Conners Continuous Performance Test Research Articles

A Novel Method to Measure Transient Impairments in Cognitive Function During Acute Bouts of Hypoxia.

INTRODUCTION: Exposure to low oxygen environments (hypoxia) can impair cognitive function; however, the time-course of the transient changes in cognitive function is unknown. In this study, we assessed cognitive function with a cognitive test before, during, and after exposure to hypoxia.METHODS: Nine participants (28 4 yr, 7 women) completed Conners Continuous Performance Test (CCPT-II) during three sequential conditions: 1) baseline breathing room air (fraction of inspired oxygen, FIo₂ 0.21); 2) acute hypoxia (FIo₂ 0.118); and 3) recovery after exposure to hypoxia. End-tidal gas concentrations (waveform capnography), heart rate (electrocardiography), frontal lobe tissue oxygenation (near infrared spectroscopy), and mean arterial pressure (finger photoplethysmography) were continuously assessed.RESULTS: Relative to baseline, during the hypoxia trial end-tidal (-30%) and cerebral (-9%) oxygen saturations were reduced. Additionally, the number of commission errors during the CCPT-II was greater during hypoxia trials than baseline trials (2.6 0.4 vs. 1.9 0.4 errors per block of CCPT-II). However, the reaction time and omission errors did not differ during the hypoxia CCPT-II trials compared to baseline CCPT-II trials. During the recovery CCPT-II trials, physiological indices of tissue hypoxia all returned to baseline values and number of commission errors during the recovery CCPT-II trials was not different from baseline CCPT-II trials.DISCUSSION: Oxygen concentrations were reduced (systemically and within the frontal lobe) and commission errors were increased during hypoxia compared to baseline. These data suggest that frontal lobe hypoxia may contribute to transient impairments in cognitive function during short exposures to hypoxia.Uchida K, Baker SE, Wiggins CC, Senefeld JW, Shepherd JRA, Trenerry MR, Buchholtz ZA, Clifton HR, Holmes DR, Joyner MJ, Curry TB. A novel method to measure transient impairments in cognitive function during acute bouts of hypoxia. Aerosp Med Hum Perform. 2020; 91(11):839844.

Do shorter inter-stimulus intervals in the go/no-go task enable better assessment of response inhibition?

Young, Sutherland, and McCoy indicated that a Go/No‐Go Task (GNG) becomes more difficult as the inter‐stimulus intervals (ISIs) becomes shorter. However, is the number of commission errors under extremely short ISIs a useful metric for assessing response inhibition? This study challenges the assumption that a shorter ISI in the GNG enables better assessment of response inhibition. University students (N = 213) completed the GNG, the Conners Continuous Performance Test 3rd Edition (CCPT), and the Modified Stroop Task. The GNG comprised four blocks of 400, 600, 800, and 1000 ms ISIs, whereas the stimulus presentation was fixed at 250 ms. Consistent with Young et al., shorter ISIs in the GNG resulted in more commission errors. In the block with the shortest ISI, participants also failed more frequently in responses in go trials than in the other blocks, which appears to increase in error variance of commission errors. Consistent with this interpretation, the association between the number of commission errors in the block with 400 ms ISI and CCPT performance was weaker than those between the number of commission errors in other blocks and CCPT performance. It is concluded that using the number of commission errors in the condition with extremely short ISIs in the GNG might be inappropriate for assessing response inhibition.

Patterns of Regional Cerebral Blood Flow as a Function of Obesity in Adults.

Background:While obesity has been shown to be a risk factor for Alzheimer’s disease, the potential mechanisms underlying this risk may be clarified with better understanding of underlying physiology in obese persons.Objective:To identify patterns of cerebral perfusion abnormality in adults as a function of body mass index (BMI) defined weight categories, including overweight or obese status.Methods:A large psychiatric cohort of 35,442 brain scans across 17,721 adults (mean age 40.8±16.2 years, range 18–94 years) were imaged with SPECT during baseline and concentration scans, the latter done after each participant completed the Connors Continuous Performance Test II. ANOVA was done to identify patterns of perfusion abnormality in this cohort across BMI designations of underweight (BMI < 18.5), normal weight (BMI = 18.5 to 24.9), overweight (BMI 24.9 to 29.9), obesity (BMI≥30), and morbid obesity (BMI≥40). This analysis was done for 128 brain regions quantifying SPECT perfusion using the automated anatomical labeling (AAL) atlas.Results:Across adulthood, higher BMI correlated with decreased perfusion on both resting and concentration brain SPECT scans. These are seen in virtually all brain regions, including those influenced by AD pathology such as the hippocampus.Conclusion:Greater BMI is associated with cerebral perfusion decreases in both resting and concentration SPECT scans across adulthood.

