Clinical Neuropsychologist最新文献

{"title":"When failure on one performance validity test demonstrates invalid neuropsychological responding.","authors":"Laurence M Binder, Philip K Martin, Ryan W Schroeder","doi":"10.1080/13854046.2025.2570302","DOIUrl":"10.1080/13854046.2025.2570302","url":null,"abstract":"<p><p><b>Objective:</b> A commonly held rule in neuropsychology is that two performance validity test (PVT) failures are required to determine response invalidity. This study assessed whether there are exceptions to this rule based on the PVT administered and the magnitude of the failure. <b>Method:</b> 261 adult examinees completed a battery of neuropsychological tests as part of their clinical or forensic evaluations. These batteries contained 4-12 PVTs (mean = 8.1) and always included both the Test of Memory Malingering (TOMM) and Reliable Digit Span (RDS). Analyses were performed to assess associations between PVT failures. <b>Results:</b> 16.5% of examinees failed the TOMM at conventional cutoffs; 97.7% of these individuals failed at least one other PVT. RDS was failed by 14.2% of examinees; 75.7% of whom failed at least one other PVT. The TOMM was significantly more strongly associated than RDS with at least one additional PVT failure with a medium effect size. At a TOMM Trial 2 or Retention score of <43, 100% of examinees failed at least one other PVT. At an RDS cutoff of <4, 100% of individuals failed at least one additional PVT; this was not useful, because only one individual produced that score. <b>Conclusions:</b> While use of multiple PVTs is recommended, the current results suggest that failure on the TOMM, especially with Trial 2 or Retention <43, is sufficient for determining that test data are invalid if multiple PVTs are not available for analysis. Further research is recommended to cross-validate these findings and generalize the results to other PVTs.</p>","PeriodicalId":55250,"journal":{"name":"Clinical Neuropsychologist","volume":" ","pages":"1659-1670"},"PeriodicalIF":2.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Derivation of embedded symptom validity indicators for the Brief Symptom Inventory-18.","authors":"Jeremy J Davis, Scott R Millis","doi":"10.1080/13854046.2025.2555587","DOIUrl":"10.1080/13854046.2025.2555587","url":null,"abstract":"<p><strong>Objective: </strong>Symptom validity assessment is an important component of the evaluation of psychological sequelae of traumatic brain injury (TBI). Many personality inventories have embedded symptom validity scales (SVTs). A growing body of research reports derivation of embedded SVTs in brief symptom and self-report measures. We sought to develop embedded SVT indicators based on the Brief Symptom Inventory-18 (BSI-18).</p><p><strong>Method: </strong>This project involved secondary analysis of TRACK-TBI data obtained from the Federal Interagency Traumatic Brain Injury Research Informatics System repository. Participants (<i>N</i> = 1,694) sustained TBI (<i>n</i> = 1,515) and or non-head orthopedic injury (<i>n</i> = 179). Independent SVTs were used to identify TBI cases with questionable validity (QV). Two novel SVTs were examined: BSI-V, which was developed using Bayesian model averaging (BMA) to determine a subset of BSI-18 items that predict QV, and BSI GSI, which is a total score cutoff based on the BSI-18 Global Severity Index. Receiver operating characteristic (ROC) analysis was used to compare classification accuracy of BSI-V and BSI GSI.</p><p><strong>Results: </strong>Four BSI-18 items were determined to be optimal predictors of QV. The BSI-V and BSI GSI both showed outstanding discrimination with area under the ROC curve (AUC) of .95. BSI-V (≥5) and BSI GSI (≥64 T) cutoffs showed 83% sensitivity and 90% specificity.</p><p><strong>Conclusions: </strong>Findings provide preliminary evidence of novel embedded SVTs in the BSI-18 with comparable support for BSI-V and BSI GSI. These findings warrant independent cross-validation to provide additional evidence of classification accuracy and refine cutoffs prior to implementation in practice.</p>","PeriodicalId":55250,"journal":{"name":"Clinical Neuropsychologist","volume":" ","pages":"1688-1707"},"PeriodicalIF":2.