This study examined the impact of childhood traumatic brain injury (TBI) on self-regulation and social and behavioral functioning, and the role of self-regulation as a predictor of children's social and behavioral functioning. Participants included 65 children with moderate to severe TBI and 65 children without TBI, all between 6 and 11 years of age. Self-regulation and social and behavioral functioning were assessed 2 to 5 years following injury. Children with TBI displayed deficits in self-regulation and social and behavioral functioning, after controlling for socioeconomic status (SES), although the magnitude of the deficits was not related to injury severity. Self-regulation accounted for significant variance in children's social and behavioral functioning, after controlling for SES and group membership. Self-regulation may be an important determinant of children's social and behavioral functioning following TBI. (JINS, 2006, 12, 609–621.)

Children with specific language impairment (LI) have deficits on some nonverbal tasks, but it is not clear if these are related to specific visuospatial deficits or to more general deficits in processing strategies. Children with LI were given two visuospatial tasks that we have shown to be sensitive to strategy use as well as specific processing deficits. In Study 1, children with LI (N = 29, ages 6 to 12 years) performed significantly worse than typically developing children (N = 26) on the Hierarchical Forms Memory task. In Study 2, children with LI (N = 15; ages 9 to 12 years) performed significantly worse than typically developing children (N = 40) on the Rey-Osterrieth Complex Figure task. Children with LI were less accurate and tended to use a fairly piecemeal (immature) strategy when copying the figure and were less likely to draw the core rectangle in a more integrated fashion during the immediate memory condition. These results suggest children with LI have subtle deficits on visuospatial tasks that may be more indicative of limitations associated with processing load and planning than of specific visuospatial processing deficits (JINS, 2006, 12, 465–474.)

The clinical presentation of electrical injury commonly involves physical, cognitive, and emotional complaints. Neuropsychological studies, including case reports, have indicated that electrical injury (EI) survivors may experience a broad range of impaired neuropsychological functions, although this has not been clarified through controlled investigation. In this study, we describe the neuropsychological test findings in a series of 29 EI patients carefully screened and matched to a group of 29 demographically similar healthy electricians. Participants were matched by their estimated premorbid intellectual ability. Multivariate analysis of variance was used to assess group differences in the following neuropsychological domains: attention and mental speed, working memory, verbal memory, visual memory, and motor skills. EI patients performed significantly worse on composite measures of attention/mental speed and motor skills, which could not be explained by demographic differences, injury parameters, litigation status, or mood disturbance. Results suggest that cognitive changes do occur in patients suffering from electrical injury. (JINS, 2006, 12, 17–23.)

We assessed midsagittal corpus callosum size in sickle cell disease (SCD) and its relationship to lesion volume, lesion location, and cognitive functioning. Twenty-eight children with SCD and 16 demographic controls completed magnetic resonance imaging (MRI) and neuropsychological testing. Corpus callosum (CC) size was smaller for children with silent infarcts (n = 8) or overt stroke (n = 8) than for those without visible infarcts (n = 12) or control participants. Lesion volume was a robust predictor of IQ and other cognitive scores; total CC size did not typically add explanatory power for these measures. The size of the rostral body of the CC, however, independently predicted measures of distractibility, speeded production, and working memory. Posterior CC size was also decreased among many of the children with SCD, even in the absence of visible infarcts in this region. Brain morphology appears to provide additional information about SCD-related effects on the brain above and beyond visible infarcts. (JINS, 2006, 12, 24–33.)

Recent investigations have emphasized the importance of the prefrontal cortex for humor processing. Although the prefrontal cortex is thought to be affected by normal aging, relatively little work has been carried out to investigate the effects of aging on humor processing. In the present investigation participants in three age groups were assessed on a humor comprehension task. They then answered mentalistic and nonmentalistic questions. Executive tasks were also administered. The older group selected significantly fewer correct punchlines from alternatives than the other groups. They were also poorer at answering mentalistic questions, but did not differ significantly for nonmentalistic questions. The findings of the present investigation showed altered in humor processing in normal aging, and this appeared to be related to mentalizing ability. (JINS, 2006, 12, 184–191.)

