Behavioral Assessment Screening Tool Research Articles

Neurobehavioral Symptom Profiles for the Behavioral Assessment Screening Tool in Chronic Traumatic Brain Injury.

To identify neurobehavioral symptom profiles among persons with chronic traumatic brain injury (TBI) using the Behavioral Assessment Screening Tool (BAST) and to consider participant characteristics that differ between profile groups. Community. Participants (n=615) were English-speaking adults (≥18) and had a self-reported history of at least one TBI of any severity. Secondary analysis of cross-sectional data. The BAST measures neurobehavioral symptoms in the domains of Negative Affect, Fatigue, Executive Dysfunction, Impulsivity, and Substance Misuse. Using latent profile analysis (LPA), we identified 3 different neurobehavioral profiles. Overall symptom frequency and differences in the pattern of symptom frequency across domains differentiated the profile groups. Average domain scores differed significantly across the profiles ( P <.001) for all domains except Fatigue ( P =.076). Those in profile 3 (High-Risk group) reported the most frequent symptoms across all domains (similar Negative Affect frequency as profile 1). Substance Misuse was especially high in this group. Compared to profile 2 (High Negative Affect group), participants in profile 1 (Moderate-Risk group) endorsed significantly more frequent (and more variable) symptoms across all BAST domains, particularly Impulsivity and Substance Misuse. Participants in profile 2 endorsed the least frequent symptoms across all domains. Demographic comparison showed that groups differed based on gender, age, and injury severity (mild vs moderate-severe), with profile 3 composed of the most men and the most persons in early adulthood, and profile 2 composed of the most women and those with mild TBI. We differentiated 3 neurobehavioral symptom profiles among persons with chronic TBI and determined differences in sociodemographic factors between the groups. Future research should focus on validating these profiles in another sample of individuals with chronic TBI. Characterizing persons according to multidimensional symptom profiles could allow for more tailored approaches to predict and prevent long-term negative outcomes.

Variability of the Behavioral Assessment Screening Tool for Mobile Health (BASTmHealth) for ecological momentary assessment in chronic traumatic brain injury

Variability of the Behavioral Assessment Screening Tool for Mobile Health (BASTmHealth) for ecological momentary assessment in chronic traumatic brain injury

18 Nightmares Independently Predict Neurobehavioral Symptoms in Adults with mTBI

Objective:To investigate the informative value of nightmares on neurobehavioral functioning in individuals with mild traumatic brain injury (mTBI) beyond general sleep disturbance.Participants and Methods:A sample of 146 adults with mTBI (mean age = 45.1±16.0), recruited from a specialized concussion treatment center, underwent an assessment of neurobehavioral functioning using the Behavioral Assessment Screening Tool (BAST), self-reported habitual sleep disturbance and quality (via the Pittsburgh Sleep Quality Index; PSQI), and reported nightmare frequency in the past two weeks.Results:Nightmare frequency was the strongest predictor of negative affect (ß = .362, p &lt;.001), anxiety (ß = .332, p &lt;.001), and impulsivity (ß = .270, p &lt;.001) after controlling for sex and age. Sleep disturbance accounted for the greatest variance in depression (ß = .493, p &lt;.001), burden from concussion (ß = .477, p &lt;.001), and fatigue (ß = .449, p &lt;.001) after controlling for sex and age.Conclusions:Nightmares independently associate with neurobehavioral symptoms and likely have differential etiology from reported sleep disturbance. Nightmare frequency was more strongly related to positive neurobehavioral symptoms (i.e., added factors that impact functioning, e.g., anxiety), while general sleep disturbance was associated with negative neurobehavioral symptoms (i.e., factors taken away that impact functioning, e.g., lack of energy). Our findings suggest that neuropsychological evaluations of individuals with mTBI should assess for sleep disturbance and nightmare frequency as risk factors for neurobehavioral barriers to functioning.

Rasch Analysis of the Behavioral Assessment Screening Tool for Adolescents (BAST-A) in Mild Traumatic Brain Injury

Rasch Analysis of the Behavioral Assessment Screening Tool for Adolescents (BAST-A) in Mild Traumatic Brain Injury

Emotional, Behavioral, and Cognitive Symptom Associations With Community Participation in Chronic Traumatic Brain Injury.

