Youth with spina bifida (SB) are at increased risk of neuropsychological deficits, including executive dysfunction and inattention. While these deficits are well-documented cross-sectionally, little research has considered the development of these difficulties longitudinally. The limited research on executive dysfunction over time in youth with SB has been mixed, with some studies suggesting stable, elevated executive dysfunction (Tarazi et al., 2008) and others demonstrating improvements in inhibition and shifting in particular (Zabel et al., 2011). In contrast, no research has examined inattention over time in SB. Understanding the development of these constructs is critical for early identification of dysfunction and intervention development. This study thus aims to characterize the development of executive dysfunction and inattention in youth with SB.

One hundred forty youth with SB were recruited as part of a larger, longitudinal study. Mothers, fathers, and teachers of participants (Time 1: Myouth age = 11.4 years, 53.6% female) completed questionnaire-based measures of executive dysfunction (Behavior Rating Inventory of Executive Function, BRIEF; inhibit, shift, working memory, plan/organize subscales) and inattention (Swanson, Nolan, and Pehlam Teacher and Parent Rating Scale - Fourth Edition, SNAP-IV). Data were collected over five time points occurring at two-year intervals. Growth curves were estimated using linear mixed effects models to estimate development over time.

Difficulties with inhibition decreased across age in youth with SB according to mother, father, and teacher reports (p=.000-.007). Mother and father reports of shifting problems decreased across age (p=.009), while teacher reports showed no significant change (p=.799). Working memory problems also significantly decreased over time, but only according to fathers and teachers (p=.004-.005). Difficulties with planning/organizing remained stable across age for all reporters (p=.076-.935). With regards to inattention, symptoms decreased across age according to mothers and teachers (p=.000-.017), but not fathers.

Overall, inhibition, shifting, and inattention improved across age in this sample of youth with SB according to at least two reporters. Contrary to existing literature, working memory also improved over time in this sample. Planning/organizing was the only area of executive functioning that remained stable over time across reporters. These results support previous findings of improvements in behavioral regulation (i.e., inhibition, shifting), and stable, elevated planning/organizing difficulties. These findings also highlight the importance of considering different contexts and reporters’ perspectives when examining change over time. Predictors of the development of executive dysfunction and inattention should be considered, as this information may aid with increased understanding of neuropsychological function in SB and identifying which individuals may be most likely to benefit from early intervention. Examining predictors may also help explain differences in working memory development demonstrated in the current study compared to extant literature.

Early childhood is recognized as a critical window of rapid cognitive development. Unfortunately, many risk factors for atypical cognitive development may occur during this period, including genetic syndromes, congenital neuroanatomical malformations, pre- or perinatal injury, and neurological and medical disorders. The impact of these risk factors on cognitive functioning may not always map onto patterns typically observed in adults. Limited literature exists on the presentation of cognitive profiles within clinical populations in the preschool developmental period. The present study aimed to evaluate whether discrete a priori cognitive profiles consistent with common neurobehavioral syndromes emerge and are distinguishable on testing in early childhood in a mixed clinical sample. We also aimed to determine if there was a consistent association between known medical risk factors and resultant cognitive profiles.

Participants included 163 children aged 1-5 years (M=48.5 months, SD=12.8 months) referred for neuropsychological evaluation. The sample was predominantly male (67.5%) and White (72.9%), followed by other/mixed race (11.6%), Black (9.7%), and Latino/Hispanic (5.8%). Cognitive abilities assessed included broad intellectual abilities, verbal abilities, nonverbal abilities, attention, and executive functioning. Continuous test scores were transformed into categorical ranges of performance, with scores classified as “above average,” “average,” “below average,” or “extremely low” to allow for profile classification. Theoretical clinical profiles consistent with common neurobehavioral syndromes were determined a priori by consensus among three authors (JK, AH, LM). Chi square tests of independence were conducted to compare membership across neurobehavioral diagnostic groups, clinical profile groups, and medical groups.

Based on cognitive data, 55.2% of the sample (n=90) was classified as Global Developmental Delay/Intellectual Disability, 19.6% (GDD/ID; n=32) was classified as

Language Disorder, and 18.4% (n=30) was classified as Typical Cognitive Development. 4.3% (n=7) of the sample was classified as Attention-Deficit/Hyperactivity Disorder (ADHD), and 2.5% (n=4) was classified as Nondominant Hemisphere Dysfunction. As hypothesized, cognitive profile group membership was consistent with diagnostic impressions, as actual clinical diagnoses of Language Disorder, ADHD, GDD/ID, or a classification of typical cognitive development were significantly associated with theorized cognitive profile based on test performance alone (x2 (1,20) = 147.29, p < .001). Cognitive profile group membership was also significantly associated with referral source (1,28) = 62.88, p < .001) and the presence of a neurological disorder (1,4) = 14.64, p =.006).

Findings support the presence of specific theorized cognitive profiles in preschoolers in a mixed clinical sample. Specifically, GDD/ID, Language Disorder, and typical cognitive development are discrete and consistently distinguishable cognitive profiles in this age range. Early life neurological risk factors are also significantly related to cognitive profile membership, suggesting that these factors may be useful in predicting cognitive development even in very young children. Future work is needed to examine the consistency of these profiles over time and their predictive value in estimating subsequent development, and the possibility of discriminating unique cognitive profiles for specific medical conditions in preschoolers.

Childhood obesity is a serious health epidemic affecting the world today. Children who are obese earlier in life are more likely to stay obese and have an increased risk of poorer health outcomes later in life, such as diabetes and cardiovascular diseases. Obesity is also associated with deficits in executive function. Executive function (EF) is comprised of several distinct but interrelated abilities including working memory, planning, inhibition, and flexibility. Prior research suggests that obesity drives brain changes which implicate executive function structures. Our aim is to examine the relationship between childhood obesity and executive function in children with neurodevelopmental disorders.

