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Utility of recently-developed questionnaires in mild traumatic brain injury assessment
380
Abstracts of 16th Annual Meeting
hemisphere domains, i.e., verbal tasks. Multivariate analyses of the relationships of trauma and subsequent neuropsychological deficits indicate a significant effect on verbal skills and a moderate effect in attention processes. The results are useful in directing future investigations of the neurocognitive sequelae of psychological trauma and clinical interventions for children who have been traumatized. The results will also be useful in academic assessment and planning for child victims of psychological trauma.
Palumbo, D., Maughan, A., Como, P., & Kurlan, R. Executive Dysfunction in Tourette Syndrome: The Role of Comorbidity. Tourette Syndrome (TS) is a neuropsychiatric disorder of childhood onset characterized by chronic vocal and motor tics which is currently considered to be hereditary in etiology. Current research has also revealed that obsessive-compulsive behavior and attention deficits are common among children diagnosed with TS, suggesting a shared pathophysiology involving the basal ganglia. Moreover, other types of behavioral, neurodevelopmental, and psychiatric symptomatology associated with executive dysfunction have also been reported in patients with TS. However, previous research directly examining executive functioning in children with TS has thus far been inconclusive regarding whether children with TS demonstrate executive dysfunction. This study sought to evaluate executive functions in a sample of children diagnosed with TS, and determine which symptoms may be associated with executive dysfunction. METHODS: 103 children, ages 5 to 17 years, who met DSM-IV criteria for TS, were administered a brief neuropsychological screening battery which included: Intermediate Trailmaking Forms A & B; Symbol Digit Modalities Test (SDMT); and The Underlining Tests. All patients also received a diagnostic evaluation in order to assess the degree and severity of TS symptomatology and the presence of other behavioral, neurodevelopmental, and psychiatric symptomatology. Results: Children with TS only were compared to children with TS plus comorbid symptomatology (TS+). Significant impairment was demonstrated in the TS+ group on Trails A (p < .05); Trails B (p < .01); and the SDMT (p < .01) while the TS only group performed within normal limits. Further analyses revealed that the presence of other neurodevelopmental disorders (stuttering, learning disabilities and motor delays) predicted impaired neuropsychological test performance whereas the presence of comorbid behavioral and psychiatric symptomatology did not. Conclusion: These results suggest that children with TS plus associated neurodevelopmental disorders demonstrate executive dysfunction when compared to children with TS only. The presence of comorbid symptomatology must be thoroughly evaluated in TS patients since 1) an accurate characterization of TS is critical to the interpretation of neuropsychological data in future studies; and 2) The presence of comorbid symptomatology in TS patients may have significant implications for diagnosis and treatment.
Paniak, C., Toiler-Lobe, G., Nagy, J., Stock, A., & Goltz, M.I. Utility of Recently-Developed Questionnaires in Mild Traumatic Brain Injury Assessment. The purpose of this study was to assess the utility of recently developed questionnaires in mild traumatic brain injury (MTBI) assessment. The questionnaires were the Problem Checklist (PCL) from the Head Injury Family Interview (Kay et al., 1995), the Community Integration Questionnaire (CIQ; Wilier et al., 1994), and the Short Form-36 (SF-36; Ware et al., 1992), a measure of overall health functioning. Subjects were 53 MTBI patients and their significant others, drawn from consecutive admissions at two hospital emergency wards. There were 26 males, 27 females; average age was 30.8 (SD=I 1.08); and patients were seen an average of 12.1 (SD=2.3) days post-injury. MTBI was defined using the recent (1993) definition provided by the American Congress of Rehabilitation Medicine. Results showed that the MTBI patients' symptom self-ratings on the PCL were very similar to the ratings
Abstracts of 16th Annual Meeting
381
provided by their significant others. Both patients and significant others rated the patients' cognitive problems as more severe than either affective/behavioral or physical/dependency problems. On the SF-36, both the physical and mental composite mean scores of the patients were significantly worse than normative data means. Patients' CIQ mean total score did not differ significantly from CIQ normative data; this is consistent with the fact that 73% of patients had returned to work. Results suggest that the PCL and SF-36 are sensitive enough to detect problems soon after MTBI, but that most patients nevertheless return to work and other activities soon after injury. These findings are consistent with what has been found in previous prospective research, that has used many different measures. The recent and well-developed measures used in this study should be considered as standard outcome measures after MTBI, facilitating more consistency across researchers.
