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Research supports cascading relationships among internalizing and externalizing symptoms, and academic problems. This constellation of problems is characteristic of early-onset, persistent delinquent [EOPD] youth, and appropriately targeted interventions accounting for this comorbidity may improve outcomes. To investigate these relationships in EOPD youth, we characterized their cross-diagnostic psychopathology and verbal (word-list) learning/memory and evaluated: 1) verbal learning/memory profiles of Withdrawn/Depressed relative to Non-Withdrawn/Depressed youth; 2) cognitive and psychiatric predictors of verbal learning; and 3) emotion regulation as a mediator of psychiatric and cognitive relationships. Results indicated Withdrawn/Depressed youth recalled significantly fewer words during immediate, and some delayed, recall conditions. Less word-learning was predicted by: Withdrawn/Depressed classification, higher trauma-specific re-experiencing symptoms, greater emotion dysregulation, weaker executive skills, fewer trauma-avoidance and aggressive symptoms, and earlier alcohol-use onset. Emotion regulation strongly mediated the relationship between verbal learning and psychopathology, but not other cognitive skills, among these youth at high-risk for school dropout. Mental health and education implications are discussed.

Despite profound adversity exposure (loss, trauma) among delinquents, with adversity linked to early-onset persistent delinquency [EOPD], externalizing syndromes (Conduct Disorder) continue to overshadow impairing internalizing syndromes. Three understudied factors potentially contribute to both syndromes among delinquents: bereavement-related distress [BRD] from death-exposures; psychopathy-spectrum traits associated with system-involvement; and emotional abuse, implicated in lifespan morbidities. Therefore, we characterized loss/BRD among 107 EOPD adolescent girls and boys, comparing: (1) psychopathology and maltreatment (emotional, physical and sexual abuse); and (2) adversity-related (BRD, Post-traumatic Stress Disorder [PTSD], maltreatment) and psychopathy-spectrum predictors of internalizing and externalizing syndromes. Death exposure was common, resulting in developmental disruptions (school difficulties: 49.4%) and clinically significant BRD (33.8%), with girls evidencing greater BRD severity. BRD and psychopathy-traits, not PTSD, positively predicted all youths’ internalizing, and boys’ externalizing, syndromes. More frequent physical abuse increased both syndromes among boys. Emotional abuse alone predicted girls’ externalizing syndromes, highlighting the contribution of this overlooked maltreatment-type.

Aim Psychotic-spectrum symptoms are linked to trauma, substance/alcohol use (SAU), criminality/violence and poor functional outcomes, supporting the need for early detection in vulnerable populations. To better understand high-risk girls' mental health, we assessed: (1) psychotic-spectrum symptoms; (2) cumulative trauma, adversity and loss exposures (C-TALE) and adversity-indicators (symptoms, maladaptive coping, stressor-reactivity); and SAU risk-factors; and (3) relationships among psychotic-spectrum symptoms, adversity-indicators and SAU risk-factors. Methods We administered the Structured Clinical Interviews for Psychotic Spectrum, and Trauma and Loss Spectrum to 158 adolescent delinquent girls. Results Girls' psychotic-spectrum profiles were similar to previously reported adult psychotic patients and characterized by typical symptoms (hallucinations/delusions, reported largely SAU-independent), interpersonal sensitivity, schizoid traits and paranoia (over-interpretation, anger over-reactivity, hypervigilance). Auditory/visual hallucinations (55.7%), delusions (92.4%), ideas of reference (96.8%) and adversity (90.0% ≥10/24 C-TALE-types) were common. Mean loss (4) and trauma (8) onset-age occurred before SAU-onset (12). Significant positive correlations were found among psychotic-spectrum symptoms, stressor-reactivity, C-TALE, adversity-indicators; and number of SAU-types; and a negative correlation occurred between psychotic-spectrum symptoms and earlier alcohol use onset. After controlling for number of SAU-types, stressor-reactivity and adversity-related numbing individually had the largest associations with total psychotic-spectrum symptoms (b = 2.6-4.3). Girls averaged more than 4 maladaptive coping strategies (e.g., 24.8% attempted suicide) in response to adversity, amplifying potential health-disparities. No racial/ethnic differences emerged on psychotic-spectrum symptoms. Conclusions This symptom constellation during adolescence likely interferes with social and academic functioning. Whether representing a prodromal phase, trauma-response or cross-diagnostic psychopathology, accurate early detection and appropriate treatment of psychotic-spectrum symptoms are warranted to improve functional outcomes in vulnerable populations.

