Comprehensive assessment of memory functioning following traumatic brain injury in children

This study examined specific memory functions in 52 children with mild‐moderate or severe traumatic brain injury (TBI) and 29 noninjured controls using the Wide Range Assessment of Memory and Learning (WRAML). Children's recall varied as a function of injury severity and task demands. The participants with severe brain injuries performed worse than controls on global measures of visual memory, learning, and general memory functioning, as well as on specific subtests measuring recall of contextual verbal information. Children with mild‐moderate brain injuries performed similarly to controls except for poorer performance on 2 subtests measuring sound‐symbol learning and recall of geometric designs. Results suggest that the WRAML provides clinically useful information and that specific aspects of memory processing need to be evaluated following childhood TBI.     

Predictive Accuracy of the Wide Range Assessment of Memory and Learning in Children With Attention Deficit Hyperactivity Disorder and Reading Difficulties

The predictive accuracy of the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990) over and above more standardized diagnostic tools in children with attention deficit hyperactivity disorder (ADHD) and reading disabilities (RD) was examined. Fifty-three children with ADHD, 63 with RD, 63 with ADHD-RD, and 112 normal comparison children were administered the WRAML, the Wechsler Intelligence Scale for Children-Third Edition (WISC-III; Wechsler, 1991), the Achenbach (1991) Child Behavior Checklist (CBCL), and the Woodcock-Johnson Psycho-Educational Battery-Revised (WJ-R; Woodcock & Johnson, 1989). Results of a series of discriminant function analyses revealed that the academic, intellectual, and behavioral measures could correctly classify 73.1% of children, but the WRAML subtests alone were able to correctly classify only 58.5% of participants. Combining all of the memory, academic, intellectual, and behavioral measures resulted in 77.5% of cases being correctly classified. These results suggest that the use of a measure of memory functioning such as the WRAML did not significantly improve the predictive accuracy of a diagnosis of ADHD, RD, or both over and above more standard diagnostic academic, intellectual, and behavioral measures.     

Visual and Verbal Short-Term Memory Deficits in Childhood Leukemia Survivors After Intrathecal Chemotheraphy

Assessed survivors of childhood lymphoblastic leukemia (ALL)treated with intrathecal chemotherapy, using the Wide RangeAssessment of Memory and Learning (WRAML), compared to controlswithout cancer, matched as closely as possible-in age, SES,and gender. Mild, but consistent, deficits were found in bothvisual-spatial and verbal single-trial memory tasks. In multitriallearning, only visual-spatial tasks resulted in deficient scores,while verbal learning was within the normal range. IQ resultsindicated scores 10–20 points lower in the ALL group.Memory results are related to deficits in strategic planningand attentional distractiveness. The WRAML may be a useful clinicaltool to evaluate differential memory deficits in children withALL.     

Factor structure of the WRAML in children with ADHD or reading disabilities: Further evidence of an attention/concentration factor

This study investigated the validity of the factor structure of the Wide Range Assessment of Memory and Learning (WRAML) in samples of children with attention deficit hyperactivity disorder (ADHD) and reading disability, as well as a group of controls. An attention/concentration factor emerged for all 3 groups. For the ADHD group it accounted for the highest proportion of the variance. These results support the validity of an attention/concentration factor and call into question the 3 published indexes of the WRAML.     

Testing Children: A Practitioner's Guide to the Assessment of Mental Development in Infants and Young Children

Memory and attention skills were assessed in 84 children with epilepsy who had no documented learning or behavioral disorders. Seizure type, level of control, and antiepileptic drug effects were examined in relation to their influence on memory and attention function. For the entire sample, verbal and visual memory skills were found to be within the average range. However, subtle problems with attentional skills were noted. Two‐way analyses of variance, based on seizure type by level of control, did not indicate significant group differences in memory and attention skills between children with complex partial versus absence seizures. Children with uncontrolled seizures had more difficulty with recall of complex verbal information. A notable finding was that children on polytherapy had significantly lower verbal and visual memory scores than children on monotherapy. Results suggest that children with epilepsy, without learning or behavioral disorders, have intact memory skills but may have subtle difficulties with attention. These children would benefit from repetition of information, whereas children on polytherapy need to be more closely monitored due to increased risk for problems with memory and attention skills.     