A-045 Sluggish Cognitive Tempo in Youth: An Examination of Executive Functioning and Self-Reported Internalizing Symptoms

Abstract Objective Sluggish cognitive tempo (SCT) is a group of attention-related symptoms that are characterized by slowed behavior and thinking, excessive daydreaming, mental confusion or fogginess, and drowsiness.4 Studies have shown that SCT is related to higher rates of anxiety, depression, and social isolation.4 Additionally, recent publications have indicated that aspects of executive functioning (EF) may be impacted in children with SCT.2,5 Meta-analysis confirmed that most SCT research has focused on parent and teacher report.1,3,4 There is an increased need for studies examining SCT with self-report.5 This study will examine how SCT is related to EF and self-reported internalizing symptoms in youth with Attention-Deficit/Hyperactivity Disorder (ADHD). Method Participants were youth aged 8 to 18-years with ADHD (N = 130) referred for neuropsychological testing. Participant demographics: males (N = 82, 63.1%). Measures included the Wechsler Intelligence Scale for Children/Wechsler Adult Intelligence Scale (WISC-V/WAIS-IV) Processing Speed Index (PSI), Conners Continuous Performance Test (CPT) Hit Reaction Time (HRT), Delis-Kaplan Executive Function System Color Word Identification (CWI) and Tower subtests, Behavior Assessment Systems for Children (BASC) self-report scales, and Personality Assessment Inventory-Adolescent (PAI-A) scales. Results Bivariate correlations showed that the PSI was significantly correlated with CWI Inhibition (r = 0.52, p &amp;lt; .01), CWI Inhibition/Switching (r = 0.53, p &amp;lt; .01), Tower (r = −0.20, p &amp;lt; .05), and Social Isolation (r = −0.19, p &amp;lt; .05), with Depression approaching significance (p = .06). The CPT HRT was also significantly correlated with CWI Inhibition (r = −0.19, p &amp;lt; .05) and CWI Inhibition/Switching (r = −0.22, p &amp;lt; .05), with Depression approaching significance (p = .05). Conclusions SCT is associated with EF and self-reported internalizing symptoms and should be included when considering interventions.

A-159 Effects of Sleep and Mood on Attentional Functioning in Pediatric Cancer Survivors

Abstract Objective Sleep-related problems have been shown to adversely affect pediatric cancer survivors’ mood, behavior, and quality of life (Litsenburg et al., 2011). Depressed mood also contributes to decreased quality of life in pediatric leukemia survivors (Jankowska-Polańska et al., 2019). However, minimal research has considered how sleep and mood affect cognitive outcomes in pediatric cancer survivors. The present study utilized both direct assessment and parent report to investigate how sleep and mood affect attentional functioning in this population. Method Parents of 54 pediatric cancer survivors (59% Caucasian, 44% female, mean age at testing = 11.27 years) referred for clinical evaluation completed the Behavior Assessment System for Children-3 (BASC-3) and Patient-Reported Outcomes Measurement Information System (PROMIS). A subset of survivors also completed the Conners Continuous Performance Test-3 (CPT-3). Variables selected for analysis were BASC-3 Depression, Hyperactivity, Attention Problems; PROMIS Sleep Impairment, Fatigue; CPT-3 Omissions. Results Multiple linear regressions found that patients whose parents rated them higher on Depression and Sleep Impairment demonstrated more Omission errors (ΔR2 = .265, ΔF[4,42] = 3.785, p = .01). Similarly, multiple linear regressions found that parents who rated their children higher on Depression, Fatigue, and Sleep Impairment were more likely to rate their children high on Hyperactivity (ΔR2 = .182, ΔF[4,49] = 2.725, p &amp;lt; .05). Higher Depression ratings also predicted ratings of worse Attention Problems (r[53] = .330, p = .007). Conclusions Findings suggest that both depressive symptoms and sleep impairment may adversely affect attention functioning following pediatric cancer treatment. This highlights the importance of addressing mood and sleep in interventions to address attention difficulties in pediatric oncology survivors. Future directions for research are discussed.