Parents can play a vital role in shaping teenagers’ sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent-adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent adolescent sexual communication was examined at 12-months among adolescents with mental health problems. Of the 721 parent- adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent-adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent Body-Language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11 hours of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12-months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent-adolescent sexual communication among a mental health sample.

Objective Sexual activity often begins in early adolescence, and adolescents with mental health symptoms are at greater risk for sexual activity and other health risks. This study aimed to evaluate a developmentally targeted intervention designed to enhance early adolescents' emotion regulation competencies as a strategy for reducing health risk behaviors, including sexual initiation. Method Adolescents 12 to 14 years old (N = 420; 53% male) with mental health symptoms participated in either an emotion regulation (ER) or health promotion (HP) intervention consisting of 12 after-school sessions. Participants completed questionnaires on laptop computers at baseline, 2-, 6-, and 12-month follow-ups. Results Time to event analyses were used to compare intervention conditions on rate of initiation to vaginal sex. Results showed that participants in the ER condition were less likely to transition into vaginal sexual activity by 1-year follow-up than were those in the HP condition (adjusted hazard ratio = 0.58, 95% confidence interval [0.36, 0.94], p = .01). However, those who were sexually active did not report differences in sexual risk behaviors (e.g., condomless sex). Participants in the ER condition were significantly less likely to report violence behaviors and showed improvement on a behavioral measure of emotion identification; however, they did not differ from HP participants on self-reports of emotional competence. Conclusions Emotion regulation strategies can be used to delay sexual initiation among early adolescents with mental health symptoms and may have an important role in health education. (PsycINFO Database Record

Cognitive functioning affects health. This study assessed cognitive functioning among participants in the Northwestern Juvenile Project, a stratified random sample of 1,829 newly detained juveniles (10-18 years old) from Cook County, Illinois. We examined receptive vocabulary, oral reading, arithmetic computation skills, and general intellectual abilities. Our sample exhibited impaired overall intellectual functioning and deficits in all areas. Males performed more poorly than females overall. More than three-quarters of males showed below average overall intellectual functioning, and nine in ten males had below average receptive vocabulary skills. Hispanic and African American males performed more poorly than non-Hispanic white males; The multiple systems that serve delinquent youth—correctional, health, legal, and rehabilitative—must collaborate to tailor needed services to the cognitive level of youth in the juvenile justice system.

Delinquent youth have substantial trauma exposure, with life-course persistent delinquents [LCPD] demonstrating notably elevated cross-diagnostic psychopathology and cognitive deficits. Because adolescents remain in the midst of brain and neurocognitive development, tailored interventions are key to improving functional outcomes. This structural magnetic resonance imaging study compared neuroanatomical profiles of 23 LCPD and 20 matched control adolescent boys. LCPD youth had smaller overall gray matter, and left hippocampal, volumes alongside less cortical surface area and folding within the left pars opercularis and supramarginal cortex. LCPD youth had more adversity-related exposures, and their higher Cumulative Trauma, Adversity and Grief [C-TAG] symptoms were associated with less surface area and folding in the pars opercularis and lingual gyrus. Neuroanatomical differences between LCPD and control youth overlap with data from both maltreatment and antisocial literatures. The affected left frontal regions also share connections to language- and executive-related functions, aligning well with LCPD youths' cognitive and behavioral difficulties. These data also dovetail with research suggesting the possibility of neurodevelopmental delays or disruptions related to cumulative adversity burden. Thus, concurrent treatment of LCPD youths' C-TAG symptoms and, cognitive deficits with overlapping neuroanatomical bases, may be most effective in improving outcomes and optimizing neurodevelopmental trajectories.

