
Jonathan D LichtensteinDartmouth–Hitchcock Medical Center | DHMC · Department of Psychiatry
Jonathan D Lichtenstein
PsyD, MBA
About
61
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Publications (61)
Persisting symptoms after concussion (PSaC) affect up to 30% of children, adolescents, and young adults beyond 1 month post-injury, posing challenges in clinical care. This retrospective study examined 54 patients referred for neuropsychological evaluation due to PSaC, exploring factors contributing to symptom persistence. Results showed that 75.9%...
Objective
Explore the tip-of-the-tongue (TOT) scores from the Children’s Auditory and Visual Naming Tests (cANT, cVNT) as embedded validity indicators (EVIs).
Method
A retrospective design of 98 consecutively referred youth aged 6–15 years (M = 11.28, SD = 2.80) that completed neuropsychological evaluation at a tertiary-care academic medical cente...
Objective
Children with HIV (CWH) are at increased risk for cognitive and developmental delays, although HIV's influence on reading development remains unclear. Research using internationally validated reading measures with control for factors known to influence literacy outcomes is needed. The Early Grade Reading Assessment (EGRA) is a tool for as...
Objective
Persisting symptoms after concussion (PSaC) present significant challenges in clinical practice, with up to 30% of youth experiencing prolonged difficulties beyond one-month post-injury. This project aimed to characterize a sample of patients referred for neuropsychological evaluation due to PSaC and explore factors contributing to persis...
Objective: Severe acute respiratory syndrome coronavirus 2 may result in persistent physical, psychological, and/or cognitive symptoms, termed postacute sequelae of COVID-19 (PASC). A growing literature has documented the presence of cognitive deficits in individuals diagnosed with PASC; however, the use of performance validity tests (PVTs) has var...
Purpose
To (1) describe the challenges identified by cancer survivors, healthcare providers, and employers related to work maintenance and optimization during and after cancer treatment and (2) identify strategies that can address those challenges.
Methods
We conducted content analysis of semi-structured interview data collected from cancer surviv...
Tests of the brain’s ability to process complex sounds (central auditory tests) correlate with overall measures of neurocognitive performance. In the low- middle-income countries where resources to conduct detailed cognitive testing is limited, tests that assess the central auditory system may provide a novel and useful way to track neurocognitive...
Few confrontation naming tests are designed for pediatric populations. The Children's Visual Naming Test (cVNT; Hamberger et al., 2018) was developed to fill this gap. No independent studies using cVNT with clinical populations have been published to date. We aimed to characterize cVNT performance in a clinical sample and analyze the relationship b...
Objective
When neuropsychologists serve as consultants to schools, concussion management programs are associated with fewer referrals, faster cognitive recovery, and reduced incidence of protracted recovery compared to programs with physician consultants. However, accessing neuropsychological services can be challenging due to geographical and fina...
Objective
Neuropsychological assessment is the cornerstone of concussion management, and the nature of its delivery can vary widely. While literature concerning post-concussion care typically revolves around in-person evaluation, the proliferation of computerized neuropsychological tests (CNTs) has allowed for some distance between concussion patie...
Objective
Rapid automatized naming (RAN) assesses pre-literacy and could be useful for assessing the effects of HIV infection on the development of literacy. Many children with HIV live in sub-Saharan Africa, but the RAN has not been well-studied there. Cultural differences in when children learn color names and in how they prioritize between accur...
Objective
Central nervous system (CNS) damage from HIV infection or treatment can lead to developmental delays and poor educational outcomes in children living with HIV (CLWH). Early markers of central nervous system dysfunction are needed to target interventions and prevent life-long disability. The Frequency Following Response (FFR) is an auditor...
Objective
Coronavirus anxiety (CA) is associated with depression, general anxiety, and subjective cognitive dysfunction (SCD) in community samples. Furthermore, individuals with SARS-CoV-2 infection (acute & post-acute) report greater CA and SCD. No study to date has examined CA in patients diagnosed with post-acute sequelae of COVID-19 (PASC). We...
