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OBJECTIVE: The purpose of this study was to explore racial/ethnic differences in neurobehavioral symptom reporting and symptom validity testing among military veterans with a history of traumatic brain injury (TBI). METHOD: Participants of this observational cross-sectional study (N = 9,646) were post-deployed Iraq-/Afghanistan-era veterans enrolled in the VAs Million Veteran Program with a clinician-confirmed history of TBI on the Comprehensive TBI Evaluation (CTBIE). Racial/ethnic groups included White, Black, Hispanic, Asian, Multiracial, Another Race, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander. Dependent variables included neurobehavioral symptom domains and symptom validity assessed via the Neurobehavioral Symptom Inventory (NSI) and Validity-10, respectively. RESULTS: Chi-square analyses showed significant racial/ethnic group differences for vestibular, somatic/sensory, and affective symptoms as well as for all Validity-10 cutoff scores examined (≥33, ≥27, ≥26, >22, ≥22, ≥13, and ≥7). Follow-up analyses compared all racial/ethnic groups to one another, adjusting for sociodemographic- and injury-related characteristics. These analyses revealed that the affective symptom domain and the Validity-10 cutoff of ≥13 revealed the greatest number of racial/ethnic differences. CONCLUSIONS: Results showed significant racial/ethnic group differences on neurobehavioral symptom domains and symptom validity testing among veterans who completed the CTBIE. An enhanced understanding of how symptoms vary by race/ethnicity is vital so that clinical care can be appropriately tailored to the unique needs of all veterans. Results highlight the importance of establishing measurement invariance of the NSI across race/ethnicity and underscore the need for ongoing research to determine the most appropriate Validity-10 cutoff score(s) to use across racially/ethnically diverse veterans.

Purpose: The purpose of current study was to evaluate change in hours of Applied Behavior Analysis (ABA) therapy utilization for autistic children during the year prior to the COVID-19 pandemic, the first three months of the pandemic (crisis phase), and the following 9 months of the pandemic (mitigation phase). Additionally, this study aimed to evaluate if change in therapy utilization differed based on child race, ethnicity, and primary payer of services. Finally, we aimed to identify potential mechanisms of ABA therapy disruption by interpreting findings using an extended version of Donabedian's structure-process-outcome model. Methods: Retrospective clinical data on client demographics and therapy utilization (n = 283) were collected from ABA clinics in California and analyzed with four piecewise growth multi-level models. Results: We found that therapy utilization dropped during the first three months of the pandemic (-10.65 h/month; p < 0.001) and increased during the following 9 months (2.39 h/month; p < 0.001). Moderator analyses revelated that Asian, Non-Latinx and school-district funded children had significantly different trajectories of change in therapy utilization compared to white, non-Latinx participants and private insurance funded participants, respectively. Conclusion: Findings suggest that utilization of ABA therapy was disrupted for a full year following the onset of the COVID-19 pandemic and that child race/ethnicity and primary payer influenced the degree to which autistic children were impacted by service disruption. These findings have implications for autistic children who lost therapy access during key developmental periods and for the ABA care delivery system.

Purpose: The purpose of current study was to evaluate change in hours of Applied Behavior Analysis (ABA) therapy utilization for autistic children during the year prior to the COVID-19 pandemic, the first three months of the pandemic (crisis phase), and the following 9 months of the pandemic (mitigation phase). Additionally, this study aimed to evaluate if change in therapy utilization differed based on child race, ethnicity, and primary payer of services. Finally, we aimed to identify potential mechanisms of ABA therapy disruption by interpreting findings using an extended version of Donabedian's structure-process-outcome model. Methods: Retrospective clinical data on client demographics and therapy utilization (n = 283) were collected from ABA clinics in California and analyzed with four piecewise growth multi-level models. Results: We found that therapy utilization dropped during the first three months of the pandemic (-10.65 h/month; p < .001) and increased during the following 9 months (2.39 h/month; p < .001). Moderator analyses revelated that Asian, Non-Latinx and school-district funded children had significantly different trajectories of change in therapy utilization compared to white, non-Latinx participants and private insurance funded participants, respectively. Conclusion: Findings suggest that utilization of ABA therapy was disrupted for a full year following the onset of the COVID-19 pandemic and that child race/ethnicity and primary payer influenced the degree to which autistic children were impacted by service disruption. These findings have implications for autistic children who lost therapy access during key developmental periods and for the ABA care delivery system., Author(s): Cassin W. Gonzales [sup.1] , Jennifer R. Simonell [sup.1] , Mark H.C. Lai [sup.1] , Steven R. Lopez [sup.1] , Jonathan Tarbox [sup.1] Author Affiliations: (1) grid.42505.36, 0000 0001 [...]