To determine the association between self-reported emotional and cognitive symptoms and participation outcomes in chronic traumatic brain injury (TBI) and to explore the relative contribution of self-reported versus performance-based cognition to participation outcomes. Community. Community-dwelling adults ( n = 135) with a lifetime history of mild to severe TBI. Secondary analysis of a cross-sectional study on neurobehavioral symptoms in chronic TBI. Behavioral Assessment Screening Tool (BAST) (Negative Affect, Fatigue, Executive Dysfunction, Impulsivity, Substance Abuse subscales) measured self-reported neurobehavioral symptoms; Participation Assessment with Recombined Tools (Productivity, Social Relations, and Out and About) measured self-reported participation outcomes; and Brief Test of Adult Cognition by Telephone (BTACT) measured performance-based cognition (Episodic Memory and Executive Function summary scores) in a subsample ( n = 40). The BAST Executive Dysfunction was significantly associated with less frequent participation and had the strongest effect on participation in all participation domains. No other BAST subscales were associated with participation, after adjusting for all subscale scores and age, with the exception of BAST Impulsivity, which was associated with more frequent Social Relationships. Exploratory analysis in the sample including the BTACT revealed that, after accounting for subjective Executive Dysfunction using the BAST, performance-based Executive Function was associated with Productivity and Working Memory was associated with Social Relations, but neither was associated with being Out and About; the BAST Executive Dysfunction remained significant in all models even after including BTACT scores. Self-reported Executive Dysfunction contributed to participation outcomes after mild to severe TBI in community-dwelling adults, whereas self-reported emotional and fatigue symptoms did not. Performance-based cognition measures may capture different variability in participation after injury.

Associations of Nightmares and Sleep Disturbance With Neurobehavioral Symptoms Postconcussion.

This study investigates the association of nightmares beyond general sleep disturbance on neurobehavioral symptoms in adults with mild traumatic brain injury (mTBI). Secondary analysis of a concussion cohort study. One hundred and eleven adults older than 20 years with mTBI were recruited from a specialized concussion treatment center. Behavioral Assessment Screening Tool, Pittsburgh Sleep Quality Index, and self-report of nightmare frequency in the past 2 weeks. Among adults with mTBI, nightmares accounted for the greatest amount of variability in negative affect (β = .362, P < .001), anxiety (β = .332, P < .001), and impulsivity (β = .270, P < .001) after adjusting for age and sex. Overall sleep disturbance had the strongest association with depression (β = .493, P < .001), fatigue (β = .449, P < .001), self-reported executive dysfunction (β = .376, P < .001), and overall burden from concussive symptoms (β = .477, P < .001). Nightmares and sleep disturbance are differentially associated with variance in neurobehavioral symptoms. Nightmares were independently associated with neurobehavioral symptoms representing an excess of normal functioning (eg, anxiety, impulsivity), while general sleep disturbance was associated with neurobehavioral symptoms representing functioning below normal levels (eg, depression, fatigue, self-reported executive dysfunction). Clinical and research implications are discussed.

Rasch Analysis of the Behavioral Assessment Screening Tool for Adolescents with Mild Traumatic Brain Injury

<h3>Research Objectives</h3> To provide psychometric evidence for the Behavioral Assessment Screening Tool for Adolescents (BAST-A) using Rasch analysis according to the RULER guidelines. <h3>Design</h3> Measurement Development. <h3>Setting</h3> Community. <h3>Participants</h3> Adolescents ages 12-17 with a documented concussion (n=107). <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> The Behavioral Assessment Screening Tool for Adolescents (BAST-A),3,4 adapted from the BAST for adults,5,6 is a 59-item measure of neurobehavioral functioning. The measure captures severity of symptoms in three domains: Negative Affect and Fatigue, Executive and Social Function, and Risk Behaviors. <h3>Results</h3> Each of the BAST-A subscales met criteria for unidimensionality. There were 5 misfitting items for Negative Affect and Fatigue and 1 misfitting item for both Executive and Social Function and Risk Behaviors. However, upon removal of these items, the average domain measures and standard errors did not improve so the items were retained. Item difficulty (i.e., a measure of symptom severity) also displayed a range across subscales (-1.14 to 2.11 logits). In this sample of adolescents with concussion, less severe symptoms were more commonly endorsed for each of the subscales. However, risk behaviors were endorsed the least. The Executive and Social Function subscale displayed appropriate targeting, but the Negative Affect and Fatigue and Risk Behaviors subscales had higher domain values (-1.06 and -3.38) indicating that more items need to be added to capture different severity levels. <h3>Conclusions</h3> The BAST-A displayed adequate psychometric properties for this sample according to RULER guidelines for the Negative Affect and Fatigue and Executive and Social Function subscales but not the Risk Behaviors subscale. Future work should include adolescents with traumatic brain injury (TBI) of various severity levels and causes of injury as this sample consisted of mostly sports concussion. <h3>Author(s) Disclosures</h3> The authors report no conflicts of interest.