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The need for PICU follow-up and evaluation of post-intensive care syndrome in pediatrics in a community children's hospital.","authors":"Neelima Marupudi, Jessica Morgan, Sarah Karabatsos, Neethi P Pinto","doi":"10.1080/13854046.2025.2566200","DOIUrl":"10.1080/13854046.2025.2566200","url":null,"abstract":"<p><p><b>Objective</b>: Children admitted to the PICU are at risk for acquiring morbidities from their hospitalization known as post-intensive care syndrome in pediatrics (PICS-p). The objectives of this study were to examine the need for neurocognitive follow-up in evaluating for PICS-p, describe acquired PICS-p morbidities, and characterize recommended interventions. <b>Methods</b>: Children ages 1 day to 18 years admitted to the PICU between January 1, 2016 to December 31, 2023 who were evaluated in the pediatric neuropsychology outpatient clinic within 3-8 months of hospital discharge were included. <b>Results</b>: Among 453 referrals, 343 (76%) children were evaluated by the neuropsychology team. The most common post-discharge morbidities were sleep disturbances (63%), developmental/functional concerns (60%), and coping difficulties (56%). 289 children (84%) received interventions as a result of their neurocognitive evaluations. Medical interventions including referrals to physical, occupational, and speech therapy, psychiatry, psychotherapy, and neurology were recommended for 73.8% of children. Home interventions to address sleep and mood disturbances were recommended for 73.2% of children. Academic interventions including recommendations for educational services and provision of additional time to complete tasks were provided for 76.1% of children. <b>Conclusions</b>: The majority of children received recommendations for interventions as a result of their evaluations suggesting that neurocognitive follow-up has a role following pediatric critical illness. The high uptake of neuropsychology services among children referred for follow-up suggests that many PICU survivors experience significant functional and psychosocial morbidities after hospital discharge and are willing to seek support.</p>","PeriodicalId":55250,"journal":{"name":"Clinical Neuropsychologist","volume":" ","pages":"1622-1636"},"PeriodicalIF":2.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The inventory of problems-29 (IOP-29) in a US clinical sample.","authors":"Robert D Shura, Bradley N Axelrod, Katherine M Craig, Jennifer A Pender, Kyrstina H Mariouw","doi":"10.1080/13854046.2025.2564157","DOIUrl":"10.1080/13854046.2025.2564157","url":null,"abstract":"<p><p><b>Objective:</b> Research on the Inventory of Problems-29 (IOP-29) has primarily used simulation designs and non-US samples. This study evaluated the IOP-29 in US clinical samples relative to validity scales obtained from Minnesota Multiphasic Personality Inventory (MMPI). <b>Method:</b> Clinical patients (<i>N</i> = 217) were administered the IOP-29 and the second or third version of the Minnesota Multiphasic Personality Inventory (MMPI) as part of routine care. Correlations evaluated criterion validity of the IOP-29 False Disorder Probability Score (FDS). Diagnostic accuracy statistics were calculated, with the invalid group (<i>n</i> = 25) identified as those producing invalid scores on any two or more MMPI scales compared to those with no invalid scores. <b>Results:</b> The IOP-29 was positively correlated to overreport scales (<i>ρ</i> = .24 to .62), and not or negatively correlated to underreport scales. At FDS ≥ .50, sensitivity was .72 at specificity of .88. To reach a specificity of .90, the cutoff score needed raised to .58, but without any change in sensitivity. At the more conservative ≥ .64, specificity raised to .95 but sensitivity dropped to .56. <b>Conclusions:</b> The IOP-29 showed utility as a broad measure of negative response bias in mixed clinical sample in the US. The recommended cutoff of FDS ≥ .50 worked well in this mixed clinical sample, though a slight increase in cutoff was needed to achieve .90 specificity. The measure would benefit from additional criterion group studies in different clinical and forensic samples and using additional methods for identifying participants with invalid profiles.</p>","PeriodicalId":55250,"journal":{"name":"Clinical Neuropsychologist","volume":" ","pages":"1708-1718"},"PeriodicalIF":2.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post‑stroke disorders of ownership and agency, alien/anarchic hand syndrome: A longitudinal case analysis and systematic review.","authors":"Davide Cardile, Serena Campana, Carmelo Mario Vicario, Fabrizio Doricchi, Stefano Lasaponara, Rocco Salvatore Calabrò, Francesco Tomaiuolo","doi":"10.1080/13854046.2025.2557973","DOIUrl":"10.1080/13854046.2025.2557973","url":null,"abstract":"<p><strong>Objective: </strong>Disorders of motor agency and ownership following stroke represent a complex clinical spectrum, ranging from transient phenomena to chronic syndromes. However, the prognostic factors that govern symptom persistence remain poorly defined.