Attention and Functional Connectivity Among Patients With Early-Stage Subcortical Ischemic Vascular Disease and Alzheimer's Disease.

The current study compared attention profiles and functional connectivity of frontal regions in patients with early-stage subcortical ischemic vascular disease (SIVD) and Alzheimer’s disease (AD). Twenty patients with SIVD, 32 patients with AD, and 23 subjects with normal cognition (NC) received cognition and resting-state functional MRI (rs-fMRI) evaluations. The Cognitive Abilities Screening Instrument (CASI) was used to assess global cognition, and simple attention, processing speed, divided attention, and vigilance/sustained attention were evaluated using the Digit Span Forward, Trail Making Test, Symbol Digit Modality Test, and Conners Continuous Performance Test, respectively. Voxel-based regional homogeneity (ReHo) derived from rs-fMRI data was analyzed to identify significant clusters, which were further correlated with attention profiles. Although the patients with SIVD and AD had comparable global cognitive ability, those with SIVD exhibited worse divided attention and vigilance/sustained attention than those with AD. Compared with the NC group, the patients with SIVD exhibited decreased ReHo within the right middle frontal gyrus (MFG) and left anterior cingulate gyrus (ACG), whereas the patients with AD exhibited increased ReHo within the right orbital part of frontal regions. Correlations between these three clusters with attention exhibited distinct patterns according to the dementia subtype, as did attention indices with significance in predicting global cognition. In summary, our study suggested that worse attention performance was associated with functional disconnection within the frontal regions among patients with SIVD than in those with AD. Frontal functional disconnection may underlie the pathogenesis responsible for defective divided attention, vigilance/sustained attention, and notable within-group variations identified in SIVD.

Examining embedded validity indicators in Conners continuous performance test-3 (CPT-3)

Objective Prior research has identified a variety of embedded performance validity indicators on the Conners’ Continuous Performance Test-II (CPT-II). The purpose of this study was to examine embedded validity indicators within the updated third edition of the Conners Continuous Performance Test (CPT-3). Method This study used a retrospective chart review from an ADHD evaluation clinic at a Mid-Atlantic VA hospital. Participants were 197 military veterans who completed a clinical assessment for ADHD. All participants were consecutive referrals to the ADHD clinic who completed the CPT-3 and the Test of Memory Malingering, Trial 1 (TOMM1). Results Logistic regression analyses indicated that the following five variables were able to significantly predict validity status on the TOMM1: detectability (d’), omissions (OMI), commissions (COM), hit reaction time (HRT) standard deviation (SD), and HRT inter-stimulus interval (ISI) change. Among these measures, HRT SD and HRT ISI change were identified as the scores with the highest AUC values. Optimal cutoffs for all significant predictors were identified. A number of composite EVIs were created using various combinations of CPT-3 scores. All composite EVIs significantly differentiated between pass and fail status on the TOMM1. Conclusions Several CPT-3 variables have clinical utility as embedded validity indicators; however, due to low sensitivity, they should not be used in isolation. These scores may be used as indicators of invalid performance but should not be used to rule out invalid performance. Identified CPT-3 scores may be useful as one component in a multivariate, multi-point continuous approach to performance validity sampling.

Neuropsychological Outcomes of Exposure to Hurricane Katrina and Relocation.

Survivors of natural disasters are at risk for mental health sequela, including deficits in neurocognitive functioning. This study explores links between hurricane exposure and resulting psychiatric symptoms and deficits in cognitive processing, attention, learning, and memory. Relocated Katrina survivors and demographically matched controls completed neurocognitive tests assessing processing speed (Trail Making Test, Part A), mental flexibility (Trail Making Test, Part B), sustained attention (Conner's Continuous Performance Test), and learning and memory (Rey Auditory-Verbal Learning Test). PTSD (Clinician-Administered PTSD Scale) and depressive symptoms (BDI- II) were also measured. Survivors had more PTSD and depression symptoms and weaker performance in cognitive processing, mental flexibility, and sustained attention, but not memory and learning compared to controls. When controlling for depression and PTSD symptoms (analysis of covariances), only CPT-II response time remained significantly different for survivors, so that sustained attention deficits were independent of emotional symptoms. Survivors had more psychiatric symptoms and neurocognitive dysfunctions than controls in most assessed measures. Our study had mixed results in identifying cognitive deficits related to psychopathology. Results suggest that disaster survivors, even those without psychopathology, should be assessed for cognitive issues that may affect their ability to process post-disaster instructions and access assistance in recovery efforts.