The Behavioral Assessment Screening Tool for Mobile Health (BASTmHealth): Development and Compliance in 2 Weeks of Daily Reporting in Chronic Traumatic Brain Injury

ObjectivesTo develop and evaluate the feasibility of a short form of the Behavioral Assessment Screening Tool (BASTmHealth) for high frequency in situ self-reported assessment of neurobehavioral symptoms using mobile health technology for community-dwelling adults with traumatic brain injury (TBI). DesignProspective, repeated-measures study of mHealth assessment of self-reported neurobehavioral symptoms in adults with and without a lifetime history of TBI over a 2-week period. SettingCommunity. ParticipantsCommunity-dwelling adults with (n=52) and without (n=12) a lifetime TBI history consented to the study (N=64). InterventionsNot applicable. Main Outcome MeasuresBASTmHealth subscales (2-items each): negative affect, fatigue, executive function, substance abuse, impulsivity; feasibility measured via compliance (assessments assigned/assessments completed) and participant-reported usability. ResultsWe developed the 10-item BASTmHealth as a screener for high frequency in situ self-reported assessment of neurobehavioral symptoms leveraging mHealth. Compliance for 2 weeks of BASTmHealth supports its feasibility. Fifty-six of 64 participants (87.5%) who completed baseline assessments completed the 2 weeks of daily assessments; all 8 participants who did not complete ecological momentary assessment had a history of TBI. Overall compliance was 81.4% (496 completed of 609 assigned assessments) among all 52 participants with TBI and 96.7% (494 completed of 511 assigned assessments) among the 44 who completed any daily measures, compared with 91.8% (135 completed of 147 assigned assessments) among those with no TBI history. Participants thought the daily surveys were easy to understand and complete and the number of prompts were reasonable. ConclusionsConducting daily high-frequency in situ self-reported assessment of neurobehavioral symptoms using the BASTmHealth is feasible among individuals with and without a lifetime history of TBI. Developing and evaluating self-reported assessments for community-based assessment is a critical step toward expanding remote clinical monitoring systems to improve post-TBI outcomes.

Neurobehavioral Symptoms and Heart Rate Variability: Feasibility of Remote Collection Using Mobile Health Technology.

To determine the covariance of heart rate variability (HRV) and self-reported neurobehavioral symptoms after traumatic brain injury (TBI) collected using mobile health (mHealth) technology. Community. Adults with lifetime history of TBI (n = 52) and adults with no history of brain injury (n = 12). Two-week prospective ecological momentary assessment study. Behavioral Assessment Screening Tool (BASTmHealth) subscales (Negative Affect, Fatigue, Executive Dysfunction, Substance Abuse, and Impulsivity) measured frequency of neurobehavioral symptoms via a RedCap link sent by text message. Resting HRV (root mean square of successive R-R interval differences) was measured for 5 minutes every morning upon waking using a commercially available heart rate monitor (Polar H10, paired with Elite HRV app). Data for n = 48 (n = 38 with TBI; n = 10 without TBI) participants were included in covariance analyses, with average cross-correlation coefficients (0-day lag) varying greatly across participants. We found that the presence and direction of the relationship between HRV and neurobehavioral symptoms varied from person to person. Cross-correlation coefficients r ≤ -0.30, observed in 27.1% to 29.2% of participants for Negative Affect, Executive Dysfunction, and Fatigue, 22.9% of participants for Impulsivity, and only 10.4% of participants for Substance Abuse, supported our hypothesis that lower HRV would covary with more frequent symptoms. However, we also found 2.0% to 20.8% of participants had positive cross-correlations (r ≥ 0.30) across all subscales, indicating that higher HRV may sometimes correlate with more neurobehavioral symptoms, and 54.2% to 87.5% had no significant cross-correlations. It is generally feasible for community-dwelling adults with and without TBI to use a commercially available wearable device to capture daily HRV measures and to complete a short, electronic self-reported neurobehavioral symptom measure for a 2-week period. The covariance of HRV and neurobehavioral symptoms over time suggests that HRV could be used as a relevant physiological biomarker of neurobehavioral symptoms, though how it would be interpreted and used in practice would vary on a person-by-person and symptom domain basis and requires further study.

