Renee Testa - Academia.edu (original) (raw)

Papers by Renee Testa

Journal of Child and Adolescent Psychopharmacology

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental cond... more Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental conditions among schoolage children. Early intervention and ongoing evaluation of treatment effectiveness are essential to minimize the lifelong negative impact of ADHD. Neurocognitive functions have been reported to improve with pharmacological and cognitive training interventions for children with ADHD. We evaluated the value of measuring change in neurocognitive functions following ADHD interventions as a treatment outcome. We systematically reviewed randomized control trials of two distinctive types of ADHD interventions-pharmacological treatments and cognitive training-and summarized the changes in neurocognitive and clinical outcomes using a series of meta-analyses. Both pharmacological and cognitive training interventions showed positive effects on some aspects of neurocognitive functions. However, there were no significant correlations between changes in neurocognitive function (e.g., inhibition) and changes in ADHD behavioral symptoms (e.g., impulsive behavior). Although the associations between changes in neurocognitive function and clinical outcomes are not well studied, based on current findings, it is not suitable to use change in neurocognitive outcomes as a proxy for change in ADHD clinical symptom-based outcomes. There is, however, notable value in monitoring changes in neurocognitive function associated with ADHD interventions to achieve the following aims: (1) understanding full treatment effect on children with ADHD, (2) identifying ancillary indicators of subclinical changes, and (3) provision of objective and less biased measures of treatment effects. These findings are important evidence that changes in neurocognitive function could be a co-occurring objective indication that parallels the clinical effects of ADHD treatments.

Neuropsychology Review, 2021

Attention problems are thought to be a hallmark feature of prenatal alcohol exposure (PAE). Despi... more Attention problems are thought to be a hallmark feature of prenatal alcohol exposure (PAE). Despite decades of research however, these findings have never been pooled to assess the association between PAE and the different domains of attention functioning. This systematic review and meta-analysis aimed to examine the relationships between low-moderate, binge and heavy PAE with domains of attention functioning (encode, focus, shift, sustain and behavioural) in children. Thirteen studies compared children with PAE to abstinent controls. A significant adverse effect of any PAE on shifting attention (Cohen's d = -0.61), and a trend towards an adverse effect of heavy PAE on encoding attention (Cohen's d = -0.79) were identified. Compared to controls, there were trends showing that low-moderate PAE (odds ratio = 1.21) was associated with greater odds of behavioural attention problems. Remaining analyses were limited by insufficient studies or were non-significant. In summary, a vulnerability of higher-level attention skills to PAE was found. Urgent investigation into the effects of low to moderate PAE is needed given the prevalence of this drinking pattern, trends towards behavioural attention problems, the lack of comprehensive and high-quality research and the known impacts of attention difficulties on academic and social development in children.

The relationship between prenatal maternal stress and/or anxiety and children’s cognitive develop... more The relationship between prenatal maternal stress and/or anxiety and children’s cognitive development is inconclusive. This systematic review and meta-analysis aims to examine the relationship between the different domains of stress, anxiety and children’s cognitive outcomes during the first 18 years of life. Five databases were searched for all observational studies investigating the association between symptoms of prenatal maternal anxiety and/or stress and children’s cognitive outcomes. Of 7,004 articles identified, 21 met the inclusion criteria and 11 provided usable data that were further analysed quantitatively. A weak negative association was found between prenatal stress and/or anxiety exposure and the offspring’s language development. Associations varied based on the type of prenatal psychological exposure (i.e., trait anxiety, state anxiety, perceived stress, stress response). Specifically, maternal prenatal exposure to stress but not anxiety was found to correlate with ch...

