Traumatic brain injury (TBI) is associated with impairments of attention, most typically measured through tests of information processing, or by subjective symptom endorsement by patients, families, and clinicians. We have previously shown increased rates of off-task behavior among patients with TBI versus controls as defined by videotaped records of independent work in distracting environments. In this research, we report on a more detailed method of coding such videotaped records which allows measurement of the precise number of off-task behaviors, their durations, and their relationship to distracting events. Using this method, we studied 20 patients with recent moderate-to-severe TBI and 20 demographically comparable controls as they performed independent work tasks while being subjected to controlled distracting events. This research confirms that patients are markedly less attentive than controls both in the presence of distractions and in their absence, that distractions have an influence on off-task behavior in both groups, and that the disruptive impact of distractors wanes relatively quickly for controls but not for patients. The duration of distraction produced by various classes of distracting events appeared similar for patients and controls, although the power to detect differences in behavioral duration between groups was limited. The pattern of inattentiveness among patients showed minimal relationship to measures of injury severity within this sample. (JINS, 2000, 6, 1–11.)

Patients with probable Alzheimer's disease (AD) often have difficulties associated with semantic knowledge. Therefore, conceptual apraxia, a defect of action semantics and mechanical knowledge, may be an early sign of this disease. The Florida Action Recall Test (FLART), developed to assess conceptual apraxia, consists of 45 line drawings of objects or scenes. The subject must imagine the proper tool to apply to each pictured object or scene and then pantomime its use. Twelve participants with Alzheimer's disease (NINCDS–ADRDA criteria) and 21 age- and education-matched controls were tested. Nine Alzheimer's disease participants scored below a 2-standarddeviation cutoff on conceptual accuracy, and the three who scored above the cutoff were beyond a 2-standard-deviation cutoff on completion time. The FLART appears to be a sensitive measure of conceptual apraxia in the early stages of Alzheimer's disease. (JINS, 2000, 6, 265–270.)

The discourse of 91 children who had sustained severe (n = 68) or mild (n = 23) closed head injury (CHI) was examined at least three years postinjury. The groups' retellings of a narrative story were analyzed according to two domains, information and language. In comparison to the mild CHI group, the severe group produced stories characterized by reduced content and information, impaired organization, fewer words, and less complex sentences. The relationships between discourse production and the groups' performance on measures of language, executive function, memory, and processing speed were examined. Correlations were found between discourse production and general verbal ability including verbal fluency. Correlations were also found for discourse performance and executive function measures associated with problem solving and working memory. Site and extent of lesion were not useful in predicting discourse production. These findings indicate that children who sustain a severe closed head injury during early to middle childhood are at risk for persisting deficits in discourse processing and other cognitive abilities. (JINS, 2000, 6, 741–751)

Executive functions in their broadest sense may be impaired in patients with frontal lobe lesions. The Wisconsin Card Sorting Test, perhaps the most robust test sensitive to frontal lobe dysfunction, requires the flexibility to switch a response pattern to meet the change in task demands. However this task has only two category switches and normal respondents tend to score at ceiling. Verbal fluency tasks also incorporate a switching component and it was hypothesized that a word generation task that maximized a switching requirement might provide a more satisfactory verbal measure of frontal lobe dysfunction. A new test of homophone meaning generation that requires multiple switches between verbal concepts (e.g., tick = insect, correct, etc.) was devised. Normative data was obtained from a sample of 170 control participants. Seventy-one patients with unilateral anterior or posterior cerebral lesions were also tested. A normal distribution of scores was obtained in the standardization sample. The anterior lesion groups were more impaired than the posterior groups. There were no significant differences due to laterality. This homophone meaning generation task is a measure of frontal lobe dysfunction that has the advantage of psychometric properties that permit measurement of the degree of impairment. (JINS, 2000, 6, 643–648.)

