk for decreased neurocognitive functioning as a result of multiple factors, including age at adoption, lack of prenatal care, and institutionalization. This study evaluated 10 children following clinical neuropsychological evaluation for behavioral and learning concerns. Six children


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were female, and country of origin spanned from China to Eastern Europe (Kazakhstan, Russia, Bulgaria) to Africa (Ethiopia). Average age at adoption was 28.6 months (SD = 23.84) and average age at testing was 9.23 years (SD = 2.83). A full neuropsychological evaluation was completed with each child. Based upon findings, a trend was found for age at adoption significantly correlating with FSIQ scores on the WISC-IV and WPPSI-III [F(1, 8) = 49.64, p = 0.10], with older age at adoption correlating with lower FSIQ. Country of origin (China versus Eastern Europe) did not significantly predict later FSIQ. However, half of the children were rated by their parents as having significant concerns in the areas of Hyperactivity, Atypicality, and Functional Communication on the BASC-2. Results demonstrate that children who are internationally adopted are at significant risk for reduced intellectual abilities and increased behavior problems, and require significant supports psychologically and educationally.

Pediatric Neurology #153 S HORTON, D., TAN, A., AYRES, A., HUGHES, S., CONGER, D., & PLUMB, P. Neuropsychological and Academic Functioning in Pediatric Optic Neuritis Optic neuritis (ON) is an inflammation of the optic nerve, often resulting in pain and temporary vision loss. Although the primary function of the optic nerve involves transmission of visual information, literature suggests ON can result in cognitive impairment years after diagnosis and symptom resolution. However, no studies have examined neuropsychological and academic outcomes in pediatric ON. Twelve participants, ages 5 to 17 years (mean = 11), were administered a neuropsychological screening battery during an initial visit to a specialty clinic for pediatric demyelinating diseases. One-sample t-tests revealed statistically significant differences from the mean (p < .05) for visualmotor integration, digit span, and fine-motor skills involving the non-dominant hand, as well as self- and parent-reported fatigue and quality of life (QOL). Furthermore, 33% showed impairment on Trail-Making Tests A and B and 20% in verbal fluency. Parent responses on a questionnaire of emotional and behavioral functioning indicated that 50% had concerns related to attention problems. Regarding academics, 55% were experiencing school problems. Results suggest that pediatric ON patients are at risk for cognitive and motor impairment, as well as difficulties related to academics, fatigue, and QOL. Novel findings from this study support the need for a multidisciplinary approach in the care of this population. #154 SHAY, N.L., & HULING, A.M. A Juvenile-Onset Case of Atypical Metabolic Storage Disorder Metabolic storage disorders, including Krabbe disease, generally are characterized by infantile-onset, progressive neurological deterioration, and early death. The current case study presents neuropsychological and neurobehavioral consequences of an atypical case of juvenile-onset Krabbe disease. Initial presentation to the hospital included psychosis, autonomic storming, and altered mental status. Diagnosis of Krabbe disease was made via brain biopsy. Neuropsychological testing was completed three months


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post-presentation to the hospital and presentation at that time included disinhibition, inattention, and odd behaviors. Neuropsychological testing revealed decline in functioning from estimated premorbid functioning in all domains on the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV).