Brain Injury, 2017

Despite peaks of mild traumatic brain injury (mTBI) incidence in young children, few studies have... more Despite peaks of mild traumatic brain injury (mTBI) incidence in young children, few studies have examined the nature of post-concussive symptoms (PCSs) in children under the age of eight, whilst controlling for pre-injury symptoms and effects of trauma. The current study aimed to identify which PCSs differentiate children with mTBI from trauma controls early post-injury, and whether these differed among preschool and school-aged children. The sample comprised 101 children aged 2-12 presenting to an emergency department, with concussion or other minor bodily injury (control). Groups were divided by age (preschool and school-aged). PCSs were assessed within 72 hours post-injury using a comprehensive PCS checklist, administered to their parents via structured interview. Parents of children with mTBI reported significantly more symptoms in their children than parents of children with other minor bodily trauma, p < 0.001, r = 0.84. Parents of preschool and school-aged children reported an equal number of symptoms. However, subtle differences were observed between symptom profiles of preschool and school-aged children. Primary care clinicians should be aware of post-concussive symptom presentations in children of varying ages, in order to provide optimal care, especially in younger children. Methods of eliciting symptoms may influence the identification of symptoms. This issue warrants further examination in the paediatric population. ABBREVIATIONS ED emergency department; GCS Glasgow coma scale; mTBI mild traumatic brain injury; PCS post-concussive symptoms; PTA post-traumatic amnesia; TC trauma control.

Res Dev Disabil, 2014

The literature on the association between behavioural and emotional problems and ageing in adults... more The literature on the association between behavioural and emotional problems and ageing in adults with Down syndrome (DS) without dementia is limited and has generally not reported on a wide range of behavioural and emotional problems. This research aimed to extend the field by examining the associations between age and a wide spectrum of behavioural and emotional problems in adults with DS without dementia. A preliminary analysis of the association between potential covariates and behavioural and emotional problems was also undertaken. Parents and caregivers completed a questionnaire on behavioural and emotional problems for 53 adults with DS aged between 16 and 56 years. Twenty-eight adults with DS and their caregivers were part of a longitudinal sample, which provided two time points of data approximately four years apart. Additionally, 25 participants with DS and their caregivers were from a cross sectional sample, which provided one time point of data. Random effects regression analyses were used to examine the patterns in item scores for behavioural and emotional problems associated with age. No significant associations between age and the range or severity of any behavioural and emotional items were found. This suggested a more positive pattern for ageing adults with DS than has been previously described. Given that behavioural and emotional problems were not associated with age, investigation into other factors that may be associated with the behavioural and emotional difficulties for adults with DS is discussed.

Epilepsy & Behavior, 2014

This study explored the impact of developmental stage on cognitive function in children with rece... more This study explored the impact of developmental stage on cognitive function in children with recently-diagnosed epilepsy. In keeping with a neurodevelopmental framework, skills in a critical developmental period were expected to be more vulnerable than those stable at the time of seizure onset. We studied children with earlyonset (EO) symptomatic focal epilepsy (onset: 3-5 years; n = 18) and compared their performance with that of the group with late-onset (LO) epilepsy (onset: 6-8 years performance of; n = 8) on a range of cognitive tasks. Performance of both groups was compared with normative standards. 'Critical' and 'stable' classifications were based on developmental research. Nonparametric analyses revealed that skills in a critical developmental period for the group with EO epilepsy fell below normative standards (Phonological Processing: p = .007, Design Copying: p = .01, Visuomotor Precision:, p = .02) and fell below the performance of the group with LO epilepsy (Design Copying: p = .03, Visuomotor Precision: p = .03). There were no differences between the group with EO epilepsy and the group with LO epilepsy on measures of receptive vocabulary and memory, which were proposed to be in a stable developmental period across both groups. Auditory span, as measured by Word Order, was reduced for both the group with EO epilepsy (p = .02) and the group with LO epilepsy (p = .02) relative to normative standards, but the groups did not differ from each other. These results are consistent with a prolonged period of critical development for this skill. These findings support the notion that skills in a critical phase of development are particularly vulnerable following the onset of symptomatic focal epilepsy in childhood.

The Neuropsychology of Mental Illness

Schizophrenia Research, 2010

adolescents, as it would likely lead to high rates of false-positive predictions. Yet, especially... more adolescents, as it would likely lead to high rates of false-positive predictions. Yet, especially cognitive basic symptoms may be valuable criteria in 'at risk' studies in adolescents.