These data are from an ongoing study on neural and behavioral phenotypes of executive functioning in children with developmental disabilities, primarily Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). Only study participants with complete BMI and BRIEF data were included in these analyses (n = 184). 134 representing (72.8%) of the participants were Male, 49 representing (26.6%) were Female, and 1 representing (.5%) were Gender nonconforming. 50 representing (27.2%) of the participants were between 8-9 years, 55 representing (29.9%) were between 10-11 years, and 80 representing (43.0%) were between 12-13 years. Average age was 11 years. 11 representing (6.0%) of the participants were underweight, 115 representing (62.5%) were healthy, 29 representing (15.8%) were overweight, and 29 representing (15.8%) were obese. Average BMI was 19.0, ranging from 13.2 to 36.3. 106 representing (57.6%) of the participants identified as White, 65 representing (35.3%) identified as BIPOC (2 Asian, 31 Hispanic/Latinx, 32 Black) and 13 representing (4.4%) identified as other/unspecified. 114 representing (61.9%) of the participants had a diagnosis of ADHD, ASD, or comorbid ASD and ADHD, 70 representing (38.1%) had a diagnosis of other. Average FSIQ-2 score was 106.98. Parents were asked to complete the Behavior Rating Inventory of Executive Function (BRIEF-2) and the Inhibit, Shift, Working Memory (WM), Planning, and Global Executive Composite (GEC) scales were used as the dependent measure in analyses. BMI (kg/mA2) was calculated based on CDC 2000 growth charts and classified into 4 mutually exclusive categories—underweight, healthy, overweight, and obese. There was a prediction that higher BMI would be associated with lower executive function.

A one-way ANOVA revealed a statistically significant difference between groups (F(3,180) = 3.649, p = .014). A Tukey post hoc test revealed more Shift problems in the obese group (74.55 ± 11.7) compared to the overweight group (65.79 ± 11.6, p = .026). There was no statistically significant difference between the underweight/healthy and obese groups (p = .999/p = .054). There was no statistically significant difference in mean T-scores for the Inhibit, WM, Planning, or GEC scales.

Childhood obesity and executive function deficits are significant risk factors for adult health outcomes. Obesity and elevated executive function T-scores for flexibility are related in a group of children with neurodevelopmental disorders. Future investigation will explore the role of cortical thickness and medication in these data.

Children with congenital heart disease (CHD) have increased likelihood for Autism Spectrum Disorder (AuSD; Sigmon, Kelleman, Susi, Nylung & Oster, 2020). Even those not meeting full criteria remain at greater risk for problems with social processing/communication (Cassidy et al, 2018). The current study examined what symptoms indicative of potential AuSD were qualitatively reported by parents, and what symptoms were noted behaviorally by clinicians. These behaviors may be targets for both further clinical inquiry and intervention.

A retrospective chart review of CHD patients seen for neuropsychological assessment between the ages of 6-18 years and between 2016-2021 was conducted. The final sample included 88 patients (Ethnicity: 14% Hispanic; Race: 76% White, 17% Black/African American, 5% Asian, 1% Native American, 1% Unknown). A coding system for AuSD symptoms was derived by the authors, who are experienced in AuSD diagnosis and assessment, based on DSM-5 criteria. A comprehensive list of behaviors consistent with each symptom category was generated, and assessment reports were subsequently reviewed noting the presence, absence or “no mention” of each symptom. A second coding system was derived to assess for AuSD symptoms documented in each report’s behavioral observations. Three pediatric neuropsychologists, one post-doctoral fellow, and one psychometrist were coders, with very good reliability (k=.854 (95% CI, .827 to .881), p < .0001).

Twelve patients (14%) were diagnosed with AuSD. Age of diagnosis ranged from 3-14 years (M=7.82, SD=3.92). Main concerns parents expressed included difficulty with reciprocal conversation (75%), making friends (75%), initiating and maintaining social interactions (67%), and restrictive/intense interests (58%). During testing, providers noted variable eye contact (67%), appropriate responses to questions but minimal social conversation (67%), and exaggerated prosody (42%). Of those who did not have an AuSD diagnosis, the most frequent parent concerns included difficulty making friends (38%), difficulty initiating or maintaining social interactions (33%), atypical affect (25%), and restrictive/intense interests (18%). In this sample, providers noted concerns with answering questions but not maintaining conversation (26%), flat affect (16%), loud (17%) or soft (21%) speech volume, and socially immature behaviors (10%). Within this No Diagnosis group, general social concerns were highly correlated (point biserial) with more specific autism symptoms (e.g., intense interests, difficulty with transitions, sensory sensitivities r = .986 - .784), although most often the presence or absence of these concerns were not documented.

We examined qualitative parent-reported and provider-observed behaviors indicative of potential AuSD as detailed in a comprehensive neuropsychological evaluation report. Behaviors in children with formal AuSD diagnoses were consistent with that diagnosis, based on both parent and provider description. Of note, in children without AuSD, though, both parents and providers reported AuSD-like concerns (e.g., social communication/interaction problems, atypical interests, atypical affect, atypical speech volume) in a large minority of children. It is important that if general social concerns are present, that providers follow-up on, and document, a broader constellation of AuSD symptoms. These behaviors deserve further exploration and study within the CHD population and are important areas of inquiry in any clinical evaluation, as they should directly inform intervention.

Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) is a complex, yet treatable autoimmune disorder characterized by a fairly abrupt onset of a constellation of symptoms attributable to diffuse brain dysfunction (Tarantino et al., 2021). Despite the potential for a severe disease course, most patients have a favorable outcome with substantial recovery (Dalmau et al., 2011; Titulaer et al., 2013). Nevertheless, there is limited literature discussing the long-term outcomes in patients with anti-NMDARE, particularly in pediatric patients. The primary objective of this study is to examine and describe behavioral, emotional, adaptive, and executive functioning outcomes in pediatric and young adult patients with this disease. This study also sought to provide information on the perceived health-related quality of life (HRQoL) of patients and their parents and investigate the impact of anti-NMDARE on parents and family functioning.

All individuals known to have been diagnosed and treated for anti-NMDARE at The Children’s Hospital of Philadelphia (CHOP) between January 1, 2005, and October 1, 2020, were contacted with both patients and their parents/guardians invited to participate. Eighteen pediatric patients between the ages of 6 and 26 and/or their parents/caregivers participated in the study. Of the 18 patients represented in the sample, 50% were white/Caucasian, and 67% were female. The mean duration of time since symptom onset was 7.1 years. Primary outcomes were measured through standardized questionnaires of emotional, behavioral, and adaptive functioning (BASC-3) and executive functioning (BRIEF2 or BRIEF-A). Secondary outcomes related to family functioning and HRQoL were measured through (PedsQL™ and PedsQL™ Family Impact Module.)

All aggregate T-scores for the BASC and BRIEF placed children with anti-NMDARE within an age-appropriate range regarding behavioral, emotional, adaptive, and executive functioning outcomes. Children with anti-NMDARE were not found to have lower HRQoL compared to their healthy same-age peers. Moreover, parents of children with anti-NMDARE did not endorse a prolonged impact of this illness on family functioning and adjustment.

This study aimed to better understand the neurobehavioral profile and the long-term outcomes of children diagnosed with anti-NMDARE, with the ultimate goal of advancing understanding of this encephalitis. Consistent with findings from several reviewed studies on long-term follow-up, the present study suggests that most children with a history of anti-NMDARE show good functional recovery over time. However, data on the neurobehavioral sequelae, quality of life, and adaptive behavior in patients diagnosed with anti-NMDARE are still sparse, especially at pediatric age. In order to understand and learn to manage the needs of patients with anti-NMDARE, particularly regarding the impact this disease can have on daily life and school performance, additional neuropsychological research involving larger samples, longitudinal studies, and increased methodological consistency is required.

Individuals with sickle cell disease (SCD) are at increased risk for developing impairment across cognitive domains, although the most common deficits are thought to be related to processing speed and executive functions. One of the most common ways of evaluating cognitive functioning is through the administration of intellectual tests. While lower overall intellectual functioning in individuals with SCD compared to healthy controls has been found, the specific pattern of strengths and weaknesses across indices is not well known. Anecdotally, it has been observed at our clinic that individuals with SCD are more likely to show relative or significant weaknesses in visuospatial abilities, but this has not been formally investigated. Further, based on the extant research, individuals with SCD would likely demonstrate lower working memory and processing speed indices, but, as far as we are aware, this has not been investigated either. The purpose of the present study is to examine the intellectual profiles, including areas of relative and significant strengths and weaknesses, of children and adolescents with SCD.

Participants are children and adolescents (age 6-16) with SCD who were referred for a neuropsychological evaluation at Montefiore Medical Center’s Neuropsychological Assessment Service from 2015 to 2022. These participants (N=54) were identified through a thorough review of patients seen through this service and were administered the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V; Wechsler, 2014). Mean scores were calculated for WISC-V indices. In addition, differences were calculated between WISC-V indices (e.g., VCI-VSI, etc.), and a discrepancy analysis was conducted comparing the base rates of these differences in the present sample to the WISC-V standardization sample.

In our sample, the mean total FSIQ of our sample was 85 (SD=14.5). The following mean scores were obtained across indices: VCI, SS=90 (SD=14.5); VSI, SS=86.5 (SD=14.9); FRI, SS=90 (15.5); WMI, SS=89 (SD=15.6); and PSI, SS=82 (SD=17.4). Many of the index score discrepancy base rates were similar to the standardization sample. However, our sample had greater discrepancies between several indices compared to the standardization sample. In particular, the following base rate discrepancies between index scores emerged as being different in our sample compared to the standardization sample: VCI>VSI and VCI>PSI. Notably, a 30+ point difference VCI>VSI was found in 6% of our sample (compared to 1.6% of the standardization sample) and a 30+ point difference between VCI>PSI was found in 12% of our sample (compared to 4.6% of the standardization sample). In addition, a 10+ point difference found between VCI>PSI was found in 50% of our sample (compared to 29% of standardization sample).

In our sample, FSIQ and index scores fell approximately 0.5-1.33 SD below the standardization sample means, with the lowest index scores being PSI and VSI. Consistent with the literature, the PSI (but not WMI) emerged as an area most discrepant to other indices (particularly VCI). In line with our observations, the VSI emerged as an area of relative difficulty as compared to the VCI. These results suggest that, in addition to processing speed, visuospatial/constructional ability is an area that warrants consideration in the assessment of individuals with SCD.

Reduced hearing is associated with increased risk for social, emotional, and behavioral difficulties. Studies to date have typically compared DHH children with their hearing peers without regard for unilateral hearing loss (UHL) versus bilateral hearing loss (BHL). Children with UHL are often perceived as more like their typically hearing peers than their peers with BHL. Children with UHL typically access sound and spoken language which facilitates their functioning with fewer supports (e.g., interpreters, captioning). These children, however, show cognitive, academic, and communication profiles more similar to children with BHL than typically hearing peers. They may also experience similar social, emotional, and behavioral challenges as their BHL peers. We examined social, emotional, and behavioral functioning in a clinically referred sample of children with UHL versus BHL.

