Wechsler Intelligence Scale Research Articles

35 Pairwise Concurrence Rates Between Standalone and Embedded Performance Validity Tests

Objective:Determine the classification concordance between a standalone performance validity test (PVT) and embedded PVTs from multiple cognitive domains.Participants and Methods:Participants were 106 patients (49.1% female; 69% white) that underwent neuropsychological evaluation at an outpatient university doctoral clinical psychology training and research clinic (M/SD: age = 32.38/11.95; education = 13.7/2.75). A comprehensive neuropsychological battery included the Medical Symptom Validity Test (MSVT) and embedded PVTs from different cognitive domains: attention - Wechsler Adult Intelligence Scale - Fourth Edition Reliable Digit Span and Digit Span age-corrected scaled score (DS ACSS); memory - California Verbal Learning Test, 3rd Edition (CVLT-3) Forced-Choice Recognition (FCR), executive functions -Wisconsin Card Sorting Test (WCST) Failure to Maintain Set (FMS); visual-spatial/construction -Rey Complex Figure Test (RCFT) Copy raw score; language - Boston Diagnostic Aphasia Examination Complex Ideation Material (CIM); and motor functions - Finger Tapping Test (FTT). All participants were administered the MSVT but not all participants were administered all seven embedded PVTs. Credible/noncredible classification concordance rates and kappa correlations (i.e., percentage of agreement) were computed for each pairwise PVT combination.Results:Twenty-two percent (n = 23) of the sample failed at least one PVT, with 17.0% (n = 18) failing at least two. DS ACSS was the embedded PVT with the highest MSVT concordance rate at 92.4% and a fair kappa coefficient of .39; WCST FMS had the lowest concordance with MSVT at 82.9% and a slight kappa coefficient of .19. The highest concordance among embedded PVTs from different cognitive domains was CVLT-3 FCR and RCFT Copy raw score at 89.7% with a fair kappa coefficient of .35; the lowest agreement among embedded PVTs was WCST FMS and FTT at 74.0% with a kappa coefficient of -.02. More conservative kappa coefficients among all pair-wise embedded PVT combinations from different cognitive domains ranged from -.02 to .36. For all standalone and embedded PVT pairwise concordance rates, only two fell below the recommended minimum agreement of 80%: FCR vs. FMS = 79.3% and FMS vs. FTT = 74.0%.Conclusions:Embedded PVTs across various cognitive domains have high agreement with a standalone PVT to aid in classifying noncredible performance, in the 83-92% range. Embedded PVTs from different cognitive domains also have mostly high agreement classification rates amongst themselves in aiding to determine noncredible performance, in the 74-90% range, with the lowest agreement rate between executive function and motor tests at 74%. More conservative kappa-based agreements between PVT pair-wise combinations were fairly consistent with other studies, with most being in the fair range. Finally, these findings indicate about a 17% base rate of noncredible cognitive performance in an outpatient university-based clinic.

55 Health literacy mediates racial differences in cognitive functioning among people with and without HIV

Objective:Health disparities among African Americans (AAs) in the United States are evident, especially among older adults and people living with HIV (PLWH). These health disparities include worse cognitive functioning among AAs than White counterparts. Though disparities in health literacy among AAs impact health outcomes across clinical populations, less is known on the mechanistic role health literacy may play in explaining racial differences in cognitive functioning among older PLWH. The current study investigated the association between health literacy and global cognitive functioning among middle-aged and older AA and White adults with and without HIV in the Deep South.Participants and Methods:Two hundred and seventy-three people (170 PLWH: 146 AA, 24 White; 103 HIV-negative: 67 AA, 36 White) were enrolled in an observational study and completed measures of sociodemographic characteristics, as well as the reading subtest of the Wide Range Achievement Test-3rd Edition to assess verbal IQ. A composite score of socioeconomic status (SES) was created using total years of education and annual household income. Neurocognitive functioning was assessed using a comprehensive cognitive battery (i.e., verbal, attention/working memory, executive function, learning, recall, speed of processing, and motor), from which a sample-based global Z-score composite was created. Health literacy was measured using a sample-based composite Z-score derived from the Rapid Estimate of Adult Literacy in Medicine, Test of Functional Health Literacy in Adults Reading Comprehension, Newest Vital Sign, and Expanded Numeracy Scale. First, multivariable linear regression analyses were performed within both PLWH and HIV-negative samples examining the association between race, SES, verbal IQ, and health literacy with cognitive functioning. These results informed two bootstrap confidence interval mediation analyses to determine whether health literacy mediated the association between race and global cognitive functioning.Results:In both PLWH and HIV-negative individuals, linear regressions showed that Whites had better global cognitive functioning, health literacy, and verbal IQ than AAs. Linear regressions showed that health literacy had an independent association with cognitive function when accounting for verbal IQ and SES. Mediations showed that health literacy significantly mediated the association between race and global cognitive functioning in both samples, independent of verbal IQ (PLWH: b = .07, 95% CI [0.0096, 0.2149]; HIV-negative: b = .15, 95% CI [0.0518, 0.2877]), indicating that Whites were expected to obtain higher global cognitive Z-scores than AAs in both PLWH and HIV-negative samples, through the mediating effect of better health literacy.Conclusions:Health literacy significantly mediated the association between race and global cognitive functioning among middle-aged and older adults with and without HIV, underscoring the importance of health literacy in explaining racial disparities in cognitive outcomes among AAs in the Deep South. Findings have implications for guiding clinicians and healthcare providers in developing interventions that promote health literacy in these underserved populations, which may have downstream impacts on cognitive functioning. Future work is needed to examine mechanisms whereby health literacy impacts neurocognition among AA PLWH.