BackgroundA clinical diagnosis of cognitive impairment is traditionally based on a single cognitive exam, but serial cognitive testing can be sensitive to subtle cognitive changes in asymptomatic individuals and inform cognitive trajectory.ObjectiveWe evaluated the prognostic utility of identifying longitudinal neuropsychological decline along with single cognitive exam and Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers in predicting dementia. We also examined brain volumetric differences based on decline trajectories.MethodRegression models quantified 12-month neuropsychological decline relative to normative expectations among non-demented older adults (N = 1,074). Progression to dementia over follow-up (18-120 months) was diagnosed using independent modes of assessment.ResultsIn Cox regression models controlling for age, sex, education, apolipoprotein E4, and baseline cognitive diagnosis, neuropsychological decline predicted increased dementia risk, χ2 = 69.861, p

This study evaluated measurement invariance across males and females on the Neurobehavioral Symptom Inventory (NSI) in U.S. military veterans enrolled in the VA Million Veteran Program. Participants (N = 17,059; males: n = 15,450; females: n = 1,609) included Veterans who took part in the VA Traumatic Brain Injury (TBI) Screening and Evaluation Program and completed the NSI. Multiple-group confirmatory factor analyses investigated measurement invariance of the NSI 4-factor model. The configural (comparative fit index [CFI] = 0.948, root mean square error of approximation [RMSEA] = 0.060) and metric (CFI = 0.948, RMSEA = 0.058) invariance models showed acceptable fit. There was a minor violation of scalar invariance (Δχ2 = 232.50, p <.001); however, the degree of noninvariance was mild (ΔCFI = −0.002, Δ RMSEA = 0. 000). Our results demonstrate measurement invariance across sex, suggesting that the NSI 4-factor model can be used to accurately assess symptoms in males and females following TBI. Findings highlight the importance of considering validity of measurement across study groups to increase confidence that a measure is interpreted similarly by respondents from different subgroups. [ABSTRACT FROM AUTHOR]

As student engagement in science learning continues to garner significant attention from educational researchers, practitioners, and policymakers, the importance of understanding person and context-related factors that impact student engagement is increasingly recognized. In this mixed methods study, middle school students' (N = 1,848) engagement was examined in relation to opportunities to participate in science learning (OtP in science) from 29 schools in the United States. Drawing on the ecological systems and opportunity-propensity frameworks, multilevel structural equation modeling was applied to test the relationship between OtP in science and student engagement, accounting for student (gender, grade, ethnicity) and school (socioeconomic status) factors. Results showed that at the student level, OtP in science was a statistically significant predictor of engagement, and this relationship varied by school. In addition, school SES predicted school-average OtP in science, and there was a statistically significant cross-level interaction for school SES, in that the relationship between OtP in science and engagement was stronger for schools with higher SES. In the qualitative phase, 6 student focus group interviews were analyzed to develop explanatory accounts for the quantitative results. Collaborative hands-on activities, peer-to-peer discourse, and positive teacher and student relationships were identified as social processes that facilitated students' propensity to engage in the science learning opportunities. Factors related to school SES that explain the link between OtP in science and student engagement are also described. Taken together, our findings provide a more complete picture of how students' engagement in science relates to person and context-related factors and hold theoretical and practical implications for the study of engagement in diverse classrooms.

Previous studies have detailed the consequence of ignoring a level of clustering in multilevel models with straightly hierarchical structures and have proposed methods to adjust for the fixed effect standard errors (SEs). However, in behavioral and social science research, there are usually two or more crossed clustering levels, such as when students are cross-classified by schools and neighborhoods, yet it is not uncommon that researchers focus only on one level of clustering. Using the generalized least squares framework, in this study, we derive the bias in the fixed effect SE estimators when one crossed random effect is omitted. We then showed, using data from the Scotland Neighborhood Study, how one can correct for the SEs and obtain corrected statistical inference when a misspecified two-level model was used in a primary study, which is useful when evaluating observational studies or cluster randomized trials that ignored a crossed random effects or when conducting meta-analyses. In addition, our analytic results provide theoretical insights on how one can quantify imbalance with cross-classified data by the strength of association between the two-crossed random effects in a contingency table and how the degree of imbalance relates to the correction factor for the fixed effect SEs.