Parents of 100 children aged 2 to 17 years (M=7.12) with either UHL (n=30) or BHL (n=70) completed the Behavioral Assessment System for Children, Third Edition (BASC-3) as part of neuropsychological evaluation in a Deaf and Hard of Hearing Program within a tertiary pediatric hospital. BASC-3 scores based on General Combined norms were compared to an expected distribution of typically developing hearing children using non-parametric one-sample tests. Profiles of scores for children with UHL and BHL were examined in a repeated measures MANOVA.

The groups of children with UHL and BHL showed similar age, gender, race, ethnicity, and Area Deprivation Index compositions. Eighty four percent of BHL children communicated with spoken language, and 100% of UHL children communicated with spoken language (p=.02). There were similar rates of comorbid diagnoses for ADHD (20%), Anxiety/Depression (18%), Autism Spectrum Disorder (8%), and Intellectual Disability/Global Developmental Delay (9%). However, children with BHL tended to be at greater risk for Language Disorders (50%) than those with UHL (30%, = 3.41 p=.065). Together, children with hearing loss showed significantly higher scores on the BASC-3 Hyperactivity, Aggression, Attention Problems, Atypicality, and Withdrawal clinical scales than expected (One-Sample Kolmogorov-Smirnov Test; p<.01). Profile analysis showed that children with any type of hearing loss had a varied pattern of scores across scales (F(7,686)=4.33, p<.01), with highest scores on Hyperactivity and Attention Problems scales and lowest scores on Somatization. Scale profiles did not differ, however, between UHL and BHLgroups (p=.127).

Children with UHL have access to auditory input, typically enabling early language development more like their hearing peers compared to children with BHL. In turn, these children may be overlooked more so than their BHL peers. However, the likelihood of social, emotional, and behavioral difficulties is similar between the two groups of children with hearing loss, whether that is unilateral or bilateral. Our study showed both groups of children had similar profiles across BASC-3 scales with elevations relative to norms. Measuring these everyday functions in children with hearing loss is important for early detection of risks to promote early intervention.

Individuals with Spina Bifida (SB) are at increased risk for difficulties with various aspects of adaptive functioning. Poorer adaptive functioning could delay or prevent an individual from successfully living independently and managing their own condition. Despite the importance of understanding adaptive functioning in SB, currently the literature on predictors of and associated neurocognitive skills with adaptive functioning is sparse. Thus, this retrospective chart review study aimed to explore the extent to which intellectual functioning, predicts adaptive functioning in a clinical sample of children with SB.

A retrospective chart review of children with SB was conducted at a Midwestern academic medical center. Children were seen in the context of routine neuropsychological evaluations to identify neuropsychological diagnoses and provide treatment recommendations. All measures were administered based on the age of the child and in accordance with administration guidelines. Only children with complete data were included in analyses. The sample included 42 participants (Mage=10.89, SDage=3.15; 18 male, 24 female). Intellectual functioning was evaluated using either the Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V) or Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV). Adaptive functioning was evaluated using primary caregiver-report scores from the Adaptive Behavior Assessment System - Third Edition (ABAS-3). Hierarchical regressions were conducted to investigate the extent to which intellectual functioning predicts parent-reported adaptive functioning. The unique contribution of each predictor variable was also considered.

Model predictors included participant sex, verbal comprehension, working memory, processing speed, and full scale IQ to predict 4 different indices on the ABAS-3. Results showed a significant contribution of participant sex in all models, with males having been rated as having poorer adaptive skills. Intellectual functioning did not significantly contribute to the models. Semipartial correlations revealed that processing speed and working memory often each accounted for a fair amount of variability when controlling for all of the remaining variables in the models. In particular, when accounting for all of the remaining variables, processing speed accounted for 6.3% of variability in global adaptive functioning, 6.1% in Conceptual Skills, and 10.11% in Social Skills. Furthermore, after controlling for all of the other variables, working memory accounted for 4.5% of the variability in global adaptive functioning.

The present results suggest that males with SB are at increased risk for poorer adaptive functioning, and there may be some preliminary evidence of processing speed and working memory playing contributory roles as well. This may suggest at least in childhood, the verbal and global cognitive capacities of individuals with SB are not as contributory to adaptive functioning as more basic cognitive skills, such as processing speed and working memory. It is recommended that males with SB in particular should be closely monitored with regard to their development of adaptive skills, as they may be at risk of poorer adaptive abilities. Additionally, our findings provide preliminary evidence of processing speed and working memory impacting adaptive functioning. Thus, interventions and accommodations targeting both of these domains may be appropriate to implement to help with poorer adaptive skills in this population.

There is limited and mixed research describing the memory performance of boys with Duchenne muscular dystrophy (DMD), a progressive disorder that affects the muscle and the brain, presumably due to the absence of dystrophin; however, the literature indicates either the existence of a selective deficit in verbal working memory, or more generalized impairment in both verbal and visual memory. Far less is documented about the neurocognitive profile of boys with Becker muscular dystrophy (BMD), a closely related neuromuscular disorder which allows for at least some functional dystrophin protein to circulate. The Child and Adolescent Memory Profile (ChAMP) is a valid and widely used memory battery that has not been studied in either DMD or BMD. This study aimed to assess the verbal and visual memory performance in boys having either a DMD or a BMD diagnosis using the ChAMP. A working memory measure, the Digit Span subtest from the Wechsler Intelligence Scale for Children-Fifth Edition, was also included for comparison.

Twenty-one patients (Age M = 12.19 ± 3.60; 100% male; 76% DMD, 24% Becker) were selected from retrospective data collection of neuropsychological performance in children with neuromuscular disorders. Patients were recruited and assessed as part of a larger scale IRB-approved research study designed to better understand the neurocognitive and behavioral trajectories of boys with DMD or BMD with a complete neuropsychological battery.