3 Fluoride Exposure and Hypothyroidism in Pregnant Women: A Potential Mechanism of Fluoride Neurotoxicity

Objective:Fluoride exposure has been associated with thyroid dysfunction, but fluoride's impact on thyroid function in pregnancy is unclear, especially during early gestation when the fetus is dependent on maternal thyroid hormone. We examined the potential thyroid-disrupting effects of maternal fluoride exposure in pregnancy and tested whether thyroid disruption in pregnancy mediates the association between maternal fluoride exposure and child intelligence quotient (IQ) among Canadian mother-child dyads living in areas with optimal fluoridation.Participants and Methods:We measured fluoride concentrations in drinking water and in spot urine samples collected in each trimester from pregnant women enrolled in the Maternal-Infant Research on Environmental Chemicals study. We also measured thyroid hormone (thyroid stimulating hormone [TSH], free thyroxine [FT4], and total thyroxine [TT4]) levels during the first trimester of pregnancy and categorized women as euthyroid (n=1301), subclinical hypothyroid (n=100), or primary hypothyroid (n=28). Those categorized as primary hypothyroid were combined with an additional 79 women who reported clinical diagnoses at time of study enrolment (total n=107). In a sample of 1508 women, we used logistic regression to estimate the association between fluoride exposure and risk of either subclinical or primary hypothyroidism, separately, and linear regression to estimate associations between fluoride exposure and women's thyroid hormone levels (TSH, FT4, TT4). We tested effect modification by child sex and thyroid peroxidase (TPO) antibody status. In a subsample of 439 mother-child pairs, we measured child Full-Scale IQ (FSIQ) at 3-4 years of age using the Wechsler Preschool and Primary Scale of Intelligence. We used linear regression to test associations between maternal hypothyroidism or thyroid hormone levels, and children's FSIQ scores. Finally, mediation analysis in the counterfactual framework was used to estimate the proportion of the effect of maternal fluoride exposure on child FSIQ mediated by maternal hypothyroidism, through evaluation of the natural direct (not through hypothyroidism) and indirect (through hypothyroidism) effects.Results:Using categorical measures of thyroid status, a 0.5 mg/L increase in water fluoride concentration was associated with a 1.64 (95% confidence interval [CI], 1.04 to 2.58) increased odds of primary hypothyroidism. This association was stronger among women with normal TPO antibody levels (< 5.61 IU/mL) (odds ratio, 2.80; 95% CI, 1.24 to 6.36). In contrast, we did not find a significant association between maternal urinary fluoride and hypothyroidism. For continuous measures of thyroid hormone levels, a 1 mg/L increase in maternal urinary fluoride was associated with a 35% (p=0.01) increase in TSH among women pregnant with a female fetus. In our subsample analyses, children born to women with primary hypothyroidism had lower FSIQ than children of euthyroid women, especially among boys (B, 8.78; 95% CI, -16.78 to -0.79). In contrast, maternal TSH, FT4, and TT4 levels were not significantly associated with child FSIQ scores. Maternal primary hypothyroidism did not significantly mediate the relationship between maternal water fluoride concentration and child FSIQ (p natural indirect effect= .35).Conclusions:Fluoride in drinking water may increase the risk of hypothyroidism in pregnancy. Thyroid dysfunction in pregnancy may be one mechanism underlying developmental neurotoxicity of fluoride.

22 The Effect of Ibogaine on Cognitive Functioning

Objective:To determine the effects of the non-classic psychedelic, ibogaine, on cognitive functioning. Ibogaine is an indole alkaloid derived from the Tabernanthe Iboga plant family, indigenous to Africa, and traditionally used in spiritual and healing ceremonies. Ibogaine has primarily been studied with respect to its clinical efficacy in reducing substance addiction. There are, however, indications that it also may enhance recovery from traumatic experiences. Ibogaine is a Schedule 1 substance in the USA.ParticipSabants and Methods:Participants were U.S. Special Operations Veterans who had independently and voluntarily referred themselves for an ibogaine retreat at a specialized clinic outside the USA prior to learning about this observational study. After meeting rigorous screening requirements, 30 participants were enrolled, all endorsing histories of combat and repeated blast exposure, as well as traumatic brain injury. Participants were seen in person pre-treatment, post-treatment, and one-month post-treatment for neuropsychological testing, neuroimaging, and collection of clinical outcome measures. All 30 participants were seen pre- and post-treatment, of whom 27 were also able to return one-month post-treatment.The neuropsychological battery included the the Hopkins Verbal Learning Test (HVLT), the Brief Visuospatial Memory Test - Revised (BVMT-R), the Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV) Working Memory Index (Digit Span and Arithmetic) and Processing Speed Index (Symbol Search and Coding), and the Delis-Kaplan Executive Function System (D-KEFS) tests of Verbal Fluency (VF), Trail Making (TMT), Color Word (CW), and Tower Test (TT). For repeated measures, alternate forms were used whenever possible.Results:Repeated-measures ANOVA revealed significant effects of time, with post-treatment improvements across multiple measures including processing speed (WAIS-IV PSI; F(2,25) = 26.957, p < .001), executive functions (CW Conditions 3 and 4: F(1.445,25) = 11.383, p < .001 and F(1.381,25) = 7.687, p = .004, respectively), verbal fluency (VF Condition 3 correct and accuracy: F(2,25) = 6.419, p = .003 and F(2,25) = 153.076, p < .001, respectively), and verbal learning (HVLT Total Recall (alternate forms used at each time point): F(1.563,23) = 6.958, p = .004). Score progression graphs are presented. Performance on all other cognitive measures did not significantly change following treatment.Conclusions:To our knowledge, this is the first prospective study examining neuropsychological test performance following ibogaine use at post-treatment and one-month post-treatment time points. Our results indicated that several cognitive domains improved either post-treatment or one-month post-ibogaine treatment, suggesting ibogaine’s therapeutic potential for cognition in the context of traumatic brain injury and mood disorders. Potential explanations include neuroplastic changes, reduction of PTSD and mood-related effects on cognitive functioning, and practice effects. While we found no evidence of negative cognitive consequences for up to one-month post-single-ibogaine treatment, further study of this substance is necessary to clarify its clinical utility and safety parameters.

27 Examining the Relationship Between Spanish-English Bilingualism and Digit Span Performance

Objective:Bilingualism has shown to have significant implications for neuropsychological assessment, namely, the Digit Span task. Moreover, bilingual individuals have been shown to exhibit both advantages and disadvantages on Digit Span; however, the relationship between bilingualism and performance on this subtest is poorly understood. This research aims to better understand how Hispanic Spanish-English bilinguals perform on this commonly administered working memory subtest.Participants and Methods:Participants included 82 Hispanic Spanish-English bilinguals [Age: M=29.11 (SD=6.369); Education: M=15.68 (SD=2.255); 53.7% female]. The participants completed the Language and Social Background Questionnaire (LSBQ; composite factor scores) and the Wechsler Adult Intelligence Scale -Fourth Edition (WAIS-IV) Digit Span (raw scores) subtest via Zoom, an online video conferencing platform. A hierarchical multiple regression analysis was utilized to predict participants’ Digit Span performance based on their LSBQ composite factor scores. Hierarchical multiple regression analyses were conducted using SPSS Version 27.Results:LSBQ composite factor scores significantly predicted Digit Span Forward, F (3, 78) = 1.835, p < 0.43 (R2 = .030) and Longest Digit Span Forward, F (1, 78) = 4.02, p < 0.48 (R2 = .041) scores. LSBQ composite factor scores did not significantly predict Digit Span Backward, F (3, 78) = .344, p = .941, Digit Span Sequencing, F (3, 78) = .598, p = .731, Digit Span Total, F (3, 78) = .440, p = 0.296, Longest Digit Span Backward, F (3, 78) = .510, p = .666, or Longest Digit Span sequencing F (3, 78) = .200, p = .751 scores.Conclusions:Results suggest that Hispanic Spanish-English bilinguals perform worse on Digit Span Forward and Longest Digit Span Forward as their bilingual experiences increase. However, bilingual experiences did not significantly predict Digit Span Backward, Digit Span Sequencing, Digit Span Total, Longest Digit Span Backward, or Longest Digit Span Sequencing scores. The contrasts in Digit Span performance may be attributed to the different ways in which each condition of the subtest is cognitively processed. Therefore, clinicians and researchers should use caution when interpreting test data for Digit Span with Hispanic Spanish-English bilinguals.