#155 S COPPENS, A.M., WESTMACOTT, R., DEVEBER, G.A., & ABEARE, C.A. Attention Following Pediatric Arterial Ischemic Stroke: The Importance of Age At Stroke and Testing Attention is a network of cognitive processes underlying the development of most cognitive skills. Understanding outcomes on factors of attention following pediatric cerebral insult is critical for timely identification of impairment and treatment planning. In this study, 196 children with arterial ischemic stroke participated in neuropsychological testing, examining factors of attention. A latent variable model was used to determine whether age at stroke and testing are predictors of outcome on Mirsky’s factors of attention (Shift, Focus/Execute, Encode, Sustain). Younger ages at stroke and testing predicted worse performance on measures of Shift, but better performance on Focus/ Execute. Performance on measures of Encode and Sustain were not predicted by the age variables. Although Shift is one of the earliest factors to develop, it is not fully established until adolescence. Earlier strokes, occurring before the skill is established, are associated with worse outcomes; however, performance may improve with age, as the skill continues to develop. As one of the latest factors to develop, Focus/Execute appears more vulnerable to later insult, potentially indicating that the damage affects a skill that is in a critical period of development or is already established. #156 S SHISHIDO, Y., LATZMAN, R.D., BURNS, T.G., & PAPAZOGLOU, A. Neuropsychological Functioning of Pediatric Patients with Chiari Malformation Type I Chiari Malformation Type I (CMI) refers to a structural defect of the brain involving the cerebellar tonsils herniating into the foramen magnum. CMI may be asymptomatic or present as a range of symptoms including headache, neck pain, or motor or sensory problems. Although limited, studies of adults with CMI suggest increased risk of neuropsychological deficits, particularly, with visual-spatial skills, processing speed, executive functioning (EF), and internalizing symptoms. Research, however, has yet to fully examine the effects of CMI on neuropsychological functioning in children, which may limit their access to services and supports. The current retrospective, cross-sectional study included a clinical sample of 16 children aged 6 to 18 years and aimed to clarify the neuropsychological profiles of children with CMI. Consistent with the adult literature and current research on cerebellar functions, pediatric CMI patients evidenced a higher rate of difficulties with EF (BRIEF Parent, Global Executive Composite; t(12) = 4.75, p < .01) and processing speed (WISC-IV PSI; t(10) = −3.91, p < .01; WJ-III math fluency, t(8) = −2.62, p < .05) compared to norms, while evidencing average intelligence, verbal memory, academic achievement, and internalizing symptoms. Overall, results suggest increased risk of deficits in EF and processing speed in children with CMI. Clinical implications will be discussed.

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#157 S LOVE, C.E., SALINAS, C.M., WEBBE, F.M., KIM, G., & LEE, K.H. Executive Functioning Predicts Health-Related Quality of Life in Children with Intractable Epilepsy The relationship between executive functioning (EF) and health-related quality of life (HRQOL) in children with intractable epilepsy is unclear, with only one study found (Sherman, Slick, & Eyrl, 2006). The present study included 51 consecutive pre-surgical admissions (Mean age = 11.75 years; Mean age of onset = 6.46 years). Twenty-five children had localized seizure onset, 15 had generalized onset, and one had mixed onset. Those with IQ measures, the Behavior Rating Inventory of Executive Function (BRIEF), and the Quality of Life in Childhood Epilepsy (QOLCE) were included. A significant difference was found in HRQOL between those with and without clinical impairments on the BRIEF [t(32) = 3.47, p < .002], favoring those without executive dysfunction. A multiple regression showed that all BRIEF scales were predictive of overall QOL [F(8, 42) = 6.830, p < .001, R2 = .565], with BRIEF scales accounting for 57% of the variance in overall QOL. Organization of Materials and Working Memory were the best predictors of HRQOL. Epilepsy severity was associated with decreased IQ, but not with EF or HRQOL. Our results confirm that parent report of EF, particularly metacognition, predicts poor HRQOL. Therefore, identification of executive dysfunction should be an essential component of pre-surgical evaluations and targets for interventions. #158 S JORDAN, L.L., ARNETTE, A., RODWELLER, C., & SALORIO, C.F. Is A History of Febrile Seizures Associated with Increased Neuropsychological Morbidity in Children with Attention Deficit Hyperactivity Disorder? Febrile seizures (FS) are the most common type of childhood seizures. Historically, FS have been considered relatively benign medical events. However, a recent nationwide population-based cohort study (Ku et al., 2013) reported that children with history of FS are at 1.66 times greater risk than matched controls to be later diagnosed with attention deficit hyperactivity disorder (ADHD). The current study aimed to further examine the association between FS and ADHD symptoms in a clinical sample. Demographic and neuropsychological data for children diagnosed with ADHD (aged 6–16) were extracted from a clinical database. Forty patients with history of FS were identified and included in subsequent analyses. A control group of forty ADHD patients without history of FS were matched to the FS group by age and gender. Descriptive and between-group analyses of ADHD-IV Rating Scale and Conners-3 ratings revealed strikingly similar group profiles, with no statistically significant group differences in parent reported attention or behavioral symptoms (all p > .10). Both groups were clinically elevated on the Conners-3 Inattention, Hyperactive/Impulsive, Learning, and Executive Functioning Scales. These findings suggest that in children diagnosed with ADHD, history of FS is not associated with increased attention or behavioral difficulties.