Reduced Attention in Former Smokers with and without COPD.

Attention difficulties are often reported by patients with chronic obstructive pulmonary disease (COPD); however, limited research exists using objective tests designed specifically to measure attention in this population. This study aimed to (1) identify specific attention deficits in COPD and (2) determine which demographic/clinical characteristics are associated with reduced attention. Eighty-four former smokers (53 COPD, 31 no COPD) completed questionnaires, pulmonary function testing, and the Conner's Continuous Performance Test II (CPT-II). Participants with and without COPD were compared on CPT-II measures of inattention, impulsivity, and vigilance. CPT-II measures that differed significantly between the two groups were further examined using hierarchical regression modeling. Demographic/clinical characteristics were entered into models with attention as the dependent variable. Participants with COPD performed worse than those without COPD on CPT measures of inattention and impulsivity (i.e., detectability [discrimination of target from non-target stimuli], perseverations [reaction time under 100ms], omissions [target stimuli response failures], and commissions [responses to non-target stimuli]). More severe COPD (measured by greater airflow limitation) was associated with poorer ability to detect targets vs. foils and perseverative responding after adjusting for age and other covariates in the model. Former smokers with COPD experience problems with attention that go beyond slowed processing speed, including aspects of inattention and impulsivity. Clinicians should be aware that greater airflow limitation and older age are associated with attention difficulties, as this may impact functioning.

High Yield of Screening for ADHD in the Epilepsy Monitoring Unit

Objective: ADHD is common in patients with epilepsy, but adult patients with possible epilepsy are not routinely screened for ADHD. We aimed to characterize the results of two validated screening tools in the setting of an Epilepsy Monitoring Unit (EMU). Method: This study utilized the validated Adult ADHD Self-Report Scale version 1.1 (ASRS) and Conners Continuous Performance Test, third edition (CPT-III) to screen patients who were admitted to the EMU at a Level 4 epilepsy center. Patients with epileptic seizures (ES) were compared with patients with psychogenic nonepileptic seizures (PNES). Results: In all, 40.6% of patients screened positive using the ASRS. A significantly greater proportion of patients with PNES (63.6%) screened positive compared with patients with ES (27.8%, Fisher’s exact test, p = .005). Positive ASRS screens showed no significant association with positive CPT screens (chi-square test, p = .146). Conclusion: Adult patients admitted to the EMU are at a high risk of comorbid attention deficits.

Sustained attention and vigilance of children treated for sagittal and metopic craniosynostosis

ABSTRACTAttention problems are common in patients with craniosynostosis. Craniosynostosis is a rare condition, studies face challenges of selection bias, small sample sizes, and wide age ranges. The aim of the study was to assess the sustained attention and vigilance of children treated for sagittal and metopic craniosynostosis. To reduce selection bias, we included children that had previously undergone surgery for craniosynostosis, were between 8 and 16 years, and lived close to the craniofacial centre. The Connors Continuous Performance Test (3rd edition) was used to measure sustained attention and vigilance (n = 61; response rate: 76.3%). Attrition analysis revealed no differences between responding and non-responding groups regarding background variables. One identified difference between the SS (n = 28) and MS (n = 23) groups involved significantly better performance by the SS group in the hit-reaction time (HRT) test relative to the MS group (p < 0.05). Compared with the norms, the SS group showed significantly worse response style, detectability, omissions, commissions, perseverations, HRT response speed (HRT-SD), HRT inter-stimulus interval change (HRT-iC) (p < 0.01 for all), and variability (p < 0.05). The MS group showed significantly worse detectability, HRT-SD, variability (p < 0.01 for all), commissions, perseverations and HRT-iC (p < 0.05 for all) as compared with norms. No differences regarding attention was detected for the two different surgical techniques used for correction of sagittal synostosis. There were shortcomings in sustained attention and vigilance as compared with the norms in the SS and MS groups, although the deviations were small.