Learning following prenatal alcohol exposure: performance on verbal and visual multitrial tasks.

Verbal Learning deficits have been reported following prenatal alcohol exposure (PAE). This study examined verbal and visual multitrial learning in children with fetal alcohol syndrome (FAS) or fetal alcohol effects (FAE) and controls matched on age and gender from the same community. In this study, the FAS/FAE group's immediate memory on the Verbal Learning and Visual Learning tasks from the Wide Range Assessment of Memory and Learning (WRAML) was significantly weaker than that of the control group. Although the FAS/FAE group also recalled significantly less information after a delay, they did retain an equivalent proportion of the visual and verbal information as compared to the control group. Thus, the overall pattern of performance on both verbal and visual measures was consistent with that observed in previous studies of Verbal Learning: despite weaker learning, the FAS/FAE group's relative retention of information was no different than that of controls.     

The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

OBJECTIVE:

Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil.

METHODS:

A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively.

RESULTS:

Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence.

CONCLUSIONS:

Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth.     

Substance use disorders in an adolescent inpatient psychiatric population.

This study examined the comorbidity of substance use disorders and other psychiatric disorders in adolescent populations. The study population was comprised of 100 consecutive admissions, ages 13 to 17, to an acute care adolescent psychiatric inpatient unit for substance use disorders. Patients were assessed using the Personal Experience Screening Questionnaire (PESQ) and the substance-use disorder portion of the Structured Clinical Interview for DSM III-R (SCID-R). Thirty-three (33%) patients were identified as having a substance abuse or dependence diagnosis. There was no significant difference in the age between substance users and nonsubstance users. There were significantly more whites in the substance-using group. Sixty percent of all adolescents interviewed had histories of sexual or physical trauma, with trauma being significantly more common in the substance-using group. There were no significant differences in the number or type of other Axis I or Axis II diagnoses between the two groups. While substance users and nonsubstance users had no significant difference in the number of past psychiatric hospitalizations, nonsubstance users had significantly more past medical hospitalizations. These results indicate that high rates of comorbid substance abuse and psychiatric disorders exist in adolescents, and more in-depth study of comorbidity among adolescents is warranted.     

Association of child maltreatment and psychiatric diagnosis in Brazilian children and adolescents

OBJECTIVES:

The objective of this study was to evaluate the association between different types of child maltreatment and the presence of psychiatric disorders in highly vulnerable children and adolescents served by a multidisciplinary program.

METHODS:

In total, 351 patients with a mean age of 12.47, of whom 68.7% were male and 82.1% lived in shelters, underwent psychiatric evaluations based on the Kiddie-Sads-Present and Lifetime Version. Two different methods were used to evaluate maltreatment: medical records were reviewed to identify previous diagnoses related to socioeconomic and psychosocial circumstances, and the Childhood Trauma Questionnaire was used to obtain a structured history of trauma. Bivariate associations were evaluated between psychiatric disorders and evidence of each type and the frequency of abuse.

RESULTS:

The most frequent psychiatric diagnoses were substance use disorders, affective disorders and specific disorders of early childhood, whereas 13.67% of the sample had no psychiatric diagnosis. All patients suffered neglect, and 58.4% experienced physical or sexual abuse. The presence of a history of multiple traumas was only associated with a diagnosis of substance use disorder. Mental retardation showed a strong positive association with reported physical abuse and emotional neglect. However, a negative correlation was found when we analyzed the presence of a history of multiple traumas and mental retardation.

CONCLUSION:

All children living in adverse conditions deserve careful assistance, but we found that physical abuse and emotional neglect were most strongly associated with mental retardation and multiple traumas with substance abuse.     