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#159 S JONES, K.E., PATRICK, K.E., HILDENBRAND, A.K., APOLLONSKY, N., & TARAZI, R.A. Neurocognitive Risk and Blood Flow Velocity in Pediatric Sickle Cell Disease: Are “Normal” Values Benign? Cognitive impairment in sickle cell disease (SCD) is associated with a number of risk factors. Transcranial Doppler ultrasonography (TCD) is used to assess cerebral blood flow velocity and determine stroke risk. Previous research has investigated cognitive functioning according to TCD stroke risk criteria (i.e. normal, conditional, abnormal). However, there is little understanding of the association between blood flow velocity within the “normal” range and cognitive functioning. Adolescents with SCD-HbSS (N = 15, age 13–18 years) and normal TCD studies completed neuropsychological testing. Multiple linear regressions investigated the relationship between vasculopathy (highest TCD value across all arteries) and intellectual functioning (WASI-II FSIQ), executive functioning (D-KEFS Color Word Interference, Trail Making Tests), processing speed index, working memory index, and verbal learning (CVLT-C/II), controlling for maternal education. Though not statistically significant, results revealed a strong relationship between TCD and IQ, (β = −.52, p = .059), and moderate relationships between TCD and set-shifting (β = −.37, p = .217) and inhibition (β = −.38, p = .202) among this small sample of neurologically healthy adolescents with SCD. Findings suggest that relatively higher blood flow velocity, even within the normal range, may affect neurocognitive functioning in youth with SCD. Further research with larger samples is warranted. #160 WILKINSON-SMITH, A., HOWARTH, R., & GREENBERG, B. Behavioral and Adaptive Functioning in Young Children with Anti-N-Methyl-DAspartate (NMDA) Receptor Encephalitis Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a relatively newly identified form of autoimmune limbic encephalitis. Literature regarding psychological and cognitive functioning in these patients is limited for pediatric patients. We present data regarding six young children with this diagnosis. The children were between 11 and 73 months of age at the time of diagnosis (mean = 43 months), and 31 to 83 months at the time of assessment (mean = 64 months). They were an average of 21 months from initial presentation. All children received first-line treatments including corticosteroids, intravenous immunoglobulin, and plasmapheresis. Three had also received second-line treatments of Cytoxan and/or rituximab. Parents of these children completed the Adaptive Behavior Assessment System for Children, Second Edition (ABAS-2) and the Behavior Assessment System for Children, Second Edition (BASC-2). Ratings indicated clinically significant concerns with adaptive functioning (ABAS-2: General Adaptive Composite mean SS = 77.3), particularly communication (ABAS-2: Communication mean ss = 5.6) and self-help skills (ABAS-2: Self-Care mean ss = 5.4). Behavioral problems, particularly hyperactivity, were also noted (BASC-2: Hyperactivity mean T = 60.2). Results suggest that developmental and behavioral problems are worth monitoring in children, particularly young children, with anti-NMDA receptor encephalitis.