We evaluated the preliminary effectiveness of a novel intervention that was developed to address combat stress injuries in active-duty military personnel. Adaptive disclosure (AD) is relatively brief to accommodate the busy schedules of active-duty service members while training for future deployments. Further, AD takes into account unique aspects of the phenomenology of military service in war in order to address difficulties such as moral injury and traumatic loss that may not receive adequate and explicit attention by conventional treatments that primarily address fear-inducing life-threatening experiences and sequelae. In this program development and evaluation open trial, 44 marines received AD while in garrison. It was well tolerated and, despite the brief treatment duration, promoted significant reductions in PTSD, depression, negative posttraumatic appraisals, and was also associated with increases in posttraumatic growth.

This study evaluated a community-based correctional program in California, in which parolees tested positive on illicit drugs were given the option of going into a treatment program or having their parole revoked and returned to prison in California. Two comparison groups were constructed to assess the treatment effect—a propensity-based comparison group extracted from the general parolee population and program dropouts. Although implicitly coercive, some parolees who finished the program were less likely to be reincarcerated 12 months following release than both comparison groups. However, the observed treatment advantage quickly eroded in the second observation year. Savings realized from the incarcerations avoided were more than enough to pay for the program. Findings from this study suggest that boosting participation in reentry services through coercive measures may yield currently unrealized individual and societal benefits. However, systemic efforts are needed to extend the short-term treatment effects. Design and data limitations in the study weaken the persuasiveness of these findings. Methodological implications and policy issues about coerced treatment are discussed.

Objective Functional neuroimaging studies have led to a significantly deeper understanding of the underlying neural correlates and the development of several mature models of depression in adults. In contrast, our current understanding of the underlying neural substrates of adolescent depression is very limited. Although numerous studies have consistently demonstrated a hyperactive amygdala in depressed adults, the few published pediatric studies have reported opposite results in the amygdala. Thus, the main purpose of this study was to further our knowledge of the underlying neural substrates of adolescent depression by examining the bilateral amygdala specifically and the whole brain in depressed adolescents compared to healthy controls. Method Twelve unmedicated adolescents diagnosed with current major depressive disorder without a comorbid psychiatric disorder and 12 well-matched controls ages 13 to 17 years performed a facial-emotion matching task during functional magnetic resonance imaging at 3 T. Results Region-of-interest analyses demonstrated: (1) significant bilateral amygdala activation in depressed and healthy adolescents, and (2) significantly greater left amygdala activation in depressed adolescents compared to controls. Whole-brain analysis revealed areas of significantly different brain activity in depressed adolescents compared to controls. Conclusions These results suggest that (1) depressed adolescents without a comorbid psychiatric disorder exhibit an abnormally hyperactive amygdala compared to healthy controls; (2) models of adult depression might be extended to include depressed adolescents; and (3) neuropsychiatric interventions that have been developed in depressed adults should be further examined in adolescents.

Recent adult studies suggest that the subgenual anterior cingulate cortex (sgACC) is involved in fundamental mental operations such as affective processing and inhibitory control. However, little is known about inhibition-associated sgACC function in adolescents, and there are no published data regarding whether personality characteristics are related to inhibition-associated sgACC brain activity in adolescents. This study examined the relationship between personality and inhibition-associated sgACC response in healthy adolescents. Seventeen adolescents of 13–17 years of age underwent functional magnetic resonance imaging while performing a parametric stop-signal task. Greater harm avoidance levels were significantly associated with increased inhibition-related sgACC activity. These results establish, for the first time, a link between personality and differential sgACC activation in adolescents.