Independent samples f-tests revealed no significant differences between groups across verbal (DMD M = 88.71; BMD M = 100.80; p = .08), visual (DMD M =90.36; BMD M 93.60; p = .33), and working memory (DMD M = 84.69; BMD: M 82.60; p = .40) domains. In additional analyses, a one sample f-test comparing verbal and visual memory within DMD children revealed significantly worse verbal than visual memory scores (verbal memory M = 88.71; visual memory M = 90.36; p = <.001).

There were no significant differences between groups in verbal, visual, and working memory performance, though sample size was a significant limitation. However, based on a comparison of means, children with BMD appear to have stronger verbal memory skills than children with DMD. Furthermore, significant differences between verbal and visual memory within DMD children were observed, such that verbal memory skills were weaker. These findings add to the absence of literature on verbal and visual memory outcomes in children with DMD and BMD.

Anti-N-methyl-D-aspartate receptor encephalitis (ANMDARE) is a rare and progressive neurological autoimmune disease that disproportionally affects pediatric patients (Yeshokumar et al., 2022). Patients diagnosed with ANMDARE experience a host of neurocognitive and psychiatric sequelae, but data on the rate of recovery are generally mixed (Wilkinson-Smith et al., 2022). Misdiagnosis of ANMDARE is common and may complicate recovery given the progressive nature of the syndrome (Shimoyama et al., 2016); thus, knowledge of the etiology may result in enhanced resolution of symptoms. The current study assessed the rate of functional recovery for pediatric patients diagnosed with ANMDARE and admitted to an inpatient rehabilitation program. Specifically, we hypothesized that patients with idiopathic autoimmune encephalitis (IAE) would have a protracted rate of acute recovery compared to patients diagnosed with ANMDARE.

The current study included archival data of pediatric patients (N=10) aged 3-16 years (M=12.39, SD=4.97) admitted to an inpatient rehabilitation program at a metropolitan academic medical center between 2017-2022; of these patients, 7 were characterized as having IAE, 5 were female-at-birth, and 7 were of Hispanic/Latine origin. The Functional Independence Measure for Children (WeeFIM; Msall et al., 1994) domain scores (i.e., cognition, self-care, mobility, motor) were utilized to assess acute recovery. Welch’s t-tests were analyzed separately at admission and discharge between etiological conditions (i.e., idiopathic vs. known) for each WeeFIM domain. Subsequently, change scores were calculated across the length of inpatient stay for each WeeFIM domain, and Welch’s t-tests determined statistical differences in change scores between etiological conditions.

Contrary to predictions, WeeFIM self-care domain scores were significantly higher at inpatient admission for patients with IAE (M=27.57) as compared to patients with ANMDARE (M=13.00), t(7) = 1.95, p < .05; trending differences were also found in admission scores on the WeeFIM motor domain between IAE (M=43.86) and ANMDARE (M=24.00) diagnostic groups, t(6) = 1.71, p = .07. Consistent with predictions, patients with ANMDARE generally had an appreciable acute recovery as compared to patients with IAE. Specifically, trending differences were found in change scores on the WeeFIM self-care domain between IAE (M=10.29) and ANMDARE (M=30.33) diagnostic groups, t(6) = -1.64, p = .05. Likewise, trending differences were found in change scores on the WeeFIM motor domain between IAE (M=21.43) and ANMDARE (M=47.67) diagnostic groups, t(5) = -1.82, p = .06. No significant or trending differences were observed at discharge.

Results have implications for optimizing the assessment and treatment of pediatric patients diagnosed with autoimmune encephalitis. Specifically, patients with ANMDARE may have a more severe initial presentation yet improved recovery course compared to patients characterized as idiopathic during their inpatient stay, particularly in motor and self-care functional domains; data highlights the importance of inpatient rehabilitation for patients diagnosed with ANMDARE. Current limitations include small sample sizes across diagnostic groups, likely due to the rarity of the disease. It is recommended that future research investigate the prognosis of pediatric patients diagnosed with autoimmune encephalitis longitudinally, at follow-up and across the lifespan.

Multiple sclerosis (MS) is associated with cognitive and social cognitive deficits. Social cognition impairments may include difficulty with facial expression and emotion recognition. People with MS (PwMS) may also not be aware of their cognitive challenges as demonstrated through discrepant objective and subjective assessments. Research recently conducted in demyelinated mouse models demonstrated that metformin, a drug typically used to treat type II diabetes mellitus (DMII), promotes remyelination and reverses existent social cognition impairment by repressing the monoacylglycerol lipase (MgII) enzyme in the brain. We aim to translate this basic science research and are conducting a pilot study to determine if metformin improves social cognition in PwMS. This project will compare social cognition in those with MS and comorbid DMII who are treated with metformin and those who are not. For the purposes of this interim data analysis, we collapse across both MS groups who are, and who are not, treated with metformin. The current objective is to evaluate the relationship between subjective (i.e., perceived empathy), objective social cognition and information processing speed (IPS) in PwMS and co-morbid diabetes.

Preliminary data on 15 PwMS are included. Participants completed a demographic questionnaire, a cognitive assessment battery, an objective social cognition assessment and self-report questionnaires. These questionnaires assessed subjective social cognition, fatigue, mood, and disability level.

Preliminary results showed that IPS was positively correlated with the affective empathy domain of social cognition, r = .53, p = .04. Additionally, IPS was positively correlated with objective social cognition, r = .71, p = 003. Follow-up regression analyses demonstrated that IPS predicted objective social cognition, R2 = .71, SE = 3.04, F(1,13) = 13.36, p = .003 and subjective social cognition, R2 = .53, SE = 5.39, F(1,13) = 4.97, p = .04. However, subjective and objective measures of social cognition were not correlated, p > .05 and remained uncorrelated when IPS was controlled for, p > .05.