Pyrethroid exposure, attention and executive function in 6-year old children from the Infants′ Environmental Health Study (ISA)

OPS 55: Pesticides and neurological outcomes, Room 412, Floor 4, August 26, 2019, 1:30 PM - 3:00 PM Background: Pyrethroid insecticides may impair children’s neurodevelopment but little evidence from prospective studies is available. In Costa Rica, pyrethroids are widely used for vector control. We examined whether prenatal and current pyrethroid exposure was associated with impaired attention and executive function in children from the Infants Environmental Health Study (ISA). Methods: To evaluate attention and executive function, we applied the Conners Continuous Performance Test (CPT-II) and Dimensional Change Card Sort (DCCS in 6-year old children (mean 6.4 ± 0.4 years) (n=268). We obtained repeated urine samples during pregnancy and 5-6 years of age, determined 3-(2,2-dichlorovinyl)-2,2-dimethyl-cyclopropanecarboxylicacid (DCCA) and 3-phenoxybenzoicacid(3-PBA), and summed concentrations of both. We subsequently ran separate linear regression models for log-10 transformed mean prenatal, and mean child metabolite concentrations and CPT-II, and ran separate logistic regression model for DCCS. We adjusted a priori for child age, child sex, HOME score, and maternal education. We also ran analysis stratified by sex. Results: Median (p25-p75) prenatal and current specific gravity-adjusted summed DCCA and 3PBA were 2.4 (1.3-3.9) µg/L and 6.4 (3.8-10.5) µg/L, respectively. Prenatal summed DCCA and 3PBA concentrations were associated with increased CPT-II T-scores of error commissions for boys (ß= 4.5, 95%CI -0.1, 9.1, per ten-fold increase in exposure), but not for girls (ß= -5.1, 95%CI -11.9, 1.8), or all children (1.6, 95%CI -2.3, 5.6). Prenatal summed DCCA and 3PBA were associated with lower scores of DCCS for all children (OR=0.25; 95% 0.1-0.9). Current DCCA and 3PBA concentrations were not associated with measures of attention or executive function.Conclusion: Children aged six years with higher prenatal exposure to pyrethroids had poorer executive function as compared to children with lower prenatal exposure. Boys with higher prenatal exposure also had poorer attention, whereas girls did not. Prenatal exposure to pyrethroid may affect children’s neurodevelopment, some effects may be stronger in boys.

Exposure to fungicides and attention in 6-year old children from the Infants′ Environmental Health Study (ISA)

TPS 731: Neurological effects in children, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background: Several fungicides are suspected endocrine disruptors and may impair children’s neurodevelopment, but data from prospective studies are lacking. In Costa Rica, fungicides are aerially sprayed and used postharvest on bananas. We examined whether exposure to fungicides was associated with poor attention in children from the Infants Environmental Health Study (ISA). Methods: To evaluate attention, we applied the Conners Continuous Performance Test (K-CPT-II) in 6-year old children (mean 6.4 ± 0.4 years) (n=268) using T-scores of omissions, commissions and Hit Reaction Time (HRT). To assess exposure to the fungicides mancozeb, pyrimethanil, and thiabendazole, we measured ethylenethiourea (ETU), hydroxy pyrimethanil (OHP), and 5-hydroxythiabendazole (5-OHT), respectively, in repeated urine samples collected during pregnancy and 5-6 years of age. We ran separate linear regression models for log-10 transformed mean prenatal, and mean child metabolite concentrations and CPT-II, adjusting for child age, child sex, HOME score, and maternal education. We examined effect-modification by sex. Results: Median (p25-p75) prenatal specific gravity-adjusted ETU, OHP and 5-OHT were 3.40 (2.38-4.79), 0.50 (0.21-1.28) and 0.10 (0.03-0.53) µg/L, and current ETU, OHP and 5-OHT were 2.66 (1.90-3.63), 0.86 (0.34-2.32) and 0.12 (0.04-0.49) µg/L, respectively. Higher current ETU concentrations were associated with increased omissions (ß=8.4 95%CI 3.5-13.4, per ten-fold increase in exposure). The association was stronger for girls (ß=7.3, 95%CI 0.6-13.9) as compared to boys (ß=5.5, 95%CI -1.6-12.6). For girls, both higher prenatal and current OHP concentrations were associated with increased omissions (ß=3.1, 95%CI 0.6-5.6 and ß=4.0, 95%CI 0.9-7.0, respectively), and current OHP concentrations were also associated with slower responses (ß=2.1, 95%CI 0.2.-2.9). OHT and prenatal ETU were not associated with measures of attention. Conclusion: Six-year old children with higher current exposure to mancozeb and higher prenatal and current exposure to pyrimethanil had poorer attention as compared to children with lower exposures, the effect was stronger for girls.