Rasch Analysis of the Behavioral Assessment Screening Tool

<h3>Research Objectives</h3> To perform a Rasch Analysis of the Behavioral Assessment Screening Tool (BAST) following the Rasch Reporting Guidelines in Rehabilitation Research (RULER) framework. <h3>Design</h3> Cross-sectional psychometric study. <h3>Setting</h3> Community. <h3>Participants</h3> A total of n=135 adult participants with a history of mild to severe TBI. <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> The BAST is an established multidimensional measure of neurobehavioral symptoms with five subscales: Negative Affect, Fatigue, Executive Function, Impulsivity, and Substance Abuse. We assessed all subscales, except substance abuse (due to need for further development of this subscale), using the RULER framework. <h3>Results</h3> The BAST subscales all met the assumption of unidimensionality, with only one item from the Impulsivity scale displaying item misfit (MnSQ=1.40). Upon removing this item, we found a lower average domain measure (1.42 to -1.49) and larger standard error (0.34 to 0.43) so we retained the item. Items for each of the four subscales ranged in difficulty (i.e. endorsement of symptom frequency) with more severe symptoms endorsed in the Fatigue subscale and milder symptoms endorsed in the Impulsivity subscale. Though Negative Affect and Executive Function displayed appropriate targeting, the Fatigue and Impulsivity Subscales had larger average domain values (1.35 and -1.42) meaning that more items may need to be added to these subscales to capture differences across a wider range of symptom severity. <h3>Conclusions</h3> Overall, the BAST displayed excellent item and person separation indices and distinct strata for each of the four subscales assessed. Future work should examine the BAST using Rasch analysis in a larger, more representative sample, include more items for the Fatigue and Impulsivity subscale, and include the Substance Abuse subscale. <h3>Author(s) Disclosures</h3> All authors report no conflicts.

Injury-Related and Personal Predictors of Persistent Neurobehavioral Symptoms in Adults with mTBI