In school settings, students are typically evaluated using group achievement tests, IQ scales, and college entrance exams that focus more on rote-verbal skills (e.g., vocabulary, mathematical facts) than on higher level executive functions (e.g., abstract thinking, problem solving). However, recent neuropsychological findings suggest that rote-knowledge skills and executive functions are divergent cognitive domains that can be dissociated in both adults with frontal lesions and children with neurodevelopmental disorders. New correlational findings obtained from 470 children and adolescents provide additional support for the divergent nature of these cognitive domains and the existence of subgroups of students who exhibit either strengths in abstract, creative thinking with relative weaknesses in rote-verbal skills or vice versa. The results suggest that current school assessment practices may result in academic roadblocks for those students who have strengths in abstract, creative thinking but whose relative weaknesses in rote-verbal skills may hinder their ability to take college entrance exams.

Verbal learning and memory (VLM) following pediatric stroke was characterized in a cross-sectional neuropsychological and neuroimaging study of 26 subjects, aged 5 to 17, with a history of pediatric stroke and 26 age, SES, and gender matched orthopedic controls. Further comparisons were made between the VLM profiles of stroke subjects with rightversusleft hemisphere lesions and early (≤12 months)versuslate (>12 months) strokes. Overall, stroke subjects scored significantly lower than control subjects on several VLM indices (California Verbal Learning Test–Children; CVLT–C), as well as on measures of intellectual functioning (IQ) and auditory attention/working memory (Digit Span). Subgroup analyses of the stroke population foundnosignificant differences in VLM, Digit Span, Verbal IQ or Performance IQ when left-hemisphere lesion subjects were compared to right-hemisphere lesion subjects. In contrast, early strokes were associated with significantly fewer words recalled after delay, reduced discriminability (fewer correct hits relative to false positive errors on recognition testing), and relatively worse auditory attention/working memory scores (Digit Span). These findings indicate that pediatric stroke subjects demonstrated more VLM impairment than control subjects, and early strokes were associated with greater recall and recognition deficits. In stark contrast with adult-onset stroke, both left- and right-hemisphere lesions during childhood resulted in similar VLM performance. (JINS, 2004,10, 742–752.)

To better characterize pediatric psychopathology after neurological insult, secondary attention deficit hyperactivity disorder (SADHD)-or ADHD that develops after traumatic brain injury (TBI)-and its clinical and neuroimaging correlates were investigated. Outcome data were available for 118 children, ages 5 through 14 at the time of hospitalization following TBI (severe TBI n = 37; mild-moderate TBI n = 57) and orthopedic injury (n = 24). Standardized psychiatric, adaptive functioning, cognitive functioning, family functioning, and family psychiatric history assessments were conducted on all participants. Severity of injury and neuroimaging lesion assessments were conducted on TBI participants only. The diagnosis of SADHD was mutually exclusive with preinjury ADHD, which occurred in 13 of 94 TBI participants and 4 of 24 orthopedic injury participants. SADHD occurred in 13 of 34 eligible participants with severe TBI but resolved in 4 of 13 of these participants. SADHD also occurred in 1 of 8 eligible moderate TBI participants, only in the presence of preinjury ADHD traits and 3 of 39 of eligible mild TBI cases. SADHD occurred in 1 of 20 of eligible participants with orthopedic injury without any brain injury. SADHD was significantly associated with TBI severity recorded by categorical and dimensional measures, intellectual and adaptive functioning deficits, and personality change due to TBI, but not with lesion area or location. These results suggest that SADHD is a clinically important syndrome after severe TBI in children and adolescents.