P: 62 Neurometabolism in Grey Matter of Children With Chronic Liver Disease or Portosystemic Shunting: A 1H-MRS Study at 7T

BACKGROUND: Neurocognitive deficits in children with chronic liver disease (CLD) or congenital porto-systemic shunts (CPSS) are incompletely understood. Understanding the molecular underpinnings by non-invasive means could inform management. Aims To characterize the neurometabolic profile in the grey matter (GM) of children with CLD or CPSS and analyze correlations with neurocognitive and biological results. METHODS: Children aged 8–14 were enrolled if they presented with CLD or CPSS. Short-echo-time (16 ms) using 1H-MRS at 7T in GM dominated medial prefrontal cortex was performed, and neurocognitive testing and routine labs were obtained within 3 months of each other following informed consent. RESULTS: 5 patients (8–14 y) including 4 with CLD (2 girls), 1 with CPSS (1 girl), and 4 controls (10–14 y, 2 girls) underwent 1H-MRS. Causes of CLD: congenital disorder of glycosylation (1), progressive familial intrahepatic cholestasis type-2 (1), portal obliterative venopathy (1), autoimmune hepatitis (1). Mean plasma ammonium in patients was 26 umol/l, mean serum bilirubin was in normal range and mean platelet count was 201 G/L (59–346). The 3 patients with CLD showed scores in average or above average on Total Intellectual Quotient measures (WISC-IV). One of the 3 scored below average on the working memory sub-scale of the WISC-IV (&lt;1, 65 SD), while the intellectual profiles were homogenous and above average for the 2 others patients. One of these 2 scored below average on 6/10 parameters on the Conners Continuous Performance Test, suggesting attention deficit. The other two were in range. The patient with CPSS displayed Total Intellectual Quotient below average (&lt;1, 65 SD on the WISC-IV), with additional deficits (&lt;1, 65 SD) in executive and attentional functioning as well as expressive and receptive language. 1H-MRS results: 13 metabolites were reliably quantified. Figure 1 illustrates the differences between CLD and CPSS: the expected increase of brain glutamine and decrease of brain osmolytes (inositol, taurine, total choline) together with a previously unreported decrease in the neurotransmitters glutamate, GABA and N-acetylaspartate. No statistically significant differences were observed between the CLD patients and controls. CONCLUSIONS: In patients with compensated CLD, there were no significant neurometabolic alterations as assessed by high resolution 1H-MRS. In CPSS, however, neurometabolic changes were clear, and likely related to measurably impaired neurocognitive functioning. Together, these results suggest that in CPSS (type B encephalopathy) the brain is likely exposed to a higher load of neurotoxic substances than in patients who have some degree of portal flow (type C).

Acute blood pressure change with methylphenidate is associated with improvement in attention performance in children with ADHD

This exploratory study aims to determine whether the change in systolic blood pressure (sBP) after acute methylphenidate (MPH) administration (ΔBPMPH) is associated with the neurocognitive response to MPH in the Conners Continuous Performance Test (CPT) in 513 children with ADHD (aged 6 to 12 years old).We noted that higher increases in sBP were associated with larger improvement in CPT performance with MPH. In the univariate regression model, the ΔBPMPH accounted for an additional 2% of the variance in the change in CPT-Overall Index (OI) after controlling for covariates (p < .001). Linear regression analysis also indicated that ΔBPMPH significantly contributed to predict a change in omission errors, reaction time, and reaction time variability (p < .001, p < .01, p = .001, respectively), but not in commission errors or detectability index (d`).Participants with a clinically meaningful sBP increase of at least 5 mmHg (n = 191) improved by 4.8 points on the CPT-OI score (p < .001), compared to an improvement of only 0.6 points for participants whose sBP declined by at least 5 mmHg (n = 121).In conclusion, larger sBP increases after MPH administration were associated with greater enhancement in CPT performance. These results could be useful in informing MPH dosing in clinical practice.