</p><p><strong>Methods: </strong>We conducted a systematic review of post-stroke cases with uncontrollable hand actions and structural imaging data. Eligible reports were screened for lesion sites, awareness of limb ownership, and clinical courses. The time to the last reported assessment was documented to distinguish acute/subacute from chronic trajectories. Additionally, we present a longitudinal case study of a patient with a lesion extending from the genu to the splenium of the corpus callosum and into the right medial frontal area cortex, with follow-up imaging at both acute and chronic stages. A lesion-based disconnectome analysis was performed to characterize network disconnection.</p><p><strong>Results: </strong>Agency disruption was universal, whereas ownership loss occurred selectively, typically associated with parietal, parieto-occipital, fronto-parietal, or combined callosal and medial frontal lesions. Patients with isolated callosal, fronto-parietal, or callosal plus cingulate lesions often achieved complete resolution in the early stages. In contrast, chronic persistence of symptoms was almost invariably linked to combined damage of the corpus callosum and frontal or fronto-parietal cortices. The index case exemplified this pattern, with sustained grasping behavior at long-term follow-up and disconnection of callosal fibers, the superior longitudinal fasciculus, the frontal aslant tract, and cingulum bandle confirmed by tract-based modelling.</p><p><strong>Conclusions: </strong>Chronic anarchic hand phenomena primarily result from the combined breakdown of interhemispheric and premotor networks. Early imaging of callosal and frontal pathways is essential for prognosis and therapeutic planning.</p>","PeriodicalId":55250,"journal":{"name":"Clinical Neuropsychologist","volume":" ","pages":"1760-1778"},"PeriodicalIF":2.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adapting a stepped-care model to outpatient neuropsychology in a Veterans Affairs hospital.","authors":"Julija Stelmokas, Valerie Abel, Margaret Lanca, Catherine O'Brien","doi":"10.1080/13854046.2026.2705533","DOIUrl":"https://doi.org/10.1080/13854046.2026.2705533","url":null,"abstract":"<p><p><b>Objective:</b> Evaluate an outpatient neuropsychology stepped-care model to improve healthcare quality and efficiency. Compare utilization patterns and quality outcomes between brief neuropsychology evaluations (referred to as screening visit; [SV]) and comprehensive neuropsychological evaluations (CNEs) in a retrospective sample of Veterans. <b>Methods:</b> Consults (<i>n</i> = 139) were triaged based on chart review and evaluation of who may benefit from SV over CNE (e.g. active/undertreated mental health symptoms, substance use, recent CNE). All patients offered SV were also offered CNE. Referral questions were answered for both SV and CNE. <b>Results:</b> When offered the choice between SV and CNE, all patients selected SV. Active/under-treated mental health concerns were the most common reason for SV. Most SV visits did not require further neuropsychological testing (<i>n</i> = 25/36 or 69.44%). SVs facilitated faster access to care, with shorter time to feedback (SV mean days = 1.56, CNE mean days = 12.04) and an almost 20% faster time to see patients overall. Similar recommendations were provided for both SV and CNE, with mental health referrals as the most frequently cited. Utilizing SVs resulted in time and money savings and with 20% faster time to scheduling. <b>Conclusions:</b> The application of a neuropsychology stepped-care approach using SVs at our local facility demonstrated several positive outcomes, including improved efficiency and increased access to care.</p>","PeriodicalId":55250,"journal":{"name":"Clinical Neuropsychologist","volume":" ","pages":"1-20"},"PeriodicalIF":2.6,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic utility of the Structured Inventory of Malingered Symptomatology (SIMS) in detecting feigned cognitive impairment in older adults.","authors":"Marie Kompasova, Lenka Kramska, Ales Bartos","doi":"10.1080/13854046.2026.2702531","DOIUrl":"https://doi.org/10.1080/13854046.2026.2702531","url":null,"abstract":"<p><strong>Objective: </strong>The primary aim of this study was to evaluate the diagnostic utility of the Structured Inventory of Malingered Symptomatology (SIMS) in detecting feigned cognitive impairment, specifically through self-reported cognitive and neurological symptoms, among older adults.