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#161 S JAY, M.F., UPSHAW, N.C., ROSENBERG, J., & HOWARTH, R. Tracking The Early Recovery of Anti-NMDA Receptor Encephalitis in The Pediatric Population Using The Cognitive and Linguistic Scale (CALS) Anti-NMDA receptor encephalitis is a recently described auto-immune disease with a predictable clinical course. Early symptoms may include headache followed by psychiatric and/or personality changes. The emergence of seizures, autonomic instability, and movement disorders has also been described. While research has grown over the years, limited information exists about the short and long-term neurocognitive effects in the pediatric population. The Cognitive and Linguistic Scale (CALS) is an assessment tool that has been developed to serially track recovery in children following an acquired or traumatic brain injury (TBI) in the inpatient rehabilitation setting. Scores range from 20–100. The aim of the current study is to look at the ability of the CALS to capture change over the initial phase of the Anti-NMDA disease course. This study examined the recovery trajectory of two female patients (age at diagnosis = 10–11 years) over the course of inpatient rehabilitation. Length of stay on the inpatient rehabilitation unit ranged from 25–51 days. CALS scores were obtained upon admission and at discharge. Results demonstrated notable change associated with recovery (admission CALS score mean = 32.5; discharge CALS score mean = 80.5). Findings suggest the CALS may be a useful tool to track early cognitive-linguistic recovery for patients with anti-NMDA receptor encephalitis. #162 S VEGA-CARRERO, M., GROSCH, M.C., & EVANKOVICH, K.D. Anti-N-Methyl-D-Aspartate Receptor (Anti-NMDAR) Encephalitis: A Serial Neuropsychological Case Study Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a severe neuroautoimmune disorder that progresses from neuropsychiatric symptoms, seizures, memory deficits, and language deterioration to unresponsiveness and dyskinesias. The clinical presentation is well-characterized but there is sparse information regarding long-term cognitive outcome. This case presents an overview of anti-NMDAR encephalitis and its neuropsychological correlates. We present demographic/medical information and serial neuropsychological data from a previously high-functioning 17-year-old Hispanic female. The patient was diagnosed with seropositive anti-NMDAR encephalitis in 05/ 2014 and hospitalized for 2 months. Hospital course was complicated by complex partial seizures, dyskinesias, and autonomic instability. Treatment included plasma exchange, intravenous methylprednisolone (IVMP), intravenous immunoglobulin (IVIG), rituximab, and symptomatic treatment with methylphenidate and quetiapine fumarate. Prior to discharge, patient remained disoriented, aphasic, and unable to follow commands. Initial neuropsychological evaluation (10/2014) revealed profound global impairments, most notably in processing speed, memory, expressive language, and finemotor coordination (R < L). Hallucinations persisted. Re-evaluation (02/2015) revealed significant improvement in cognitive domains noted above, with otherwise stable (still below average) performance. Hallucinations had ceased. Elevated NMDAR antibody titer necessitated repeat rituximab dosing with ongoing IVIG/IVMP. The case report is


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significant given the limited neurocognitive outcome data available for this severe neuroautoimmune disorder.


#163 S MAIMAN, M.B., SHELDON, S.E., YAFFE, B., VASSERMAN, M., MACALLISTER, W.S. Utility of The Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P) in Young Children with Epilepsy Executive functioning deficits are prominent in children with epilepsy. Although instruments such as the BRIEF are useful in detecting executive dysfunction in a school-age epilepsy population, little is available for younger children. The present study evaluated the utility of the BRIEF-P in younger children with epilepsy. 22 children with epilepsy (Age: M = 4.05, SD = .95, Range = 2–5; IQ: M = 83.31, SD = 25.65) were administered the parent version of the BRIEF-P, with a small subset also receiving the teacher form. Using a cutoff t-score of ≥65 as the threshold for impairment, the sensitivity of the BRIEF-P variables was established. Correlational analyses assessed the relationship between the BRIEF-P variables with epilepsy severity factors. At the parent scale level, both emergent metacognition (EMI) (Parent = 59%, Teacher = 42%) and global executive composite (GEC) (Parent = 41%, Teacher = 42%) were frequently elevated. The most frequently elevated subscales were inhibition (Parent = 36%, Teacher = 60%), working memory (Parent = 63%, Teacher = 75%) and planning/organization (Parent = 41%, Teacher = 33%). Epilepsy severity variables were not significantly correlated with BRIEF-P scales, with the exception of overall intelligence; lower IQ predicted more parent reported executive dysfunction, specifically with GEC (r = −.491), EMI (r = −.493), inhibitory self-control (r = −.464), working memory (r = −.669) and emotional control (r = −.483). The BRIEF-P shows promise in identifying executive dysfunction in preschool age children with epilepsy.