We studied time estimation in patients with frontal damage (F) and alcoholic Korsakoff (K) patients in order to differentiate between the contributions of working memory and episodic memory to temporal cognition. In Experiment 1, F and K patients estimated time intervals between 10 and 120 s less accurately than matched normal and alcoholic control subjects. F patients were less accurate than K patients at short (< 1 min) time intervals whereas K patients increasingly underestimated durations as intervals grew longer. F patients overestimated short intervals in inverse proportion to their performance on the Wisconsin Card Sorting Test. As intervals grew longer, overestimation yielded to underestimation for F patients. Experiment 2 involved time estimation while counting at a subjective 1/s rate. F patients' subjective tempo, though relatively rapid, did not fully explain their overestimation of short intervals. In Experiment 3, participants produced predetermined time intervals by depressing a mouse key. K patients underproduced longer intervals. F patients produced comparably to normal participants, but were extremely variable. Findings suggest that both working memory and episodic memory play an individual role in temporal cognition. Turnover within a short-term working memory buffer provides a metric for temporal decisions. The depleted working memory that typically attends frontal dysfunction may result in quicker turnover, and this may inflate subjective duration. On the other hand, temporal estimation beyond 30 s requires episodic remembering, and this puts K patients at a disadvantage. (JINS, 2000, 6, 517–528.)

Complaints on cognitive functioning are often reported in patients suffering from whiplash syndrome, although objective neuropsychological test results do not always support these. In addition, radiological abnormalities and anatomical lesions are found only in a minority of these patients. This has led to a controversy about its existence in the literature. In this systematic review, the results of 22 neuropsychological studies on whiplash were quantitatively analyzed, focusing on working memory, attention, immediate and delayed recall, visuomotor tracking, and cognitive flexibility. Our findings suggest that a consistent overall pattern of cognitive dysfunction can be demonstrated after whiplash injury through neuropsychological testing, both compared to healthy and to asymptomatic controls. Six months after the accident, improvement is found in working memory, attention, immediate recall, and visuomotor tracking. The results are discussed in the light of recent findings on the effect of cerebral dysfunction, malingering, pain-related factors, and the role of coping strategies and posttraumatic stress on neuropsychological test performance. (JINS, 2000, 6, 271–278.)

We studied a group of 31 temporal lobe epilepsy patients (25 left, 6 right) with unilateral hippocampal sclerosis evident on magnetic resonance imaging. Single slice T2 relaxation times were acquired for the left and right hippocampi. Principal components analysis of preoperative memory data resulted in two factors that reflect a distinction between arbitrary and semantic forms of verbal recall. The former component correlated with left hippocampal T2 relaxation time, while the latter component did not. This study suggests that variation in left hippocampal integrity is more related to the acquisition of arbitrary associates than semantically structured material, and reinforces the possibility that the left temporal lobe is functionally heterogeneous with respect to memory. (JINS, 2000, 6, 529–538.)

This study was undertaken to investigate whether alcoholics differ qualitatively from controls in their organizational approach to the Rey–Osterrieth Complex Figure (ROCF) and to examine the effects of problem-solving and organizational ability on learning and retention. Data were collected on 3 groups of neuromedically healthy, middle-aged men: 29 recently detoxified alcoholics (RDA) abstinent at least 2 weeks, 29 long-term abstinent alcoholics (LTA) abstinent at least 18 months, and 29 nonalcoholic controls (NAC). Groups were comparable in age, education, WAIS–R Vocabulary score, and ANART IQ. Three indices of problem-solving approach were used to score how participants produce the ROCF during the copy condition: perceptual clustering, organization, and constructional accuracy. Learning and retention were measured by immediate recall, 20-min delayed recall, and recognition performance. RDAs had significantly impaired immediate recall, delayed recall, and recognition scores compared to NACs. RDAs also had significantly lower perceptual clustering, organization, and constructional accuracy scores than their long-term abstinent and nonalcoholic counterparts. Multiple regression analyses revealed that problem-solving ability at copy accounted for a significant proportion of the variance in immediate recall, delayed recall, and recognition. Further investigation of memory performance using a repeated measures design revealed that across the 3 groups, little forgetting occurred between immediate and delayed recall, while performance improved significantly on the recognition trial. Use of less efficient problem-solving strategies appears to affect RDAs' ability to learn and retrieve complex figural information. (JINS, 2000, 6, 12–19.)

