Accurate understanding of practice characteristics, performance stability, and error on neuropsychological tests is essential to both valid clinical assessment and maximization of signal detection for clinical trials of cognitive enhancing drugs. We examined practice effects in 28 healthy adults. As part of a larger study using donepezil and simulating a Phase I trial, participants were randomized into: placebo, no-treatment and donepezil. Donepezil results are presented elsewhere. Neuropsychological tests were administered in a fixed order for 6 weeks, with alternate forms available for most tests. Despite alternate forms, ANOVAs revealed significant improvements for the pooled control group (placebo and no-treatment) on all tests except Letter Number Sequencing and Trails B. Learning occurred principally in the first three to four sessions. PASAT and Stroop interference showed the greatest learning. Thus, serial assessment with alternate forms may attenuate retest effects on some tests, but continued learning occurs on novel tests or those in which an advantageous test-taking strategy can be identified. Alternate forms and baseline practice sessions may help control early, rapid improvements in clinical trials.

Objective: This large, prospective, community-based study characterized neuropsychological functioning and academic achievement at the time of the first recognized seizure and identified risk factors for cognitive deficits. Methods:We compared 282 children (ages 6 -14 years, IQ Ն70) with a first recognized seizure to 147 healthy siblings on a battery of well-standardized and widely used neuropsychological and academic achievement tests and examined relationships with demographic and clinical variables.

Summary:Purpose: Academic underachievement is common in pediatric epilepsy. Attempts to identify seizure and psychosocial risk factors for underachievement have yielded inconsistent findings, raising the possibility that seizure and psychosocial variables play a complex role in combination with other variables such as neuropsychological functioning. This study crossvalidated a neuropsychological measurement model for childhood epilepsy, examined the relation between neuropsychological functioning and academic achievement, and tested the degree to which demographic, seizure, and psychosocial variables moderate that relation.Methods: Children with chronic epilepsy (N = 173; ages 8 to 15 years; 49% girls; 91% white/non-Hispanic; 79% one seizure type; 79% taking one medication; 69% with active seizures) completed a comprehensive neuropsychological battery. Children diagnosed with mental retardation were excluded.Results: Structural equation modeling identified a threefactor measurement model of neuropsychological function:Verbal/Memory/Executive (VME), Rapid Naming/Working Memory (RN/WM), and Psychomotor (PM). VME and RN/WM were strongly related to reading, math, and writing; PM predicted writing only. Family environment moderated the impact of neuropsychological deficits on writing (p ≤ 0.01) and possibly for reading (p = 0.05); neuropsychological deficits had a smaller impact on achievement for children in supportive/organized homes compared with children in unsupportive/disorganized homes.Conclusions: These findings lend partial support for our theoretical model showing direct effects of neuropsychological function on achievement and the moderating role of family factors. This study suggests that a subgroup of children with epilepsy (those who have not only neuropsychological deficits but also disorganized/unsupportive home environments) are particularly at risk for adverse academic outcomes. Implications for intervention are discussed. Key Words: Epilepsy-ChildrenFamily-Cognition-Academic achievement.Children with epilepsy are at great risk for academic difficulties (1-7) and for underemployment as adults (6,8). Fastenau et al. (9) described a model to explain how various risk factors might contribute to academic problems. In that model, neuropsychological functioning appears to play an integral role, possibly mediating the effects of structural and electrophysiologic abnormalities (10-14). Other risk factors in the model include seizure, demographic, and psychosocial variables (9).Studies to date have not been consistent in identifying seizure variables (e.g., seizure type, age at onset, seizure

The Rey-Osterrieth Complex Figure Test ("the Rey"; Osterrieth, 1944; Rey, 1941) has accumulated a considerable literature as a test of visual-spatial perception/construction and memory. The Extended Complex Figure Test (ECFT; Fastenau, 1996a, in press-a; Fastenau & Manning, 1992) supplements the Rey with Recognition and Matching trials that follow Copy, Immediate Recall, and Delayed Recall. The Rey and ECFT were administered to 211 healthy adults. Age ranged from 30 years to 85 years (M = 62.9, SD = 14.2), education ranged from 12 years to 25 years (M = 14.9, SD = 2.6), 55% were women, and over 95% were Caucasian. Age and education effects were evident on all trials (Multiple R ranged .23 to .50, p < .05), but education explained minimal variance (usually 2-3%) on copy and memory trials. Gender effects were negligible, if present. Age-appropriate norms are presented using Osterrieth's 36-point scoring, overlapping cells, and convenient tables for converting raw scores to scaled scores.

Adolescents with complex neurological conditions such as spina bifida require a holistic approach to their health care. Quality of Life (QOL) and the factors associated with QOL are important and understudied variables for these adolescents. A sample of 60 adolescents and their parents was interviewed to determine a) the adolescent's and family's QOL, b) condition/adolescent/family factors associated with QOL measures, and c) the relationship between adolescent and parent ratings on QOL measures. QOL was moderately high in these families. Few condition measures were related to QOL. However, several adolescent and family factors were significantly related to both overall QOL and health-related quality of life. There was no difference between adolescents and their parents on overall adolescent and family QOL items. Holistic practitioners need to be aware of areas perceived positively and negatively by these adolescents and their families as well as factors associated with outcomes.