Panayiotopoulos syndrome and Gastaut syndrome are distinct entities in terms of neuropsychological findings

BackgroundAlthough the courses of self-limited focal epilepsies of childhood are considered as benign, a handful of studies suggested that these children may suffer from cognitive problems. Implementing tailor-made educational strategies would aid these children to reach their full potentials. Therefore, it is crucial to understand and differentiate the complete neuropsychological and behavioral profiles of these rather common syndromes. We aimed to examine the distinct cognitive and behavioral profiles of the Panayiotopoulos syndrome (PS) and the Gastaut syndrome (GS), comparatively. MethodTwenty patients with PS, 20 patients with GS, and 20 healthy controls have been recruited. The testing protocol included Wechsler Intelligence Scale for Children-Revised, Conner's Continuous Performance Test, Verbal Fluency Test, Stroop Color and Word Test, Color Trails Test, Tower of London Test, Symbol Digit Modalities Test, California Verbal Learning Test-Children's Version, Rey Complex Figure Test, Benton Face Recognition Test, Benton Judgment of Line Orientation, Peabody Picture Vocabulary Test, Reading and Writing Test, Child Behavior Checklist, Conner's Parent Rating Scale-48, and Behavior Rating Inventory of Executive Function. Demographical, clinical, electrophysiological data, and imaging findings have also been evaluated. ResultsWith regard to intelligence, the patients with PS scored less in all scales compared to the healthy controls. However, only the performance IQ (intelligence quotient) scores differed significantly between the patient groups, with the patients with PS scoring lower than the patients with GS. Verbal memory problems were eminent in both of the patient groups; whereas, visual memory was impaired only in the group with PS. Psychomotor speed was affected in both groups. Reading problems were prominent only in the patients with PS. Writing and arithmetic skills were defective in both patient groups. There were no noteworthy behavioral problems in comparison to healthy subjects. ConclusionUsing neuropsychological profiles, this study demonstrated that the GS and the PS are two distinct entities. Cognitive dysfunction is a more prominent and widespread feature of the patients with PS; whereas, the patients with GS suffer only from milder and isolated cognitive problems.

A-10 Conners Continuous Performance Test-3 in the Evaluation of ADHD Among Veterans

Abstract Objective The purpose of this study was to compare performance on the Conners Continuous Performance Test, third edition (CPT-3), between veterans with and without attention-deficit/hyperactivity disorder (ADHD) and between presentation types. Method This is a retrospective chart review of 226 consecutively referred veterans who completed a standardized, ADHD assessment at a Mid-Atlantic VA Medical Center. ADHD status was determined from a structured interview; all included subjects completed the CPT-3 and validity measures. ANOVA was used to evaluate group differences in T scores across 9 CPT-3 variables. Chi square was used to further evaluate group differences using impairment ranges in the CPT-3 manual. Results Final valid sample included 85 veterans with and 54 without ADHD. Veterans with ADHD only showed significantly higher T scores on Hit Reaction Time Standard Deviation, F(1, 137) = 7.7, p = .006, η2 = 0.05, and Hit Reaction Times Inter-Stimulus Interval Change (HRT-ISIC), F(1, 137) = 12.8, p &lt; .001, η2 = 0.09. Veterans diagnosed with ADHD showed higher percentages of scores classified in the impaired ranges for Commissions χ2(1) = 4.3 (p &lt; .039, V = 0.18) and HRT-ISIC χ2(1) = 4.5 (p &lt; .035, V = 0.18). Neither ANOVA or χ2 analyses revealed group differences between ADHD presentations for any CPT-3 measures. Conclusions Performance on the CPT-3 was poorer in the ADHD group only for 2 of 9 scores. The CPT-3 was consistently unable to differentiate inattentive from hyperactive/combined ADHD. Diagnostic utility of the CPT-3 in ADHD evaluations may be limited in veteran populations.