A majority of the variance in social perception is explained by IPS, suggesting that how quickly one can think may be a fundamental cognitive process to allow optimal functioning in social situations. While the reason for the relationship between IPS and subjective social cognition is perhaps less apparent, it may reflect a more global cognitive compromise that impacts both cognitive and social processes. This lends support to the Relative Consequence Model that suggests IPS deficits are a fundamental cognitive deficit underlying other more complex cognitive processes. The lack of correlation between subjective perception of empathy and objective social cognition requires further exploration and could potentially be related to some individuals with MS having a diminished ability to judge their own social proficiency. Further analyses with a larger sample will be conducted to assess group differences in social cognitive outcomes and MgII levels between metformin and non-metformin groups. If PwMS who take metformin have better social cognition compared to PwMS who do not take metformin, Mgll levels can be used as a biomarker to guide metformin treatment with the goal of improving social cognition.

Although the cognitive profiles of people experiencing homelessness have been described in the literature, the neuropsychological profile of people experiencing complex homelessness has not been delineated. Complex homelessness is homelessness that continues despite the provision of bricks and mortar solutions. People experiencing complex homelessness often have an array of physical health, mental health, substance use, neurodevelopmental and neurocognitive disorders. The present study aimed to delineate the neuropsychological profile of people experiencing complex homelessness and explore the utility of neuropsychological assessment in supporting this population.

19 people experiencing complex homelessness in Sydney, Australia, were consecutively referred by specialist homelessness services for neuropsychological assessment. They underwent comprehensive assessment of intelligence, memory and executive functioning and completed questionnaires to screen for the presence of ADHD, PTSD, depression, anxiety and stress. A range of performance validity measures were included. Referrers were asked to complete questionnaires on history of childhood trauma, psychological functioning, drug and alcohol use, functional cognitive abilities, homelessness factors, personality, risk of cognitive impairment and adaptive functioning and to note existing or suspected mental health, neurodevelopmental and neurocognitive disorders. Referrers also completed a post-assessment pathways questionnaires to identify whether the neuropsychological assessment facilitated referral pathways (e.g., for government housing or financial assistance). Clinicians completed a post-assessment diagnosis survey, which was compared to the pre-assessment known or suspected diagnoses. Finally, referrers were asked to complete a satisfaction questionnaire regarding the neuropsychological assessment.

Mean (SD) WAIS-IV indexes were VCI = 81.1 (14.5), PRI = 86.1 (10.9), WMI = 80.5 (13.0), PSI = 81.6 (10.2). Mean WMS-IV Flexible (LMVR) indexes were AMI = 68.3 (19.6), VMI = 77.1 (19.3), IMI = 72.7 (17.2), and DMI = 70.5 (17.6). The majority of participants showed unusual differences between WAIS-IV and TOPF-predicted WAIS-IV scores and between WAIS-IV General Ability and WMS-IV Flexible (LMVR) scores. Demographically corrected scores on tests of executive functioning were mostly one or more standard deviations below the mean. The majority of participants screened positive on screening measures of executive dysfunction, PTSD and ADHD and had elevated self-reported psychological distress scores. At least one new diagnosis was made for nine (47%) participants, established diagnoses were confirmed for two (11%) participants, diagnoses were supported for 15 (79%) participants, tentative diagnoses were made for 16 (84%) participants, and five (26%) participants had at least one diagnosis disconfirmed/unsupported. Referrers indicated that the majority of post-assessment pathways were more accessible following the neuropsychological assessment and that they were very satisfied with the neuropsychological assessments overall.

This is one of the first studies to delineate the neuropsychological profile of people experiencing complex homelessness using robust psychometric approaches, including performance validity tests. This population experiences a high burden of cognitive impairment and associated substance use, neurodevelopmental and mental health comorbidities. Neuropsychological assessment makes referral pathways more accessible and is valued by referrers of people experiencing complex homelessness.

Class III obesity is associated with increased risk for cognitive impairment. Though hypothesized to be partially attributable to sedentary time (ST), past research examining the association between ST and cognitive function has produced mixed findings. One possible explanation is that studies do not typically account for the highly correlated and almost inverse relationship between ST and light intensity physical activity (LPA), such that ST displaces time engaging in LPA. Therefore, we aimed to evaluate whether: (1) higher ST-to-LPA time ratio associates with poorer performance across multiple cognitive domains in patients with Class III obesity seeking bariatric surgery; and (2) the associations differ by sex.

Participants (N = 121, 21-65 years of age, BMI > 40 kg/m2) scheduled for either Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy (SG) completed the NIH Toolbox, a computerized neuropsychological assessment battery and wore a waist-mounted ActiGraph monitor during waking hours for 7 days to measure minutes/day spent in ST, LPA, and moderate-to-vigorous physical activity (MVPA). A ratio of time spent in ST-to-LPA was calculated by dividing the percentage of daily wear time spent in sedentary behavior (SB) by the percentage of daily wear time spent in LPA.

On average, participants (mean age = 43.22 years old and BMI = 45.83 kg/m2) wore the accelerometer for 909±176 minutes/day and spent 642±174 minutes/day in ST, 254±79 minutes/day in LPA, and 14±13 minutes/day in MVPA. Mean daily ST-to-LPA time ratio was 2.81 ± 1.3 (0.73-7.11). Overall, bivariate Pearson correlations found no significant relationships between LPA and cognitive performance on any of the NIH Toolbox subtests (r values = -.002 to -.158, all p values >.05). Additionally, bivariate Pearson correlations also found no significant relationships between daily ST-to-LPA time ratio and cognitive performance on any of the subtests (r values = .003 to .108, all p values >.05). However, higher ST-to-LPA was associated with lower scores on the Dimensional Change Card Sort Test in women (r = -.26, p = .01).

