Memory functioning in children with traumatic brain injuries: a TOMAL validity study

Archives of Clinical Neuropsychology 19 (2004) 105–118 Memory functioning in children with traumatic brain injuries: a TOMAL validity study Jodi L. Lowther a,∗ , Joan Mayfield b a b Texas Woman’s University, Denton, TX, USA Our Children’s House at Baylor, Dallas, TX, USA Accepted 10 October 2002 Abstract Traumatic brain injury (TBI) leads the causes of death and disability among children and adolescents. Despite the prevalence of TBI among children, few studies have examined memory in children. The purpose of this study was to compare memory functioning, as measured by the Test of Memory and Learning (TOMAL), of children with and without TBI and with moderate and severe TBI to determine if differences existed. Of the 140 participants, 70 had sustained a head trauma and 70 served as controls. The results indicated that, when the TBI and control group were compared, significant differences were found on all of the TOMAL indexes. With the exception of the verbal delayed recall items, significant differences were demonstrated on all the TOMAL subtests. No differences were identified when moderate and severe groups were compared. These findings further the understanding of memory following pediatric TBI, as well as have implications for interventions with this population. © 2002 National Academy of Neuropsychology. Published by Elsevier Ltd. All rights reserved. Keywords: Memory; Pediatric; Traumatic brain injury 1. Introduction Approximately every 11 minutes a child sustains a brain injury resulting in permanent disabilities (National Center for Injury Prevention and Control, 2000). In the United States, over one million children will be diagnosed with a brain injury this year. The children who survive ∗ Corresponding author. Present address: 1919 Creek Wood Drive, Arlington, TX 76006-6611, USA. Tel.: +1-817-469-9457. E-mail address: (J.L. Lowther). 0887-6177/$ – see front matter © 2002 National Academy of Neuropsychology. doi:10.1016/S0887-6177(02)00222-6 106 J.L. Lowther, J. Mayfield / Archives of Clinical Neuropsychology 19 (2004) 105–118 their brain injuries, and subsequent medical complications, often develop lifetime difficulties in their motor, language, cognitive, and sensory skills. The complex constellation of neurological impairments observed in children who sustain a TBI presents a unique challenge to the school setting. Most educators are often ill prepared for the reintegration of these children into the mainstream school setting (Glang, Singer, & Todis, 1997). In addition to identifying the specific placement for a child with a TBI, school personnel are also charged with making appropriate accommodations and modifications to promote the child’s academic success (Kraemer & Blancher, 1997). Numerous studies have documented the array of deficits that accompany a brain injury. The most prevalent difficulty following a traumatic brain injury (TBI) involves memory. Within the literature, “memory” has been defined along numerous theoretical and conceptual schools. Most researchers agree, however, that memory is not a single function or entity, but an array of cognitive processes involving the acquisition, retaining, and retrieving of information (Gross & McIlveen, 1999). Depending upon their position, some researchers have defined memory dichotomously as in implicit or explicit, verbal or visual, or immediate or delayed, whereas others have focused explanations on a specific aspect of memory functioning (e.g., working memory). 1.1. Assessment of memory Although there has been an increase in the number of assessment instruments available for children since the late 1980s, Boyd (1988) among others continues to voice concerns over the research to practice gap in age-appropriate memory instruments for children. Current pediatric memory assessment measures have evolved as downward extension of adult measures of memory. The Halstead–Reitan Neuropsychological Test Battery (HRB; Halstead, 1947; Reitan & Wolfson, 1985) and Luria–Nebraska Neuropsychological Battery (Golden, Purisch, & Hammeke, 1985) were among the first measures to incorporate assessment of children’s memory. The Halstead–Reitan Neuropsychological Test Battery for Older Children (HRB-OC; Reitan & Wolfson, 1992) included a measure of incidental memory for spatial location and patterns, as well as memory for conceptual information, while the Luria–Nebraska Children’s Battery (Golden, 1987) contained 13 memory items, mostly examining short-term memory functions. Neither protocols, however, addressed the breadth of memory functions, thus, leaving the clinician to supplement with other measures to assess all aspects of memory (Russell, 1994). Eventually, standardized assessment measures specifically designed for children were created, often including measures of memory. Several intelligence measures, for example, incorporated memory items into their battery, such as the children’s versions of Wechsler Scales (Wechsler, 1949, 1974, 1991), Kaufman Assessment Battery for Children (Kaufman & Kaufman, 1983), and Stanford–Binet Intelligence Scale (Thorndike, Hagen, & Sattler, 1988). Although these measures were tailored to the pediatric population, they continued to lack a comprehensive coverage of memory functioning. Not until 1990 was the first comprehensive battery of memory functioning in children created, named the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990). Wasserman and Cambias (1992) referred to the WRAML as the best pediatric memory battery available at the time. J.L. Lowther, J. Mayfield / Archives of Clinical Neuropsychology 19 (2004) 105–118 107 The WRAML consists of nine different tasks that assess a wide range of memory functions across visual and verbal modalities. Further, it provides information on immediate versus delayed memory, recognition versus free recall of material, and memory for rote as well as meaningful information. Although the WRAML was considered an improvement over its predecessors, Reynolds and Bigler (1997) noted that the WRAML was still too narrow in scope. As a result, Reynolds and Bigler (1994) created the Test of Memory and Learning (TOMAL) to increase the scope and depth of analysis of memory function in the preschool to high school age range (Reynolds & Bigler, 1997). The TOMAL is a comprehensive memory battery that consists of 14 subtests that provide global memory functioning, verbal and nonverbal memory, and delayed recall. Additionally, the TOMAL assesses other areas that elaborate on a child’s pattern of performance including manner of recall (i.e., sequentially, free, or associative), attention and concentration, and ability to learn a novel task. Each of these domains provides additional data beyond memory functioning that is important in educational interventions and programming for a child. Despite its appropriateness for use with children and adolescents, the TOMAL’s use in research is limited. The present investigati (...truncated)