Computerized Cognitive Rehabilitation verses Clinician Directed Therapy in mTBI

Abstract Background Cognitive problems following mTBI are common and typically managed with one-on-one clinician directed treatment (CDT); however, this is time and labor intensive. Computerized cognitive rehabilitation (CCR) programs overcome these limitation but the comparable efficacy is not well understood in mTBI. Method A randomized controlled trial included 13 active duty service members with a history of mTBI and persistent cognitive complaints. Participants received either CCR (N = 6) or CDT (N = 7) during the initial phase of this study. Treatments were one hour, 3 times a week for 4 weeks. Average age was 32.77 (SD = 7.96). Average intelligence estimated by word reading was average (WTAR M = 107.46, SD = 9.32). Specific measures for attention included Symbol Digit Modality Test (SDMT), Paced Auditory Serial Addition Test (PASAT), Conners Continuous Performance Test (CPT-3), as well as Digit Forward (DF), Digit Backward, and Driving from the Neuropsychological Assessment Battery (NAB). Standard scores corrected for age were analyzed. Change scores were computed between pre and post intervention. Results There was a significant difference for SDMT (p = 0.034, d = 1.342) and DF (p = 0.0015, d = 2.33), where those who received CDT showed greater improvement. The groups did not differ on Driving, PASAT, CPT-3, and DB (p’s &gt; 0.62). Conclusions Preliminary analysis of data suggests that clinician directed treatment was superior to a computerized intervention matched for time and intensity in treating patients with persistent cognitive complaints following mTBI. Large effects were observed on measures of processing speed and focused attention. This may suggest computerized treatment alone is less effective though further data is needed.

C-43 The Relation Between Executive Functioning and Fluid Reasoning Performance in Children with Attention-Deficit/Hyperactivity Disorder

Abstract Objective Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects about 5% of school-aged children.4 Fluid reasoning (FR) tasks assess one’s ability to detect underlying conceptual relationships and use reasoning to identify and apply rules to problem solve.4 Previous research has demonstrated that children with ADHD perform more poorly in FR, though the mechanism behind this is unclear.3,4 The literature suggests that FR is reliant on executive functioning skills such as inhibitory control, working memory, and planning.1,4 Therefore, this study examines how performance on FR from the Wechsler Intelligence Scale for Children (WISC-V) is related to measures of executive functioning (EF) and attention in children with ADHD. Method Participants were children aged 8 to 16-years with ADHD (N = 75) referred for neuropsychological testing. Participant demographics: males (N = 50, 65.8%), females (N = 26, 34.2%); African American (5.3%), Asian (1.3%), Caucasian (52.6%), Other (39.5%). Measures included the WISC-V Fluid Reasoning Index (FRI), Delis-Kaplan Executive Function System (DKEFS) Color Word Identification (CWI) and Tower subtests, omissions/commissions on the Conners Continuous Performance Test (CPT), and Behavior Rating Inventory of Executive Functioning (BRIEF) subscales. Results Bivariate correlations showed that the FRI was only significantly positively correlated with CWI Inhibition/Switching Time (r = .246, p = .047). Commission errors on the CPT approached significance (r = .217, p = .145). Conclusion The WISC-V FRI may be vulnerable to weaknesses in EF or behavioral control in children with ADHD and should be interpreted in that context. Findings suggest the FRI may be particularly impacted by weaknesses in inhibitory control.

The Relationship of Transcranial Doppler Ultrasonography with Attention, Motor, and Social-Emotional Functioning in Pediatric Sickle Cell Disease

Abstract Objective Children with sickle cell disease (SCD) are at greater risk for certain neuropsychological deficits due to their medical condition and associated complications. Previous studies have explored the relationship between Transcranial Doppler (TCD) ultrasonography and various domains of neuropsychological functioning in pediatric SCD populations; however, these studies are dated, present variable and inconsistent findings, and are somewhat limited in scope. The goal of this study was to update and expand upon previous research by examining the predictive relationship of TCD results with measures of attention, motor, and social-emotional functioning. Methods Thirty-six patients ages 3-19 with SCD with no known history of stroke, with TCD completed within the past 12 months, underwent a brief neuropsychological exam. Attention, motor, and social-emotional functioning were assessed as appropriate for age using the Conners Continuous Performance Test (K-CPT2/CPT3), Purdue Pegboard, and PROMIS, respectively. TCD values were gathered via medical record review, using the highest value of most recent TCD. Results TCD significantly predicted certain aspects of attention and motor ability, but not social-emotional functioning. Specifically, TCD significantly predicted Detectability (p = .005), Omissions (p = .001), Commissions (p = .012), Perseverations (p = .035), and HRT SD (p = .046) on K-CPT2/CPT-3 and the non-dominant (p = .009) and bilateral (p = .024) trial scores on the Purdue Pegboard. Conclusion This study provides new evidence that TCD may be predictive of motor functioning in pediatric SCD. Results confirm that TCD is predictive of attentional function, though subdomains impacted varied from previous research. While no significant relationship between psychosocial symptoms and TCD were identified, further studies utilizing more comprehensive measurement within this domain is warranted.