Male vulnerability to neurodevelopmental disorders remains controversial. For one disorder, reading disability, this sex bias has been interpreted as an artifact of referral bias. We investigated sex differences for the incidence of reading disability within a large prospective sample of White (N = 16,910) and Black (N = 15,313) children derived from the National Collaborative Perinatal Project (NCPP). Children were classified as having either moderate or severe reading disability when they had reading scores lower than 1.5 or 2.0 standard errors of prediction, respectively, given their age and intelligence. Reading disability was about twice as common in boys than girls (p < .001), irrespective of race, severity of disability, or exclusion of children with attentional disturbances or high activity levels. We conclude that there is a clear sex bias toward males for the incidence of reading disabilities. (JINS, 2000, 6, 433–442.)

To evaluate the clinical and ecological validity of affect recognition (AR) measures in a sample of community-dwelling schizophrenic outpatients (N = 40), we analyzed the relation of facial and vocal AR to intellectual, symptomatic, and quality-of-life criteria. Facial and vocal AR showed virtually identical patterns of association with these criteria, suggesting that both modalities of AR draw on the same underlying heteromodal capacity. Specifically, AR was correlated with a subset of intellectual abilities (verbal–semantic, executive–attentional), but was unrelated to age, education, or neuroleptic dose. In terms of clinical and ecological criteria, AR errors correlated with more severe psychotic symptoms (positive and disorganized) and with lower quality of life (relationships, community participation, and richness of intrapsychic experience). Even after controlling for subjects' intellectual abilities and illness severity, inaccurate AR was associated with bizarre behaviors (involving sociosexual interactions, clothing, appearance) and with impoverished interpersonal relations. Thus, while difficulty identifying basic affective cues is related to general cognitive and illness-severity factors, it appears to have specific functional implications that do not depend on generalized impairment. Assessment of AR may identify a subgroup of schizophrenic patients who have a central defect in the heteromodal monitoring of emotional-social displays, associated with dysregulation of social behaviors and disruption of interpersonal relations. (JINS, 2000, 6, 649–658.)

To examine the hypothesis that abnormalities in those cognitive functions for which cerebellar components have been implicated contribute to the pathophysiology of autism, tests of judgment of explicit time intervals and procedural learning were administered to 11 participants with autism and 17 age-and-IQ-matched controls. Results indicated that the group with autism demonstrated significant impairments in procedural learning compared with the group of controls. No significant difference in judgment of explicit time intervals was found. The data suggest that deficits in procedural learning may contribute to the cognitive and behavioral phenotype of autism; these deficits may be secondary to abnormalities in cerebellar–frontal circuitry. (JINS, 2000, 6, 752–759.)

Emotional reactions are sometimes observed during the intracarotid sodium amobarbital test. For instance, euphoric/indifference reactions can be seen during right hemisphere inactivation and catastrophic reactions may accompany left hemisphere inactivation. Less dramatic changes can also be detected in affective self-report during left and right hemisphere amobarbital tests, with more negative affect reported during left hemisphere inactivation and either neutral or mildly positive affective states reported during right hemisphere inactivation. The current study not only replicated this effect, but in addition, found significant group differences. The first group (right way) showed a pattern of affective self-report during left and right amobarbital tests entirely consistent with prior findings, while a second group (wrong way) showed results that behaved in a diametrically opposite fashion. A third group (no change) showed little, if any, difference in affective self-report during left and right amobarbital tests. The major factor distinguishing the wrong way group from the other two appeared to be an asymmetrical distribution of left and right temporal lobe lesions in the former group. In contrast, the factor differentiating the right way group from the no change group appeared to be the relative degree of left hemisphere inactivation during the left hemisphere amobarbital test. The results are discussed not only in terms of their impact on theories of cerebral lateralization for emotion, but also in terms of methodological issues in this field. (JINS, 2000, 6, 659–667.)

