Papers by Bradley Axelrod
International Journal of Psychiatry in Clinical Practice, 2007
Objective. We attempted to better evaluate clinicians&amp... more Objective. We attempted to better evaluate clinicians' understanding of Criterion A1 of Posttraumatic Stress Disorder. Method. Approximately 50 mental health clinicians from the Department of Veterans Affairs evaluated 10 scenarios in which potentially traumatic events were described. Results. The results found psychiatrists and psychologists to be slightly more conservative in claiming an event was traumatic in comparison to social workers. In addition, events were deemed at a somewhat higher level of trauma for individuals who had less years of experience at the Department of Veterans Affairs. Conclusion. These data are presented as the initial step in better understanding the features included in determining whether an event is deemed traumatic according to the DSM-IV-TR criteria.
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Journal of Head Trauma Rehabilitation, 2007
To examine the nature of agitation in patients with brain injury and quantify the relation betwee... more To examine the nature of agitation in patients with brain injury and quantify the relation between agitation and patient progress in rehabilitation. Cross-sectional, correlational. Urban, inpatient rehabilitation facility in the midwestern United States. Sixty-nine patients with acquired brain injury admitted to an acute rehabilitation hospital. Therapy Engagement using the Rehabilitation Therapy Engagement Scale; Functional Status using the Functional Independence Measure. Agitated behavior was inversely associated with engagement in rehabilitation therapy even after controlling for injury severity. Engagement in therapy mediated the relation between agitated behavior and progress in rehabilitation as assessed using a Functional Independence Measure efficiency ratio. Progress in acute brain injury rehabilitation appears to be meaningfully influenced by the complex interplay among injury severity, agitation, and engagement. The findings are consistent with a theoretical model, suggesting that agitated patients make less progress in rehabilitation not only because of greater injury severity but also because agitation disrupts engagement in rehabilitation therapies. Multiple clinical purposes may be better served by measuring behavioral excess on a continuum than in a dichotomous fashion.
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Rehabilitation Psychology, 2006
... Items with extremely high correlations (ie, Participation and Coopera-tion) but little increm... more ... Items with extremely high correlations (ie, Participation and Coopera-tion) but little incremental value were combined to decrease redundancy. ... 1. Overall performance 1.52 1.00 0.84 1.44 1.12 0.93 2. Participation/cooperation 1.63 0.98 0.81 1.69 1.20 0.94 ...
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The Journal of head trauma rehabilitation
To examine the nature of agitation in patients with brain injury and quantify the relation betwee... more To examine the nature of agitation in patients with brain injury and quantify the relation between agitation and patient progress in rehabilitation. Cross-sectional, correlational. Urban, inpatient rehabilitation facility in the midwestern United States. Sixty-nine patients with acquired brain injury admitted to an acute rehabilitation hospital. Therapy Engagement using the Rehabilitation Therapy Engagement Scale; Functional Status using the Functional Independence Measure. Agitated behavior was inversely associated with engagement in rehabilitation therapy even after controlling for injury severity. Engagement in therapy mediated the relation between agitated behavior and progress in rehabilitation as assessed using a Functional Independence Measure efficiency ratio. Progress in acute brain injury rehabilitation appears to be meaningfully influenced by the complex interplay among injury severity, agitation, and engagement. The findings are consistent with a theoretical model, sugge...
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PsycEXTRA Dataset, 2000
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The Clinical Neuropsychologist, 1997
Abstract Recently, Reitan and Wolfson (1995) questioned the validity of using age and education a... more Abstract Recently, Reitan and Wolfson (1995) questioned the validity of using age and education adjustments in the clinical practice of neuropsychology based on a study of the effects of age and education on the General Neuropsychological Deficit Scale (GNDS) ...
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Applied neuropsychology. Adult, Jan 18, 2015
The purpose of this study was to determine how well scores from the Rey Complex Figure Test (RCFT... more The purpose of this study was to determine how well scores from the Rey Complex Figure Test (RCFT) could serve as embedded measures of performance validity in a large, heterogeneous clinical sample at an urban-based Veterans' Affairs hospital. Participants were divided into credible performance (n = 244) and noncredible performance (n = 87) groups based on common performance validity tests during their respective clinical evaluations. We evaluated how well preselected RCFT scores could discriminate between the 2 groups using cut scores from single indexes as well as multivariate logistic regression prediction models. Additionally, we evaluated how well memory error patterns (MEPs) could discriminate between the 2 groups. Optimal discrimination occurred when indexes from the Copy and Recognition trials were simultaneous predictors in logistic regression models, with 91% specificity and at least 53% sensitivity. Logistic regression yielded superior discrimination compared with ind...