30 Examining the Bilingual Advantage in Executive Functioning in ADHD: A Retrospective Study

Objective:Several studies have found a bilingualism advantage on executive functioning tasks like cognitive flexibility, inhibitory control, switching, and working memory in typically developing populations. (Grote et al., 2015, Foy & Mann, 2014). However, some studies have found deficits in inhibitory control and switching for bilingual individuals with Attention Deficit/Hyperactivity Disorder (ADHD) compared to monolingual individuals and control groups (Bialystok et al., 2017, Mor et al., 2015). They suggest that this disadvantage is due to the burden of managing two language systems which perpetuates the executive dysfunction seen in ADHD. The current study aims to examine if there is a bilingualism advantage in other aspects of executive function, including inhibitory control, planning, problem solving, switching, and working memory among children and adults diagnosed with ADHD.Participants and Methods:The medical records of 170 patients evaluated in an outpatient neuropsychology clinic from 20182022 were reviewed. Sixty participants diagnosed with ADHD, between the ages of 6 and 46 (61.67% male), comprised the final sample. Forty-one were monolingual and 19 were bilingual or multilingual. Language status was based upon patient or parental report. Outcomes on various direct and indirect measures of executive function were examined.Results:Linear regression models, adjusting for age and sex, revealed a significant bilingual advantage on the following measures: Wechsler Intelligence Scale for Children- Fifth Edition (WISC-V) and Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV) Digit Span Backwards and Digit Span Sequencing, WISC-V Picture Span, and Behavior Rating Inventory of Executive Function, 2nd Edition (BRIEF-2) Parent-Report Emotion Regulation Index (ERI). There were no significant differences in scores between monolinguals and bilinguals on the following measures: Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference Inhibition versus Combined Naming Contrast Score and Inhibition/Switching versus Inhibition Contrast Score, D-KEFS Trail Making Number-Letter Switching versus Combined Number Sequencing and Letter Sequencing Contrast Score, A Developmental Neuropsychological Assessment, 2nd Edition (NEPSY-2) Naming versus Inhibition Contrast Score and Switching versus Inhibition Contrast Score, Wisconsin Card Sort Task Learning to Learn Index, BRIEF-2 Parent-rated Behavioral Regulation Index (BRI), Cognitive Regulation Index(CRI), and Global Executive Composite(GEC), BRIEF-2 Self-rated BRI, ERI, CRI, and GEC, or BRIEF Adult Version BRI, Metacognitive Index, and GEC.Conclusions:Bilingual status is associated with stronger auditory and visual working memory among people with ADHD, but not with stronger inhibitory control, switching, planning, or problem solving skills. At the same time, there were no significant differences between monolingual and bilingual ADHD patients on BRIEF parent- or self-rated behavioral or cognitive dysregulation. Our results suggest that bilingualism may confer an advantage in some aspects of executive function among a population with weak attention and executive function skills more broadly. Furthermore, we did not find any type of disadvantage for those who are bilingual. Future studies should examine whether lower parental ratings of emotion dysregulation among ADHD patients who are bilingual are due to bilingual children’s better ability to adapt to different situations or cultural differences in parenting practices.

60 Are all Embedded Measures Created Equal? A look at Embedded PVTs in Major Neurocognitive Disorder

Objective:Although performance validity is critical in determining the quality and accuracy of test data, research suggests not all neuropsychologists incorporate performance validity tests (PVTs) in dementia evaluations (McGuire et al., 2019). Furthermore, well-validated embedded measures, such as Reliable Digit Span (RDS) from the Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV), have evidenced an unusually high number of failures in a dementia population when utilizing typical clinical cut-offs (Zenisek et al., 2016). The objective of this study is to explore performance on embedded PVTs among older adults who have a major neurocognitive disorder (MND), specifically among Alzheimer disease (AD) and non-AD patients.Participants and Methods:Archival data from outpatient neuropsychological evaluations were analyzed. All participants were at least 65 years of age, diagnosed with a MND, and completed Digit Span from the WAIS-IV, Brief Visuospatial Memory Test- Revised (BVMT-R), and Hopkins Verbal Learning Test-Revised (HVLT-R). In total, 84 participants, aged 67-96 (M=78.44, SD=6.11) with 6-20 years of education (M=13.47, SD=3.30), were included. The sample predominantly identified as female (n=60) and White (n=61). More individuals were diagnosed with AD (n=50) than non-AD dementia (n=34). Common non-AD diagnoses included Vascular (n=44), Lewy bodies (n=8), and Parkinson’s (n=2) dementias. Fisher’s Exact Test of Independence was used to account for the smaller sample to determine if there was a nonrandom association between diagnosis (AD vs non-AD) and embedded PVT performance: RDS< 7, BVMT-R Hits<4, BVMT-R Recognition Discrimination (RD) < 4, and HVLT-R RD < 5 (Bailey et al., 2018).Results:The Fisher’s Exact Test of Independence revealed a statistically significant association between neurocognitive diagnosis and RDS (p= .008), BVMT-R RD (p<.001), and HVLT-R RD (p<.001). BVMT-R Hits were not significantly associated with diagnosis (p = 0.10). These measures evidenced opposite patterns with RDS demonstrating a higher percentage of fails for the non-AD (63%) versus AD (20%) group. The AD group had a higher percentage of fails for BVMT-R RD (58% for AD and 13% for non-AD groups) and HLVT-R RD (66% for AD and 29% for non-AD group).Conclusions:The current study suggests performance on embedded PVTs vary across MND diagnoses. Individuals with a non-AD diagnosis were more likely to fail RDS than those with AD. This is likely secondary to attention and working memory demands that are mediated by the frontal-subcortical networks, which are less impacted by AD pathology (Bonelli & Cummings, 2022; Loring et al., 2016). In contrast, AD patients were more likely to fail embedded PVTs within memory measures, which are largely mediated by the mesial temporal cortex associated with AD (Pluta, 2022). These results suggest embedded measures operate differently based on diagnosis and neuroanatomical systems affected. The clinical relevance of these findings includes potentially using alternative PVTs or different cut-offs based on diagnosis. Future research should attempt to better delineate more appropriate, as well as time efficient, PVTs among the dementia population.