As noted by Satz, the prevalence of lateralized language in the general population is underestimated substantially by the proportion of people who show the typical asymmetry on a laterality task. In a series of two dichotic listening experiments with a total of 171 right-handers and 170 left-handers, we tested the hypothesis that increased reliability of measurement will lead to increased classification accuracy. Experiment 1 showed that neither the frequency nor magnitude of the right-ear advantage (REA) for fused rhyming words increased as the number of trials increased from 120 to 480. Ear-difference scores were highly reliable (r = .85), even when based on 120 trials. Experiment 2, which involved lists of dichotic word pairs, yielded similar results. Even though retest reliability of the ear-difference score for 132 word pairs was only .45, neither the incidence nor strength of the REA increased significantly when the number of pairs was increased to 528. The results indicate that the poor classification accuracy of dichotic listening tasks cannot be attributed to unreliability. (JINS, 2000, 6, 539–547.)

Attentional functioning was examined in three groups of 7- to 19-year-old male participants with hemophilia: (1) HIV seronegative controls (HIV−, N = 66), (2) HIV seropositive participants with CD4+ lymphocyte counts greater than or equal to 200 (HIV+ CD4+ ≥200, N = 79), and (3) severely immune suppressed HIV seropositive participants (HIV+ CD4+ <200, N = 28). Two measures sensitive to attention deficits were used: the Continuous Performance Test (CPT) and the Span of Apprehension (Span). On the CPT, there was a decrement in attention in both HIV+ groups, as indexed by an increase in false alarm rate from Block 1 to Block 3, that was not present in the HIV− group. The longer the HIV+ children were required to sustain attention to the CPT, the more they responded to the incorrect stimulus. This effect decreased as age increased. Span percent correct and latency to correct were associated with the presence of a premorbid history of intracerebral hemorrhage, but were not sensitive to HIV status or degree of immune suppression in the HIV+ children, suggesting morbidity related to hemophilia. The remaining CPT and Span variables—hit rate, sensitivity, latency, percent correct, and latency to correct—showed the expected associations with age, but none showed conclusive associations with HIV status or immune suppression in the HIV+ participants. (JINS, 2000, 6, 443–454.)

The occurrence of personality change due to traumatic brain injury (PC), and its clinical and neuroimaging correlates were investigated. Ninety-four children, ages 5 through 14 at the time of hospitalization following traumatic brain injury (TBI; severe TBI N = 37; mild–moderate TBI N = 57), were assessed. Standardized psychiatric, adaptive functioning, cognitive functioning, family functioning, family psychiatric history, severity of injury, and neuroimaging assessments were conducted. The Neuropsychiatric Rating Schedule (NPRS) was used to establish a diagnosis of PC. Approximately 40% of consecutively hospitalized severe TBI participants had ongoing persistent PC an average of 2 years postinjury. An additional approximately 20% had a history of a remitted and more transient PC. PC occurred in 5% of mild–moderate TBI but was always transient. Interrater reliability for the diagnosis of PC was good (Kappa = .70). In severe TBI participants, persistent PC was significantly associated with severity of injury, particularly impaired consciousness over 100 hr, adaptive and intellectual functioning decrements, and concurrent diagnosis of secondary attention deficit hyperactivity disorder, but was not significantly related to any psychosocial adversity variables. These findings suggest that PC is a frequent diagnosis following severe TBI in children and adolescents, but is much less common following mild–moderate TBI. (JINS, 2000, 6, 279–289.)

Category fluency tasks are an important component of neuropsychological assessment, especially when evaluating for dementia syndromes. The growth in the number of Spanish-speaking elderly in the United States has increased the need for appropriate neuropsychological measures and normative data for this population. This study provides norms for English and Spanish speakers, over the age of 50, on 3 frequently used measures of category fluency: animals, vegetables, and fruits. In addition, it examines the impact of age, education, gender, language, and depressed mood on total fluency scores and on scores on each of these fluency measures. A sample of 702 cognitively intact elderly, 424 English speakers, and 278 Spanish speakers, participated in the study. Normative data are provided stratified by language, age, education, and gender. Results evidence that regardless of the primary language of the examinee, age, education, and gender are the strongest predictors of total category fluency scores, with gender being the best predictor of performance after adjusting for age and education. English and Spanish speakers obtained similar scores on animal and fruit fluency, but English speakers generated more vegetable exemplars than Spanish speakers. Results also indicate that different fluency measures are affected by various factors to different degrees. (JINS, 2000, 6, 760–769.)