Tests of the brain’s ability to process sound (central auditory tests) correlate with overall measure of neurocognitive performance. In the developing world where resources to do detailed cognitive testing is limited, objective tests that use the central auditory system may provide a novel and useful way to track neurocognitive performance. This co...
Background:
Employment contributes to cancer survivors' quality of life, but this population faces a variety of challenges when working during and after treatment. Factors associated with work outcomes among cancer survivors include disease and treatment status, work environment, and social support. While effective employment interventions have be...
BACKGROUND
Employment contributes to cancer survivors’ quality of life, but this population faces a variety of challenges when working during and after treatment. Factors associated with work outcomes among cancer survivors include disease and treatment status, work environment, and social support. While effective employment interventions have been...
Objective:
Children with HIV (CWH) are at increased risk for cognitive and developmental delays. Whether HIV affects literacy development, however, remains unknown. Rapid automatized naming (RAN) tasks offer the simplest preliteracy assessment a child can perform that predicts future reading skills across languages.
Design and methods:
RAN perfo...
The evidence base for interventions that support the employment goals of cancer survivors is growing but inconclusive. As the first step in initiating a community-engaged program of research aimed at developing and testing interventions to support the employment goals of cancer survivors, 23 cancer survivors, 17 healthcare providers, and 5 employer...
Objective
The coronavirus disease of 2019 pandemic has increased personal protective equipment (PPE) use in medical settings. The current study examined the effect of PPE on a nonverbal measure of neurocognitive functioning.
Methods
The Leiter International Performance Scale, Third Edition (Leiter-3) was administered to 125 children between the ag...
Objectives:
To (1) describe the prevalence of work- or school-related distress among patients with cancer and (2) compare overall distress among those impacted at work or school to overall distress among those not impacted at work or school.
Design:
Retrospective chart review.
Participants:
All patients visiting the study site March 2016-Decem...
Objective: Tests requiring central auditory processing, such as speech perception-in-noise, are simple, time efficient, and correlate with cognitive processing. These tests may be useful for tracking brain function. Doing this effectively requires information on which tests correlate with overall cognitive function and specific cognitive domains. T...
This study was designed to determine the clinical utility of embedded performance validity indicators (EVIs) in adults with intellectual disability (ID) during neuropsychological assessment. Based on previous research, unacceptably high (>16%) base rates of failure (BRFail) were predicted on EVIs using on the method of threshold, but not on EVIs ba...
Children living with HIV can experience cognitive difficulties. Most neuropsychological tests have been constructed in Western languages, meaning they may not be appropriate for use in non-Western settings. To address this, we used an entirely nonverbal measure of cognitive ability in a sub-Saharan African sample. For this cross-sectional analysis,...
Objective
Traditional reliable change index (RCI) methods may be psychometrically limited due to their inability to account for particularly high or low baseline performance and regression to the mean following serial testing. The current study sought to examine differences between RCI and standardized regression-based (RBz) methods in a cohort of...
Objective:
Although telehealth has become a central component of medical care in response to the coronavirus disease 2019 (COVID-19) pandemic, comprehensive pediatric neuropsychological assessment over virtual platforms lacks empirical efficacy. This paper presents: a) the results of a quality improvement project examining the feasibility of in-pe...
Objective:
The authors examined the prevalence and correlates of psychotropic medication prescribing among outpatient youths with intellectual and developmental disabilities.
Methods:
The authors reviewed cross-sectional data on medications for 1,333 youths (ages 5-21 years) with intellectual and developmental disabilities who were referred to a...
Objective
Administering the noose item of the Boston Naming Test (BNT) has been questioned given the cultural, historical, and emotional salience of the noose in American culture. In response, some have modified the BNT by skipping/removing this item and giving the point as if the examinee responded correctly. It is unknown, however, whether modify...