Objectives: To determine the rate, types, and correlates of psychiatric disorder (PD) following stroke and orthopedic disorders in children and adolescents. Method: Children aged 5 to 19 were assessed. The study used a cross-sectional design that compared 29 stroke subjects with 29 congenital clubfoot or scoliosis subjects. Assessments of psychiatric status; cognitive, adaptive, academic, and family functioning; family psychiatric history; neuroimaging; and neurological status were conducted. The main outcome measure was a current PD not present before the stroke or orthopedic disorder. Results: Poststroke PD occurred significantly more often than postorthopedic diagnosis PD (17/29 [59%] versus 4/29 [14%], p ≤ .001). Subjects with ongoing poststroke PD had significantly more impaired intellectual and adaptive functioning, higher intensity family psychiatric history scores, and tended toward higher neurological severity index scores, but they were not different regarding lesion volume or family functioning compared with stroke subjects without PD. Regression analyses showed that neurological severity and family psychiatric history independently contributed significantly to predicting PD. Conclusions: The data suggest that there are significant biopsychosocial correlates of PD in children with focal neurological lesions. These include a relatively abnormal neurological exam, lower IQ, and increased family psychopathol

The authors aimed to contribute a clinically rich description of personality change due to traumatic brain injury (PC) in children. The sample consisted of consecutively injured children. Ninety-four subjects ages 5 to 14 years were assessed at the time of hospitalization after a traumatic brain injury (TBI). A standardized psychiatric interview, the Neuropsychiatric Rating Schedule, was used to elicit symptoms of PC. PC occurred in 59% of severe (22/37) and 5% of mild/moderate (3/57) TBI subjects. Among the 37 severe TBI subjects, the labile subtype of PC was the most common (49%), followed by the aggressive and disinhibited subtypes (38% each), apathy (14%), and paranoia (5%). Also frequent in severe TBI was perseveration (35%). A detailed case example, numerous clinical vignettes of PC symptoms, and a tabulation of their frequencies provide clinicians a broader frame of reference for eliciting symptoms of PC.

The Boston Naming Test (BNT) is one of the most commonly used tests of confrontation naming. The length of the test, particularly when administered to impaired patients, has prompted the derivation of several abbreviated forms. Short forms of the BNT have typically been equated in terms of difficulty, but not empirically derived for discriminating between normals and anomic patients. Furthermore, most reports to date have been limited in sample size and generalizability. The present study examined BNT data from a total of 1,044 subjects, including 719 normals and 325 patients with Alzheimer's disease (AD). Scores were calculated for the entire 60-item version as well as for eight previously reported short forms. The scores were examined for the effects of age, education, and gender, as well as for the ability of each form to discriminate between AD patients and normals. There was a significant effect of age, education, and gender on all previously published forms, and the short forms varied in their ability to discriminate between patients and controls. A stepwise discriminant analysis was conducted to empirically derive a new, gender-neutral short form with discriminability comparable to the full 60-item test. Norms from this sample on the empirically derived short form are reported.

Confrontation naming tests are commonly employed in neuropsychological assessment. Surprisingly little work has been done, however, to determine how various demographic, linguistic, and disease status variables influence patterns of performance on these tests. The present study examined data on the Boston Naming Test (BNT) from a total of 1,131 subjects, including 719 normals, 325 patients with Alzheimer's disease, and 87 patients with temporal lobe epilepsy. The effects of age, education, gender, and diagnostic group were examined with respect to overall scores, the influence of phonemic cuing, and performance on individual items. Profiles of scores on individual items were similar across diagnostic groups, suggesting that anomia is characterized by quantitative rather than qualitative changes in naming performance. Age and education systematically influenced scores. There was a significant effect of gender across diagnostic groups (males scoring higher than females), which appears to be due to performance on specific items. Phonemic cuing effects were similar across groups. The results are discussed with respect to the neuropsychological construct of confrontation naming and the clinical interpretation of performance on the BNT.