Traumatic Brain Injury and Concussion #164 S UPSHAW, N.C., JAY, M.F., ROSENBERG, J., & HOWARTH, R. Cognitive and Linguistic Scale (CALS): Utility to Track TBI Recovery in Children and Adolescents During Inpatient Rehabilitation Traumatic brain injury (TBI) is a common cause of acquired brain injury in youth. Common mechanisms of injury include motor vehicle accidents, accidental falls, and sports incidents. The Glasgow Coma Scale (GCS) is commonly utilized to determine the severity of the TBI. Injury severity can also be influenced by primary and secondary complicating factors (e.g. skull fractures, seizures, neuroendocrine dysfunction). The Cognitive and Linguistic Scale (CALS) was created to serially track early recovery by examining multiple aspects of cognition. The current study aims to examine the utility of the CALS to monitor changes in cognitive-linguistic status during inpatient rehabilitation. Scores range from 20–100. This study examined data from 44 patients (17 females; 26 males) ages 2–19 (mean: 11.5 years) recovering from moderate-severe TBI. CALS scores were examined upon admission and at discharge. Scores consistently

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demonstrated change associated with recovery (admission CALS mean = 62.97; discharge CALS mean = 79.58). Clinical variables and the presence of complicating factors was also examined (61% with initial GCS score in the severe range 3–8]; 11% experienced seizures; 52% suffered skull fracture; 34% required neurosurgical intervention; 9% experienced neuroendocrine dysfunction). Current findings substantiate the utility of the CALS for serially tracking early cognitive recovery during inpatient rehabilitation. #165 HERNANDEZ, A.M., OSCARSON, B., & STAVINOHA, P.L. Relationship of The Glasgow Outcome Scale Extended Pediatric Revision to Cognitive and Behavioral Outcome Measures After Pediatric TBI The Glasgow Outcome Scale Extended Pediatric Revision (GOS-E Peds) assesses outcome after traumatic brain injury (TBI) in children. Validity has been demonstrated at 3 and 6 months post-TBI. This study examines the relationship between GOS-E Peds and cognitive and behavioral outcome measures at 12 and 24 months post-TBI. Children with TBI were assessed at 12 months (n = 98) and 24 months (n = 63). In addition to GOS-E Peds, subjects were administered age appropriate measures of processing speed, Short-Delay Free Recall (SDFR) and Long-Delay Free Recall (LDFR) trials from the age appropriate California Verbal Learning Test-Children’s Version, and the Global Executive Composite from the Behavior Rating Inventory of Executive Function (BRIEF). Results revealed negative correlations at 12 and 24 months with processing speed (respectively, r = −0.713, p < .001 and r = −0.494, p < .001) and memory: SDFR (respectively, r = −0.506, p < .001 and r = −0.468, p < .01) and LDFR (respectively, r = −0.520, p < .001 and r = −0.458, p < .01). A significant correlation was found between the GOS-E Peds and BRIEF at 12 months (r = 0.437, p < .001), though the correlation at 24 months was not significant. Results are discussed in light of implications, limitations, and direction for future research. #166 S HEGBERG, N.J., ONO, K., PENNA, S., & BURNS, T.G. Test–Retest Reliability of The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in Young Adolescents The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neurocognitive testing battery is a popular assessment tool used for concussion management across all ages. Despite its popularity, ImPACT’s psychometric properties, particularly the test–retest reliability, have been a recent topic of debate (e.g. Schatz, Kontos, & Elbin, 2012). Further, the test–retest reliability in young adolescents has yet to be established. As a result, we examined the test–retest reliability of the ImPACT test battery in a sample of healthy, non-concussed athletes, ranging in age from 10–15 years old. 193 athletes with baseline and follow-up testing data were used in analyses. Pearson’s correlation coefficients (r) and intraclass correlation coefficients (ICCs) for ImPACT were as follows: Verbal Memory = 0.36/0.50 (r/ICC), Visual Memory = 0.02/0.04, Visual Motor Speed = 0.11/0.19, Reaction Time = −0.05/−0.08, and Total Symptoms = 0.14/0.23. The test–retest reliability data for ImPACT in this age group are notably lower than previously reported in other age groups, and do not meet


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the threshold value of 0.60 for acceptable test–retest reliability. Results suggest that ImPACT may not be as useful for reliably assessing change in neurocognitive performance for younger adolescent athletes. Findings also highlight the importance of age-based norms for ImPACT.