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Journal of Clinical and Experimental Neuropsychology, 2015
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The Clinical Neuropsychologist
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Assessment
This study investigated the best estimate of true Wechsler Adult Intelligence Scale-Revised (WAIS... more This study investigated the best estimate of true Wechsler Adult Intelligence Scale-Revised (WAIS-R) Full Scale IQ for people who recently had been administered the WAIS-R using 65 college students. Results indicate the Verbal IQ, Verbal Comprehension factor score, and subtracting six points from the current full scale IQ yield the best estimates. (SLD)
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The Clinical Neuropsychologist
The current study aimed to clarify the relationship among the constructs involved in neuropsychol... more The current study aimed to clarify the relationship among the constructs involved in neuropsychological assessment, including cognitive performance, symptom self-report, performance validity, and symptom validity. Participants consisted of 120 consecutively evaluated individuals from a veteran's hospital with mixed referral sources. Measures included the Wechsler Adult Intelligence Scale-Fourth Edition Full Scale IQ (WAIS-IV FSIQ), California Verbal Learning Test-Second Edition (CVLT-II), Trail Making Test Part B (TMT-B), Test of Memory Malingering (TOMM), Medical Symptom Validity Test (MSVT), WAIS-IV Reliable Digit Span (RDS), Post-traumatic Check List-Military Version (PCL-M), MMPI-2 F scale, MMPI-2 Symptom Validity Scale (FBS), MMPI-2 Response Bias Scale (RBS), and the Postconcussive Symptom Questionnaire (PCSQ). Six different models were tested using confirmatory factor analysis (CFA) to determine the factor model describing the relationships between cognitive performance, s...
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The Clinical Neuropsychologist
This study derived an embedded performance validity indicator for the Rey Auditory Verbal Learnin... more This study derived an embedded performance validity indicator for the Rey Auditory Verbal Learning Test (AVLT) using an archival dataset. Participants aged 20 to 65 (N = 167) who reported traumatic brain injury and completed at least two performance validity tests were included. The group who passed all performance validity measures (n = 68) demonstrated higher scores on all AVLT trials than the group who failed two or more validity indicators (n = 62). Bayesian model averaging was used to identify the optimal combination of AVLT variables for group discrimination; Total Learning and Recognition raw scores were selected. Logistic regression using these variables showed excellent discrimination with an area under the curve of. 85. The resulting AVLT performance validity index demonstrated sensitivity of. 55 with specificity of. 91. Further study of this index is warranted and cross-validation is recommended prior to clinical use.
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Journal of Clinical and Experimental Neuropsychology
This study examined embedded performance validity indicators (PVI) based on the number of impaire... more This study examined embedded performance validity indicators (PVI) based on the number of impaired scores in an evaluation and the overall test battery mean (OTBM). Adult participants (N = 175) reporting traumatic brain injury were grouped using eight PVI. Participants who passed all PVI (n = 67) demonstrated fewer impaired scores and higher OTBM than those who failed two or more PVI (n = 66). Impairment was defined at three levels: T scores < 40, 35, and 30. With specificity ≥.90, sensitivity ranged from .51 to .71 for number of impaired scores and .74 for OTBM.
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Psychological Injury and Law, 2015
ABSTRACT Performance validity testing (PVT) is a standard of practice in situations where there a... more ABSTRACT Performance validity testing (PVT) is a standard of practice in situations where there are prominent secondary gain issues; however, it is suggested that their use may benefit neuropsychological evaluations in clinical contexts, as engagement in neuropsychological evaluations can affect the validity of testing and can occur for a variety of reasons outside of secondary gain issues. Several methods of embedded index development, as well as methods to combine them are discussed, including issues related to use of multiple indices. The potential limitations to administration of multiple indices are also explored. It is suggested that neuropsychological evaluations can benefit from PVT in regular clinical practice to assist with reaching firmer diagnostic conclusions by assuring test result validity.