The legal criteria for civil commitment dictates that individuals must be mentally ill, and either a danger to themselves, a danger to others, or substantially impaired in their ability to provide for their basic needs. These criteria, which have been adopted as medical necessity criteria by managed care programs, may result in a change in the clinical mix of the psychiatric inpatient population. The present study assesses the incidence of dangerousness among psychiatric inpatients and compares dangerous and nondangerous patients in terms of characteristics and treatment outcomes. The results indicate that for a large regional managed care program, 30% of psychiatric inpatients have a history of dangerousness in the past year. Patients who are rated as dangerous to others during admission have higher rates of complications for treatment and psychiatric disorders such as residential and vocational instability, family disruption, and higher premorbid dysfunction. They are also more likely to engage in disruptive and aggressive behavior during their hospital stays. Despite the higher incidence of acute and long-term dysfunction for dangerous patients, their hospitalization length of stay was comparable to that of patients not rated as dangerous.

This cross-sectional study examined the development of set-shifting ability from childhood into early adulthood. Six hundred and forty-nine participants (aged 8-30) were assessed on the verbal fluency, design fluency, trail making, color-word interference, and card sorting subtests of the Delis-Kaplan Executive Function System (D-KEFS). Multiple regression analyses revealed modest effects of age and gender on set-shifting tasks, after controlling for IQ and component skills. The current study provides evidence for generally increased performance of set-shifting abilities through adolescence. Women overall had statistically better performance than men on all executive functioning tasks. There were significant age by gender interactions suggesting differential age-related improvements between men and women. On color-word interference and verbal fluency switching tasks, men tended to show larger improvements than women, whereas on a design fluency switching task, women showed larger improvements than men.

Calibrated functional magnetic resonance imaging (fMRI) provides a noninvasive technique to assess functional metabolic changes associated with normal aging. We simultaneously measured both the magnitude of the blood oxygenation level dependent (BOLD) and cerebral blood flow (CBF) responses in the visual cortex for separate conditions of mild hypercapnia (5% CO(2)) and a simple checkerboard stimulus in healthy younger (n = 10, mean: 28-years-old) and older (n = 10, mean: 53-years-old) adults. From these data we derived baseline CBF, the BOLD scaling parameter M, the fractional change in the cerebral metabolic rate of oxygen consumption (CMRO(2)) with activation, and the coupling ratio n of the fractional changes in CBF and CMRO(2). For the functional activation paradigm, the magnitude of the BOLD response was significantly lower for the older group (0.57 +/- 0.07%) compared to the younger group (0.95 +/- 0.14%), despite the finding that the fractional CBF and CMRO(2) changes were similar for both groups. The weaker BOLD response for the older group was due to a reduction in the parameter M, which was significantly lower for older (4.6 +/- 0.4%) than younger subjects (6.5 +/- 0.8%), most likely reflecting a reduction in baseline CBF for older (41.7 +/- 4.8 mL/100 mL/min) compared to younger (59.6 +/- 9.1 mL/100 mL/min) subjects. In addition to these primary responses, for both groups the BOLD response exhibited a post-stimulus undershoot with no significant difference in this magnitude. However, the post-undershoot period of the CBF response was significantly greater for older compared to younger subjects. We conclude that when comparing two populations, the BOLD response can provide misleading reflections of underlying physiological changes. A calibrated approach provides a more quantitative reflection of underlying metabolic changes than the BOLD response alone.

Neuroimaging studies implicate the subgenual anterior cingulate cortex (sgACC) as a critical brain region in adult depression. However, unlike adult depression, little is known about the underlying neural substrates of adolescent depression, and there are no published data examining differences in sgACC activation between depressed and healthy adolescents. This study used functional magnetic resonance imaging to examine sgACC activity in twenty-six depressed and normal 13- to 17-year olds during the performance of a stop-signal task. Significantly greater sgACC activation was found in the depressed adolescents relative to controls. These results establish for the first time abnormal functioning of the sgACC in depressed adolescents and have important implications for understanding the underlying neural correlates and potential treatments of adolescent depression.