24 Mindfulness-based cognitive therapy enhances executive control in recurrent depression in a randomized wait-list controlled trial

Objective:Adults with recurrent depression have been shown to have cognitive deficits also while in remission. Thus, it has been suggested that with a chronic course of depression, poorer executive control can be a vulnerability factor for depressive relapse. This has led to research on how cognitive remediation training can protect against recurrent depressive episodes. Findings indicate that such training has short term effects on cognitive functioning, and small effect on depression symptoms. Less focus has been on how “standard” psychotherapy can have positive effects on executive and attentional control. Mindfulness-based cognitive therapy (MBCT) has been shown to be as effective as antidepressant medication in preventing relapses of depressive episodes. Mindfulness training in healthy samples seems to improve executive and attentional control. However, the few studies of MBCT in recurrent depression show mixed effects on executive and attentional control. As far as we know, no prior study has investigated the effect of MBCT in recurrent depression with the revised version of the attention network test (ANT-R). In a randomized controlled trial, we expected that the MBCT group would show enhanced executive control and lower levels of attentional fluctuations than the wait-list controls (WLC) from pre (T0) to post (T1) treatment. We further investigated if positive effects of MBCT on executive and attentional control were associated with reduction in depression symptoms.Participants and Methods:Adults with recurrent depression in partial or full remission (N = 64) were randomized to MBCT or WLC. In the MBCT and WLC groups, 25 and 29, respectively, performed the ANT-R at T0 and T1. The attention network reaction time scores of executive control, alerting, and orienting were calculated in addition to attention fluctuations scores of intra-individual reaction time variability (IIVRT) and exgaussian-mean of longer reaction times (TAU). Self-reported depression symptoms were measured with BDI-II. The two groups were compared at baseline on full-scale IQ (WASI), executive control (D-KEFS Stroop), and processing speed (D-KEFS TMT).Results:The MBCT and WCL groups did not differ significantly in age or gender distribution, education, full-scale IQ or in baseline executive and attentional control as measured with the ANT-R, Stroop and TMT. The MBCT group showed a higher efficiency in conflict detection as measured with the executive control score from T0 to T1 compared to the WLC. This positive effect of MBCT on executive control was independent from the greater reductions in depression symptoms in the MBCT group compared to in the WLCs. However, reduction in depression symptoms at T1 was associated with enhanced efficiency in responding to alerting cues in conflict detection. No effects of MBCT compared to WLC were found at T1 on the attention fluctuation measures (IIVRT and TAU).Conclusions:The findings from the current study indicates that MBCT enhances executive control in adults with recurrent depression. As such, MBCT may target an important cognitive vulnerability factor in the chronic course of recurrent depression that may contribute to its efficacy in preventing depressive relapses. It was also observed that reductions in depression symptoms led to higher alertness in conflict detection.

3 Latent Wechsler Profiles in Presurgical Pediatric Epilepsy

Objective:The Pediatric Epilepsy Research Consortium (PERC) Epilepsy Surgery Database Project is a multisite collaborative that includes neuropsychological evaluations of children presenting for epilepsy surgery. There is some evidence for specific neuropsychological phenotypes within epilepsy (Hermann et al, 2016); however, this is less clear in pediatric patients. As a first step, we applied an empirically-based subtyping approach to determine if there were specific profiles using indices from the Wechsler scales [Verbal IQ (VIQ), Nonverbal IQ (NVIQ), Processing Speed Index (PSI), Working Memory Index (WMI)]. We hypothesized that there would be at least four profiles that are distinguished by slow processing speed and poor working memory as well as profiles with significant differences between verbal and nonverbal reasoning abilities.Participants and Methods:Our study included 372 children (M=12.1 years SD=4.1; 77.4% White; 48% male) who completed an age-appropriate Wechsler measure, enough to render at least two index scores. Epilepsy characteristics included 84.4% with focal epilepsy (evenly distributed between left and right focus) and 13.5% with generalized or mixed seizure types; mean age of onset = 6.7 years, SD = 4.5; seizure frequency ranged from daily to less than monthly; 53% had structural etiology; 71% had an abnormal MRI; and mean number of antiseizure medications was two. Latent profile analysis was used to identify discrete underlying cognitive profiles based on intellectual functioning. Demographic and epilepsy characteristics were compared among profiles.Results:Based on class enumeration procedures, a 3-cluster solution provided the best fit for the data, with profiles characterized by generally Average, Low Average, or Below Average functioning. 32.8% were in the Average profile with mean index scores ranging from 91.7-103.2; 47.6% were in the Low Average profile with mean index ranging from 80.7 to 84.5; and 19.6% were in the Below Average profile with mean index scores ranging from 55.0-63.1. Across all profiles, the lowest mean score was the PSI, followed by WMI. VIQ and NVIQ represented relatively higher scores for all three profiles. Mean discrepancy between indices within a profile was as large as 11.5 IQ points. No demographics or epilepsy characteristics were significantly different across cognitive phenotypes.Conclusions:Latent cognitive phenotypes in a pediatric presurgical cohort were differentiated by general level of functioning; however, across profiles, processing speed was consistently the lowest index followed by working memory. These findings across phenotypes suggest a common relative weakness which may result from a global effect of antiseizure medications and/or the widespread impact of seizures on neural networks even in a largely focal epilepsy cohort; similar to adult studies with temporal lobe epilepsy (Hermann et al, 2007). Future work will use latent profile analysis to examine phenotypes across other domains relevant to pediatric epilepsy including attention, naming, motor, and memory functioning. These findings are in line with collaborative efforts towards cognitive phenotyping which is the aim of our PERC Epilepsy Surgery Database Project that has already established one of the largest pediatric epilepsy surgery cohorts.

59 Perinatal Risk Factors and Cognitive Outcomes in Children HIV-Exposed, Uninfected

Objective:Children who are HIV-exposed uninfected (CHEU) are at risk of neurodevelopmental impairments due to perinatal HIV and antiretroviral therapy exposure as well as additional health and psychosocial burdens. There is limited understanding of the impact of perinatal risk factors on long-term outcomes of CHEU. The present study investigated the association between perinatal risk factors and the intellectual and language abilities in CHEU and children who are HIV-unexposed uninfected (CHUU).Participants and Methods:CHEU and CHUU, 6 to 10 years, of age underwent neurodevelopmental assessments through the Kids Imaging and Neurocognitive Development (KIND) study at the Hospital for Sick Children in Toronto, Canada between January 2020 and August 2022. CHUU were recruited from the community with similar sociodemographic backgrounds based on residential area in Toronto and parental income levels. Measures of Full-Scale IQ (FSIQ), Verbal Comprehension (VCI), Visual Spatial skills (VSI), Fluid Reasoning (FRI), Working Memory (WMI), and Processing Speed (PSI) were evaluated with the Wechsler Intelligence Scale for Children - Fifth Edition. Core Language, Receptive Language, and Expressive Language skills were assessed with the Clinical Evaluation of Language Fundamentals - Fifth Edition. Perinatal risk factors included birthweight, birth complications (e.g., premature rupture of membranes, jaundice, etc.), maternal smoking and alcohol use during pregnancy, and NICU admission. Analyses of variance and chi-square tests were performed to investigate group differences and multiple regression analyses tested the relation between neurodevelopmental measures and birth factors. Significance was held at p <0.05.Results:36 CHEU (21 female, 8.74 ±1.56 years) and 26 CHUU (12 female, 8.53 ±1.50 years) children were included. For both groups, mean standardized scores of the cognitive abilities assessed were in the average range. CHEU had significantly lower birth weight than CHUU, but there were no differences between these groups with respect to maternal smoking and alcohol use, birth complications or NICU admission. There were no between group differences identified for the intellectual and language abilities. In the CHEU group, birthweight was significantly associated with lower VCI, WMI, and expressive language. In the CHUU group, prenatal alcohol and smoking exposure was associated with lower VCI scores. Birth complications were associated with lower WMI, PSI, and FSIQ scores.Conclusions:In this interim analysis, perinatal risk factors impacted neurodevelopmental outcomes of CHEU and CHUU differently. While the groups did not differ in frequency of birth complications and maternal smoking and alcohol use, these factors negatively impacted aspects of intellectual ability in the CHUU group. CHEU with lower birthweight are at greater risk of working memory and language difficulties, supporting the need for early interventions and close neuropsychological follow-up of this population throughout childhood.

