Performance-based Measures Research Articles

An Incomplete Model of Disability: Discrepancies Between Performance-Based and Self-Reported Measures of Functioning.

Appropriate conceptualization and measurement of disability are critical for population-focused resource allocation and policy development. Self-reported and performance-based measures of functioning have been used to represent disability. Variation in environmental context or self-perception of ability may influence self-reports; however, performance-based measures that attempt to control environmental context may not accurately capture real-world aspects of functioning. This study examined the agreement between self-report and performance-based measures of functioning within 4 domains among older adults. Cross-sectional data from the 2021 National Health and Aging Trends Study was used. Self-reported and performance-based measures of functioning were assessed for vision, hearing, mobility, and memory domains. We examined the diagnostic characteristics of performance-based versus self-reported measures using sensitivity, specificity, and receiver operating characteristics curves. Differences in the agreement of these measures across sociodemographic groups were investigated using logistic regression. Among 2442 respondents 71 years and older (mean 78.5±5.3, 56% female participants), performance measures of hearing and mobility had high sensitivity (89% and 91%, respectively) and low/moderate specificity (36% and 63%, respectively). The sensitivity and specificity of vision measures were 71%. Memory measures had high specificity (89%) and low sensitivity (28%). Performance-based discrimination ranged from 0.59 (memory) to 0.78 (mobility). Agreement varied across sociodemographic factors. Performance measures diverge from self-reported functioning among older adults. Discordance may reveal opportunities for environmental intervention where participants' performance does not capture the full extent of barriers in their daily lives. Additional research is needed to investigate individual and environmental factors which could explain the observed differences.

Can emotional acceptance buffer the link between executive functioning and mental health in late life?

Emotional acceptance is thought to play an important role in protecting mental health. However, few studies have examined emotional acceptance among older adults who may experience declines in functioning, including executive functioning. The present laboratory-based study examined whether emotional acceptance and (to determine specificity) detachment and positive reappraisal moderated links between executive functioning and mental health symptoms in a sample of healthy older adults. Emotion regulation strategies were measured using questionnaire-based measures (using established questionnaires) as well as performance-based measures (instructing individuals to use emotional acceptance, detachment, and positive reappraisal in response to sad film clips). Executive functioning was measured using a battery of working memory, inhibition, and verbal fluency tasks. Mental health symptoms were measured using questionnaires to assess anxiety and depressive symptoms. Results showed that (a) emotional acceptance moderated the link between executive functioning and mental health such that lower executive functioning predicted higher levels of anxiety and depressive symptoms at low but not at high levels of emotional acceptance. Moderation effects tended to be (b) stronger for emotional acceptance compared to the other emotion regulation strategies (though not all comparisons were statistically significant). Findings were (c) robust when controlling for age, gender, and education for questionnaire-based (but not performance-based) emotional acceptance. These findings contribute to the literature on emotion regulation specificity and highlight the mental health benefits of emotional acceptance in the face of low executive functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Relationship between Balance Confidence and Center of Pressure in Lower-Limb Prosthesis Users

Background: Agreement between the activities-specific balance confidence scale (ABC) and center of pressure (CoP) in prosthesis users is still very much unknown. The purpose of this study was to investigate the agreement between ABC and CoP in lower-limb prosthesis users. Methods: Twenty-one individuals with lower-limb prostheses were recruited. Participants were provided with the ABC scale and performed static balance tasks during eyes opened (EO) and eyes closed (EC) conditions whilst standing on a force platform. Pearson product moment coefficients between CoP displacements and ABC scores were performed. Participants were also stratified by those who had better (≥80 on ABC scale) and less (<80 on ABC scale) perceived balance confidence. Displacement was compared using an independent t-test with Cohen’s d to estimate effect size with alpha set at 0.05 for these tests. Results: There was a significant inverse moderate relationship between eyes opened displacement (EOD) (18.3 ± 12.5 cm) and ABC (75.1 ± 18.3%), r = (19)−0.58, p = 0.006, as well as eyes closed displacement (ECD) (37.7 ± 22.1 cm) and ABC, r = (19)−0.56, p = 0.008. No significant difference in EOD (t(19) = 1.36, p = 0.189, d = 0.61) and ECD (t(19) = 1.47, p = 0.156, d = 0.66) was seen between those with greater and less balance confidence. Conclusions: Self-report and performance-based balance outcome measures are recommended when assessing lower-limb prostheses users.

P115: Testing the feasibility of a multicomponent neuropsychological intervention for individuals at-risk of dementia: the REMINDER program