#167 HOLLAND, A.A., HERNANDEZ, A.M., & STAVINOHA, P.L. Longitudinal Predictive Value of CVLT-C for Academic Skills Following Pediatric TBI Miller & Donders (2003) showed that following pediatric traumatic brain injury (TBI), acute performance on the California Verbal Learning Test, Children’s Version (CVLTC) predicted special education placement at 12 and 24 months post-injury. The present study expanded on those findings by investigating the predictive value of CVLT-C performance in a sample of 12 patients (M = 8.75 years at 12-month evaluation, SD = 4.3) following moderate-to-severe TBI. CVLT-C learning trials T-score at 12 months post-injury significantly predicted performance at 60 months post-injury on language-based composites of the Woodcock-Johnson III: Tests of Achievement (WJ-III) but did not predict performance on subtests primarily assessing math skills. For example, as illustrated in findings for broad composites, CVLT-C learning trials T-score at 12 months significantly predicted WJ-III index scores for Broad Reading (F = 16.043, p = .003) and Broad Written Expression (F = 18.962, p = .002) at 60 months but did not predict Broad Math performance. Overall, results suggest that stronger encoding performance on CVLT-C learning trials at 12 months post-TBI predicts stronger language-based academic outcomes at 60 months post-TBI. These findings may inform screening efforts to detect children at-risk for academic difficulties in the areas of reading and writing after moderate-to-severe TBI. #168 LAROCHE, A.A., NELSON, L.D., PFALLER, A.Y., & MCCREA, M.A. Predictors of Recovery in Sport-Related Concussion A wide array of tools are commonly used to assess sport-related concussion (SRC). Although these tools have been validated for their sensitivity in detecting SRC, it is unclear if these measures assist in predicting symptom duration. This study evaluated multiple assessments of SRC for predictive validity of symptom duration in a population of high school and collegiate athletes in southeastern Wisconsin from 2012–2014. These measurements included computerized neurocognitive tests (CNTs), health histories, common concussion assessment tools, and a variety of psychological and symptom questionnaires. N = 166 athletes who sustained a concussion during the study were assessed at multiple time points. Baseline and post-injury data (within 24 hours of injury) were used to predict symptom duration. Consistent with prior work, 24-hour symptom score was the most robust predictor of symptom duration (r = .44; p < .001). Other factors also showed significance at a univariate level (pre-injury psychological symptoms, grade point average, retrograde amnesia, altered mental status, and various CNT subtests at 24 hours; ps < .05). Select univariate predictors (e.g. use of over-the-counter medication post-injury, ImPACT 24-hour verbal memory score)

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contributed uniquely to the prediction of symptom duration after accounting for early post-concussive symptom burden.