75 Can the Children’s Communication Checklist Differentiate Between Children with High Functioning Autism, ADHD, and Academically-Based Learning Disabilities?

Objective:The Children’s Communication Checklist-Second Edition (CCC-2) is a rating scale designed to assess domains of communication skills with emphasis on pragmatics (Bishop, 2006). The CCC comprises 10 subtests addressing various aspects of oral communication skills: Speech, Syntax, Semantics, Coherence, Initiation, Scripted Language, Context, Nonverbal Communication, Social Relations, and Interests. In a study conducted on the original CCC, Geurts et al. (2004) found that when compared to normal controls, pragmatic difficulties occurred in children with either high functioning autism (HFA) or ADHD. Since the initial version of the CCC, no study has examined whether the revised version can differentiate children with HFA, ADHD, and LD, the purpose of the present study. Focus was on derived factors of the structure/content of language and the pragmatics of language.Participants and Methods:Forty-one participants grouped according to diagnosis were drawn from two archival data pools, one adapted from a previous study conducted by Casey and Scott (2016) and the other from a set of anonymized patients from a neuropsychological clinic. Fourteen participants met clinical criteria for autism (Mage = 11.95), 12 participants met criteria for ADHD without co-morbid disorders (Mage = 9.5), and 15 participants met criteria for a learning disability involving reading, writing, math, or some combination (Mage = 10.13). Group-specific descriptive statistics were computed for the participants’ age, full scale intelligence quotient (IQ), and General Communication Composite (GCC). Two factor scores were computed, one composed of the subtests that constitute the structure/content aspects of language (Speech, Syntax, Semantics, and Coherence) and one composed of the pragmatic aspects of language (Initiation, Nonverbal Communication, Social Relations, and Interests), an area of particular weakness in HFA. Independent samples ANOVAs were conducted on both factor scores to determine whether the CCC-2 could differentiate the three groups. Post-hoc comparisons were planned for the subtests comprising the factor(s) that differentiated the groups.Results:Participants in the ADHD (M = 9.45, SD = 2.45) group were significantly younger than those in the HFA group (M = 11.95, SD = 2.24) and LD group (M = 10.13, SD = 2.58), the latter two not differing significantly. The groups did not differ significantly on IQ, nor on the structure/content factor. On the pragmatic factor, the LD group (M = 10.18, SD = 9.91) had significantly higher scores than the ADHD group (M = 7.79, SD = 6.54), which in turn, had significantly higher scores than the HFA group (M = 5.48, SD = 8.26), F(2, 38) = 17.81, p < .01. Within this composite, the same pattern was shown on Nonverbal Communication, F(2, 38) = 9.29, p < .01, and Interests, F(2, 38) = 17.81, p < .01.Conclusions:Compared to children with an academically-based learning disability, children with ADHD and HFA demonstrated pragmatic difficulties on the CCC-2. Although there was overlap between the pragmatic language characteristics of children with ADHD and children with HFA, the CCC-2 demonstrated utility in distinguishing the two disorders on certain aspects of communication skills, suggesting that it is a useful tool in differential diagnosis.

2 Water-Based Exercise Improves Cognition and Reduces Neurological-Related Plasma Proteins in Older Adults.

Objective:In the United States, Alzheimer’s disease (AD) is the most common cause of dementia and the seventh leading cause of death. Exercise has demonstrated health benefits in older adults and reduces the risk of developing AD. Exploring underlying biological mechanisms of exercise could aid in identifying therapeutic targets to prevent AD progression, especially for high-risk individuals such as those with Mild Cognitive Impairment (MCI). Many studies of dementia focus on memory; however, executive function and processing speed are also vulnerable to the neuropathology that causes AD. This exploratory study aimed to identify potential mechanisms by which physical activity can facilitate change in cognitive functioning in older adults. This was accomplished by investigating correlations between changes in neurology-related plasma proteins and changes in measures of executive function and processing speed after participation in a water-based exercise intervention.Participants and Methods:The sample included 20 older adults with amnestic MCI, ages 55-82 years (mean 68.15 ±7.75). Participants were predominately male (90%), White (70%), and non-Hispanic (85%), with more than high school education (95%). Participants engaged in supervised high-intensity water-based exercise three times per week for six months. Neuropsychological assessments and blood samples were assessed at baseline and after completion of the exercise intervention. Cognitive measures included: the Digit Span subtests from the Wechsler Adult Intelligence Scale, 4th Edition, Trail-Making Test (TMT), Stroop Color Word Test (SCWT), and the Symbol Digit Modalities Test (SDMT). Plasma protein levels were analyzed using the Olink Target 96 Neurology assay (Uppsala, Sweden), selected a priori for the established markers linked to neurobiological processes and diseases. Changes in cognitive measures and protein levels were assessed using paired-sample t-tests, and Pearson’s correlations were calculated for significant findings.Results:Participants’ cognitive performance significantly improved on the SCWT color trial (t = -2.19, p = 0.042) and SDMT (t = -2.17, p = .043). Significant decreases in plasma proteins levels were found for GDNF family receptor alpha-1 ([GFRA1]: t =2.05, p = 0.055), neuroblastoma suppressor tumorigenicity-1 ([NBL1]: t = 2.13, p= .046), and neuropilin-2 ([NRP2]: t = 2.61 p= 0.017). Correlational analyses showed reductions in NBL1 were significantly associated with changes in both SDMT (r = -.61, p = 0.006) and the color trial of SCWT (r = .48, p = .038), and NRP2 was significantly associated with improvement on the SDMT (r = -.46, p = 0.045). GFRA1 was not significantly associated with change on any cognitive measure.Conclusions:In a sample of older adults with MCI, participation in high-intensity water-based exercise led to significant improvements in cognitive function as well as changes in neurological plasma proteome. Improved outcomes in processing speed, attention, visuospatial scanning, and working memory were associated with changes in specific plasma protein concentrations. This highlights potential activity-dependent neurobiological mechanisms that may underlie the cognitive benefits derived from physical activity. Future studies should explore these findings in Randomized Control Trials with a comparative condition and larger sample size.