Objective:Interventions aimed to optimize cognitive function and functionality in individuals at risk of dementia were scarce in validity studies. While some RCTs have been developed in cognitive training interventions, studies of multicomponent interventions (cognitive, social, and behavioral) integrating intervention targeting psychosocial risk factors (social isolation, depression, low cognitive reserve) is absent. Additionally, few efforts have been made to develop such validity studies with individuals at higher risk of dementia who still do not present objective cognitive decline, despite current recommendations in this regard. We aimed to start the validation of a 20-session multicomponent intervention – REMINDER program - with a feasibility test and a preliminary efficacy testing using a comprehensive outcome assessment protocol.Methods:A feasibility randomized controlled trial (RCT) was conducted, recruiting community-dwelling individuals between 60 to 75 years old with increased risk of dementia (LIBRA dementia risk score). Fifteen participants took part in twice-a-week sessions of the REMINDER program, during twelve weeks. Data on the acceptability, satisfaction and adherence to the REMINDER program was collected, and an association between pre and post intervention motivation and knowledge about dementia risk was examined. For the preliminary efficacy testing we considered as primary outcome a performance-based functionality measure (UPSA) and secondary outcomes will include global cognition, emotional status, and lifestyle habits, tested prior and after the intervention.Results:Rates of satisfaction throughout the REMINDER program sessions were high (75%, mean) as well as the adherences that was superior to the main dementia risk reduction programs referred in literature. (83%). Post-intervention efficacy testing is ongoing, however, levels of knowledge about dementia risk increased 12% compared with pre-intervention (34% pre-intervention, to 46% post intervention; p=.045)Discussion:Preliminary data on feasibility and efficacy of the REMINDER program suggests this program is an engaging and motivating tool for dementia risk reduction, justifying the future implementation of a large-scale RCT. We expect that, with a larger efficacy study we can demonstrate the REMINDER program effects in behavior change and in the adoption of protective lifestyles for dementia prevention, and that the comprehensive outcome assessment proves to be effective and, therefore, replicable in further studies.

Empathy in Preschoolers: Exploring Profiles and Age- and Gender-Related Differences.

Empathy is a key skill in the daily life of preschoolers, and it is important to understand how it evolves during this crucial period of development. This paper includes two studies. The first study, which had a cross-sectional design, examined affective, cognitive, and behavioral empathy in 354 children (aged from 3 to 6 years) through a performance-based measure and questionnaires completed by their mothers. Although girls tended to have better affective empathy than boys on the performance-based task, no difference was noted in the mothers' perceptions of their children's empathy. Empathy dimensions varied depending on the age of the children. The hierarchical cluster analyses of the cases identified differentiated subgroups of children, according to their empathic skills in the three dimensions. The second study, which was longitudinal, used the same measures and investigated the developmental trajectory of empathy in 69 preschoolers over one year. The results showed that each empathic dimension predicted itself one year later, but did not predict the two others. The implications for potential interventions are emphasized in this study.

Neurocognitive Outcomes over the First 3 Months after Chimeric Antigen Receptor T-Cell (CAR T) Therapy: Preliminary Findings from a Longitudinal Study

Introduction People treated with systemic therapies for cancer may exhibit changes in neurocognitive functioning over time, affecting domains such as memory, processing speed, and executive functioning. There is a need for prospective data regarding neurocognitive outcomes among patients treated with Chimeric Antigen Receptor T-Cell (CAR T) therapy. The purpose of this study was to investigate the trajectory of neurocognitive performance and self-reported cognitive functioning over the first 3 months of CAR T therapy. Methods As part of a larger cohort study of patients treated with CAR T, neurocognitive outcomes were assessed prior to starting CAR T and again at 1- and 3- months post-CAR T. Neurocognitive performance was measured using standardized neuropsychological tests including measures of verbal memory (Hopkins Verbal Learning Test-Revised (HVLT-R) - immediate recall, delayed recall, retention), processing speed (Trail-making Test - Part A (TMT-A)) and executive functioning (Trail-making Test Part B (TMT-B), Controlled Oral Word Association Test (COWAT)). Raw test scores were converted to z-scores (Mean 0, SD 1) based on norms adjusted for age, sex, and education, where applicable. Impairment on individual tests was defined by a z score ≤ -1.64. Participants were categorized as showing overall impairment if they had at least two tests with a z-score of ≤ -1.5 or a z-score ≤ -2.0 on one test. Self-reported cognitive functioning was measured using the Functional Assessment of Cancer Therapy - Cognition, Perceived Cognitive Impairment score (FACT-Cog3 PCI) and the European Organisation for Research and Treatment of Cancer - Quality of Life Questionnaire C-30, Cognitive Functioning scale (EORTC QLQ-C30 CF). Demographic and clinical data were collected through self-report and patient records. Frequencies of impairment were determined at each time point, with clinically significant changes on individual test scores in the first month determined based on z-score changes of ≥1.0 or minimal clinically important differences for self-report questionnaires. Linear mixed models were generated to estimate the trajectory of neurocognitive performance and self-reported cognitive functioning over time from baseline to 3 months. Results Neurocognitive outcomes were available for 37 participants at baseline, with follow-up data available for 29 patients at 1 month and 17 patients at 3 months. Participants were 54% male, had a mean age 58.4 years (sd 11.3) and a mean 15.5 years (sd 3.2) education. All patients had a diagnosis of non-Hodgkin lymphoma (53% diffuse large B-cell lymphoma (DLBCL), 31% transformed DLBCL from follicular lymphoma). Immune effector cell-associated neurotoxicity syndrome (ICANS) affected 32% of patients (5% Grade 4, 3% Grade 3, 8% Grade 2, 16% Grade 1). Cytokine release syndrome (CRS) affected 97% of patients (3% Grade 3, 76% Grade 2, 19% Grade 1). Frequency of overall impairment at each time point was 10/37 (27%) at baseline, 12/29 (41.4%) at 1 month, and 3/17 (17.6%) at 3 months. At each time point, impairment was most common on tests of executive functioning and memory. Based on individual test score changes between baseline and 1 month, rates of decline on individual tests of neurocognitive performance ranged from 11.5% (TMT-A) to 34.6% (COWAT). Decline on self-reported cognitive functioning was observed for 14.3% (FACT-Cog PCI) and 28.6% (EORTC QLQ-C30 CF) of participants. Based on mixed models (Table 1), there was a statistically significant decline in estimated mean z-scores on a test of executive function (COWAT: -0.52, 95% CI -0.89-(-0.16), p=0.007) at 1-month compared to baseline. At three months, there was a statistically significant improvement in estimated mean z-scores on memory (HVLT-R immediate recall: 0.56, 95% CI 0.11-1.01, p=0.017) and executive functioning (TMT-B: 0.87, 95% CI 0.17-1.57, p=0.019; COWAT: 0.68, 95% CI 0.19-1.16, p=0.009) compared to baseline. Conclusions Impairment is present in a subgroup of patients prior to starting CAR T therapy. Patients may demonstrate declines on performance-based measures and report worsening cognitive symptoms in the first month after CAR T therapy, but also improved performance in some domains by three months. Enrollment and long-term follow-up of patients in this study is ongoing. Future analyses will explore differences in trajectories among subgroups, such as those who have experienced ICANS and CRS.