Paniak, C., Murphy, D., Lee, M., & Miller, H. Sensitivity of the WMS-R Logical Memory and Visual Reproduction Subtests to Traumatic Brain Injury in Children. We have previously presented WMS-R Logical Memory (LM) and Visual Reproduction (VR) norms on 716 children ages 9 to 15. The purpose of the present study was to assess the sensitivity of these WMS-R subtests to the effects of traumatic brain injury (TBI) in children. In the first study, a group of 26 children with moderate to severe traumatic brain injury (TBI: M age = 12.5 years, SD = 2.2; 14 males, 12 females) were compared to a group of normal control children individually matched on age and sex. The TBI children performed significantly worse than controls on LM I, LM II, VR II, LM II/LM I percent recall (i.e., savings), and VR II/VR I percent recall score. The groups did not differ on the VR I variable. In the second study, the TBI children were compared to different normal control children individually matched to the TBI children on age, sex, and WISC-III Vocabulary score (overall standard score M = 7.5, SD = 2.4). Results showed that the TBI children performed significantly worse on VR II, LM IULM I and VR II/VR I percent recall. The groups did not differ on LM I, LM II, or VR I. The LM and VR percent recall scores and the VR II score thus differed between controls and TBI children even when subjects were individually matched on WISC-III Vocabulary score. The particular utility of LM and VR percent recall scores has also been shown previously with adult amnesic, head-injured and Alzheimer disease patients. The relative insensitivity of the immediate recall LM I and VR I scores attests to the need for delay trials to properly assess memory deficits in TBI children. In summary, the WMS-R LM and VR subtests are brief, easy to administer measures that show sensitivity to memory deficits associated with moderate to severe TBI in children ages 9 to 15.
Papero, P. H., Cunningham, M. V., & Margolis, L. J. Performance of Kindergarten to Second Grade Children on the Fuld Object Memory Evaluation ( OME). Purpose. The Fuld Object-Memory Evaluation (OME) is a simplified measure of learning and memory based on Buschke's method of selective reminding which utilizes a set of 10 familiar objects "hidden" in a cloth bag. No pediatric normative data have been published to date despite the immediate appeal of the OME's novel, multimodal presentation of hidden objects, and its potential for reducing learning interference stemming from attentional fluctuations and/or receptive language confusion. The purpose of the current study was to gather preliminary norms for children of school entry age (K-Gr. 2). Method. Seventy-six children were recruited by grade from a local parochial elementary school: 29 K (mean 73 + 4 months), 20 Gr. 1 (mean 84 + 4 months), and 27 Gr.2 (mean 95 + 5 months). The sample represented middle class (two-factor Hollingshead Index mean 55 + 6), predominantly white
Abstracts of 16th Annual Meeting
hemisphere domains, i.e., verbal tasks. Multivariate analyses of the relationships of trauma and subsequent neuropsychological deficits indicate a significant effect on verbal skills and a moderate effect in attention processes. The results are useful in directing future investigations of the neurocognitive sequelae of psychological trauma and clinical interventions for children who have been traumatized. The results will also be useful in academic assessment and planning for child victims of psychological trauma.
Palumbo, D., Maughan, A., Como, P., & Kurlan, R. Executive Dysfunction in Tourette Syndrome: The Role of Comorbidity. Tourette Syndrome (TS) is a neuropsychiatric disorder of childhood onset characterized by chronic vocal and motor tics which is currently considered to be hereditary in etiology. Current research has also revealed that obsessive-compulsive behavior and attention deficits are common among children diagnosed with TS, suggesting a shared pathophysiology involving the basal ganglia. Moreover, other types of behavioral, neurodevelopmental, and psychiatric symptomatology associated with executive dysfunction have also been reported in patients with TS. However, previous research directly examining executive functioning in children with TS has thus far been inconclusive regarding whether children with TS demonstrate executive dysfunction. This study sought to evaluate executive functions in a sample of children diagnosed with TS, and determine which symptoms may be associated with executive dysfunction. METHODS: 103 children, ages 5 to 17 years, who met DSM-IV criteria for TS, were administered a brief neuropsychological screening battery which included: Intermediate Trailmaking Forms A & B; Symbol Digit Modalities Test (SDMT); and The Underlining Tests. All patients also received a diagnostic evaluation in order to assess the degree and severity of TS symptomatology and the presence of other behavioral, neurodevelopmental, and psychiatric symptomatology. Results: Children with TS only were compared to children with TS plus comorbid symptomatology (TS+). Significant impairment was demonstrated in the TS+ group on Trails A (p < .05); Trails B (p < .01); and the SDMT (p < .01) while the TS only group performed within normal limits. Further analyses revealed that the presence of other neurodevelopmental disorders (stuttering, learning disabilities and motor delays) predicted impaired neuropsychological test performance whereas the presence of comorbid behavioral and psychiatric symptomatology did not. Conclusion: These results suggest that children with TS plus associated neurodevelopmental disorders demonstrate executive dysfunction when compared to children with TS only. The presence of comorbid symptomatology must be thoroughly evaluated in TS patients since 1) an accurate characterization of TS is critical to the interpretation of neuropsychological data in future studies; and 2) The presence of comorbid symptomatology in TS patients may have significant implications for diagnosis and treatment.