34 The Influence of Bilingualism in Young Adults

Objective:The research examining the influence of bilingualism on cognition continues to grow. Past research shows that monolingual speakers outperformed bilingual speakers on language, memory, and attention and processing speed tasks. However, the opposite has been found favoring bilingual speakers, when comparing executive functioning abilities. Furthermore, researchers have reported that no differences in executive functioning abilities exist between young adult monolingual speakers compared to young adult bilingual speakers. Moreover, limited research exists examining cognition abilities between monolinguals, bilinguals that learn a language (e.g., English) first, and bilinguals that learn the same language (e.g., English) second. We examined young adult monolinguals cognition abilities (e.g., memory) compared to young adult bilinguals that learned English as a first or second language. It was expected that the monolingual group would outperform both bilingual groups on memory, language, and attention and processing tasks, but no differences would be found on executive functioning tasks.Participants and Methods:The sample consisted of 149 right-handed undergraduate students with a mean age of 19.58 (SD = 1.90). Participants were neurologically and psychologically healthy and divided into three language groups: English first language (EFL) monolingual speakers, EFL bilingual speakers, and English second language (ESL) bilingual speakers. All the participants completed a background questionnaire and comprehensive neuropsychological battery that included memory, language, executive functioning, and attention and processing speed tasks in English. A series of ANOVA’s were used to evaluate cognitive tasks (e.g., Boston Naming Test, Trail Making Test) between the language groups. Participants demonstrated adequate effort on one performance validity test.Results:Language groups were well demographically matched. We found the EFL monolingual group outperformed the ESL bilingual group on the Wide Range Achievement Test, fourth edition task and the Controlled Oral Word Association Test (COWAT) phonemic task, p’s < .05, np’s2 = .04-.05. Additionally, results revealed both monolingual groups outperformed the ESL bilingual group on the Wechsler Adult Intelligence Scale, Third edition vocabulary task and the Boston Naming Test, p’s < .05, np’s2 = .06-.15. No significant differences were found on any of the cognitive tasks between the EFL monolingual group and the EFL bilingual group.Conclusions:As expected, the ESL bilingual group performed worse on language tasks compared to both monolingual groups, specifically the EFL monolingual group. However, in the opposite direction, we found the EFL monolingual demonstrated better phonemic verbal fluency abilities on the COWAT compared to the ESL bilingual group. The current data suggest that bilingualism influences cognitive abilities (e.g., language, executive functioning) more ESL bilingual speakers compared to EFL monolingual speakers. A possible explanation may be due to the type of interaction that ESL bilingual speakers may prefer to have (i.e., mix language conversations) compared to EFL speaking groups. Future studies with a larger bilingual speaking sample should investigate if the Adaptive Control Hypothesis which suggest that different types of conversations may be placing different demands of language control influences cognitive abilities.

47 Attention and Working Memory (WM) in Pediatric Patients Prior to Hemopoietic Stem Cell Transplant (HSCT) for Hematologic Malignancies

Objective:HSCT is increasingly used for curative therapy for patients with high risk hematologic diseases. Existing research regarding the neurocognitive impact of HSCT on pediatric patients is notably variable. One area of identified risk is attention/working memory (WM) [Perkins et al., 2007]. The current study examines the degree to which difficulties in attention/WM are present prior to HSCT, as assessed using parent-report of working memory and cognitive tests of attention span and working memory.Participants and Methods:Participants were 19 children and adolescents ages 6-17 years (M= 9.63, SD= 3.22) who were enrolled in a prospective longitudinal study monitoring neurocognitive outcomes in children undergoing HSCT. Participants were eligible for this study if they were 2-18 years old at the time of transplant and had a diagnosis that qualified for an allogenic HSCT. Participants were ineligible if they had a pre-HSCT developmental delay, were non-English speaking, and had a prior HSCT or prior CAR T-cell therapy. Participants were 53% female and 95% Caucasian. Diagnoses in the current study sample included acute lymphoblastic leukemia (n=10), acute myeloid leukemia (n=8), and myelodysplastic syndrome (n=1).Measures included were the Working Memory Index score from the Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000) and the Digit Span subtest from the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV; Wechsler, 2003) and the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV; Wechsler, 2008).Results:Mean scores on parent-reported WM scores and cognitive measures of attention/WM fell within normal limits, including the Digit Span Total score (M = 48.42, SD= 6.33), Digit Span Forward score (M = 47.28, SD = 9.9.83), and Digit Span Backward score (M = 48.94, SD = 6.31). However, further analyses suggested that between 11-32% of patients had scores falling at least one standard deviation below the mean on these measures, with more than half of the sample (52.6%) identified with at least one measured weakness in attention and WM. The most commonly identified weakness (33.3% of patients) was Digit Span Forward. Correlations between parent-reported WM issues and cognitive measures of attention and WM were generally strong, with parent report of WM significantly correlated with the Digit Span Total score (r(18)= -0.52, p=.02) and the Digit Span Forward score (r(18) = -0.51, p=.03). No correlations were found between Digit Span Backward and other measures of attention and WM.There were no significant differences in WM scores between patients with ALL and AML. Additional analyses will examine potential contribution of medical factors (e.g., pre-HSCT treatment) to pre-HSCT performance on measures of attention and WM.Conclusions:These results suggest that, prior to undergoing HSCT, pediatric patients present with attention and WM issues. This finding has implications for research related to neurocognitive outcomes in HSCT, indicating the need to obtain pre-HSCT cognitive data in this area in order to fully understand potential change after HSCT. In addition, providers may need to consider adapting communication methods with patients during their transplant stay, given potential attention and WM issues within this population.

65 Verbal and Visual-Spatial Abilities Differ by Ethnicity in a Referred Pediatric Sample

Objective:To compare performances of matched groups derived from caregiver-reported ethnicity on measures of verbal comprehension and visual-spatial abilities, and to identify factors potentially related to differences.Participants and Methods:Participants included 159 English speaking children from 615 years of age who were referred for neuropsychological evaluation at a clinic in the southwestern region of the United States. Participants were matched across four groups based on caregiver-reported ethnicity, including American Indian (n = 41), Hispanic (n= 41), White (n = 41), and Other (i.e., Black, Asian; n = 36) categories. Propensity score matching was used to derive samples, with participants matched on age, caregiver-reported sex assigned at birth, and the full-scale intelligence quotient on the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V).Results:Using a dependent variable derived from subtracting the WISC-V Verbal Comprehension Index from the Visual-Spatial Index, significant differences across groups were found via a factorial analysis of variance model (p = .02, eta squared = .06). Achieved power was .82. Post-hoc analysis indicated significantly greater differences between verbal comprehension and visual-spatial abilities amongst participants of American Indian (mean difference = -6.61 standard score points) and Hispanic (mean difference = -6.66 standard score points) ethnicity relative to participants of White ethnicity (mean difference = 2.17 standard score points; p < .01). Differences did not relate to participant age or assigned sex.Conclusions:Greater differences between visual and verbal intellectual abilities were found amongst Hispanic and American Indian participants relative to White participants. Hispanic and American children tended to perform higher on visual spatial rather than verbal tasks, while the pattern was reversed for White children. Findings are congruent with previous research conducted using older versions of the WISC and continue to highlight potential issues related to the external validity of this measure in certain populations. This study contributes to the existing literature by replicating previous findings with the most recent iteration of the WISC in a referred sample. Current results continue to suggest that the WISC-V Verbal Comprehension Index may function more as a measure of English language ability rather than verbal intellectual ability. Given these findings, it is important that weaknesses in verbal comprehension amongst children of Hispanic or American Indian ethnicity be interpreted in this context when identified in clinical and research settings. Discrepancies between ethnic groups may relate broadly to cultural and systemic factors (e.g., differing patient/examiner characteristics, inequalities in access to education/intervention and healthcare, bilingualism/exposure to the English language).