Higher order neurocognition in pediatric brain tumor survivors: What can we learn from white matter microstructure?

Pediatric brain tumor survivors (PBTS) experience neurocognitive late effects, including problems with working memory, processing speed, and other higher order skills. These skill domains are subserved by various white matter (WM) pathways, but not much is known about these brain-behavior links in PBTS. This study examined the anterior corona radiata (ACR), inferior fronto-occipital fasciculi (IFOF), and superior longitudinal fasciculi (SLF) by analyzing associations among diffusion metrics and neurocognition. Thirteen PBTS and 10 healthy controls (HC), aged 9-14years, completed performance-based measures of processing speed and executive function, and parents rated their child's day-to-day executive skills. Children underwent magnetic resonance imaging (MRI) with diffusion weighted imaging that yielded fractional anisotropy (FA) and mean diffusivity (MD) values. Independent samples t-tests assessed group differences on neurocognitive and imaging measures, and pooled within-group correlations examined relationships among measures across groups. PBTS performed more poorly than HC on measures of processing speed, divided attention, and shifting (d=-1.08 to -1.44). WM microstructure differences were significant in MD values for the bilateral SLF and ACR, with PBTS showing higher diffusivity (d=0.75 to 1.21). Better processing speed, divided attention, and shifting were associated with lower diffusivity in the IFOF, SLF, and ACR, but were not strongly correlated with FA. PBTS demonstrate poorer neurocognitive functioning that is linked to differences in WM microstructure, as evidenced by higher diffusivity in the ACR, SLF, and IFOF. These findings support the use of MD in understanding alterations in WM microstructure in PTBS and shed light on potential functions of these pathways.

Effort-based decision-making as a determinant of supported employment outcomes in psychotic disorders

Schizophrenia is associated with a heavy economic burden in the United States that is partly due to the high rates of chronic unemployment. Individual Placement and Support (IPS) is an evidenced-based type of supported employment that can improve job obtainment and work outcomes in psychotic disorders. Outcomes vary widely and a persistent challenge for IPS is low levels of engagement in the initial job search phase. Past studies have focused on interview-based motivation deficits as a key determinant of poor treatment engagement and work outcomes in schizophrenia. New validated performance-based measures of motivation, including effort-based decision-making (EBDM) tasks, may explain supported employment outcomes and provide insights into individual differences in IPS outcomes. This study investigated the degree to which IPS engagement (i.e., number of sessions attended during the first four months of service delivery) was related to baseline interview-based motivation deficits and performance on three EBDM tasks – two tasks of physical effort and one of cognitive effort (i.e., Balloon Task, Effort Expenditure for Rewards Task, Deck Choice Effort Task) – in a sample (N = 47) of people with a psychotic disorder. Results indicated that the level of EBDM performance, specifically on the Balloon Task, predicted IPS engagement, accounting for an additional 17 % of the variance above and beyond interview-based motivation deficits (total R2 = 24 %). Overall, these findings suggest that addressing motivational deficits in effort-based decision-making may be beneficial to IPS engagement, which in turn may improve the trajectory of work outcomes.

Performance-based outcome measures for physical capacity and functional ability among patients with pulmonary embolism

Abstract Introduction Pulmonary embolism (PE) is a serious health condition with up to 50 % of patients experiencing persisting symptoms with shortness of breath, pain, reduced physical performance and psychological distress, also known as post-PE syndrome. This condition has received increasing attention, including recommendations of assessing physical capacity to identify patients who may benefit from rehabilitation interventions to increase functional ability and health. However, as the PE population is heterogeneous compared to other cardiac patient groups, outcome measures for assessing physical capacity traditionally used in cardiac rehabilitation may not be reliable. This scoping review aims to map the performance-based outcome measures (PBOM) used in research literature to measure physical capacity in a PE population, to map the nature of the research and investigate the psychometric properties of the identified instruments in a PE population. Methods The methodology of the review process was guided by the Joanna Briggs Institute (JBI) framework for scoping reviews and reporting followed the PRISMA guidelines. Results The search identified a total of 4585 potentially relevant studies of which 234 studies met the inclusion criteria. A substantial part of studies (190 studies) was on a CTEPH population (chronic thromboembolic pulmonary hypertension), a condition developed by just 1-2% of patients with PE. The majority of included research articles originated from Europe (51%) and Asia (36%). Ten different PBOMs were identified for measuring physical capacity in a PE/CTEPH population, with 6MWT and CPET as the far most commonly used and the Bruce protocol/Modified Bruce protocol and Incremental Shuttle Walk test (ISWT) as third and fourth. No studies were identified reporting on psychometric properties of the 10 PBOMs in a PE / CTEPH population. Conclusions No studies were identified reporting on validity or reliability of any of the 10 identified PBOMs in a PE/CTEPH population. Thus, there is a need for conducting studies that establish the reliability, validity and responsiveness of PBOMs in a PE population, to enable identification of at-risk patients and to monitor effects of treatment and rehabilitation interventions.