</p><p><strong>Method: </strong>The study was carried out at the University Hospital Kralovske Vinohrady in Prague, Czech Republic. The study included 172 participants: 56 patients with cognitive impairment (33 patients with MCI and 23 patients with dementia), 54 healthy elderly volunteers as a simulation group, and 62 healthy elderly honest responders. SIMS was used as the primary research tool. Cognitive performance was evaluated using the RBANS and the MoCA. Emotional status and functional abilities were measured using the GDS-15, BAI, and FAQ.</p><p><strong>Results: </strong>Our results support the utility of SIMS in older adults, as the instrument significantly distinguished feigned symptoms from genuine cognitive impairment. At the proposed cutoff score of > 20, the SIMS Total Score yielded 100% sensitivity and specificity. For the AM scale, sensitivity reached 89% and specificity 98% (cutoff > 7), while the NI scale achieved 87% sensitivity and 96% specificity (cutoff > 6). AUC values for these scales exceeded .959.</p><p><strong>Conclusions: </strong>The primary contribution of this work is the introduction of revised cutoff scores specifically tailored for older adults (Total Score > 20, AM > 7, NI > 6, AF > 6, <i>p</i> > 2, and LI > 2). These adjusted criteria minimize the risk of false-positive results while extending the potential applications of SIMS within both clinical and forensic settings.</p>","PeriodicalId":55250,"journal":{"name":"Clinical Neuropsychologist","volume":" ","pages":"1-17"},"PeriodicalIF":2.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New regression-based norms for letter and semantic fluency tests on Norwegian older adults.","authors":"Therese Händel Waggestad, Bjørn-Eivind Kirsebom, Carsten Strobel, Linda Gjøra, Geir Selbæk, Peter Bekkhus-Wetterberg, Jens Egeland","doi":"10.1080/13854046.2026.2701151","DOIUrl":"https://doi.org/10.1080/13854046.2026.2701151","url":null,"abstract":"<p><strong>Objective: </strong>This study presents updated regression-based norms for verbal fluency tests: \"FAS,\" \"Animals,\" and \"Supermarket\" in older Norwegian adults. By examining the potential modulating effects and putative interaction effects of age, education, and sex, we aim to investigate cognitive aging and the effects of education.</p><p><strong>Method: </strong>The study includes 449 healthy participants, aged 70-92 years, from the NorFAST (<i>n</i> = 254) and HUNT (<i>n</i> = 195) studies. Regression-based norms for all three verbal fluency tasks were produced. Models were assessed for pertinent linear, curvilinear, or interaction effects of age, education, and sex. We compared our norms to previously published norms.</p><p><strong>Results: </strong>The task \"FAS\" was predicted by education (<i>b</i> = 0.773, partial <i>R</i>² = 0.117, <i>p</i> < .001) and sex (<i>b</i> = 1.110, partial <i>R</i>² = 0.037, <i>p</i> < .001), and the task \"Animals\" was predicted by education (<i>b</i> = 0.313, partial <i>R</i>² = 0.021, <i>p</i> < .01) and age (<i>b</i> = -0.123, partial <i>R</i>² = 0.045, <i>p</i> < .001). Higher education and being female were associated with better performance, whereas older age was associated with poorer performance. Finally, for the task \"Supermarket,\" we found an interaction effect between age and education (<i>b</i> = -0.063, partial <i>R</i>² = 0.034, <i>p</i> < .01), but the major predictor was sex (<i>b</i> = 1.446, partial <i>R</i>² = 0.068, <i>p</i> < .001).</p><p><strong>Conclusions: </strong>The norms were adjusted for the demographic variables that predicted the individual tasks. The illustrative norm comparison estimated similar mean performance but larger differences between the \"exceptionally low\" scores. The results also indicate that only processing speed declines with age, and that higher education has minimal effect on test-performance.