51 Cognitive Functioning in Neurofibromatosis Type 1: The Role of Community Socioeconomic Status

Objective:Neurofibromatosis type 1 (NF1) is a neurogenetic disorder associated with increased risk of neuropsychological challenges. While research has evidenced associations between environmental factors and neurocognitive development, few studies have examined the role that socioeconomic status (SES) plays on neuropsychological development in NF1. The aim of this study is to examine the relationship between community SES and cognitive/psychosocial outcomes in a neuropsychology clinic sample of pediatric NF1 patients.Participants and Methods:The sample consisted of 47 youth with NF1 (M age=11.91, SD=3.69). The sample was 51.1% female, 72.3% White, 19.1% Black/African American, and 4.3% Hispanic. All participants had completed neuropsychological assessments for clinical purposes at an outpatient clinic in an urban, midwestern medical center. Data from neuropsychological measures and demographic information were pulled from records and entered into a de-identified dataset. The Wechsler Intelligence Scales, California Verbal Learning Test (CVLT), Woodcock Johnson Test of Achievement, and parent- and teacher-report versions of the Behavior Assessment System for Children (BASC) and the Behavior Rating Inventory of Executive Function (BRIEF) were used to examine broad neuropsychological functioning. The Area Deprivation Index (ADI) measures SES at the community level, as opposed to the individual level. It is composed of 17 factors related to education, poverty, employment, and housing. This information is used to assign index scores by zip code, with scores on a scale of 110 and 10 indicating the highest level of socioeconomic disadvantage. Mean ADI for this sample was 4.02 (SD=1.93).Results:Mean neurocognitive scores were consistently in the low average to average range. Parent and teacher scores on the BASC were in the average range. Mean scores on the BRIEF indicated Global Executive Composite scores in the mildly and moderately elevated range for parents and teachers, respectively. Correlational analyses revealed significant associations between ADI scores and immediate recall performance on the CVLT (Trials 1-5; r=.37; p=.03) and the BRIEF Planning and Organization subscale (r=.35; p=.02). Both remained significant after controlling for FSIQ (CVLT: rFSIQ=.49, p=.003; BRIEF: rFSIQ=.38; p=.02).Conclusions:Mean cognitive scores for the sample are consistent with existing literature demonstrating that individuals with NF1 are at risk of reduced functioning in several domains. Sample mean ADI of 4 indicates a relatively low level of disadvantage in this sample., ADI was significantly associated with two variables, and greater deprivation was associated with better list learning performance. This suggests that the role of community SES is likely nuanced in how it impacts neurocognitive development. Results provide mild evidence of an association between ADI and learning and planning/organization. However, limitations to the current study, including a small sample size, and the retrospective nature, likely limits a more detailed understanding of the true relationship between community resources and cognitive and psychosocial outcomes among children with NF1. Future research comparing larger low and high ADI samples is necessary to fully examine the relationship between these factors. With better understanding of how community SES may limit or support neurocognitive and psychological growth in this population, more effective interventions can be designed for this group whose members are at notable risk for cognitive and psychological challenges.

79 The Clinical Utility of Reliable Digit Span in Predicting Effort on the TOMM in Youth with a History of a Concussion

Objective:Performance validity testing (PVT) is important in neuropsychological evaluations to ensure accurate interpretation of performance. While research shows children pass PVTs with adult cut-offs, PVTs are more commonly used with adults (Lippa, 2018). The Test of Memory Malingering (TOMM), a standalone PVT, is commonly used with adults and children (DeRight & Carone, 2015). The Reliable Digit Span (RDS), an embedded PVT derived from the Digit Span subtest of the Wechsler Intelligence Scales (Wechsler Intelligence Scale for Children-4th Edition, WISC-IV; Wechsler, 2003), is less commonly used with children (DeRight & Carone, 2015). RDS cut-off scores are associated with an increased rate of false positives in children, indicating mixed results regarding the clinical utility in pediatric populations (Welsh et al., 2012). Research shows that youth with a history of concussion (HOC) may demonstrate suboptimal effort for many reasons (e.g., external incentives, boredom, pressure), thus highlighting the need to investigate the utility of PVTs in this population (Araujo et al., 2014; DeRight & Carone, 2015). The present study aimed to examine the clinical utility of RDS in detecting poor effort on the TOMM in youth athletes with a HOC.Participants and Methods:Participants included 174 youth athletes aged 8 to 18 (20.1% female; 42.5% people of color (POC)) who completed a baseline neuropsychological battery that included the TOMM and WISC-IV Digit Span. Of the sample, 29 youth athletes reported a HOC (13.8% female; 37.9 POC). RDS was calculated for each Digit Span administration, and sensitivity (SN) and specificity (SP) were calculated for RDS when invalid performance was operationalized by a more stringent cut-off score of <49 to increase the SN of the TOMM Trial 1 (Stenclik et al., 2013). Receiver operator characteristics (ROC) curve analysis determined whether RDS performance accurately predicted participants’ performance on the TOMM.Results:The ROC curve analysis resulted in an area under the curve (AUC) of just 0.427 for RDS. A cut-off score of <7 (as suggested by Kirkwood et al. (2011)) for RDS results in 100% SN, 8.3% SP, 5% positive predictive validity (PPV), and 95% negative predictive validity (NPV). However, a cut-off score of <9 for RDS results in 75% SN, 15% SP, 25% PPV, and 75% NPV.Conclusions:Little research shows the utility of different PVTs predicting children’s performance on other PVTs, despite evidence that children with a HOC are vulnerable to variable or insufficient effort (Araujo et al., 2014; DeRight & Carone, 2015). In a sample of 29 youth athletes with a HOC, RDS predicted TOMM performance at rates worse than chance. While RDS has advantages as an embedded PVT, its limited ability to predict performance on a standalone PVT suggests interpreting with great caution. These findings highlight the importance of implementing multiple PVTs throughout testing to ensure accurate findings and interpretations, particularly in youth with a HOC. The small sample size is a limitation that possibly impacted the ability of RDS to predict TOMM performance. Further research is needed to understand the utility of RDS as a predictor of PVT performance in different populations. Replication of these findings with a larger sample size is needed to provide confirmatory evidence of poor predictive performance of the RDS.