Impulsivity and sensitivity to reward as mediating factors of the negative relationship between emotional intelligence and health-related risk-taking: evidence from a sample of university students

BackgroundBetter abilities in emotional intelligence (EI) have been linked to a decreased tendency to engage in health-related risk behaviour. However, the processes underlying this relationship are still unclear. The aim of this research was to examine the role of impulsivity and sensitivity to reward as mediating factors in the relationship between EI and health risk-taking.MethodsTwo hundred and fifty participants (Mage = 23.60, age range = 18–59; SD = 6.67; 71.60% women) were assessed on ability EI levels, risk-taking in health contexts, impulsivity, and sensitivity to reward. Unlike previous studies in the literature, we employed a performance-based ability measure to assess EI (Mayer-Salovey-Caruso Emotional Intelligence Test, MSCEIT).ResultsThe results confirmed the negative relationship between EI and health risk-taking and revealed the existence of a significant negative indirect effect of EI on health-risk taking through various dimensions of impulsivity and sensitivity to reward. EI abilities —particularly the ability to manage emotions— were associated with lower levels of impulsivity under positive and negative emotional states, a better management of the tendency towards sensation seeking, and a decreased emotional reactivity to rewards.ConclusionsThe present research provides a better understanding of the processes underlying the negative relationship between EI and health risk-taking. Our findings suggest that having higher levels of EI abilities would allow for a more objective evaluation of risk scenarios and a more appropriate and safer decision making through its influence on the levels of impulsivity and emotional reactivity to rewards. Practical implications, limitations, and future lines of research are discussed.

Field-based longitudinal evaluation of multimodal worker fatigue assessments in offshore shiftwork

Fatigue in offshore environments is a critical safety hazard, yet the utility of daily fatigue assessments has not been longitudinally examined in these environments. The aim of this exploratory longitudinal field study across two drillships in the Gulf of Mexico was to determine the changes in subjective, performance-based, and physiological fatigue measures over time across different shift types (day, night, and swing) and to identify correlations between these multimodal fatigue assessments. Repeated measures correlation analyses of daily fatigue data from seventy offshore workers revealed that while total sleep time remained unaffected by time on rig, workers’ performances on the psychomotor vigilance test (PVT) deteriorated over time across all shift types. Several correlations between the various multimodal measures were consistent with the extant literature on worker fatigue symptoms and perceptual and physiological manifestations. These findings emphasize the utility of PVT and single item self-reports to capture worker fatigue in offshore shiftwork.

Birth-Related Risk Factors Impact Cognitive and Academic Outcomes in Children with Sickle Cell Disease

Pre- and peri-natal-related risk factors are associated with slowed neurocognitive development and increased risk of learning difficulties in the general population. A recent study reported expressive language deficits were associated with preterm birth in young children with sickle cell disease (SCD) (Bills et al., 2021); however, no studies to date have examined the long-term impact of low birth weight in children and adolescents with SCD. In this cohort study, we examined associations between low birth weight (<2500g) and cognitive and academic outcomes, including formal school support services (i.e., 504 Plan or Individual Education Program), in children with SCD. Gestational age and neonatal intensive care unit (NICU) admission were investigated as covariates. Participants were children ages 8-18 years old with SCD enrolled in the Sickle Cell Clinical Research and Intervention Program (SCCRIP), an observational cohort study of clinical outcomes in SCD. Participants received targeted neurocognitive evaluations as standard of care every 3-4 years. Performance-based neurocognitive measures were used to assess cognitive and academic abilities, including the Wechsler Abbreviated Scale of Intelligence, Second Edition; Wechsler Intelligence Scale for Children, Fourth and Fifth Editions; Wechsler Adult Intelligence Scale, Fourth Edition; Delis Kaplan Executive Function System; Conners Continuous Performance Test, Second and Third Editions; and Woodcock-Johnson Tests of Achievement, Third and Fourth Editions. Multivariable generalized linear regression examined associations between birth-related risk factors (i.e., birth weight, gestational age, and NICU admission) and cognitive outcomes, academic achievement, and need for school support services after adjusting for age, sex, hydroxyurea treatment, sickle genotype, and socioeconomic status. P-values <0.05 were considered significant. False discovery rate-adjusted p-values or q-values were calculated across the outcomes and all birth-related risk factors to correct for multiple corrections. Of the 326 participants in SCCRIP who completed neurocognitive evaluations, 282 children had normal birth weight (HbSS/HbSβ 0thalassemia=56%) and 44 children were born with low birth weight (HbSS/HbSβ 0=45%). Birth weight groups (<2500g and >2500g) were matched for demographic and disease characteristics (Table 1). The mean age at time of cognitive evaluation was 11.16 (SD= 3.27) years and half of participants were male (51%). Low birth weight was associated with worse word reading (p=0.011; Table 2). Across all participants, admission in the NICU was associated with lower verbal reasoning (p=0.022), processing speed (p=0.017), working memory (p=0.044), word reading (p=0.021), and math fluency (p=0.05). Similarly, across all participants, earlier gestational age was associated with lower verbal fluency (p=0.011). Low birth weight and gestational age predicted need for school support services (p=0.003 and p=0.007, respectively). History of birth-related risk factors should be considered a comorbidity for neurodevelopmental differences in SCD. Specifically, children with SCD who are born with low birth weight or admitted to the NICU are at increased risk for difficulties with processing speed, working memory, language, and academics. The need for formal school support services in SCD is associated with gestational age and birth weight.