This study was designed to examine the relative contribution of symptom (SVT) and performance validity tests (PVTs) to the evaluation of the credibility of neuropsychological profiles in mild traumatic brain injury (mTBI). An archival sample of 326 patients with mTBI was divided into four psychometrically defined criterion groups: pass both SVT and...
BACKGROUND
The development of neurocognitive deficits in those infected with human immunodeficiency virus (HIV) is a significant public health problem. Previous cross-sectional studies show that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist. We have been perform...
Background:
The development of neurocognitive deficits in those infected with human immunodeficiency virus (HIV) is a significant public health problem. Previous cross-sectional studies show that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist. We have been perfo...
Background
It is essential to increase the knowledge base of teachers involved in facilitating return to learning in middle school students following a concussion. However, the best method to enhance the transfer of learning for teachers remains to be elucidated. Application of Adult Learning Theory (ALT) is a plausible solution to this problem.
P...
The Global Assessment of School Functioning (GASF) provides a robust estimate of a student's overall level of functioning within the school environment. It is intended to capture a global metric reflecting academic, social and general behavioral functioning within the school. It is a modification of the Global Assessment of Functioning and reflects...
The objective of this study was to determine the effect of physical exertion on computerized neuropsychological test performance in high school athletes as part of concussion return-to-play protocols. ImPACT data and consultation records were retrospectively reviewed among athletes undergoing their physical stepwise progression for return-to-play f...
Regional fluctuations in cognitive ability have been reported worldwide. Given perennial concerns that the outcome of performance validity tests (PVTs) may be contaminated by genuine neuropsychological deficits, geographic differences may represent a confounding factor in determining the credibility of a given neurocognitive profile. This pilot stu...
This study reports on the use of ten knowledge competencies related to the behavioral management of concussion in schools. Trainings using these competencies as learning objectives were delivered to school personnel. This aims of the use of competencies in this way are to streamline the education of key stakeholders, to establish clear roles and re...
Objective:
To replicate previous research on Conners' Continuous Performance Test - Second Edition subscales as performance validity tests (PVTs) in children.
Method:
Classification accuracy for the Omissions (OMI), Hit Reaction Time (HRT), and Perseverations (PER) subscales was computed for 414 children and adolescents.
Results:
Overall, OMI,...
Children with intellectual and developmental disabilities (IDD) are likely to receive high-risk prescribing practices, such as polypharmacy, long-term use of psychotropic medications, and overuse of antipsychotics. Behavioural interventions, such as applied behavioural analysis, are evidence-based practices for children with IDD and should be the f...
Objective To replicate previous research on the forced choice recognition trial for the California Verbal Learning Test—Children’s Version (FCR-C).
Method Classification accuracy of the FCR-C was computed in 178 children referred for neuropsychological assessment to a tertiary care hospital.
Results FCR-C ≤ 14 produced the best combination of sensi...
Background: Sport-related concussion (SRC) generally does not result in structural anomalies revealed through clinical imaging techniques such as MRI and CT. While advanced neuroimaging techniques offer another avenue to investigate the subtle alterations following SRC, the current pediatric literature in this area has yet to be reviewed. The aim o...
Introduction:
At least 20% of children in the U.S. are highly vulnerable because they lack healthcare and protection. Several factors produce vulnerability: trauma, disruptions of parenting, poverty, involvement in the juvenile justice and/or child welfare systems, residence in restrictive settings, and problems related to developmental disabiliti...
Background
Ultimate Frisbee (ultimate) is a fast-growing, popular sport played nationally by over 4 million athletes. While several studies have examined injury rates in ultimate, no work has investigated the prevalence of concussions specifically or players’ knowledge and management of those injuries.
Purpose
To estimate the lifetime prevalence o...
There is significant comorbidity between autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). For children with ASD, their functional impairment becomes more pronounced when ADHD is present. Despite ASD and ADHD being different disorders, they share etiological factors such as environmental factors, genetic factors, a...
School-based concussion management programs cover thousands of young athletes, yet there is little in the way of research to assess program processes or outcomes. This study examined the referral patterns of consultants working with ten high school concussion management programs. In addition to the number of referrals made to specialists, other pot...