Results showed that participants’ mean daily time spent in ST was 2.5 times higher than that spent in LPA and a higher ratio of ST-to-LPA was associated with poorer set-shifting in women with Class III obesity. Future studies should look to clarify underlying mechanisms, particularly studies examining possible sex differences in the cognitive benefits of PA. Similarly, intervention studies are also needed to determine if increasing LPA levels for individuals with Class III obesity would lead to improved cognitive performance by means of reducing ST.

Prion disease is a rare, invariably fatal neurodegenerative disease characterized by rapid neuronal degeneration; Mutations to PRNP gene cause genetic prion disease (GPD). In animal models, microglial activation, astrocytosis, and release of neurofilament precede the onset of frank symptoms (Sorce & Nuvolone 2020, Minikel 2020). In humans at risk for GPD, prodromal pathology appears to occur in only a brief window prior to symptom onset (Vallabh et al. 2020, Thompson et al. 2021), but some data suggest that known PRNP mutation carriers may exhibit cognitive abnormalities prior to meeting clinical diagnostic criteria (Mole et al., 2021). We aim to examine pre-symptomatic differences in cognitive processing speed (CPS) and executive function (EF) in PRNP mutation carriers and controls.

Our sample includes two groups from an ongoing observational study on GPD (Vallabh et al., 2020): known PRNP mutation carriers (N = 32, Age M = 45.77, SD = 14.75) and control group of non-carriers with a family history of GPD and healthy controls with no known history (N = 11, Age M = 42.01, SD = 12.43). All participants completed a full cognitive battery at baseline and on an annual basis. We compared first visit cognitive testing measuring CPS and EF using: National Institute of Health (NIH) Toolbox [Pattern Comparison (NIH-PC), Flanker, Dimensional Card Sorting Task (NIH-DCCS)], Trail Making Test (TMT) A and B, and Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference Test (CWIT).

Independent t-tests and Mann-Whitney U tests compared cognitive test performance between groups. Across all cognitive test measures assessed, none exhibited significant differences between groups after Bonferroni correction for N=10 tests (corrected P > 0.05). Mean scores for mutation carriers were non-significantly lower than controls on TMT-B (Z-score Mdn = .29, SD = 1.33 vs. Z-score Mdn = .96, SD = .97), NIH-PC (Age-corrected Standard Score [ACSS] M = 100.13, SD = 20.76 vs. ACSS score M = 114.82, SD = 14.61) and NIH-Flanker (ACSS score M = 83.58, SD = 9.72 vs. ACSS score M = 90.64, SD = 10.94), and NIH-DCCS (ACSS M = 101.29, SD = 16.37 vs. ACSS score M = 112.00, SD = 16.28) but not for TMT-A or all four conditions of CWIT.

We did not detect any significant cognitive deficits in known PRNP mutation carriers. This is consistent with the lack of prodromal pathological biomarker changes or cognitive changes as reported in Vallabh et al 2020, and with the finding of Mole et al. 2021 that most tests reveal impairment only at a stage where carriers report subjective symptoms. Our results suggest an opportunity for primary prevention to preserve full cognitive health in at-risk individuals. However, small sample size and limited test sensitivity may leave us underpowered to detect subtle deficits. Future research is warranted to further investigate the neuropsychological profile of pre-symptomatic GPD.

The field of clinical neuropsychology has increasingly recognized the importance of cultural and identity factors through the development of clinical, research, and educational initiatives. Only within the last 10 years have guidelines for psychological practice with lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people included recommendations for neuropsychological assessment. However, it remains unclear to what extent neuropsychologists have acquired the knowledge and skills necessary to implement these recommendations. It is also unknown whether they engage in LGBTQ+ inclusive neuropsychological assessment. In this study, we surveyed the LGBTQ+ related education, training, and clinical practice of independently licensed neuropsychologists in the United States. We sought to understand the implementation of inclusive guidelines, including factors that predict affirmative neuropsychological assessment. We hypothesized that sexual/gender identities, female identity, recency of training, and LGBTQ+ related education would be associated with use of recommended practices.

A workgroup of clinical psychologists with experience in LGBTQ+ psychology and neuropsychology developed a survey to identify personal and professional factors that predict LGBTQ+ affirmative neuropsychological assessment practices. The survey was distributed through professional organizations and listservs between August and September 2021 with 118 responses meeting inclusionary criteria. We used logistic, multinomial logistic, and ordinal logit regressions to examine unadjusted, univariate effects. Predictors included in the final, adjusted, univariate and multivariate models were those for which we had specific hypotheses and variables that predicted more than two affirming practice behaviors.

The majority of participants identified as heterosexual (70.3%), cisgender (97.5%), and female (66.1%). Participants reported obtaining their highest degree between 1977 and 2019. Most obtained a Ph.D. (73.7%), were not board-certified (69.5%), and worked primarily with adults (54.2%). Generally, participants reported having little experience working with LGBTQ+ patients. However, they reported greater exposure to lesbian, gay, and bisexual identities as compared to transgender and queer identities. Most (48-63%) received LGBTQ+ training post-licensure. Between 19% and 32% of participants reported never completing LGBTQ+ specific education. Participants described using affirmative clinical practice behaviors either “always/often” or “never/rarely.” Factors predicting those practice behaviors were LGBTQ+ education/training, prior experience with LGBTQ+ patients, primary patient population (child vs. adult), and personal background (sexual minority status, female gender, and years since degree). When in need of consultation, the current sample consulted with their colleagues most often (n = 95) followed by academic literature (n = 90) and professional organizations (n = 80). Qualitative responses indicated varying attitudes and knowledge regarding collection of LGBTQ+ information and modification of clinical practice.