Path models with observed composites based on multiple items (e.g., mean or sum score of the items) are commonly used to test interaction effects. Under this practice, researchers generally assume that the observed composites are measured without errors. In this study, we reviewed and evaluated two alternative methods within the structural equation modeling (SEM) framework, namely, the reliability-adjusted product indicator (RAPI) method and the latent moderated structural equations (LMS) method, which can both flexibly take into account measurement errors. Results showed that both these methods generally produced unbiased estimates of the interaction effects. On the other hand, the path model--without considering measurement errors--led to substantial bias and a low confidence interval coverage rate of nonzero interaction effects. Other findings and implications for future studies are discussed.

Measurement invariance holds when a latent construct is measured in the same way across different levels of background variables (continuous or categorical) while controlling for the true value of that construct. Using Monte Carlo simulation, this paper compares the multiple indicators, multiple causes (MIMIC) model and MIMIC-interaction to a novel use of alignment optimization (AO) for detecting measurement noninvariance when the violator is a continuous variable. Results showed that MIMIC and MIMIC-interaction in sequential likelihood ratio tests and Wald tests with a Bonferroni correction provided a good balance between identifying invariant and noninvariant (linear violations) items when n ≥ 500 in terms of classification accuracy (CA). AO (CA ≥ .86) was as competitive as MIMIC and MIMIC-interaction to linear invariance violations but was far better under nonlinear quadratic violations when n ≥ 1,000 (i.e., 100 per group for 10 groups). [ABSTRACT FROM AUTHOR]

Although letter naming fluency (LNF) and letter sound fluency (LSF) measures are widely available to educators for assessing early literacy skills of kindergarten children, better understanding of the contributions of these skills to reading development can help improve the interpretation of LNF and LSF data for instructional decisions. This study investigated the interrelations of growth in LNF and LSF across the kindergarten year and their unique roles in predicting later reading fluency. Piecewise parallel-process growth models indicated that although LNF and LSF were highly correlated at kindergarten entry, fall LNF status was positively predictive of LSF growth across the fall. Bidirectional effects were present, as initial LSF was also a positive predictor of LNF growth across the fall; however, its effects were not as strong as those of initial LNF on LSF growth. More importantly, both initial status and growth in LNF and LSF were uniquely predictive of first-grade reading fluency, indicating the independent effects of each on subsequent text reading skills. Indirect effects were also observed for kindergarten LNF and LSF growth on reading fluency in second and third grades. Implications for kindergarten assessment and instruction are discussed.

Educational researchers commonly use the rule of thumb of "design effect smaller than 2" as the justification of not accounting for the multilevel or clustered structure in their data. The rule, however, has not yet been systematically studied in previous research. In the present study, we generated data from three different models (which differ in the location of the clustering effect). With a 3 (design effect) × 5 (cluster size) × 4 (number of clusters) Monte Carlo simulation study we found that the rule should not be applied when researchers: (a) are interested in the effects of higher-level predictors, or (b) have a cluster size less than 10. Implications of the findings and limitations of the study are discussed.