The Memory Assessment Scales and lateralized temporal lobe epilepsy

We report Memory Assessment Scales (MAS) performance in 101 patients with unilateral temporal lobe epilepsy (TLE; left, n = 51; right, n = 50) with left cerebral language dominance. A significant multivariate group effect was present for the major summary indices (Verbal Memory, Visual Memory, and Global Memory, p < .04). Univariate analyses revealed no significant differences for either the Global Memory or Verbal Memory summary scores, although a significant group difference was present for Visual Memory (p < .04). The Verbal Memory-Visual Memory discrepancy score was significantly different between right and left TLE groups (p < .004). Verbal Memory scores were at least 14 points lower than Visual Memory scores in 34 patients (left = 20, 59%; right = 14, 41%). Visual Memory scores were at least 14 points lower than Verbal Memory performance in 20 patients (left = 5, 25%; right = 15, 75%). Diagnostic efficiency statistics show higher sensitivity but lower specificity in group classification for left TLE patients. These data suggest that the MAS is sensitive to material-specific memory deficits associated with a unilateral temporal lobe seizure focus. However, over one-third of the patients (19/54) with at least a 14-point Verbal Memory-Visual Memory discrepancy were classified incorrectly. The MAS, like other material-specific memory measures, should be interpreted within the context of other clinical findings.     

Dissociation, PTSD, and substance abuse: an empirical study

Few studies have examined the relationship between posttraumatic stress disorder (PTSD), substance use disorder, and dissociation. We studied 77 women with current PTSD and substance dependence, classified into high- versus low-dissociation groups per the Dissociative Experiences Scale. They were compared on trauma- and substance-related symptoms, cognitions, coping skills, social adjustment, trauma history, psychiatric symptoms, and self-harm/suicidal behaviors. We found the high-dissociation group consistently more impaired than the low-dissociation group. Also, the sample overall evidenced relatively high levels of dissociation, indicating that even in the presence of recent substance use, dissociation remains a major psychological phenomenon. Indeed, the high-dissociation group reported stronger expectation that substances could manage their psychiatric symptoms. The high-dissociation group also had more trauma-related symptoms and childhood histories of emotional abuse and physical neglect. The discussion addresses methodology, the "chemical dissociation" hypothesis, and the need for a more nuanced understanding of how substances are experienced in relation to dissociative phenomena.     

The Guide to the Assessment of Test Session Behavior: Validity in Relation to Cognitive Testing and Parent-Reported Behavior Problems in a Clinical Sample

Examined the validity of the Guide to the Assessment of Test Session Behavior (GATSB) in a clinical sample. The GATSB is a structured and standardized measure that was normed on the Wechsler Intelligence Scale for Children-Third Edition (WISC-III) standardization sample. The purpose of this study was to extend validity research on the GATSB to cognitive measures other than the WISC-III and to parent-reported child behavior problems. Test observations were taken for 122 children ages 6 to 16 years who were referred to an outpatient psychology clinic for psychoeducational evaluations. GATSB scores demonstrated a moderate relation with general indexes from the WISC-III, the Woodcock-Johnson Psychoeducational Battery-Revised (WJ-R), and the Wide Range Assessment of Memory and Learning (WRAML), but displayed low magnitude correlations with the Child Behavior Checklist (CBCL). These results expand existing data supporting the validity of the GATSB and suggest that it may be fruitfully adopted into a clinic setting.     

The Relations Among Abuse,Depression, and Adolescents' Autobiographical Memory

This study examined the relations among early and recent experiences with abuse, depression, and adolescents' autobiographical memory in a longitudinal study of family violence. Participants' (N = 134) exposure to violence was documented when they were 6 to 12 years old and again when they were 12 to 18 years old. The second assessment included measures of depression and autobiographical memory for childhood experiences. Memory problems were more consistently related to current circumstances than childhood abuse history. For instance, depressive symptoms were associated with increased rates of "overgeneral" childhood memories. Recent exposure to family violence predicted more overgeneral memories, shorter memories, and lower rates of negative memories. The patterns suggest that adolescents currently stressed by depression or family violence might strategically avoid the details of past experiences to regulate affect.     