Comparison of foot function and physical performance between women with and without bilateral painful hallux valgus

BackgroundWe aimed to investigate whether foot function and physical performance differ between women with and without bilateral painful hallux valgus (HV). MethodsForty-four women with bilateral painful HV and forty-three controls were included. The Foot Function Index, American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joints Scale, and Manchester-Oxford Foot Questionnaire were used. The time while walking 10 m-walkway at maximum speed and ascending and descending ten stairs as fast as possible also single-limb stance time were measured. ResultsAll self-reported and performance-based measures showed that women with HV had poorer foot function and physical performance than controls (p < 0.05). Women with mild HV had better self-reported foot function than those with moderate HV or severe HV (p < 0.05), but physical performance did not differ (p > 0.05). ConclusionsWomen with bilateral painful HV exhibited poorer self-reported foot function and performance-based physical function than those without HV. Levels of evidenceLevel III

24 Adaptive Functioning and Academic Achievement in Survivors of Childhood Acute Lymphoblastic Leukemia

Objective:Executive functioning (EF) and socioeconomic status (SES) are associated with functional outcomes (adaptive functioning and academic achievement) in healthy controls and pediatric populations with executive dysfunction. However, these relationships have yet to be investigated in survivors of childhood acute lymphoblastic leukemia (ALL), a population with EF impairment resulting from disease and treatment characteristics. The objective of this study was to examine the associations of functional outcomes with EF and SES (neighborhood-specific variables and academic support) in survivors of childhood ALL.Participants and Methods:Forty-four participants (38.6% female, 72.7% non-Hispanic White, ages 6-17) previously diagnosed with low-risk or standard-risk pre-B cell ALL and treated with chemotherapy-only were included. Participants were evaluated on performance-based measures of EF (cognitive flexibility, verbal fluency, working memory, and processing speed) and academic achievement (word reading and math calculation), and parent-ratings of EF and adaptive functioning. All measures were expressed as T-scores with lower scores indicating better performance. Neighborhood-specific variables were based on participants’ zip codes and census block group, and included area deprivation index (ADI) and child opportunity index (COI). Lower ADI and COI indicate lesser deprivation and greater opportunity. Individualized education plan (IEP) status was used as a proxy of academic support, coded dichotomously as with or without IEP. Percentages of participants showing impairments in functional outcomes were calculated using a cutoff of &gt; 1 SD above the normative mean. Partial correlations were conducted while controlling for age at evaluation, age at diagnosis, sex, and verbal IQ, to examine whether participants with poorer performance-based and parent-rated EF would show reduced functional outcomes. Multiple regression analyses were conducted to evaluate whether neighborhood-specific variables and IEP status would predict functional outcomes while controlling for covariates.Results:Compared to population norms, survivors of childhood ALL showed worse functional outcomes. Within adaptive functioning, 45.5% of participants showed impairment in activities of daily living and leadership. Adaptive functioning was significantly positively correlated with parent-rated, but not performance-based, EF (r=0.694, p&lt;0.001). Compared to female survivors, male survivors were at increased risk for adaptive functioning difficulties (r=-0.401, p&lt;0.05). Impairments for word reading and math calculation were 25% and 41.7%, respectively. Greater math calculation was associated with better verbal fluency (r=0.378, p&lt;0.05) and processing speed (r=0.439, p&lt;0.05). Older participants at evaluation (/3=-0.580, p&lt;0.001) and those without IEP support (ß=0.465, p&lt;0.05) showed better word reading. Lower ADI predicted better verbal fluency (ß=0.282, p=0.041), however, neighborhood-specific variables were not associated with functional outcomes.Conclusions:Prior findings indicate that performance-based measures and parent-ratings assess different constructs of EF. Thus, adaptive functioning may relate more to the behavioral construct of EF than its cognitive construct. Current findings also suggest that male survivors are at increased risk for reduced adaptive functioning, consistent with recent reports that male survivors of ALL are at greater risk for specific neurocognitive outcomes. Overall, functional outcomes may be more strongly related to EF than neighborhood-specific variables. Long-term goals include early screening of adaptive and academic difficulties, targeted intervention, and neuropsychological monitoring to support pediatric survivors’ neurocognitive and psychosocial development.

