Objectives: Many combat Veterans exhibit cognitive limitations of uncertain origin. In this study, we examined factors that predict cognitive functioning by considering effects of blastrelated concussion (BRC), non-blast-related concussion (NBRC), and posttraumatic stress disorder (PTSD) symptoms. Analyses specifically tested whether: (a) BRC and NBRC were distinct in their prediction of cognitive performance; (b) a dose-response relationship existed between recurrent concussion (BRC and NBRC) and cognitive impairment; and (c) PTSD symptoms mediated the relationship between BRC and cognitive performance.Method: Two-hundred eighty Veterans with combat zone deployment histories completed semistructured clinical interviews to define BRC and NBRC histories, current and past mental health disorders, and dimensional ratings of PTSD symptomatology. Participants were also administered a number of neuropsychological measures to appraise cognitive functioning.Results: A structural equation model (SEM) suggested that BRC and NBRC were not distinct in their prediction of cognitive performance, and there was no evidence that recurrent concussion (blast or non-blast) was directly associated with cognitive performance. BRC was significantly associated with PTSD symptoms (r = .24), PTSD symptoms were significantly associated with cognitive performance in the SEM (r = −.27), and PTSD symptoms significantly mediated the link between BRC and cognitive performance (p = .03).Conclusions: These results suggest that concussion history fails to directly contribute to cognitive performance, regardless of mechanism (blast or non-blast) and recurrence. BRC is nonetheless unique in its contribution to PTSD and PTSD-related cognitive deficits. Results support interventions specific to PTSD management in the interest of promoting neuropsychological functioning among war Veterans.
Military service members' self-reports of mTBI are generally consistent over time; however, inconsistency in retrospective self-reporting of mTBI status is associated with current post-traumatic stress symptoms and non-specific physical health complaints.
There is a need for enhanced and more creative assessment techniques in evaluating the adolescent population. Developmental issues of adolescents, the significant mental health needs of adolescents, and problems with present diagnostic criteria are explored. Creative alternatives for more accurate and inclusive assessment are discussed, with emphasis on issues of rapport and empowerment. The diagnostic interview, family diagnostic interview, differential diagnosis (a systems approach to collateral contact), and effective followthrough are explored.The adequate psychological assessment of adolescents, in the vernacular of the age group, is definitely a "piece of work"! The normal developmental explosions of growth inherent in the adolescent, on physiological, social, cognitive, and emotional fronts, mean that we are attempting to assess a rapidly evolving and changing person who is struggling with issues of "becoming," including autonomy, separation and individuation, self-esteem, and self-doubt. In this stormy and stressful time, conflict within, and conflict with the larger society (family, friends, school) are often assumed to be normal rights of passage of Correspondence regarding this article should be addressed to I. Louis Young,
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