Between 1991 and 1994 a sample of high- and low-functioning 10-18-year-old children of alcohol misusing and nonalcohol misusing parents were assessed on degree of problematic parental role functioning (parentification) and global self-concept. The high functioning children had been chosen by their teachers to receive training as peer counselors, whereas the low functioning children were in either psychiatric facilities or the custody of family and children services. The parentification scores of the latter significantly exceeded those of the former. Children of alcoholic parents also scored higher on the parentification measure than did those with nonalcoholic parents. Within the high functioning group hierarchical regression analysis revealed that while parental alcohol misuse status accounted for a small but significant amount of the variance in self-concept, the effect of this variable was substantially reduced after entering level of parentification into the equation. By contrast, within the low functioning group parental alcohol misuse status was not significantly related to self-concept whereas level of parentification was. The results are discussed within a family systems framework.

Recent factor analyses of the Mattis Dementia Rating Scale (DRS; S. Mattis, 1973) have questioned the validity of its subscales, raising questions regarding their interpretation. This study examined the measurement structure of the standard DRS and of an abbreviated DRS form in a homogenous sample of 171 patients with Alzheimer's disease using (a) confirmatory factor analysis and (b) correlation of factors identified in the best fitting model with supplementary neuropsychological tests. We found confirmation of the validity of the Construction, Conceptualization, and Memory subscales associated with both the standard and abbreviated DRS. Correlations between these factors and supplementary neuropsychological measures supported the validity of the identified factors. The variability in DRS factor composition reported in previous studies appears to be related to sample heterogeneity, which is critically important to the resulting factor structure.The Mattis Dementia Rating Scale (DRS; Mattis, 1973) was designed to provide a brief assessment of cognitive abilities in patients "with known cortical impairment, particularly of the degenerative type" (Mattis, 1973, p. 1). Since its development, this measure has become one of the most popular instruments used to track cognitive changes in dementia patients. The test takes approximately 20-45 min to administer (Vitaliano et al., 1984). Reliability is high (van Belle, Uhlmann, Hughes, & Larson, 1990;Vitaliano et al., 1984) and portions of the DRS have been used to screen for dementia (Green, Woodard, & Green, 1995; Shay etal., 1991; Vitaliano etal., 1984). When combined with scores from the Instrumental Activities of Daily Living scale (IADL), patient assessments have been reported to closely approximate clinical judgments of dementia severity based on full clinical evaluation (Shay et al., 1991).The DRS includes items and provides cut-off scores for assessing specific cognitive domains including attention, initiation and perseveration, construction, conceptualization, and memory. Domain-specific scoring has the advantage of differentiating the strengths and weaknesses of an individual patient (Schmitt, Ranseen, & DeKosky, 1989

The Mattis Dementia Rating Scale (MDRS) is a commonly used cognitive measure designed to assess the course of decline in progressive dementias. However, little information is available about possible systematic racial bias on the items presented in this test. We investigated race as a potential source of test bias and differential item functioning in 40 pairs of African American and Caucasian dementia patients (N = 80), matched on age, education, and gender. Principal component analysis revealed similar patterns and magnitudes across component loadings for each racial group, indicating no clear evidence of test bias on account of race. Results of an item analysis of the MDRS revealed differential item functioning across groups on only 4 of 36 items, which may potentially be dropped to produce a modified MDRS that may be less sensitive to cultural factors. Given the absence of test bias because of race, the observed racial differences on the total MDRS score are most likely associated with group differences in dementia severity. We conclude that the MDRS shows no appreciable evidence of test bias and minimal differential item functioning (item bias) because of race, suggesting that the MDRS may be used in both African American and Caucasian dementia patients to assess dementia severity.

Effort testing has become commonplace in clinical practice. Recent research has shown that performance on effort tests is highly correlated with performance on neuropsychological measures. Clinical application of effort testing is highly dependent on research derived interpretive guidelines. The Victoria Symptom Validity Test (VSVT) is one of many measures currently used in clinical practice. The VSVT has recommended interpretive guidelines published in the test manual, but the samples used in developing interpretive guidelines are small and heterogeneous and concern has been expressed regarding high false negative rates. In this study, a homogeneous sample of acute, severely brain injured persons were used to assess the sensitivity of the VSVT. Results confirmed that acute, severely brain injured persons (N=71) perform very well on the VSVT. The severe brain injury population is 99% likely to have between 44.1 and 46.8 correct VSVT Combined Score responses. While the VSVT was insensitive to memory dysfunction, the presence of severe visual perceptual (Benton Visual Form Discrimination Score<21) and verbal fluency (Controlled Oral Word Association Score<15) deficits predicted poor performance on the VSVT. These results provide further evidence that performance expectations currently incorporated in the VSVT manual interpretative criteria are too conservative. Empirically based alternative criteria for interpreting VSVT Combined Scores in the TBI population are presented.

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