Consistent with the broader clinical psychology literature, neuropsychologists have limited education/training on LGBTQ+ concepts. Neuropsychologists underutilize affirming practices as evidenced by low rates of querying pronouns, knowing whether LGBTQ+ health information is available at their institutions, and adjusting evaluation and feedback approaches. Our findings imply a great need to expand continuing education trainings to address providers’ gaps and limitations, including opportunities for inclusive neuropsychological services throughout the assessment process (interview, testing, feedback). We present additional recommendations for future research as well as resources.

Alzheimer’s Disease (AD) and dementia present major and escalating public health concerns for the U.S., especially among ethnoculturally diverse (e.g., Latinx, non-Latinx Black [NLB]) populations who represent an increasing percentage of the older adult population in the US and bear greater AD burden compared to non-Latinx Whites (NLWs). Notably, neurocognition and functional status are highly correlated in those with AD. However, little has been done to understand these associations and validate functional measures across geographically diverse, multiethnic samples. The aims of this study were to characterize the neurocognition and functional status of a large, multiethnic sample and subsequently examine any associations between neurocognition and functional status among Latinx, NLB, and NLW older adults.

This cross-sectional, retrospective study utilized archival data drawn from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). ADNI is a national, longitudinal, multi-site, observational study aiming to measure the progression of AD (see https://adni-info.org). Study measures included the: 1) Alzheimer’s Disease Assessment Scale Cognitive subscale (ADAS-cog; 13-items), a global neurocognitive battery evaluating neurocognition in people with AD; 2) Functional Activities Questionnaire (FAQ; 10-item questionnaire) to assess functional status; 3) Geriatric Depression Scale (GDS; 15-item questionnaire) for depression; and 4) American National Adult Reading Test (ANART; 50-word test) for reading level. The sample included 1537 older adults who completed baseline visits for the ADNI study, 1333 of whom were NLW, 123 NLB, and 81 Latinx. The average age of the sample was 73 years, average 16 years of education, and 53% male. Compared to the NLW group, the NLB and Latinx groups were significantly younger and had a higher percentage of female participants. Compared to NLW and Latinx groups, the NLB group also had significantly fewer years of education and lower reading scores. Potential confounds (i.e., demographic variables, depression) were identified a priori based on the literature and subsequently analyzed for inclusion as covariates in the primary analyses. Analyses revealed variables were non-normally distributed, therefore Independent Samples Kruskal-Wallis tests and Spearman’s Correlations were computed to examine differences and correlations between ethnocultural groups.

After controlling for age and education, Latinx and NLB groups had significantly higher ADAS-cog and FAQ scores than the NLW group (Hs = 9.50-21.53, ps < .05). Spearman’s partial correlations controlling for age, education, gender, and depression revealed that higher ADAS-cog scores were associated with higher FAQ scores within Latinx (p=.49, p<.001), NLB (p=.66, p<.001), and NLW (p=.60, p<.001) groups.

Findings indicate that neurocognition is positively associated with functional status and support the ecological and external validity of the ADAS-cog and FAQ for use with NLB and Latinx older adults, in addition to previously established work with more homogenous samples. Study strengths include the overall sample size, geographic diversity, and standardization of research approaches. Study limitations include high education level and low comorbidity rates present in the sample, limiting the generalizability of the results, in addition to the unbalanced ethnocultural groups, further emphasizing the need for increased inclusion efforts of ethnoculturally diverse older adults into brain health research studies.

Cross-national neuropsychological research is needed to understand the social, economic, and cultural factors associated with cognitive risk and resilience across global aging populations. Memory and language have been shown to be sensitive to age-related cognitive decline and pathological cognitive aging processes and may be more sensitive to subtle cognitive decline than measures of global cognitive function. Thus, we aimed to derive and validate harmonized cognitive domain scores for memory and language across population-based studies in the US and Mexico.

Data came from the Health and Retirement Study (HRS) Harmonized Cognitive Assessment Protocol (HCAP) and the Mexican Health and Aging Study (MHAS) Ancillary Study on Cognitive Aging (Mex-Cog). We used confirmatory factor analysis methodology to create statistically co-calibrated cognitive domains of memory and language. We performed differential item functioning (DIF) analysis to evaluate measurement differences across studies, using a cultural neuropsychological approach to identify comparable items across studies (i.e., cross-study anchors). We evaluated harmonized scores by examining their relationship to age and education in each study.

We included 3347 participants from the HRS-HCAP study [Mage=76.6(7.5), 60% female] and 2042 participants from the Mex-Cog study [Mage=68.1(9.0), 59% female]. Education was classified according to the International Standard Classification of Education in the following categories (HRS-HCAP and Mex-Cog, respectively): none or early childhood education: (0.7%; 50.5%), primary education (4.1%; 22.3%), lower secondary education (7.1%; 15.7%), upper secondary education (41.1%; 3.0%), and any college (47.1%; 8.5%). DIF analyses revealed that 5 out of the 7 memory items and 1 out of the 12 language items demonstrated statistical evidence of measurement differences across studies, meaning that these items measured each underlying cognitive construct differently across studies. After adjusting for DIF by not allowing the items with DIF to be cross-study anchors, harmonized memory and language scores showed generally the expected associations with age and education in each study. Increasing age was associated with lower memory (r=-0.40 in HRS-HCAP; r=-0.44 in Mex-Cog) and language (r=-0.31 in HRS-HCAP and r=-0.67 in Mex-Cog) scores. Increasing years of education was associated with better memory and language scores, with mean scores ranging from z=-0.86 and z=-0.29 among those with a primary education or lower to z=0.33 and z=0.90 among those with any college, for HRS-HCAP and Mex-Cog, respectively.

A cultural neuropsychology approach to statistical harmonization facilitates the generation of harmonized measures of cognitive functioning in cross-national studies. Future work can utilize these harmonized cognitive scores to investigate determinants of late-life cognitive decline and dementia in the US and Mexico.