Schizophrenia Bulletin, 2011

Many of the major neuropsychiatric illnesses, including schizophrenia, have a typical age of onse... more Many of the major neuropsychiatric illnesses, including schizophrenia, have a typical age of onset in late adolescence. Late adolescence may reflect a critical period in brain development making it particularly vulnerable for the onset of psychopathology. Neuroimaging studies that focus on this age range may provide unique insights into the onset and course of psychosis. In this review, we examine the evidence from 2 unique longitudinal cohorts that span the ages from early childhood through young adulthood; a study of childhood-onset schizophrenia where patients and siblings are followed from ages 6 through to their early twenties, and an ultra-high risk study where subjects (mean age of 19 years) are studied before and after the onset of psychosis. From the available evidence, we make an argument that subtle, regionally specific, and genetically influenced alterations during developmental age windows influence the course of psychosis and the resultant brain phenotype. The importance of examining trajectories of development and the need for future combined approaches, using multimodal imaging together with molecular studies is discussed.

Molecular Psychiatry, 2012

Autism spectrum disorder (ASD) depends on a clinical interview with no biomarkers to aid diagnosi... more Autism spectrum disorder (ASD) depends on a clinical interview with no biomarkers to aid diagnosis. The current investigation interrogated single-nucleotide polymorphisms (SNPs) of individuals with ASD from the Autism Genetic Resource Exchange (AGRE) database. SNPs were mapped to Kyoto Encyclopedia of Genes and Genomes (KEGG)-derived pathways to identify affected cellular processes and develop a diagnostic test. This test was then applied to two independent samples from the Simons Foundation Autism Research Initiative (SFARI) and Wellcome Trust 1958 normal birth cohort (WTBC) for validation. Using AGRE SNP data from a Central European (CEU) cohort, we created a genetic diagnostic classifier consisting of 237 SNPs in 146 genes that correctly predicted ASD diagnosis in 85.6% of CEU cases. This classifier also predicted 84.3% of cases in an ethnically related Tuscan cohort; however, prediction was less accurate (56.4%) in a genetically dissimilar Han Chinese cohort (HAN). Eight SNPs in three genes (KCNMB4, GNAO1, GRM5) had the largest effect in the classifier with some acting as vulnerability SNPs, whereas others were protective. Prediction accuracy diminished as the number of SNPs analyzed in the model was decreased. Our diagnostic classifier correctly predicted ASD diagnosis with an accuracy of 71.7% in CEU individuals from the SFARI (ASD) and WTBC (controls) validation data sets. In conclusion, we have developed an accurate diagnostic test for a genetically homogeneous group to aid in early detection of ASD. While SNPs differ across ethnic groups, our pathway approach identified cellular processes common to ASD across ethnicities. Our results have wide implications for detection, intervention and prevention of ASD.

Journal of the International Neuropsychological Society, 2012

Virtual reality (VR) assessment paradigms have the potential to address the limited ecological va... more Virtual reality (VR) assessment paradigms have the potential to address the limited ecological validity of pen and paper measures of executive function (EF) and the pragmatic and reliability issues associated with functional measures. To investigate the ecological validity and construct validity of a newly developed VR measure of EF, the Virtual Library Task (VLT); a real life analogous task-the Real Library Task (RLT); and five neuropsychological measures of EF were administered to 30 patients with traumatic brain injury (TBI) and 30 healthy Controls. Significant others for each participant also completed the Dysexecutive Questionnaire (DEX), which is a behavioral rating scale of everyday EF. Performances on the VLT and the RLT were significantly positively correlated indicating that VR performance is similar to real world performance. The TBI group performed significantly worse than the Control group on the VLT and the Modified Six Elements Test (MSET) but the other four neuropsychological measures of EF failed to differentiate the groups. Both the MSET and the VLT significantly predicted everyday EF suggesting that they are both ecologically valid tools for the assessment of EF. The VLT has the advantage over the MSET of providing objective measurement of individual components of EF.