The present study compared performance of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and high functioning autism (HFA) with that of controls on 4 tasks assessing 2 components of motor control: motor response inhibition and motor persistence. A total of 136 children (52 ADHD, 24 HFA, 60 controls) ages 7 to 13 years completed 2 measures of motor inhibition (Conflicting Motor Response and Contralateral Motor Response Tasks) and 2 measures of motor persistence (Lateral Gaze Fixation and NEPSY Statue). After controlling for age, IQ, gender, and basic motor speed, children with ADHD performed significantly more poorly than controls on the Conflicting Motor Response and Contralateral Motor Response Tasks, as well as on Statue. In contrast, children with HFA achieved lower scores than controls only on measures of motor persistence, with no concomitant impairment on either motor inhibition task. These results are consistent with prior research that has demonstrated relatively spared motor inhibition in autism. The findings highlight the utility of brief assessments of motor control in delineating the unique neurobehavioral phenotypes of ADHD and HFA. (JINS, 2006, 12, 622–631.)

Recent research has demonstrated some beneficial effects in patients with neglect using rightward shifting prismatic lenses. Despite a great deal of research exploring this effect, we know very little about the cognitive mechanisms underlying prism adaptation in neglect. We examined the possibility that prism adaptation influences visual attention by having healthy participants complete either a reflexive or a voluntary covert visual attention cuing paradigm before and after adaptation to leftward, rightward, or sham (no shift) prisms. The results for reflexive orienting demonstrated that a subset of participants with large cuing effects before prism adaptation were faster to reorient attention away from an invalid cue on the side of space opposite the prismatic shift post adaptation. For voluntary orienting, left prisms increased the efficiency of voluntary attention in both left and right visual space in participants with a small cuing effect before prism adaptation. In contrast, right prisms decreased the efficiency of voluntary attention in both left and right space for participants with a large cuing effect before prism adaptation. No significant effects were observed in the sham prism groups. These results suggest that prism adaptation may exert a variety of influences on attentional orienting mechanisms. (JINS, 2006, 12, 337–349.)

The current project examined the impact of differential motivation on baseline versus post-mild traumatic brain injury (MTBI) neuropsychological measures in athletes. Collegiate athletes were administered a neuropsychological battery prior to and post-MTBI. High Motivation at Baseline (HMB) and Suspect Motivation at Baseline (SMB) groups were established for each measure based on whether baseline performance fell +/− one or more standard deviations from the mean of the given measure. Greater improvement was expected in the SMB group than the HMB group given hypothesized differences in baseline motivation. In repeated measures analysis of covariance (ANCOVA) that removed achievement performance, the SMB groups demonstrated greater improvement than the HMB groups for the Trail Making Test A & B (TMT-A & B), Digit Span, and Stroop-Color Word (Stroop-CW) tests. Also, the percentage of participants who improved according to reliable change indices was greater for the SMB groups on the TMT-A & B, Stroop-CW, and the Vigil. These findings are likely due to lower motivation in the SMB group for each test. However, results also suggest that some tests may be relatively unaffected by motivation. These data may have clinical implications and point to the need for better methods of identifying athletes with suspect motivation at baseline. (JINS, 2006, 12, 475–484.)

The relationship of psychological and cognitive factors in the development of the postconcussion syndrome (PCS) following mild uncomplicated traumatic brain injury (mTBI) has received little study. This may be because of the widely held belief that neurological factors are the cause of early PCS symptoms, whereas psychological factors are responsible for enduring symptoms. To further understand these relationships, the association between PCS and neuropsychological and psychological outcome was investigated in 122 general trauma patients, many of whom had orthopedic injuries, around 5 days following mTBI. Apart from verbal fluency, participants with a PCS did not differ in their performances on neuropsychological measures compared to those without a PCS. Individuals with a PCS reported significantly more psychological symptoms. Large effect sizes present on the psychological measures showed that the difference between participants with a PCS and without was greater on psychological than on neuropsychological measures. Analyses also revealed a relationship between opioid analgesia and depression, anxiety and stress, and opioids and reduced learning. The results suggest that psychological factors are present much earlier than has previously been considered in the development of the PCS. (JINS, 2006, 12, 792–801.)