</p>","PeriodicalId":55250,"journal":{"name":"Clinical Neuropsychologist","volume":" ","pages":"1-26"},"PeriodicalIF":2.6,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of performance validity tests in a community sample: Rates of invalid performance for English and Spanish speakers.","authors":"Joshua M Garcia, Alexa S Gonzalez, Christopher A Krause, Kasey J Escamilla, Edwin Duran, Santiago Sanchez Cabarcas, Luis D Medina","doi":"10.1080/13854046.2026.2698710","DOIUrl":"https://doi.org/10.1080/13854046.2026.2698710","url":null,"abstract":"<p><p><b>Objective</b>: To evaluate rates of below cutoff performance (fail rates) for the Test of Memory Malingering Trial 1 (TOMM-1) and Reliable Digit Span (RDS) in a culturally and linguistically diverse community-based cognitive aging cohort. <b>Methods</b>: Cognitively and functionally normal adults from the Health and Aging Brain Study-Health Disparities (HABS-HD) cohort in the Dallas-Fort Worth area, free of major neurological, psychiatric, or cardiovascular conditions, were included. Fail rates were examined for TOMM-1 (≤41, ≤40) and RDS (≤6, ≤5) cutoffs, including combined thresholds, across demographic subgroups. Relative importance of sociodemographic variables was tested <i>via</i> regression. <b>Results</b>: In the normative sample, overall fail rates were higher for RDS (3.1-11.6%) than TOMM-1 (2.1-2.9%), with combined cutoffs yielding <1%. Higher fail rates occurred primarily among less educated (<12 years) and Spanish-speaking participants, with the highest among Spanish speakers on RDS (46.7%). Acceptable false-positive rates for the TOMM-1 (≤5.9%) and combined (≤3.2%) TOMM-1 and RDS were demonstrated across all evaluated groups. Language and education explained most variance in RDS scores (14.9%, 10.3%, respectively), while education and age explained most variance in TOMM-1 scores (2.3%, 1.4%, respectively). Demographic effects were more influential on RDS than on TOMM-1. <b>Conclusions</b>: Performance validity outcomes vary across community adults without external incentives, influenced by education and language.</p>","PeriodicalId":55250,"journal":{"name":"Clinical Neuropsychologist","volume":" ","pages":"1-17"},"PeriodicalIF":2.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between sociodemographic factors and neighborhood opportunity with genetic service utilization in pediatric patients with neurofibromatosis type 1.","authors":"Rowena Ng, Rachel K Peterson","doi":"10.1080/13854046.2026.2701150","DOIUrl":"https://doi.org/10.1080/13854046.2026.2701150","url":null,"abstract":"<p><p><b>Objective:</b> Neurofibromatosis Type 1 (NF1) is a neurocutaneous disorder caused by a variant in the NF1 gene. The condition can be diagnosed through endorsement of core clinical features; however, recent diagnostic criterion was modified to include the molecular confirmation of the <i>NF1</i> gene. While recent studies reveal health disparities in NF1 disease surveillance, the relationships between sociodemographic and neighborhood-level factors with genetic testing among patients with NF1 remain unknown, despite its clinical utility in the early detection of NF1 and in the provision of essential prognostic information. <b>Methods:</b> This study includes a retrospective medical chart review for 86 pediatric patients with a diagnosis of NF1 who underwent a neuropsychological evaluation at an academic medical center. The relationship between NF1 clinical severity, neuropsychological functioning (intellectual quotient, day-to-day executive function difficulties, and adaptive behaviors), sociodemographic variables (identified race/ethnicity, sex, insurance type, English primary language status), and neighborhood opportunity (nationally-normed Childhood Opportunity Index) with genetic test completion and age of testing were examined. <b>Results:</b> Sociodemographic and neighborhood-opportunity factors were not associated with genetic test completion; however, those who underwent testing presented with more executive functioning difficulties (<i>Z</i> = 2.14, <i>p</i> = .032). Among those who completed genetic assays, poorer neighborhood opportunity was associated with delayed genetic testing (<i>r</i> = -0.30, <i>p</i> = .049), which in turn moderately, but not significantly, correlated with greater day-to-day adaptive functioning challenges (<i>r</i> = 0.37, <i>p</i> = .06). <b>Conclusions:</b> Distinct social determinants of health impact genetic test completion <i>vs</i>. timeliness of the procedure, highlighting the complex pathways social and neighborhood factors serve as barriers in NF1 diagnostic process and subsequent medical management.</p>","PeriodicalId":55250,"journal":{"name":"Clinical Neuropsychologist","volume":" ","pages":"1-16"},"PeriodicalIF":2.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}