Functional magnetic resonance imaging (fMRI) based on blood oxygenation level dependent (BOLD) signal changes is a sensitive tool for mapping brain activation, but quantitative interpretation of the BOLD response is problematic. The BOLD response is primarily driven by cerebral blood flow (CBF) changes, but is moderated by M, a scaling parameter reflecting baseline deoxyhemoglobin, and n, the ratio of fractional changes in CBF to cerebral metabolic rate of oxygen consumption (CMRO2). We compared M and n between cortical (visual cortex, VC) and subcortical (lentiform nuclei, LN) regions using a quantitative approach based on calibrating the BOLD response with a hypercapnia experiment. Although M was similar in both regions (∼ 5.8%), differences in n (2.21 ± 0.03 in VC and 1.58 ± 0.03 in LN; Cohen d = 1.71) produced substantially weaker (∼ 3.7x) subcortical than cortical BOLD responses relative to CMRO2 changes. Because of this strong sensitivity to n, BOLD response amplitudes cannot be interpreted as a quantitative reflection of underlying metabolic changes, particularly when comparing cortical and subcortical regions.

Demonstrations of memory changes in those at risk for Alzheimer's disease by the presence of the APOE e4 allele have been inconsistent to date. The present study went beyond traditional analyses of central tendency (i.e., group differences on mean test scores) and also conducted distribution analyses to search for subtle cognitive differences in subgroups of normal-functioning elderly persons with the APOE e4 genotype. The results of the study revealed that (a) the e4 and non-e4 groups failed to differ in terms of their mean scores on tests of memory and verbal skills; and (b) relative to the non-e4 group, the e4 subjects had significantly greater heterogeneity of variance on the memory measures but not on fundamental verbal skills. Logistic regression analyses indicated that the discrepancy in scores on the memory measures was a significant predictor of genotype group membership (82% correct classification rate). Implications of these findings for the detection of a preclinical phase of AD are discussed.

Recent studies have reported cognitive asymmetries in patients with Alzheimer's disease (AD) and in individuals with apolipoprotein E epsilon4 (APOE epsilon4) genotype who are in the preclinical phase of AD. This increased frequpncy of cognitive asymmetry, typically defined as a significant discrepancy (in either direction) between verbal and spatial abilities, often occurs despite an absence of differences on traditional measures of central tendency (i.e., mean test scores). We prospectively studied the relationship between APOE genotype and two modality-specific executive-function tasks: The Verbal Fluency and Design Fluency tests of the Delis-Kaplan Executive Function System (D-KEFS) in 52 normal functioning older adult participants who were grouped according to the presence (n=24) or absence (n=28) of the APOE e4 allele. Nondemented older adults with the APOE epsilon4 allele demonstrated a greater frequency of cognitive asymmetric profile on the new switching conditions of the Verbal and Design Fluency measures than the APOE non-epsilon4 individuals. This study further supports the utility of assessing cognitive asymmetry for the detection of subtle cognitive differences in individuals at-risk for AD, and suggests that dual-task executive function tests (i.e., fluency plus switching) may serve as a useful preclinical marker of AD.

This prospective study of nondemented older adults at genetic risk for AD and other types of dementia (i.e., APOE e4 allele) utilized a new Stroop test that includes a dual executive-function condition requiring both response inhibition and cognitive switching. Results indicated that, relative to non-e4 subjects, the e4 group committed more errors, but only on the new Inhibition/Switching condition. In addition, error-rate variance on this task was more heterogeneous for the e4 compared to the non-e4 group, and errors rates correlated significantly with global cognitive status (i.e., DRS scores) for the e4 group but not for the non-e4 group. These findings suggest that vulnerability to errors in response inhibition and cognitive flexibility is present in persons at risk for AD and may signal early emergence of executive dysfunction in preclinical AD. The association between these subtle executive-function deficits and the overall cognitive functioning of at-risk individuals provides further evidence of their utility as a possible preclinical marker of AD.