Research Objectives To determine predictors of persistent neurobehavioral symptoms1 in adults with mild traumatic brain injury (mTBI)/concussion. Design Cohort Study. Setting Concussion clinic. Participants Adults with concussion (n=146; n=90 (61.6%) women). Interventions Not Applicable. Main Outcome Measures Behavioral Assessment Screening Tool (BAST): measures frequency of neurobehavioral symptoms (1=never to 5=very often) in five domains at 3-months post-baseline: Negative Affect, Fatigue, Executive Function, Impulsivity, and Substance Abuse.2-5 Baseline factors included as independent variables in all predictive models were: previous head injury (Y/N), loss of consciousness (LOC) (Y/N), preinjury psychiatric diagnosis (Y/N), time since injury, and age at first concussion. Results We conducted five linear regressions (one for each BAST subscale). Models were significant for Negative Affect (R2Adj =.148, p < .001), Fatigue (R2Adj =.068, p =.012), and Executive Function (R2Adj =.090, p = .003). However, the model was not significant for Impulsivity (R2Adj =.024, p = .139) or Substance Abuse (R2Adj = -.010, p = .600). Impulsivity and Substance Abuse were both reported less frequently (M=1.76, SD=0.63 and M=1.13, SD=0.32, respectively) in this sample compared to Negative Affect (M=2.66, SD=0.73), Fatigue (M=2.96, SD=0.85), and Executive Function (M=2.09, SD=0.55). Preinjury psychiatric diagnoses (β=.307, p < .001) and age at first concussion (β=-.249, p=.005) were the strongest predictors of Negative Affect. Preinjury psychiatric diagnoses (β=.204, p=.015) and time since injury (β=.224, p=.009) were the strongest predictors of Fatigue. Age at first concussion (β=-.317, p=.001) was the strongest predictor of Executive Function. Conclusions Our research indicates that personal and injury-related factors are associated with persistent affective, fatigue, and cognitive symptoms, but not impulsivity or substance abuse. Identifying those at risk for persistent symptoms after mTBI/concussion at the time of their initial clinic visit could inform risk-stratified clinical surveillance and treatment planning. Author(s) Disclosures The authors report no conflicts of interest. To determine predictors of persistent neurobehavioral symptoms1 in adults with mild traumatic brain injury (mTBI)/concussion. Cohort Study. Concussion clinic. Adults with concussion (n=146; n=90 (61.6%) women). Not Applicable. Behavioral Assessment Screening Tool (BAST): measures frequency of neurobehavioral symptoms (1=never to 5=very often) in five domains at 3-months post-baseline: Negative Affect, Fatigue, Executive Function, Impulsivity, and Substance Abuse.2-5 Baseline factors included as independent variables in all predictive models were: previous head injury (Y/N), loss of consciousness (LOC) (Y/N), preinjury psychiatric diagnosis (Y/N), time since injury, and age at first concussion. We conducted five linear regressions (one for each BAST subscale). Models were significant for Negative Affect (R2Adj =.148, p < .001), Fatigue (R2Adj =.068, p =.012), and Executive Function (R2Adj =.090, p = .003). However, the model was not significant for Impulsivity (R2Adj =.024, p = .139) or Substance Abuse (R2Adj = -.010, p = .600). Impulsivity and Substance Abuse were both reported less frequently (M=1.76, SD=0.63 and M=1.13, SD=0.32, respectively) in this sample compared to Negative Affect (M=2.66, SD=0.73), Fatigue (M=2.96, SD=0.85), and Executive Function (M=2.09, SD=0.55). Preinjury psychiatric diagnoses (β=.307, p < .001) and age at first concussion (β=-.249, p=.005) were the strongest predictors of Negative Affect. Preinjury psychiatric diagnoses (β=.204, p=.015) and time since injury (β=.224, p=.009) were the strongest predictors of Fatigue. Age at first concussion (β=-.317, p=.001) was the strongest predictor of Executive Function. Our research indicates that personal and injury-related factors are associated with persistent affective, fatigue, and cognitive symptoms, but not impulsivity or substance abuse. Identifying those at risk for persistent symptoms after mTBI/concussion at the time of their initial clinic visit could inform risk-stratified clinical surveillance and treatment planning.

Differences in Coping Strategies Between Women and Men Based on Experience of Frequent Pain/Headaches in Chronic Traumatic Brain Injury

<h3>Research Objectives</h3> To identify gender differences in coping strategies by experience of pain/headaches in chronic traumatic brain injury (TBI). <h3>Design</h3> Cross-sectional study. <h3>Setting</h3> Community. <h3>Participants</h3> n=133 adults with chronic mild-severe TBI (M=7.5 years post-injury). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Behavioral Assessment Screening Tool (BAST) coping items: two adaptive (asking someone I trust for help, going for a walk/exercising) and four avoidant (bought things I didn't need, took my emotions out on other people, unable to make decisions, went to sleep) rated on a 1=never to 5=very often ordinal scale. <h3>Results</h3> Two-thirds of women (52/78), 45% of men (23/54), and one individual (100%) identifying as transgender reported experiencing frequent pain/headaches. Almost all participants (n=130, 97.7%) felt stressed over the past two weeks. When stressed, men without pain (n=31) exercised/walked (M=3.14, SD=1.6) more often than men with pain (M=2.39, SD=1.03, p=.024) and women without pain (M=2.46, SD=1.25, p=.037). Women with pain engaged more frequently in maladaptive coping strategies (M=2.58-3.17) than women without pain (M=2.08-2.71). Women with pain bought things they did not need more often than all others (p's=.019- < .001) and went to sleep significantly more often than men with pain (p=.029) and women without pain (p=.003). <h3>Conclusions</h3> Individuals with chronic TBI frequently report feeling stressed, and many - particularly women - report experiencing frequent pain/headaches. Women experiencing pain/headaches after TBI engage in maladaptive coping more often than women without pain/headaches or men regardless of pain experience. However, they also walk/exercise to manage stress more than women without pain or men with pain, suggesting that women experiencing pain/headaches after chronic TBI may use more coping strategies - including both adaptive and maladaptive strategies - overall to manage their stress. Providers should emphasize the benefits of physical activity and social support after TBI. <h3>Author(s) Disclosures</h3> This work was supported by funding from the National Institutes for Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NIH/NICHD). Grant #: R03HD09445 (PI: Juengst).