Introduction to the special issue on the impact of childhood psychopathology interventions on subsequent substance abuse: pieces of the puzzle

Studies of adolescents and adults have reported high levels of co-occurrence of substance abuse with other psychiatric disorders, suggesting influence between the conditions. The comorbidity seems complex and variable, indicating that there may be more than I type of association between the comorbid disorders. When occurring in childhood. some of the frequently comorbid psychopathologies typically precede later drug and alcohol abuse and may have implications for substance abuse prevention as early risk indicators and as targets for intervention. Research discussed in this article and in this special issue provides a foundation for investigating the question of whether effective treatment of childhood psychopathologies can prevent or at least mitigate substance abuse for some adolescents. Clinical, research, and policy implications are discussed.     

Association of psychosis with suicidality in pediatric bipolar I, II and bipolar NOS patients

BACKGROUND: Psychosis in pediatric mood disorder patients may be related to suicidal ideation. Bipolar (BP) adolescents are at high risk of completed suicide. We examined whether pediatric BP patients with psychosis have a higher prevalence of suicidality than non-psychotic BP patients. Based on previous findings in adult BP patients, we predicted that pediatric BP patients with psychotic symptoms would have higher prevalence of suicidality, higher occurrence of lifetime psychiatric hospitalizations and worse current Global Assessment of Functioning Scale (GAF) scores compared to non-psychotic BP patients. METHODS: We studied 43 BP children and adolescents (mean age +/- S.D = 11.2 +/- 2.8 y, range = 8-17) who did (n = 17) or did not have (n = 26) a lifetime history of psychotic symptoms. Indicators of suicidality (thoughts of death and suicidal ideation, plans, and attempts), psychiatric diagnoses, psychotic symptoms, psychiatric hospitalizations and GAF scores were assessed with the K-SADS-PL interview. LIMITATIONS: Small sample size, cross-sectional study and exclusion of substance abuse comorbidity. RESULTS: Pediatric BP patients with a lifetime history of psychotic symptoms compared to BP patients without psychosis were more likely to have thoughts of death (100% versus 69.2%, p = 0.01), suicidal ideation (94.1% versus 42.3%, p = 0.001) and suicidal plans (64.7% versus 15.4%, p = 0.002). Occurrence of psychiatric hospitalization was higher in psychotic BP patients compared to non-psychotic BP patients (82.4% versus 46.2%, p = 0.018). CONCLUSIONS: Psychotic symptoms in pediatric BP patients are associated with suicidal ideation and plans, and psychiatric hospitalizations. Psychotic symptoms are a risk factor for suicidality amongst pediatric BP patients.     

The relations among abuse, depression, and adolescents' autobiographical memory.

This study examined the relations among early and recent experiences with abuse, depression, and adolescents' autobiographical memory in a longitudinal study of family violence. Participants' (N = 134) exposure to violence was documented when they were 6 to 12 years old and again when they were 12 to 18 years old. The second assessment included measures of depression and autobiographical memory for childhood experiences. Memory problems were more consistently related to current circumstances than childhood abuse history. For instance, depressive symptoms were associated with increased rates of "overgeneral" childhood memories. Recent exposure to family violence predicted more overgeneral memories, shorter memories, and lower rates of negative memories. The patterns suggest that adolescents currently stressed by depression or family violence might strategically avoid the details of past experiences to regulate affect.     

Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness

Adolescence is a time of change that can be both exciting and stressful. In this review, we focus on the central role that disturbed sleep and daytime sleepiness occupies in interactions involving substance abuse and negative health, social, and emotional outcomes. As a means of improving sleep and lowering risk for recidivism of substance abuse, we developed and implemented a six-session group treatment to treat sleep disturbances in adolescents who have received treatment for substance abuse. The components of the treatment are stimulus control instructions, use of bright light to regularize sleep, sleep hygiene education, cognitive therapy, and Mindfulness-Based Stress Reduction. Preliminary evidence indicates that participants who completed four or more sessions in the treatment program showed improved sleep and that improving sleep may lead to a reduction in substance abuse problems at the 12-month follow-up.     

Current psychiatric morbidity, aggression/impulsivity, and personality dimensions in child and adolescent suicide: a case-control study

OBJECTIVE: The present study was designed to evaluate psychiatric risk factors for child and adolescent suicide, and to determine the association between impulsive-aggressive and other personality traits, and suicide completion in this population. METHOD: Psychiatric diagnoses, impulsive-aggressive and other personality traits were assessed in 55 child and adolescent suicide victims and 55 community controls using semi-structured proxy-based interviews and questionnaires. RESULTS: The most significant psychiatric risk factors associated with child and adolescent suicide were depressive disorders (OR=48.414, 95% CI 6.247-375.185), substance/alcohol abuse disorder (OR=5.365, 95% CI 1.434-20.076), and disruptive disorders (OR=13.643, 95% CI 2.292-23.16). Additionally, suicide victims showed higher scores on lifetime aggression/impulsivity, and harm avoidance. However, after logistic regression, the only independent significant predictors of suicide in this age group were the presence of depressive disorders (Adjusted OR (AOR)=39.652, 95% CI 4.501-349.345), substance/alcohol abuse disorders (AOR=7.325, 95% CI 1.127-47.62), and disruptive disorders (AOR=6.464, 95% CI 1.422-29.38). LIMITATIONS: Relatively small sample size, and cross-sectional design. CONCLUSIONS: Our findings confirm the existence of a particular clinical profile of children and adolescents at high risk for suicide. Additionally, our results reinforce the need for improved understanding of the interrelationships between stressors, depression, substance/alcohol abuse disorders, disruptive disorders and personality traits/dimensions in youth suicidal behavior.     

Comorbidity of mental disorders in the post-mortem diagnosis of completed suicide in children and adolescents

In a psychological autopsy of 21 children and adolescents aged 11-19 years who committed suicide as compared with a matched-pair control group, 95% of the suicide victims and 48% of the controls had at least one serious diagnosable mental disorder (P less than 0.02). The presence of two or more mental disorders (comorbidity) was the rule occurring in 81% of the suicide victims and 29% of the controls (P less than 0.001). Mood disorders such as major depression, major depression superimposed on dysthymic disorder and dysthymic disorder coexisted with either alcohol and drug abuse, conduct disorder or other mental disorders in 76% of the victims and 24% of the controls (P less than 0.025). The suicide victims experienced significantly more psychosocial stressors and the poorest level of adaptive functioning. This study suggests that suicide in children and adolescents very frequently is the outcome of serious psychiatric disorders, particularly when associated with drug and alcohol abuse.     

Benefits of community-based demonstration efforts: Knowledge gained in substance abuse prevention

Prospective studies document that preventive interventions can reduce the prevalence of substance abuse and antisocial behavior. In contrast, the justification for community-based demonstrations in substance abuse prevention and mental health promotion assumes that communities have decided to invest in prevention and now wish to learn from the experience of others on how the value of this investment can be maximized. The expectation has been that demonstration grants can be applied to improve substance abuse prevention efforts operated under State and community auspices. A review of selected knowledge gains from community-basedduration of interventions, and factors affecting implementation. Of these, the most rigorously-confirmed findings are: (1) that the transmission of generic life skills is associated with short-term reductions in substance abuse among adolescents; (2) that activities that improve self-esteem do not consistently affect adolescent substance abuse; and (3) that preventive interventions conducted among pregnant women motivated to participate produce net financial savings in hospital costs. © 2000 John Wiley & Sons, Inc.