Key Points: Question: Is there an association between sedentary behavior and risk of all-cause dementia in older adults? Findings: In this retrospective study of prospectively collected data of 49 841 adults participating in the UK Biobank, more time spent in sedentary behaviors (determined through a machine learning–based analysis of wrist-worn accelerometer data) was significantly associated with higher risk of incident dementia. Meaning: Among older adults, more time spent in sedentary behaviors was associated with higher risk of incident all-cause dementia. Importance: Sedentary behavior is associated with cardiometabolic disease and mortality, but its association with dementia is unclear. Objective: To investigate whether accelerometer-assessed sedentary behavior is associated with incident dementia. Design, Setting, and Participants: A retrospective study of prospectively collected data from the UK Biobank including 49 841 adults aged 60 years or older without a diagnosis of dementia at the time of wearing the wrist accelerometer and living in England, Scotland, or Wales. Follow-up began at the time of wearing the accelerometer (February 2013 to December 2015) and continued until September 2021 in England, July 2021 in Scotland, and February 2018 in Wales. Exposures: Mean daily sedentary behavior time (included in the primary analysis) and mean daily sedentary bout length, maximum daily sedentary bout length, and mean number of daily sedentary bouts (included in the secondary analyses) were derived from a machine learning–based analysis of 1 week of wrist-worn accelerometer data. Main Outcome and Measures: Incident all-cause dementia diagnosis from inpatient hospital records and death registry data. Cox proportional hazard models with linear and cubic spline terms were used to assess associations. Results: A total of 49 841 older adults (mean age, 67.19 [SD, 4.29] years; 54.7% were female) were followed up for a mean of 6.72 years (SD, 0.95 years). During this time, 414 individuals were diagnosed with incident all-cause dementia. In the fully adjusted models, there was a significant nonlinear association between time spent in sedentary behavior and incident dementia. Relative to a median of 9.27 hours/d for sedentary behavior, the hazard ratios (HRs) for dementia were 1.08 (95% CI, 1.04-1.12, P <.001) for 10 hours/d, 1.63 (95% CI, 1.35-1.97, P <.001) for 12 hours/d, and 3.21 (95% CI, 2.05-5.04, P <.001) for 15 hours/d. The adjusted incidence rate of dementia per 1000 person-years was 7.49 (95% CI, 7.48-7.49) for 9.27 hours/d of sedentary behavior, 8.06 (95% CI, 7.76-8.36) for 10 hours/d, 12.00 (95% CI, 10.00-14.36) for 12 hours/d, and 22.74 (95% CI, 14.92-34.11) for 15 hours/d. Mean daily sedentary bout length (HR, 1.53 [95% CI, 1.03-2.27], P =.04 and 0.65 [95% CI, 0.04-1.57] more dementia cases per 1000 person-years for a 1-hour increase from the mean of 0.48 hours) and maximum daily sedentary bout length (HR, 1.15 [95% CI, 1.02-1.31], P =.02 and 0.19 [95% CI, 0.02-0.38] more dementia cases per 1000 person-years for a 1-hour increase from the mean of 1.95 hours) were significantly associated with higher risk of incident dementia. The number of sedentary bouts per day was not associated with higher risk of incident dementia (HR, 1.00 [95% CI, 0.99-1.01], P =.89). In the sensitivity analyses, after adjustment for time spent in sedentary behavior, the mean daily sedentary bout length and the maximum daily sedentary bout length were no longer significantly associated with incident dementia. Conclusions and Relevance: Among older adults, more time spent in sedentary behaviors was significantly associated with higher incidence of all-cause dementia. Future research is needed to determine whether the association between sedentary behavior and risk of dementia is causal. This study of prospectively collected data from the UK Biobank investigates whether accelerometer-assessed sedentary behavior is associated with incident dementia in adults aged 60 years or older without a diagnosis of dementia at the time of wearing the wrist accelerometer. [ABSTRACT FROM AUTHOR]

Measurement invariance research has focused on identifying biases in test indicators measuring a latent trait across two or more groups. However, relatively little attention has been devoted to the practical implications of noninvariance. An important question is whether noninvariance in indicators or items results in differences in observed composite scores across groups. The current study introduces the Bayesian region of measurement equivalence (ROME) as a framework for visualizing and testing the combined impact of partial invariance on the group difference in observed scores. Under the proposed framework, researchers first compute the highest posterior density intervals (HPDIs)-which contain the most plausible values-for the expected group difference in observed test scores over a range of latent trait levels. By comparing the HPDIs with a predetermined range of values that is practically equivalent to zero (i.e., region of measurement equivalence), researchers can determine whether a test instrument is practically invariant. The proposed ROME method can be used for both continuous indicators and ordinal items. We illustrated ROME using five items measuring mathematics-specific self-efficacy from a nationally representative sample of 10th graders. Whereas conventional invariance testing identifies a partial strict invariance model across gender, the statistically significant noninvariant items were found to have a negligible impact on the comparison of the observed scores. This empirical example demonstrates the utility of the ROME method for assessing practical significance when statistically significant item noninvariance is found. [ABSTRACT FROM AUTHOR]

Multilevel modeling techniques are becoming more popular in handling data with multilevel structure in educational and behavioral research. Recently, researchers have paid more attention to cross-classified data structure that naturally arises in educational settings. However, unlike traditional single-level research, methodological studies about multilevel effect size have been rare and those that have recently appeared had an emphasis on strictly hierarchical data structure. This article extends the work on multilevel standardized mean differences from strictly hierarchical structure to both fully and partially cross-classified structures. Analytically derived formulae for calculating effect sizes and the corresponding sampling variances (or standard errors) are presented, verified by simulation results, and illustrated with real data examples. Implications for primary research studies and meta-analyses are discussed.