16 Validation of the Pillbox Test in a Veteran Sample: A Replication Study.

Objective:Assessment of medication management, an instrumental activity of daily living (IADL), is particularly important among Veterans, who are prescribed an average of 2540 prescriptions per year (Nguyen et al., 2017). The Pillbox Test (PT) is a brief, performance-based measure that was designed as an ecologically valid measure of executive functioning (EF; Zartman, Hilsabeck, Guarnaccia, &amp; Houtz, 2013), the cognitive domain most predictive of successful medication schedule management (Suchy, Ziemnik, Niermeyer, &amp; Brothers, 2020). However, a validation study by Logue, Marceaux, Balldin, and Hilsabeck (2015) found that EF predicted performance on the PT more so than processing speed (PS), but not the language, attention, visuospatial, and memory domains combined. Thus, this project sought to increase generalizability of the latter study by replicating and extending their investigation utilizing a larger set of neuropsychological tests.Participants and Methods:Participants included 176 patients in a mixed clinical sample (5.1% female, 43.2% Black/African American, 55.7% white, Mage = 70.7 years, SDage = 9.3, Medu = 12.6 years, SDedu = 2.6) who completed a comprehensive neuropsychological evaluation in a VA medical center. All participants completed the PT where they had five minutes to organize five pill bottles using a seven-day pillbox according to standardized instructions on the labels. Participants also completed some combination of 26 neuropsychological tests (i.e., participants did not complete every test as evaluations were tailored to disparate referral questions). Correlations between completed tests and number of pillbox errors were evaluated. These tests were then combined into the following six domains: language, visuospatial, working memory (WM), psychomotor/PS, memory, and EF. Hierarchical multiple regression was completed using these domains to predict pillbox errors.Results:Spearman’s correlation coefficients indicated that 25 tests had a weak to moderate relationship with PT total errors (rs = 0.23 -0.51); forward digit span was not significantly related (rs = 0.13). A forced-entry multiple regression was run to predict PT total errors from the six domains. The model accounted for 29% of the variance in PT performance, F(6, 169) = 11.56, p &lt; .001. Of the domains, psychomotor/PS made the greatest contribution, f(169) = 2.73, p = .007, followed by language, f(169) = 2.41, p = .017, and WM, f(169) = 2.15, p = .033. Visuospatial performance and EF did not make significant contributions (ps&gt;.05). Next, two hierarchical multiple regressions were run. Results indicated that EF predicted performance on the PT beyond measures of PS, AR2 = .02, p = .044, but not beyond the combination of all cognitive domains, AR2 = .00, p = .863.Conclusions:Results of this study partially replicated the findings of Logue et al. (2015). Namely, EF predicted PT performance beyond PS, but not other cognitive domains. However, when all predictors were entered into the same model, visuospatial performance did not significantly contribute to the prediction of pillbox errors. These results suggest that providers may benefit from investigating medication management abilities when deficits in PS, WM, and/or language are identified. Further research is needed to better understand which domains best predict PT failure.

48 Longitudinal Language Outcomes in Pediatric Brain Tumor Patients Diagnosed in Early Childhood

Objective:Pediatric brain tumor (PBT) survivors are at risk for speech (e.g., articulation, prosody, fluency) and language (e.g., vocabulary, grammar, narratives, pragmatics) difficulties (Hodges et al., 2020). It is important to understand what treatment and/or demographic factors are associated with language functioning soon after diagnosis, and what factors are associated with language functioning years after treatment completion. This study characterizes longitudinal language functioning for clinically referred PBT survivors diagnosed in early childhood.Participants and Methods:Participants were 48 PBT patients (54% supratentorial, 6% disseminated), 21% with NF-1, who were diagnosed by age 6 (M = 43.2 months, SD 24.5) and received tumor-directed intervention including surgery (85%), chemotherapy (69%), and/or radiation therapy (50%). Hearing concerns existed for 29% of the patients. Age at first neuropsychological evaluation was 2-15 years (M=7.6, SD=3.63), age at second neuropsychological evaluation was 5-19 years (M=12.04, SD=3.86), with an average of 4.42 years (SD=2.37) between evaluations. Patients were 63% male, 77% White, 94% non-Hispanic, and fluent English speakers. Verbal IQ, working memory, fluencies, comprehension, memory, and parent-reported functional communication outcomes were assessed as part of comprehensive batteries. Rates of weak performance (1 SD&lt;Mean) were compared to the expected base rate of 16%.Results:Group means significantly diverged from age-expected performance by the second evaluation in all domains except semantic fluency. Weakness was identified on at least 1 verbal subtest for 79% of the sample at the first evaluation, and for 85% of the sample at the second evaluation. As a group, patients showed a significant increase in the number of weaknesses identified on performance-based measures from the first to second evaluation [t(47) = -3.60, p &lt;.001]. Over half of the sample showed an increase in the rate of verbal weaknesses identified (56.3%). Those with more weaknesses over time had lower IQ at the initial evaluation [t(36) =-2.61, p=.013]. An increase in the number of weaknesses from first to second evaluation was not associated with tumor type/location, treatment modality, or demographic variables.Conclusions:Brain tumor diagnosis in early childhood during rapid language development is associated with language impairments soon after diagnosis, and years after treatment completion. Causes for continued and increased impairment are multifactorial and risk cannot clearly be identified by demographic and treatment variables alone. Any early language weakness identification should signal need for intervention as the causes for difficulty are complex and these weaknesses are likely to persist and increase over time.