Compliance Using Mobile Health Heart Rate Variability and Ecological Momentary Assessment Tools in a Chronic Traumatic Brain Injury Sample

<h3>Research Objectives</h3> To assess compliance with repeated heart rate variability (HRV) and ecological momentary assessments (EMA) via mobile questionnaires and a smartphone application over a two-week period. <h3>Design</h3> Repeated measures design. <h3>Setting</h3> Community. <h3>Participants</h3> Adults with a self-reported history of TBI (n=52; n=12 mild TBI [mTBI] without loss of consciousness [LOC], n=22 mTBI with LOC, n=18 moderate-to-severe TBI). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Measures of compliance (total number of completed assessments divided by number of scheduled assessments) for HRV and EMA. Participants instructed to complete HRV measures twice daily for 14 days. EMA conducted using the Behavioral Assessment Screening Tool Short Form (BAST-SF). Participants randomized to one of three study arms (Arm 1: BAST-SF sent every day at a scheduled time; Arm 2: BAST-SF sent every day at a random time; Arm 3: BAST-SF sent every other day at a scheduled time). <h3>Results</h3> Compliance with EMA calculated among all participants and within each study arm (n=17 in Arm 1, n=18 in Arm 2, n=17 in Arm 3). Participants completed 496 of 609 scheduled assessments (81.4%). For "completers" (completed >2 daily measures; n=44), participants completed 494 of 511 scheduled assessments (96.7%). Among all participants and completers, those in Arm 1 demonstrated the least compliance (79.4% and 89.0%), while those in Arm 3 demonstrated the most compliance (86.6% and 98.1%). Compliance with HRV measures calculated among all participants and by injury severity. Participants completed 1055 of 1456 scheduled HRV measures (72.5%). For "completers" (completed ≥ 1 HRV measure; n=44), participants completed 1055 of 1232 scheduled HRV measures (85.6%). Among all participants and completers, those with a mTBI with LOC demonstrated the least compliance (55.8% and 81.9%). Those with a moderate-to-severe TBI (among all participants) and those with a mTBI without LOC (among completers) demonstrated the most compliance (84.9% and 91.9%). <h3>Conclusions</h3> HRV and EMA via smartphone demonstrates initial feasibility and compliance among adults with TBI. This presents an opportunity for long-term monitoring and pairing of neurobehavioral and physiological symptom post-TBI, potentially leading to more personalized clinical interventions. <h3>Author(s) Disclosures</h3> NIH/NICHD R03HD094445.

Rasch analysis of the Behavioral Assessment Screening Tool (BAST) in chronic traumatic brain injury.

The Behavioral Assessment Screening Tool (BAST) measures neurobehavioral symptoms in adults with traumatic brain injury (TBI). Exploratory Factor Analyses established five subscales: Negative Affect, Fatigue, Executive Function, Impulsivity, and Substance Abuse. In the current study, we assessed all the subscales except Substance Abuse using Rasch analysis following the Rasch Reporting Guidelines in Rehabilitation Research (RULER) framework. RULER identifies unidimensionality and fit statistics, item hierarchies, targeting, and symptom severity strata as areas of interest for Rasch analysis. The BAST displayed good unidimensionality with only one item from the Impulsivity scale exhibiting potential item misfit (MnSQ 1.40). However, removing this item resulted in a lower average domain measure (1.42 to -1.49) and higher standard error (0.34 to 0.43) so the item was retained. Items for each of the four subscales also ranged in difficulty (i.e. endorsement of symptom frequency) with more severe symptoms being endorsed in the Fatigue subscale and more mild symptoms being endorsed in the Impulsivity subscale. Though Negative Affect and Executive Function displayed appropriate targeting, the Fatigue and Impulsivity Subscales had larger average domain values (1.35 and -1.42) meaning that more items may need to be added to these subscales to capture differences across a wider range of symptom severity. The BAST displayed excellent reliability via item and person separation indices and distinct strata for each of the four subscales. Future work should use Rasch analysis in a larger, more representative sample, include more items for the Fatigue and Impulsivity subscale, and include the Substance Abuse subscale.