Demographic factors and cognitive impairment have been found previously to have associations with outcome after brain injury. Kendall and Terry (1996) suggest that preinjury psychosocial functioning, neurological factors, and cognitive impairment have a direct relationship with multidimensional psychosocial adjustment, but that cognitive impairment also has an indirect relationship by means of the mediation of appraisal and coping variables. The aim of this study was to explore these theoretical relationships at very late stages of recovery after brain injury. A total of 131 participants who were more than 10 years after injury (mean = 15.31 yr) completed a neuropsychological assessment, plus outcome measures that included employment status, community integration, life satisfaction, quality of life (QoL), and emotion. Results indicated that injury severity was predictive of life satisfaction; gender and relationship status predicted community integration; and age at injury predicted employment status. Impairment in working memory directly predicted all outcomes except QoL and anxiety. An indirect relationship was also evident between working memory, life satisfaction, and depression. Results partially support Kendall and Terry's model but the variables that significantly influence outcome seem to be determined by the outcome dimensions selected. (JINS, 2006, 12, 350–358.)

Recent evidence suggests that changes in brain structure associated with alcohol abuse are compounded in individuals dually diagnosed with alcohol abuse and schizophrenia. To investigate the separate, and possibly interacting, effects of these diagnoses, an event-related brain potential (ERP) measure of auditory information processing (P50 sensory gating paradigm) and neuropsychological measures were administered to healthy control participants with either (1a) no history of alcohol abuse/dependence, or (1b) a remote history of alcohol abuse/dependence, and patients with schizophrenia with either (2a) no history of alcohol abuse/dependence, or (2b) a remote history of alcohol abuse/dependence. Schizophrenia was associated with impaired P50 sensory gating and poorer performance across neuropsychological scores compared to measurements in healthy control participants. Those with a positive alcohol history had impaired gating ratios in contrast to those with a negative alcohol history. There were additive effects of schizophrenia diagnosis and alcohol history for P50 sensory gating and for neuropsychological scores: attention, working memory, and behavioral inhibition. For executive attention and general memory there was an interaction, suggesting that the combination of schizophrenia and history of alcohol abuse results in greater impairment than that predicted by the presence of either diagnosis alone. (JINS, 2006, 12, 34–44.)

The Attention Network Test (ANT) uses visual stimuli to separately assess the attentional skills of alerting (improved performance following a warning cue), spatial orienting (an additional benefit when the warning cue also cues target location), and executive control (impaired performance when a target stimulus contains conflicting information). This study contrasted performance on auditory and visual versions of the ANT to determine whether the measures it obtains are influenced by presentation modality. Forty healthy volunteers completed both auditory and visual tests. Reaction-time measures of executive control were of a similar magnitude and significantly correlated, suggesting that executive control might be a supramodal resource. Measures of alerting were also comparable across tasks. In contrast, spatial-orienting benefits were obtained only in the visual task. Auditory spatial cues did not improve response times to auditory targets presented at the cued location. The different spatial-orienting measures could reflect either separate orienting resources for each perceptual modality, or an interaction between a supramodal orienting resource and modality-specific perceptual processing (JINS, 2006, 12, 485–492.)