#169 KING, T.Z., WISE, J., & HAARBAUER-KRUPA, J. Everyday Executive Abilities of Young Children with A History of A Mild Complicated TBI Executive abilities of school age children with an early childhood TBI are important to better understand. We recruited 24 mild-complicated TBI and 27 orthopedic injury (OI) with comparable demographics. Participants were on average 4.5 years since injury. Children incurred injury before 6 years old, and were on average 7.47 years old. Age at injury was younger for TBI and was used as a covariate in all analyses. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF), Family Assessment Device (FAD), and Adaptive Behavior Assessment System-11 (ABAS). TBI evidenced lower Kaufman Brief Intelligence Test scores (p < .05, η2 = .08); however, only one child performed below the average range. BRIEF Behavior Regulation and Metacognition was significantly lower in TBI, (p = .02, η2 = 11). Clinical elevation (>65) were identified in 38% TBI on Global Executive Composite (GEC) relative to 7% OI; and 29% of TBI on BRI and MI versus 8% and 13%, respectively. FAD did not moderate BRIEF or ABAS. GEC was associated with ABAS conceptual (r = .51, p = .001). Results suggest that in a mild-complicated TBI group, (M = 4.5 years since injury) a small proportion would benefit from examination of everyday executive abilities as they enter school age. Future studies should examine how the BRIEF scores relate to specific executive performance measures. #170 S RABKIN, A.N., KLAVER, J.M., KRAPF, E.Q., STANFORD, L.D., & PULSIPHER, D.T. Post-Concussion Symptoms Minimally Explain Neurocognitive Performance After Mild TBI Post-concussive symptoms (PCS) are relatively common but non-specific complaints after mild traumatic brain injury (mTBI) that are sometimes used to guide return-toschool decisions. To date, PCS are commonly examined as grouping or outcome variables rather than as predictors of cognitive performance. The present study examined how PCS accounts for neuropsychological impairment among youth who have experienced mTBI and also passed effort testing. Weighted global deficit scores (wGDS) were created based on select subtests from a comprehensive neuropsychological test battery while PCS symptoms were based on the PCS Checklist (Gouvier et al., 1992). Logistic regression examined whether the total number and severity of PCS each accounted for wGDS. Results indicated that total number of PCS, but not severity, predicted only 3.5% of the variance in neuropsychological impairment. This suggests that total number of PCS, rather than severity, may affect performance on neuropsychological testing, but only to a very small extent. Subjective PCS may not be strong predictors of cognitive functioning and reinforces literature implicating other factors (e.g. emotional distress, premorbid deficits) in cognitive impairment after mTBI. Results further reinforce the


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importance of assessing objective performance to guide clinical decisions on return-to-school.


#171 S GREEN, C.M., RANGAN, P., & BROWN, T.M. Intellectual Performance on the WISC-IV in a Pediatric Brain Tumor Population Medical journals have long documented neurocognitive difficulties in children with primary brain tumors, typically described as IQ decline across time, with greatest risk for younger children undergoing craniospinal (photon) radiation. In the current study, performance on the Wechsler Intelligence Scale for Children (WISC-IV) was reviewed for a sample of 48 pediatric brain tumor patients (67% male; mean age = 11.85 years) undergoing treatment in the past 8 years. Treatment regimens included chemotherapy (45%), radiation (36%), and surgical resection (64%). WISC-IV performance for the sample was average for all indexes, aside from low average processing speed (M=85.10, SD=14.50), with no significant composite differences among the treatment groups. In fact, scores were average for children who received the most intensive treatment combinations: surgical resection with chemotherapy and radiation. Based on our sample, changes in IQ over time appear to solely reflect processing speed variability. Further, cancer treatments created more variability in behavioral and emotional functioning, particularly anxiety, which was unrelated to intellectual functioning on the WISC-IV, age, gender, or type of treatment. Although children with primary brain tumors are at greater risk for negative sequelae, most recent research indicates that, by and large, they fare well from a cognitive and behavioral perspective.

Prion 2015 poster abstracts.

Poster Session IITuesday, December 8, 2015.

IM4US Conference 2015 Abstracts: Poster and Oral Presentations.

Poster Session 3 - Morning.

The nurses group poster session.

Poster Session 4 - Afternoon.

Abstracts from the 2014 research poster session at the american massage therapy association annual convention.

Moderated Poster Session 3.

Poster Session 1 - Morning.

Moderated Poster Session 4.

Moderated Poster Session 2.

Poster Session 2 - Afternoon.

Award-winning poster abstracts.

Abstracts of Poster Presentations: MauiDerm 2015: January 26-30, 2015 Maui, Hawaii.

2015 Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Nashville, Tennessee, USA, 15-18 April 2015 : Poster Presentations.

Poster presentation abstracts.

Conference poster abstracts.

EBMT Nurses Group - Poster Session.

Introduction to the CPNP 2014 Poster Abstracts.

Platform and poster presentation abstracts.

Abstracts of the SIR 2015 Annual Scientific Meeting, February 28-March 5, 2015, Atlanta, GA.

Detailed-comparison of average journal-impact-factors of oral and poster-abstracts presented at scientific-session that achieved publication at 2009 Radiological-Society of North-America Scientific-Assembly and Annual Meeting including cardiac-session.

Day 2.

Day 1.