Psychometric analysis of the behavioral assessment screening tool (BAST) in adults with stroke

ABSTRACT Purpose The purpose of this study was to examine the initial psychometric properties of the Behavioral Assessment Screening Tool (BAST), a self-reported measure of neurobehavioral symptoms, in adults with stroke. Methods We assessed subscale and item-level reliabilities of the five BAST subscales in 75 community-dwelling adults with stroke. We further assessed the known-groups validity of the BAST to differentiate individuals with and without self-reported lifetime stroke history (n = 47 with stroke and n = 1843 neurologically healthy controls). Results Cronbach’s alpha coefficients of all subscales were >0.7, demonstrating acceptable to good internal consistency reliabilities, and corrected item-total correlations were all >.30 demonstrating good item-level reliabilities. ROC curves demonstrated strong known-groups validity of the negative affect, executive function, and fatigue subscales for classifying stroke versus healthy controls (AUC = .669-.758, p < .001). Conclusion The BAST demonstrates good initial psychometric properties as a screening tool to identify neurobehavioral symptoms in community-dwelling adults with stroke. Future work will add stroke-specific items, further assess the validity of the BAST, and employ item response theory or Rasch analyses to identify highly discriminative items for potential smart device-based ecological momentary assessments.

Associations between frequent pain or headaches and neurobehavioral symptoms by gender and TBI severity

ABSTRACT Objective: To investigate differences in frequent pain or headaches and associated neurobehavioral symptoms among men, women, and transgender individuals with and without a history of traumatic brain injury (TBI). Setting: Community Participants: English and Spanish-speaking adults (n = 2,862) with and without self-reported TBI Design: Cross-sectional study Main Measures: Behavioral Assessment Screening Tool (BAST) subscales for Negative Affect, Substance Abuse, Executive Function, Fatigue, Impulsivity, and one item for experiencing “frequent pain or headache.” Results: Women reported more pain than men. Women with a mild TBI (mTBI) more often reported frequent headaches/pain than woman in general or those with mTBI alone. Women reporting frequent headache/pain reported more negative affect and fatigue than men with comparable TBI history. Individuals identifying as transgender/other without TBI had higher negative affect and fatigue than both men and women without TBI. Individuals with mTBI and frequent headache/pain reported more executive function problems than those with mTBI without headache/pain. Pain and moderate/severe TBI were associated with more executive function problems in men and women, but more so for women. Conclusion: Results suggest frequent headache/pain may differ between genders, particularly after mTBI. Pain, fatigue, executive function, and negative affect may be especially important in women’s recovery from TBI.

Factor analysis of the adolescent version of the behavioural assessment screening tool (BAST-A) in adolescents with concussion

ABSTRACT Objective: Develop and validate the Behavioral Assessment Screening Tool for Adolescents with brain injury. Setting: Concussion clinics Participants: Adolescents with mild traumatic brain injury 3 months after initial concussion clinic visit (n = 138). Design: Assessment development and validation (cross-sectional cohort) study Main Measures: Behavioral Assessment Screening Tool – Adolescent Results: Expert panel members added or modified items specific to adolescents to the original Behavioral Assessment Screening Tool for adults. The Content Validity Index was 97.2%. Exploratory factor analysis of the Behavioral Assessment Screening Tool – Adolescent reduced the initial 70 items to 46 primary items with a 3-factor solution: Negative Affect & Fatigue, Executive & Social Function, and Risk Behaviors. Internal consistency reliabilities ranged from good to excellent for all factors (Cronbach’s α =.80-.95). We retained four secondary maladaptive coping items (from an initial six), though these require further modification and testing (Cronbach’s α =.67). Conclusion: The Behavioral Assessment Screening Tool for Adolescents, a measure of neurobehavioral symptoms after mild traumatic brain injury in adolescents, has a multidimensional factor structure with evidence of good internal consistency reliabilities. Future work will further evaluate its convergent and discriminant validity and employ item response theory analyses for validation in a new sample of adolescents with concussion.

Neurobehavioral symptoms by gender and experience of nightmares after traumatic brain injury.