Recent cross-sectional studies have reported strong associations between visual and cognitive function, and longitudinal studies have shown relationships between visual and cognitive decline in late life. Improvement in cognitive performance after cataract surgery has been reported in patients with Mild Cognitive Impairment. We investigated whether improving visual function with cataract surgery would improve neuropsychological performance in healthy older adults. A randomized clinical trial of cataract surgery performed at acute hospitals was conducted on 56 patients (mean age 73) with bilateral cataract, after excluding a total of 54 patients at the screening stage, of whom 53 did not meet visual acuity criteria and one did not have cataract. In-home assessments included visual and neuropsychological function, computerized cognitive testing and health questionnaires. Results showed no cognitive benefits of cataract surgery in cognitively normal adults. We conclude that visual improvement following cataract surgery is not strongly associated with an improvement in neuropsychological test performance in otherwise healthy adults. Joint associations between visual and cognitive function in late life are likely to be due to central factors, and unlikely to be strongly related to eye disease. Short-term increased neural stimulation from improved visual function does not appear to affect cognitive performance. (JINS, 2006, 12, 632–639.)

Frontal functions, or impairments, have achieved the status of pornography: everyone knows them when they see them, but there is little agreement on their exact defining properties. Patients with frontal lobe lesions have impairments in planning, monitoring, sequencing, and inhibiting responses. They cannot organize complex behaviors. They are somehow simultaneously unaware and distractible, irritable and apathetic, violent and passive, impulsive and perseverative. They lack empathy, self-awareness, and emotional regulation. Patients often are incapacitated by frontal impairments that paradoxically are not at all obvious to most observers. To understand the effects of frontal lesions, science has sacrificed countless rats and nonhuman primates. Neuropsychology and Neurology have sanctified a few tests as the tests of frontal function, and then spent money, time, and the mental health of countless graduate students and research assistants trying to tease out of those tests some basic knowledge of frontal functions. Experimental Psychology has brought novel constructs to the problem of defining frontal functions, and modern neuroimaging has merged the traditional clinical and the novel experimental with imaging technology. (A quick PubMed search of “fMRI and frontal lobes” on October 12, 2005 retrieved 4,646 articles, the most recent, “An fMRI study of the Trail Making Test”.) Yet, confronted with a patient with a large right prefrontal lesion who cannot hold a job or even be relied upon to buy the groceries he set out to buy, we have precious few tools to define his problem and almost nothing to offer to fix it.

We examined the long-term retention of a learned automatic cognitive process in 17 severe TBI participants and 10 controls. Participants had initially received extensive consistent-mapping (CM) training (i.e., 3600 trials) in a semantic category visual search task (Schmitter-Edgecombe & Beglinger, 2001). Following CM training, TBI and control groups demonstrated dramatic performance improvements and the development of an automatic attention response (AAR), indicating task-specific and stimulus-specific skill learning. After a 5- or 10-month retention interval, participants in this study performed a New CM task and the originally trained CM task to assess for retention of task-specific and stimulus-specific visual search skills, respectively. No significant group differences were found in the level of retention for either skill type, indicating that individuals with severe TBI were able to retain the learned skills over a long-term retention interval at a level comparable to controls. Exploratory analyses revealed that TBI participants who returned at the 5-month retention interval showed nearly complete skill retention, and greater skill retention than TBI participants who returned at the 10-month interval, suggesting that “booster” or retraining sessions may be needed when a skill is not continuously in use. (JINS, 2006, 12, 802–811.)

Kendall and Terry (1996) include many psychosocial predictors in their theoretical model that explains individual differences in psychosocial adjustment (Lazarus & Folkman, 1984). The model depicts appraisal and coping variables as mediating relationships between situation factors, environmental and personal resources, and multidimensional outcome. The aim of this study was to explore these theoretical relationships at very late stages of recovery from traumatic brain injury. A total of 131 participants who were more than 10 years post-injury (mean = 15.31 years) completed several psychosocial measures relating to outcome dimensions comprising employment, community integration, life satisfaction, quality of life (QoL), and emotion. There was no evidence that appraisal and coping variables mediated relationships between psychosocial and any of the outcome variables. However, when appraisal and coping variables were combined with psychosocial variables as direct predictors of outcome, every outcome except employment status was reliably predicted, accounting for between 31 and 46% of the variance. Personality significantly influenced all predicted outcomes. Self-efficacy contributed to the prediction of all outcomes except QoL. Data did not support for the theory of stress and adjustment as a framework for explaining the nature of predictive relationships between psychosocial variables and very long-term, multidimensional outcome after brain injury. (JINS, 2006, 12, 359–367.)