59 An Examination of the Moderating Effect of Self-Efficacy on the Association Between Health Literacy and Healthy Activity Engagement in Older Adults

Objective:Engagement in activities that promote overall brain health and well-being is often a key step in reducing risks to cognitive health in older adults. Given that higher health literacy has been found to be associated with healthier lifestyles, it is unsurprising that it has been the focus of many studies and programs aimed at improving the health outcomes of older adults. An equally important factor to consider when it comes to such efforts is the role of moderating variables in the relationship between health literacy and engagement in healthy behaviors. The present study examined the moderating effect of self-efficacy, a variable that has been shown to be positively associated with both health literacy and health behaviors. We hypothesized that increased self-efficacy will strengthen the relationship between health literacy and healthy activity engagement in a sample of community-living older adults.Participants and Methods:Forty-nine older adults (age: M = 64.35, SD = 8.00; education: M = 16.39, SD = 2.37; 87.76% female) completed a health literacy measure (Newest Vital Sign; NVS), a self-efficacy questionnaire (General Self-Efficacy Scale; GSE), and a lifestyle behaviors questionnaire (Healthy Aging Activity Engagement Scale; HAAE). The NVS is a performance-based measure in which participants are asked to interpret the verbal and numerical information of a nutrition label to make health-related decisions. The GSE is a self-report measure that evaluates one’s belief in their ability to handle challenges, solve problems, and accomplish goals. The HAAE is a self-report measure that assesses one’s engagement in healthy activities across multiple health domains.Results:To examine whether self-efficacy moderates the relationship between health literacy and healthy activity engagement, a moderation analysis was conducted using Hayes’ PROCESS macro for SPSS with age and education included in the model as covariates. The results revealed no significant interaction between health literacy and self-efficacy, b = 0.23, p = .59, 95% CI [-0.60 to 1.05].Conclusions:Contrary to expectations, in the present sample, the degree of self-efficacy was not a condition under which level of health literacy exerted its influence on healthy activity engagement in older adults. Future studies with larger and more nationally representative samples are needed to explore self-efficacy and other potential moderating factors in order to identify individual characteristics that support older adults’ adoption and engagement in health-promoting behaviors.

26 The Importance of Executive Functioning for Academic Achievement Among a National Sample of Children with Epilepsy

Objective:Children with epilepsy are at greater risk of lower academic achievement than their typically developing peers (Reilly and Neville, 2015). Demographic, social, and neuropsychological factors, such as executive functioning (EF), mediate this relation. While research emphasizes the importance of EF skills for academic achievement among typically developing children (e.g., Best et al., 2011; Spiegel et al., 2021) less is known among children with epilepsy (Ng et al., 2020). The purpose of this study is to examine the influence of EF skills on academic achievement in a nationwide sample of children with epilepsy.Participants and Methods:Participants included 427 children with epilepsy (52% male; MAge= 10.71), enrolled in the Pediatric Epilepsy Research Consortium (PERC) Epilepsy Surgery Database who had been referred for surgery and underwent neuropsychological testing. Academic achievement was assessed by performance measures (word reading, reading comprehension, spelling, and calculation and word-based mathematics) and parent-rating measures (Adaptive Behavior Assessment System (ABAS) Functional Academics and Child Behavior Checklist (CBCL) School Performance). EF was assessed by verbal fluency measures, sequencing, and planning measures from the Delis Kaplan Executive Function System (DKEFS), NEPSY, and Tower of London test. Rating-based measures of EF included the 'Attention Problems’ subscale from the CBCL and 'Cognitive Regulation’ index from the Behavior Rating Inventory of Executive Function (BRIEF-2). Partial correlations assessed associations between EF predictors and academic achievement, controlling for fullscale IQ (FSIQ; A composite across intelligence tests). Significant predictors of each academic skill or rating were entered into a two-step regression that included FSIQ, demographics, and seizure variables (age of onset, current medications) in the first step with EF predictors in the second step.Results:Although zero-order correlations were significant between EF predictors and academic achievement (.29 &lt; r’s &lt; .63 for performance; -.63 &lt; r’s &lt; -.50 for rating measures), partial correlations controlling for FSIQ showed fewer significant relations. For performance-based EF, only letter fluency (DKEFS Letter Fluency) and cognitive flexibility (DKEFS Trails Condition 4) demonstrated significant associations with performance-based academic achievement (r’s &gt; .29). Regression models for performance-based academic achievement indicated that letter fluency (ß = .22, p = .017) and CBCL attention problems (ß = -.21, p =.002) were significant predictors of sight-word reading. Only letter fluency (ß = .23, p =.006) was significant for math calculation. CBCL Attention Problems were a significant predictor of spelling performance (ß = -.21, p = .009) and reading comprehension (ß = -.18, p =.039). CBCL Attention Problems (ß = -.38, p &lt;.001 for ABAS; ß = -.34, p =.002 for CBCL School) and BRIEF-2 Cognitive Regulation difficulties (ß = -.46, p &lt; .001 for ABAS; ß = -.46, p =.013 for CBCL School) were significant predictors of parent-rated ABAS Functional Academics and CBCL School Performance.Conclusions:Among a national pediatric epilepsy dataset, performance-based and ratings-based measures of EF predicted performance academic achievement, whereas only ratings-based EF predicted parent-rated academic achievement, due at least in part to shared method variance. These findings suggest that interventions that increase cognitive regulation, reduce symptoms of attention dysfunction, and promote self-generative, flexible thinking, may promote academic achievement among children with epilepsy.