18 Executive Dysfunction Following Treatment for Pediatric Low Grade Brain Tumors: Increased Risk Associated with Infratentorial Tumor Location

Objective:Treatment for pediatric brain tumors (PBTs) is associated with neurocognitive risk, including declines in IQ, executive function, and visual motor processing. Low grade tumors require less intensive treatment (i.e., focal radiotherapy (RT) or surgical resection alone), and have been associated with more favorable cognitive outcomes. However, these patients remain at risk of cognitive problems, which may present differently depending on tumor location. Executive functioning (EF), in particular, has been broadly associated with both frontal-subcortical networks (supratentorial) and the cerebellum (infratentorial). The current study examined intellectual functioning, executive functioning (set-shifting and inhibition), and visual motor skills in patients who were treated for low-grade tumors located in either the supratentorial or infratentorial region.Participants and Methods:Participants were survivors (age 8-18) previously treated with focal proton RT or surgery alone for infratentorial (n=21) or supratentorial (n=34) low grade glioma (83.6%) or low grade glioneuronal tumors (16.4%). Survivors >2.5 years post-treatment completed cognitive testing (WISC-IV/WAIS-IV; D-KEFS Verbal Fluency (VF), Color-Word Interference (CW), Trail Making Test (TM); Beery Visual-Motor Integration). We compared outcomes between infratentorial and supratentorial groups using analysis of covariance (ANCOVA). Demographic and clinical variables were compared using Welch’s t-tests. ANCOVAs were adjusted for age at evaluation, age at treatment, and history of posterior fossa syndrome due to significant or marginally significant differences between groups.Results:Tumor groups did not significantly differ with respect to sex (49.0% male), length of follow-up (M 4.4 years), or treatment type (74.5% surgery alone, 25.5% proton RT). Marginally significant group differences were found for age at evaluation (infratentorial M = 12.4y, supratentorial M = 14.1y, p = .054) and age at treatment (infratentorial M = 7.9y, supratentorial M = 9.7y, p =.074). Posterior fossa syndrome only occurred with infratentorial tumors (n=5, p = .003). Adjusting for covariates, the supratentorial group exhibited significantly superior performance on a measure of inhibition and set-shifting (CW Switching Time (t(32) = -2.05, p=.048, n2 =.11). There was a marginal group difference in the same direction on CW Inhibition Time (t(32 = -1.77, p = .086, n2 =.08). On the other hand, the supratentorial group showed significantly lower working memory than the infratentorial group (t(50) = 2.45, p = .018, n2 = .11), and trends toward lower verbal reasoning (t(50)=1.96, p = .056, n2 = .07) and full-scale IQ (t(50)=1.73, p = .090, n2 = .055). No other group differences were identified across intellectual, EF, and visualmotor measures.Conclusions:Infratentorial tumor location was associated with weaker switching and inhibition performance, while supratentorial tumor location was associated with lower performance on intellectual measures, particularly working memory. These findings suggest that even with relatively conservative treatment (i.e., focal proton RT or surgery alone), there remains neurocognitive risk in children treated for low-grade brain tumors. Moreover, tumor location may predict distinct patterns of long-term neurocognitive outcomes, depending on which brain networks are involved.

31 Characterizing Sociodemographic Factors Associated with the Cognitive and Linguistic Scale (CALS) Among Pediatric Rehabilitation Patients Admitted for Traumatic Brain Injury

Objective:Extant literature suggests significant heterogeneity in recovery trajectories after experiencing a moderate to severe traumatic brain injury (TBI) during childhood (Moran et al., 2016). The Cognitive and Linguistic Scale (CALS) is a promising non-norm-referenced measure designed for serial monitoring within an inpatient rehabilitation setting that may optimize prediction of acute recovery and long-term neuropsychological functioning. To date, the CALS has primarily been examined in the context of injury characteristics such as severity and etiology (e.g., Slomine et al., 2016), and it is unclear what non-injury factors may be relevant to consider. Using archival data gathered from an inpatient pediatric neurorehabilitation program, this study examined associations between the CALS and select sociodemographic factors to better inform the clinical utility of the measure.Participants and Methods:Participants included 56 youth (46% BIPOC, 66% male) aged 2-17 years (M = 12.40, SD = 3.99) who were admitted for moderate to severe TBI to an inpatient rehabilitation program at a regional tertiary care children’s hospital. Data extracted from medical records included demographic information (i.e., age at injury, sex, ethnoracial identity, address, initial Glasgow Coma Scale (GCS) rating, CALS at admission, and full-scale IQ (FSIQ) at discharge. GCS was used as a proxy for injury severity. Residential addresses were geocoded and area-level median income was used as a proxy for familial socioeconomic status (SES). A multiple regression model was utilized to parse the individual contributions of demographic variables) on initial CALS performance while accounting for injury severity. Parallel regression models were used to determine whether patient characteristics moderate the association between initial CALS performance and cognitive functioning at discharge.Results:Preliminary analyses demonstrated that there were no significant associations between GCS and demographic variables, ps > .05. Patient age at injury was significantly associated with CALS total score at admission above and beyond injury severity and other demographic characteristics, t (31) = 2.55, p = .016, such that older age was associated with higher initial CALS scores. Results of moderator analyses between CALS and patient characteristics showed a significant main effect of injury severity, such that higher GCS was associated with higher FSIQ at discharge across models, ps < .05. No significant interactions were identified.Conclusions:These findings provide additional evidence for the generalizability of the CALS and further characterize its associations with non-injury factors, which is important for better understanding aspects that contribute to recovery trajectories and outcomes after moderate to severe TBI. Given the longstanding challenges in regard to the validity of neuropsychological assessment for diverse groups, it is critical to explicitly examine cultural context when considering the clinical utility of a measure. A limitation of the current study is the utilization of broad demographic information due to limited availability of sociocultural data. Future research should examine more granular and culturally-specific variables that may impact CALS performance (e.g., educational attainment, linguistic considerations), beyond using broad-based demographic data as a proxy for sociocultural factors. Another important next step is to utilize serial administrations of the CALS to examine the impact of sociocultural factors on recovery trajectories following TBI.

Longitudinal Assessment of Preterm Infants Treated with Erythropoiesis Stimulating Agents.

We previously reported improved neurodevelopment at 2 and 4 years among preterm infants treated with erythropoietin or darbepoetin, known as erythropoiesis-stimulating agents (ESAs). We now characterize longitudinal outcomes through 6 years. Children randomized to ESAs or placebo were evaluated at 6 years. Healthy-term children served as controls. Tests of cognition and executive function (EF) were performed. Cognitive/EF scores remained similar between 4 and 6 years within each group (ESA: 43 children; placebo: 17 children; term: 21 children). ESA recipients scored higher than placebo on Full-Scale IQ (94.2±18.6 vs 81.6±16.7, p=0.022), and Performance IQ (97.3±16.2 vs 81.7±15.2, =0.005). Aggregate EF trended better for the ESA group. Term controls scored better than placebo on all measures. ESA and term controls scored similarly on cognitive and EF tests. ESA recipients had better outcomes than placebo recipients, and were similar to term children. ESAs may improve long-term cognition and executive function in preterm infants.