Young adults with autism spectrum disorder (ASD) experience significant rates of unemployment and underemployment, and the field needs an inexpensive, evidence-based vocational intervention. We examined an approach developed for people with serious mental illness, IPS supported employment, for young adults with ASD. We described a pilot IPS program...
Objective: Embedded validity indicators (EVIs) are cost-effective psychometric tools to identify non-credible response sets during neuropsychological testing. As research on EVIs expands, assessors are faced with an emerging contradiction: the range of credible impairment disappears between the “normal” and “invalid” range of performance. We labele...
Objective:
This pilot study measured the feasibility and impact of an 8-week yoga programme on the quality-of-life of adults with acquired brain injury (ABI).
Methods:
Thirty-one adults with ABI were allocated to yoga (n = 16) or control (n = 15) groups. Participants completed the Quality of Life After Brain Injury (QOLIBRI) measure pre- and pos...
Past studies have examined the ability of the Wisconsin Card Sorting Test (WCST) to discriminate valid from invalid performance in adults using both individual embedded validity indicators (EVIs) and multivariate approaches. This study is designed to investigate whether the two most stable of these indicators—failures to maintain set (FMS) and the...
Introduction:
The Recognition Memory Test (RMT) and Word Choice Test (WCT) are structurally similar, but psychometrically different. Previous research demonstrated that adding a time-to-completion cutoff improved the classification accuracy of the RMT. However, the contribution of WCT time-cutoffs to improve the detection of invalid responding has...
In previous research, several subscales of Conners’ CPT-II were found to be useful as performance validity tests (PVTs) when administered to adults with traumatic brain injury (TBI). Furthermore, invalid response sets were associated with inflated scores on several CPT-II scales. The present study proposed to investigate whether these findings woul...
Scores on the Complex Ideational Material (CIM) were examined in reference to various performance validity tests (PVTs) in 106 adults clinically referred for neuropsychological assessment. The main diagnostic categories, reflecting a continuum between neurological and psychiatric disorders, were epilepsy, psychiatric disorders, postconcussive disor...
Research suggests that select processing speed measures can also serve as embedded validity indicators (EVIs). The present study examined the diagnostic utility of Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) subtests as EVIs in a mixed clinical sample of 205 patients medically referred for neuropsychological assessment (53.3% female,...
The importance of performance validity tests (PVTs) is increasingly recognized in pediatric neuropsychology. To date, research has focused on investigating whether PVTs designed for adults function similarly in children. The downward extension of adult cutoffs is counter-intuitive considering the robust effect of age-related changes in basic cognit...
Media coverage, litigation, and new legislation have resulted in a heightened awareness of the prevalence of sports concussion in both adult and youth athletes. Baseline and postconcussion testing is now commonly used for the assessment and management of sports-related concussion in schools and in youth sports leagues. With increased use of compute...
Although no data exist, general practice recommends only rest following concussion. This randomized clinical trial found that programmed physical exertion during recovery produced no significant differences in recovery time between groups of participants. However, high levels of exertion were deleterious. This study provides initial evidence that m...
Objective: Although reported to be effective as a performance validity test (PVT) in TBI and ADHD, little is known about the
ability of the CPT-II to model performance validity in psychiatric patients. Also, while repeat CPT-II administrations have
been shown to enhance its diagnostic accuracy in ADHD evaluations, the effect of such strategic redun...
Background
Prevalence rates of invalid baseline scores on computerized neurocognitive assessments for high school, collegiate, and professional athletes have been published in the literature. At present, there is limited research on the prevalence of invalid baseline scores in pre–high school athletes.
Hypothesis
Pre–high school athletes assessed...
Of the approximately 6.8 million Americans who have been diagnosed with dementia, over 5 million have been diagnosed with Alzheimer's Disease (AD). Due to the rise in the aging population, these figures are expected to double by 2050. The following paper provides an up-to-date review of clinical issues and relevant research. Research related to the...