91 Personality Traits Account for Variability in Self-Reported Executive Functioning but not Objective Executive Performance.

Objective:This study evaluated the relation between five-factor model (FFM) personality traits and intra-individual variability (IIV) in executive functioning (EF) using both subjective self-report and objectives measures of EF.Participants and Methods:165 university participants (M=19 years old, SD=1.3; 55.2% White, 35.2% African American, 72.7% female) completed the Barkley Deficits in Executive Functioning Scale-Long Form (BDEFS), IPIP-NEO Personality Inventory, Trail-Making Test (TMT) Parts A and B, and the Neuropsychological Assessment Battery (NAB) EF module. A participant’s IIV was calculated as the standard deviation around their own mean performance. Objective EF IIV was computed from T-scores for performance on Trails A, Trails B, and the NAB EF module. Subjective EF IIV was computed from T-scores for performance across BDEFS domains.Results:Pearson r correlations were used to evaluate the relation between subjective and objective IIV and FFM traits of personality. Subjective EF IIV was positively correlated with FFM neuroticism [r=.48; p&lt;.001] and negatively correlated with FFM conscientiousness [r=-.43; p&lt;.001], extraversion [r=-.18; p=.023] and agreeableness [r=-.22; p=.004]. There were no significant associations between FFM traits and objective EF IIV performance. There was additionally no significant relation between subjective EF IIV performance and objective EF IIV.Conclusions:Personality traits were associated with individual variability on a self-reported measure of EF but not on performance-based EF measures. These results suggest that IIV for the BDEFS was influenced by personality traits, particularly neuroticism and conscientiousness, and may reflect method variance. It was notable that IIV was not correlated between subjective and objective EF measures.

27 Differentiating Attention-deficit/Hyperactivity Disorder (ADHD) Subtype Using Continuous Performance Tests Among Children with Comorbid ADHD and Anxiety

Objective:Continuous performance tests (CPT) are often considered the gold standard for the diagnosis attention-deficit/hyperactivity disorder (ADHD), particularly when parent and teacher rating scales are inconclusive. Prior work has indicated that CPT can also help differentiate between ADHD subtypes. However, the ability of CPT to differentiate ADHD subtype has not been examined among youth with comorbid ADHD and anxiety (ADHD+A). This is particularly concerning as the extant literature suggests that anxiety symptoms may exacerbate deficits associated with ADHD (e.g.. , working memory, attention) and attenuate others (e.g., inhibition); thus, anxiety may influence expected patterns on the CPT. This study therefore seeks to examine the role of ADHD subtype on the relationship between ADHD+A and performance on a CPT among youth with ADHD+A.Participants and Methods:Participants included 54 children ranging from 6 to 20 years old (Mage=11.83, 54% female) who were diagnosed with ADHD+A via neuropsychological evaluation. In terms of ADHD subtype, 51.9% (n=28) were diagnosed with ADHD combined or ADHD primarily hyperactive and 48.1% (n=26) were diagnosed with ADHD primarily inattentive. Approximately 46.30% (N=25) of participants were medication naive. Analyses were conducted using data from the Conners Kiddie Continuous Performance Test -Second Edition (KCPT-2), Conners Continuous Performance - Second Edition (CPT-2) and the Conners Continuous Performance - Third Edition (CPT-3), which are part of the same family of performance-based attention measures. Independent samples t-tests were conducted to examine performance differences in aspects of attention (e.g., inattentiveness, sustained attention) and hyperactivity (e.g., impulsivity, inhibition).Results:ADHD subtype was not significantly related to measures of inattentiveness. This includes the number of targets missed (omissions; (t(39)=-.532, p=.59)) and variability in response time (variability; (t(39)=-0.30, p=.77)). In terms of sustained attention, ADHD subtype was not related to variability in response speed across blocks (Hit SEBC/HRT Block Change; (t(39)=-0.26, p=.79)). Importantly, these results were consistent regardless of ADHD medication status. ADHD subtype was also not significantly related to impulsivity. This includes responses to nontargets (commissions; (t(39)=-1.05, p=.30)), random or anticipatory responding (perseverations; (t(39)=-0.19, p=.85)), and mean response speed of correct responses (HR; (t(39)=-0.72, p=.48)).Conclusions:The extant literature suggests that CPT can help clinicians differentiate between ADHD subtypes. However, the results of this study indicate that there are no performance differences on the CPT among youth with comorbid ADHD and anxiety. There are several limitations to consider. First, this study had a relatively small sample size, which also limited the ability to examine ADHD primarily hyperactive/impulsive as a distinct subtype. Additionally, this study did not examine the effect of individual anxiety disorders (i.e., generalized anxiety disorder, specific phobias). Finally, these findings may not generalize to other standardized measures of attention or more ecologically valid measures. Despite these limitations, this study is an important step in understanding the relationship between ADHD+A and performance on attention measures. Clinicians should be cautious in using results from CPT to distinguish between ADHD subtype among children with comorbid anxiety.