Paniak, C., Toiler-Lobe, G., Nagy, J., Stock, A., & Goltz, M.I. Utility of Recently-Developed Questionnaires in Mild Traumatic Brain Injury Assessment. The purpose of this study was to assess the utility of recently developed questionnaires in mild traumatic brain injury (MTBI) assessment. The questionnaires were the Problem Checklist (PCL) from the Head Injury Family Interview (Kay et al., 1995), the Community Integration Questionnaire (CIQ; Wilier et al., 1994), and the Short Form-36 (SF-36; Ware et al., 1992), a measure of overall health functioning. Subjects were 53 MTBI patients and their significant others, drawn from consecutive admissions at two hospital emergency wards. There were 26 males, 27 females; average age was 30.8 (SD=I 1.08); and patients were seen an average of 12.1 (SD=2.3) days post-injury. MTBI was defined using the recent (1993) definition provided by the American Congress of Rehabilitation Medicine. Results showed that the MTBI patients' symptom self-ratings on the PCL were very similar to the ratings
Abstracts of 16th Annual Meeting
381
provided by their significant others. Both patients and significant others rated the patients' cognitive problems as more severe than either affective/behavioral or physical/dependency problems. On the SF-36, both the physical and mental composite mean scores of the patients were significantly worse than normative data means. Patients' CIQ mean total score did not differ significantly from CIQ normative data; this is consistent with the fact that 73% of patients had returned to work. Results suggest that the PCL and SF-36 are sensitive enough to detect problems soon after MTBI, but that most patients nevertheless return to work and other activities soon after injury. These findings are consistent with what has been found in previous prospective research, that has used many different measures. The recent and well-developed measures used in this study should be considered as standard outcome measures after MTBI, facilitating more consistency across researchers.
Paniak, C., Murphy, D., Lee, M., & Miller, H. Sensitivity of the WMS-R Logical Memory and Visual Reproduction Subtests to Traumatic Brain Injury in Children. We have previously presented WMS-R Logical Memory (LM) and Visual Reproduction (VR) norms on 716 children ages 9 to 15. The purpose of the present study was to assess the sensitivity of these WMS-R subtests to the effects of traumatic brain injury (TBI) in children. In the first study, a group of 26 children with moderate to severe traumatic brain injury (TBI: M age = 12.5 years, SD = 2.2; 14 males, 12 females) were compared to a group of normal control children individually matched on age and sex. The TBI children performed significantly worse than controls on LM I, LM II, VR II, LM II/LM I percent recall (i.e., savings), and VR II/VR I percent recall score. The groups did not differ on the VR I variable. In the second study, the TBI children were compared to different normal control children individually matched to the TBI children on age, sex, and WISC-III Vocabulary score (overall standard score M = 7.5, SD = 2.4). Results showed that the TBI children performed significantly worse on VR II, LM IULM I and VR II/VR I percent recall. The groups did not differ on LM I, LM II, or VR I. The LM and VR percent recall scores and the VR II score thus differed between controls and TBI children even when subjects were individually matched on WISC-III Vocabulary score. The particular utility of LM and VR percent recall scores has also been shown previously with adult amnesic, head-injured and Alzheimer disease patients. The relative insensitivity of the immediate recall LM I and VR I scores attests to the need for delay trials to properly assess memory deficits in TBI children. In summary, the WMS-R LM and VR subtests are brief, easy to administer measures that show sensitivity to memory deficits associated with moderate to severe TBI in children ages 9 to 15.
Papero, P. H., Cunningham, M. V., & Margolis, L. J. Performance of Kindergarten to Second Grade Children on the Fuld Object Memory Evaluation ( OME). Purpose. The Fuld Object-Memory Evaluation (OME) is a simplified measure of learning and memory based on Buschke's method of selective reminding which utilizes a set of 10 familiar objects "hidden" in a cloth bag. No pediatric normative data have been published to date despite the immediate appeal of the OME's novel, multimodal presentation of hidden objects, and its potential for reducing learning interference stemming from attentional fluctuations and/or receptive language confusion. The purpose of the current study was to gather preliminary norms for children of school entry age (K-Gr. 2). Method. Seventy-six children were recruited by grade from a local parochial elementary school: 29 K (mean 73 + 4 months), 20 Gr. 1 (mean 84 + 4 months), and 27 Gr.2 (mean 95 + 5 months). The sample represented middle class (two-factor Hollingshead Index mean 55 + 6), predominantly white