We investigated the frequency and neurocognitive correlates of attention deficit hyperactivity disorder and traits of this disorder (ADHD/Traits) after childhood stroke and orthopedic diagnosis in medical controls. Twenty-nine children with focal stroke lesions and individually matched children with clubfoot or scoliosis were studied with standardized psychiatric, intellectual, academic, adaptive, executive, and motivation function assessments. Lifetime ADHD/Traits were significantly more common in stroke participants with no prestroke ADHD than in orthopedic controls (16/28 vs. 7/29; Fisher's Exact p < .02). Lifetime ADHD/Traits in the orthopedic controls occurred exclusively in males with clubfoot (7/13; 54%). Participants with current ADHD/Traits functioned significantly worse (p < .005) than participants without current ADHD/Traits on all outcome measures. Within the stroke group, current ADHD/Traits was associated with significantly lower verbal IQ and arithmetic achievement (p < .04), more nonperseverative errors (p < .005), and lower motivation (p < .004). A principal components analysis of selected outcome variables significantly associated with current ADHD/Traits revealed “impaired neurocognition” and “inattention-apathy” factors. The latter factor was a more consistent predictor of current ADHD/Traits in regression analyses. These findings suggest that inattention and apathy are core features of ADHD/Traits after childhood stroke. This association may provide clues towards the understanding of mechanisms underlying the syndrome. (JINS, 2003, 9, 815–829.)

Objective To test the hypotheses that female juvenile delinquents would have higher rates of psychological symptoms, DSM-IV psychiatric and substance use disorders, functional impairment, and familial risk factors than male juvenile delinquents. Method A stratified random sample of adjudicated delinquents ( n = 513 males, n = 112 females) was drawn from San Diego County administrative databases. Of those sampled youths who could be located, 65.7% completed interviews. Psychological symptoms, DSM-IV diagnoses, and familial risk factors were assessed between October 1997 and January 1999. Results Female delinquents scored higher on parent and self-report measures of psychological symptoms and had higher rates of DSM-IV mental disorders than did male delinquents. Girls also experienced greater incidences of physical, emotional, and sexual abuse; physical neglect; and family history of mental illness than their male counterparts. No gender differences were found on parental ratings of youth functional impairment, substance use disorders, comorbidity, or parental history of antisocial behavior. Conclusions Findings indicated that female adjudicated delinquents have significantly higher rates of psychopathology, maltreatment history, and familial risk factors than males and suggest that the mental health needs of girls in juvenile justice deserve increased attention.

Objective To investigate the association between focal stroke lesions of the putamen and either attention-deficit/hyperactivity disorder or traits of the disorder (ADHD/Traits). Method Twenty-five children with focal stroke lesions were studied with standardized psychiatric assessments and anatomic brain magnetic resonance imaging. The pattern of lesion overlap in subjects with ADHD/Traits was determined. Results Fifteen of 25 subjects had ADHD/Traits. The densest area of overlapping lesions ( n = 7) in subjects with ADHD/Traits included the posterior ventral putamen. The median lesion volume was 9.7 cm 3 , and the distribution was highly skewed. Lesion volume was not associated with ADHD/Traits. Therefore the following analyses focused on the 13 subjects with lesions 3 : ADHD/Traits were exhibited in 6/7 subjects with putamen lesions versus 2/6 with no putamen lesions (Fisher exact test p = .1). Half (4/8) of the subjects with ADHD/Traits had overlapping lesions encompassing the posterior ventral putamen. None of the 5 subjects without ADHD/Traits had lesions in this empirically derived region of interest (Fisher exact test p = .1). Conclusions Lesions within the dopamine-rich ventral putamen, which is part of the ventral or limbic striatum, tended to increase the risk of ADHD/Traits. ADHD/Traits may therefore be a disinhibition syndrome associated with dysfunction in this cortical-striato-thalamocortical loop.