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Purpose: To identify useful acute indicators of long-term neurocognitive outcome beyond clinical variables for children and adolescents treated for a traumatic brain injury (TBI). Materials and Methods:The efficacy of magnetic resonance spectroscopy (MRS) acquired 6 Ϯ 4 days after TBI in 20 children/adolescents in predicting intellectual and neuropsychological functioning one to four years post injury was assessed. Short echo-time single voxel MRS (SVS) from normal-appearing brain was compared to intermediate echo-time multivoxel MR spectroscopic imaging (MRSI) from normal-appearing and visibly-injured brain acquired through the level of the corpus callosum (CC).Results: N-acetyl aspartate (NAA) was moderate to strongly correlated with cognitive scores. Mean NAA/creatine (Cre) from MRSI alone explained over 40% of the variance in cognitive scores and 18% of the variance above and beyond demographic and clinical variables alone. Mild to moderate associations were noted between SVS metabolites (glutamate/glutamine [Glx] and myoinositol [mI]) and cognitive scores, with no such associations apparent for choline (Cho) or Cre. Exploratory analyses revealed trends for regional neuroimaging data and specific cognitive abilities. Conclusion:Acute MR spectroscopy of the pediatric brain injury patient improves prognostic ability and may provide valuable information for early treatment and intervention planning.

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Most theories of behavior and therapy have tended to focus on why behaviors are present. By contrast, the theory and practice of Gestalt therapy have focused primarily on how behaviors are present. This article describes a Gestalt model of character structure and function from the point of view of Gestalt process theory in coordination with E. Tulving's (1985) concept of procedural memory from cognitive and developmental psychology. Current developmental research is used to clarify how character as an operating system is developed. This conceptual framework permits a description of how character functions and has implications for creating change in psychotherapy. Examples of the application of this formulation are provided.

Evaluation of psychotherapy and its application requires a lucid theoretical base. Part of that base must be a clear and testable theory of personality that fits contemporary scholarly criteria. Such a theory must not only must provide a description of personality function but also allow for discrimination that can be descriptive of “pathology.” This article attempts to provide a foundation for a theory of personality which, with reference to the person, is both phenomenologically and process based. The relationship of this theory to current thinking in personality theory is introduced, along with possible applications to psychopathology.