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Applied neuropsychology. Adult, 2015
The objective of this study was to determine to what extent verbal fluency measures can be used a... more The objective of this study was to determine to what extent verbal fluency measures can be used as performance validity indicators during neuropsychological evaluation. Participants were clinically referred for neuropsychological evaluation in an urban-based Veteran's Affairs hospital. Participants were placed into 2 groups based on their objectively evaluated effort on performance validity tests (PVTs). Individuals who exhibited credible performance (n = 431) failed 0 PVTs, and those with poor effort (n = 192) failed 2 or more PVTs. All participants completed the Controlled Oral Word Association Test (COWAT) and Animals verbal fluency measures. We evaluated how well verbal fluency scores could discriminate between the 2 groups. Raw scores and T scores for Animals discriminated between the credible performance and poor-effort groups with 90% specificity and greater than 40% sensitivity. COWAT scores had lower sensitivity for detecting poor effort. A combination of FAS and Animal...
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Neuropsychiatry, neuropsychology, and behavioral neurology, 2002
To evaluate neuropsychologic performance among women occupationally exposed to products commonly ... more To evaluate neuropsychologic performance among women occupationally exposed to products commonly used in nail studios. Organic solvents and (meth)acrylates commonly used in nail studios have known neurotoxic properties. Few studies have examined the potential for cognitive and neurosensory effects of occupational exposure to these substances, and none has addressed exposure occurring in the cosmetics industry. Participants in this study included nail-salon technicians (n = 33) and demographically similar controls who had no known history of exposure to toxic chemicals (n = 35). The groups were administered psychologic, neuropsychologic, and neurosensory tests. Aspects of the workplace environment (e.g., square footage of the salon, adequacy of ventilation, and hours worked) also were assessed. Multivariate analysis of variance (MANOVA) revealed that the nail technicians performed more poorly than did controls on tests of attention and processing speed (p = 0.015; eta(2) = 0.20). Olf...
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International Journal of Neuroscience, 2007
Two methods were addressed to evaluate the incidence of false positive impairment on tests in neu... more Two methods were addressed to evaluate the incidence of false positive impairment on tests in neuropsychological evaluation. One method used a mathematical model based on the binomial theory (Ingraham &amp;amp;amp;amp;amp; Aiken, 1996) to offer predictions based on probability. The model sets boundaries to determine when score variations would occur by chance and is therefore useful for identifying when cases exceed established boundaries. In addition, the present study examined test performance in a non-clinical sample of 94 college students via the Halstead Reitan Neuropsychological Test Battery. Results found that 15% of the sample had impairments suggested by the Halstead Impairment Index, using criteria established by Reitan and Wolfson (1993). In addition, one-half of the sample obtained impaired scores on one or two tests. These results are consistent with what the binomial model predicted. The model would therefore serve as a useful resource for clinicians when considering the probability of impaired test performance.
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Psychological Injury and Law, 2015
ABSTRACT Effort assessment is a relevant area in neuropsychological assessment. There are well-es... more ABSTRACT Effort assessment is a relevant area in neuropsychological assessment. There are well-established self-report measures, such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) FBS Symptom Validity Scale (FBS; Lees-Haley, English &amp; Glenn, Psychological Reports 68: 203-210, 1991) and MMPI-2 Response Bias Scale (RBS; Gervais, Ben-Porath, Wygant &amp; Green, Assessment 14: 196, 2007). However, there is also a need for brief measures of symptom exaggeration. The Structured Inventory of Malingered Symptomatology (SIMS) appears to be a promising self-report measure of symptom validity (e.g., Smith &amp; Burger, Academy of Psychiatry and the Law 25: 183-189, 1997). In order to understand the psychometric properties of the SIMS, a comprehensive item analysis was performed with the questionnaire. Items were removed due to invariable response or lack of relationship with the total SIMS. Receiver operating characteristics (ROC) curve analyses were completed using RBS and FBS Symptom Validity Scale (FBS) of the MMPI-2 with items grouping from the SIMS indices. The results found that limiting the number of items did not affect overall utility. The abbreviated indices on the SIMS had excellent discrimination with the neurologic impairment (NI) and affective disorder (AF) scales and good discrimination with psychosis (P) and amnesic disorder (AM) scales of the SIMS. The briefer measure allows for less time required to administer the measure, while still maintaining the integrity of the SIMS.
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Psychological Injury and Law, 2013
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Papers by Bradley Axelrod