The relationship between dementia diagnosis and everyday action (e.g., meal preparation, grooming) is not well understood. This study examines differences between individuals diagnosed with vascular dementia (VaD; n = 25) versus Alzheimer's disease (AD; n = 23) on the Naturalistic Action Test (NAT; Schwartz et al., 2003), a performance-based measure that includes three tasks of increasing complexity. The percentage of task steps accomplished, number of errors, and performance times were recorded for each task. While the groups did not differ in dementia severity or overall impairment on the NAT, the VaD group committed more errors (3.3 vs. 1.6, p = 02). The VaD group also accomplished significantly fewer steps when salient distractor objects were present (74.0% vs. 91.3%, p < .01). Correlations between NAT variables and neuropsychological tests suggest the executive control deficits associated with VaD may contribute to specific action difficulties, such as distractor interference and inefficient, error-prone action on complex tasks. In AD, everyday action may be negatively influenced by episodic memory failures. Thus, dementia diagnosis has relevance to everyday function. (JINS, 2006, 12, 45–53.)

This article considers the scientific process whereby new and better clinical tests of executive function might be developed, and what form they might take. We argue that many of the traditional tests of executive function most commonly in use (e.g., the Wisconsin Card Sorting Test; Stroop) are adaptations of procedures that emerged almost coincidentally from conceptual and experimental frameworks far removed from those currently in favour, and that the prolongation of their use has been encouraged by a sustained period of concentration on “construct-driven” experimentation in neuropsychology. This resulted from the special theoretical demands made by the field of executive function, but was not a necessary consequence, and may not even have been a useful one. Whilst useful, these tests may not therefore be optimal for their purpose. We consider as an alternative approach a function-led development programme which in principle could yield tasks better suited to the concerns of the clinician because of the transparency afforded by increased “representativeness” and “generalisability.” We further argue that the requirement of such a programme to represent the interaction between the individual and situational context might also provide useful constraints for purely experimental investigations. We provide an example of such a programme with reference to the Multiple Errands and Six Element tests. (JINS, 2006, 12, 194–209.)

Subject-performed tasks (SPTs) may facilitate the deficit in associative learning among individuals with amnestic mild cognitive impairment (aMCI) by inducing episodic integration of object-action associations. To test this hypothesis, we examined free recall and recognition memory following enactment and verbal encoding in healthy elderly controls and individuals with aMCI. Study lists contained either semantically integrated (“Bounce the ball”) or crossed object-action commands, in which episodic and semantic associations were placed in opposition (“Pet the compass”). Associative learning was indeed better after SPT than verbal encoding and with integrated relative to crossed lists for the aMCI group, as it was for controls. Moreover, the degree to which SPTs reduced the semantic interference inherent in the crossed conditions was equivalent for the two groups. The results showed that enactment facilitates formation of episodic associations, even when not supported by preexisting semantic knowledge, and even among individuals who have particular difficulty forming new associations (JINS, 2006, 12, 493–501.)

Stroke is the leading health care problem requiring rehabilitation services today (CDC, 2001; Lee et al., 1996) with the worldwide incidence estimated to be between 300 and 500 per 100,000 people (Sudlow & Warlow, 1997). In most recent years, the rates of mortality are decreasing, resulting in a significant increase in the number of survivors living with the disabilities/handicaps associated with stroke (Thorvaldsen et al., 1997). Not only is stroke a common health problem, but the cognitive disorders that result are common as well (Mayo, 1993; Paolucci et al., 1996).This article is based in part on a Presidential Address by the first author to the Annual meeting of the International Neuropsychological Society in Honolulu, Hawaii in February, 2002.