Journal of Child Neurology, 2011

Our objective was to describe the prevalence, comorbidity, and neuropsychological profiles of chi... more Our objective was to describe the prevalence, comorbidity, and neuropsychological profiles of children with hoarding and learning disabilities. From 61 children with learning disabilities, 16.4% exhibited hoarding as a major clinical issue. Although children with learning disabilities and hoarding displayed greater rates of obsessive-compulsive disorder (30%) as compared to those with learning disabilities without hoarding (5.9%), the majority of patients belonging to the former group did not display obsessive-compulsive disorder diagnosis. When learning disability patients with hoarding were compared to age-, sex-, and IQ-matched learning disability subjects without hoarding, hoarders exhibited a slower learning curve on word list-learning task. In conclusion, salient hoarding behaviors were found to be relatively common in a sample of children with learning disabilities and not necessarily associated with obsessive-compulsive disorder, supporting its nosological independence. It i...

Archives of Clinical Neuropsychology, 2012

Although there has been some progress in identifying the range of skills that comprise the execut... more Although there has been some progress in identifying the range of skills that comprise the executive neurocognitive system, their assessment has proved to be a challenge. Operationalization of executive functions (EFs) may be progressed by identifying the cognitive constructs that underlie EF test performance via principal components analysis. The underlying factor structure of 19 EF tests was examined in a nonclinical sample of 200 adults (mean age ¼ 30.8 [18-64] years); the sample comprised 97 men. Findings revealed only weak correlations between various measures derived from the EF tests. Exploratory factor analysis revealed a model comprising six independent factors, consistent with previous reports, describing the functions of the EF system. The factors comprised: Prospective Working Memory, Set-Shifting and Interference Management, Task Analysis, Response Inhibition, Strategy Generation and Regulation, and Self-Monitoring and Set-Maintenance. Results confirm the diverse and heterogeneous nature of EFs and caution against conceptualizations that underestimate its complexity. Furthermore, variability within the "normal" executive system is evident, and further research is required to understand executive functioning in healthy populations.

Applied Neuropsychology: Adult, 2013

Numerous variants of verbal fluency tasks exist within clinical and research domains that purport... more Numerous variants of verbal fluency tasks exist within clinical and research domains that purport to measure &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;executive function.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; However, to date, there has been a paucity of research examining what specific abilities are measured by these tasks. In this study, the relationships between a select group of cognitive constructs and phonemic, semantic, alternating, and excluded-letter verbal fluency tests were examined in 93 young healthy individuals (aged 18 to 35 years old). Forward-selection multiple regression analyses were performed for each fluency task. Phonemic fluency was associated with verbal intellectual function and processing speed; semantic fluency was associated with working memory and semantic word retrieval; excluded-letter fluency was associated with processing speed; and alternating fluency was associated with semantic word retrieval. These results highlight verbal intellectual function, processing speed, and semantic word-retrieval contributions to verbal fluency performances. The main conclusion from this study is that the abilities associated with verbal fluency performance in a young healthy population are multifactorial and differ across fluency variants. These findings progress our theoretical understanding of what is measured by different verbal fluency tasks and will assist interpretation of performance.

Schizophrenia Research, 2009

Spatial working memory (SWM) dysfunction has been suggested as a trait marker of schizophrenia an... more Spatial working memory (SWM) dysfunction has been suggested as a trait marker of schizophrenia and implicates a diffuse network involving prefrontal, temporal and parietal cortices. However, structural abnormalities in both grey and white matter in relation to SWM deficits are largely unexplored. The current magnetic resonance imaging (MRI) study examined this relationship in a sample of young first-episode schizophrenia (FES) patients using a whole-brain voxel-based method. SWM ability of 21 FES patients and 41 comparable controls was assessed by the CANTAB SWM task. Using an automated morphometric analysis of brain MRI scans, we assessed the relationship between SWM abilities and both grey matter volume and white matter density in both groups. Our findings demonstrated the different directionality of the association between SWM errors and grey matter volume in left frontal regions and white matter tracts connecting these regions with temporal and occipital areas between FES patients and controls. This suggests that the substrate underpinning the normal variability in SWM function in healthy individuals may be abnormal in FES, and that the normal neurodevelopmental processes that drive the development of SWM networks are disrupted in schizophrenia.