The purpose of this study is to assess how neurobehavioral symptoms following traumatic brain injury (TBI) may differ based on gender and the experience of nightmares. Research Method/Design: This cross-sectional study of community-dwelling adults ≥ 3 months post-TBI (n = 110) assessed differences in neurobehavioral symptoms between women (n = 41) and men (n = 69) by experience of nightmares. Outcome measures included the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Behavioral Assessment Screening Tool subscales for negative affect, substance abuse, executive functioning, fatigue, impulsivity, and maladaptive coping. N = 22 participants (n = 7 women, n = 15 men) experienced nightmares at least "sometimes" over the past 2 weeks. Nightmares were associated with more substance abuse, negative affect, fatigue, maladaptive coping, depressive symptoms, and anxiety symptoms (ps < .02). Women reported more negative affect, maladaptive coping, depressive symptoms, and anxiety symptoms (ps < .05) than men. Men experiencing nightmares reported more substance use than men without nightmares (p = .036), a difference not seen in women (p = .233). Women experiencing nightmares reported more impulsivity than women without nightmares (p = .028), a difference not seen in men (p = .559). Nightmares, post-TBI, are associated with more neurobehavioral symptoms. However, symptom patterns associated with nightmares may differ by gender. Nightmares may be a symptom of, or contribute to, sleep disruptions post-TBI or may indicate other conditions, like posttraumatic stress disorder. Future research should examine gender differences in neurobehavioral symptoms post-TBI in the context of nightmares and/or sleep disorders. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Cohort Differences in Neurobehavioral Symptoms in Chronic Mild to Severe Traumatic Brain Injury.

Our understanding of neurobehavioral symptoms after traumatic brain injury (TBI) largely relies on data gathered in studies conducted at academic medical centers or large clinical centers with research infrastructure. Though this often provides a well-characterized clinical sample, it may also introduce bias based on geographic locations served by these institutions and personal factors associated with patient access to these institutions. We collected neurobehavioral symptoms via the self-reported Behavioral Assessment Screening Tool (BAST) in a National TBI Cohort (n = 263) and a Medical Center TBI Cohort (n = 218) of English-speaking community-dwelling adults with chronic TBI. The primary focus of the present study was to compare demographics and neurobehavioral symptom reporting across the two cohorts and to discuss the implications of any such differences on interpretation of symptom scores. Across all BAST subscales (Negative Affect, Fatigue, Executive Function, Impulsivity, and Substance Abuse), participants in the National TBI Cohort reported significantly more frequent symptoms than those in the Medical Center TBI Cohort (p's < 0.001). Participants in the National TBI Cohort were more likely to be non-White and Hispanic compared to the Medical Center TBI Cohort, and those with mild TBI in the National TBI Cohort were more likely to have less than a high school education than those with mild TBI in the Medical Center TBI Cohort. Individuals with TBI recruited through academic and clinical institutions may not be representative of individuals with TBI living across the United States.

Neurobehavioral Symptoms in Community-Dwelling Adults With and Without Chronic Traumatic Brain Injury: Differences by Age, Gender, Education, and Health Condition.

Neurobehavioral symptoms after Traumatic Brain Injury (TBI) are prevalent, persist for many years, and negatively affect long-term health, function, and quality of life. Symptoms may differ based on age, gender, education, race, ethnicity, and injury severity. To better understand neurobehavioral functioning after TBI, we need a comprehensive picture of emotional, cognitive, and behavioral symptoms in the context of personal factors that may affect these symptoms. We also need to understand the extent to which these symptoms are specific to TBI, shared across other neurological conditions, or attributable to factors outside of the injury itself. We collected neurobehavioral symptoms via the self-reported Behavioral Assessment Screening Tool (BAST) in a National Cohort of English (n = 2,511) and Spanish speaking (n = 350) community-dwelling adults with and without chronic TBI and other neurological and mental health conditions. The primary focus of the present study was to comprehensively describe neurobehavioral symptoms in adults with and without TBI, broken down by gender and health conditions and then further by age group or educational attainment. As expected, participants with TBI reported more symptoms than Healthy Controls. Regardless of condition, women reported more fatigue, while men reported more substance abuse and impulsivity. Hispanic participants reported more neurobehavioral symptoms than non-Hispanic participants did across health conditions, though primarily Spanish-speakers reported fewer symptoms than English-speakers, suggesting that level of acculturation may contribute to symptom reporting. These data provide a comprehensive characterization of neurobehavioral symptoms in adults with TBI and adults without TBI (healthy controls, adults with other neurological conditions, and adults with mental health conditions).