Professional Education

  • Internship, VA Palo Alto Health Care System, Clinical Psychology (2020)
  • Ph.D., University of Kentucky, Clinical Psychology (2020)

Stanford Advisors

All Publications

  • A Meta-Analysis of Malingering Detection Measures for Attention-Deficit/Hyperactivity Disorder PSYCHOLOGICAL ASSESSMENT Wallace, E. R., Garcia-Willingham, N. E., Walls, B. D., Bosch, C. M., Balthrop, K. C., Berry, D. R. 2019; 31 (2): 265–70


    This meta-analysis compares stand-alone and embedded performance and symptom validity tests (PVTs and SVTs) for attention-deficit/hyperactivity disorder (ADHD) malingering detection in college students. Simulation design studies utilizing college student samples were included (k = 11). Analyses consisted of measures designed or previously used for malingering detection. Random-effects models were constructed to provide aggregated weighted effect sizes (Hedges' g), indicating the difference between genuine ADHD and simulation groups. Overall PVTs (stand-alone and embedded) produced a large effect size (g = 0.84, 95% confidence interval [CI; 0.72, 1.13], p < .001), whereas overall SVTs (stand-alone and embedded) produced a medium-effect size (g = 0.54, 95% CI [0.44, 0.65], p < .001). Stand-alone PVTs (g = 0.98, 95% CI [0.84, 1.12], p < .001) outperformed embedded PVTs (g = 0.66, 95% CI [0.51, 0.80], p < .001). The stand-alone SVT (g = 0.66) and embedded SVTs (g = 0.54, 95% CI [0.43, 0.65], p < .001) produced medium-effect sizes. These findings support stand-alone PVTs and suggest that performance-based measures should be included in ADHD evaluation batteries, which may consist solely of symptom self-report measures. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

    View details for DOI 10.1037/pas0000659

    View details for Web of Science ID 000456434800010

    View details for PubMedID 30359048

  • Lifespan Socioeconomic Context: Associations With Cognitive Functioning in Later Life JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES Scott, A. B., Reed, R. G., Garcia-Willingham, N. E., Lawrence, K. A., Segerstrom, S. C. 2019; 74 (1): 113–25


    Early socioeconomic status (SES) correlates with later-life cognition. However, the effect of socioeconomic context (SEC), which reflects influences from broader ecological contexts, has not been examined. The present study developed a measure of SEC using lifetime residential addresses and examined SEC and residential mobility effects on later-life cognition.Older adults (N = 117, Mage = 75) reported addresses since birth. Latent SEC was constructed from census income, employment, and education (1920-2010) for each county and census year, extrapolated between census years. Controlling for current SES, SEC in childhood (ages 0-18) and adulthood (ages 19-60), with finer granulations in young adulthood (ages 19-39) and midlife (ages 40-60), predicted later-life cognition. Effects of residential mobility on later-life cognition were also examined.Higher childhood and adulthood SEC were associated with better Auditory Verbal Learning Test recognition (β = .24, p = .012) and immediate recall (β = .26, p = .008). Higher midlife SEC was associated with faster task switching (β = .26, p = .025) and better task switching efficiency (β = .27, p = .022). Higher residential mobility in childhood was associated with higher crystallized intelligence (β = .194, p = .040).Independent of current SES, childhood and adulthood SEC predicted later-life cognition, which may be sensitive to effects of social institutions and environmental health. SEC assessed across the lifespan, and related residential mobility information may be important complements to SES in predicting later-life cognitive health.

    View details for DOI 10.1093/geronb/gby071

    View details for Web of Science ID 000462603100011

    View details for PubMedID 29878250

    View details for PubMedCentralID PMC6294237

  • Self-Regulation and Executive Functioning as Related to Survival in Motor Neuron Disease: Preliminary Findings PSYCHOSOMATIC MEDICINE Garcia-Willingham, N. E., Roach, A. R., Kasarskis, E. J., Segerstrom, S. C. 2018; 80 (7): 665–72


    Disease progression varies widely among patients with motor neuron disease (MND). Patients with MND and coexisting dementia have shorter survival. However, implications of mild cognitive and behavioral difficulties are unclear. The present study examined the relative contribution of executive functioning and self-regulation difficulties on survival over a 6-year period among patients with MND, who scored largely within normal limits on cognitive and behavioral indices.Patients with MND (N = 37, age = 59.97 ± 11.57, 46% female) completed the Wisconsin Card Sorting Task as an executive functioning perseveration index. The Behavior Rating Inventory of Executive Functions (BRIEF-A) was used as a behavioral measure of self-regulation in two subdomains self-regulatory behavior (Behavioral Regulation) and self-regulatory problem-solving (Metacognition). Cox proportional hazard regression analyses were used.In total, 23 patients died during follow-up. In Cox proportional hazard regressions adjusted for a priori covariates, each 10-point t-score increment in patient-reported BRIEF-A self-regulatory behavior and problem-solving difficulties increased mortality risk by 94% and 103%, respectively (adjusted HR = 1.94, 95% CI = 1.07-3.52; adjusted HR = 2.03, 95% CI = 1.19-3.48). In sensitivity analyses, patient-reported self-regulatory problem-solving remained significant independent of disease severity and a priori covariates (adjusted HR = 1.68, 95% CI = 1.01-2.78), though the predictive value of self-regulatory behavior was attenuated in adjusted models (HR = 1.67, 95% CI = 0.85-3.27). Caregiver-reported BRIEF-A ratings of patients and Wisconsin Card Sorting Task perseverative errors did not significantly predict survival.Preliminary evidence suggests patient-reported self-regulatory problem-solving difficulties indicate poorer prognosis in MND. Further research is needed to uncover mechanisms that negatively impact patient survival.

    View details for DOI 10.1097/PSY.0000000000000602

    View details for Web of Science ID 000443954400009

    View details for PubMedID 29771729

    View details for PubMedCentralID PMC6113088

  • Psychological functioning in Parkinson's disease post-deep brain stimulation: Self-regulation and executive functioning JOURNAL OF PSYCHOSOMATIC RESEARCH Combs, H. L., Garcia-Willingham, N. E., Berry, D. R., van Horne, C. G., Segerstrom, S. C. 2018; 111: 42–49


    Parkinson's disease (PD) is a neurodegenerative disorder involving the basal ganglia, resulting in motor and extra-motor deficits. These extra-motor deficits may be reflective of a self-regulatory deficit impacting patients' ability to regulate cognitive processes, thoughts, behaviors, and emotions. There is a need to further examine the prevalence and range of self-regulation (SR) and executive functioning (EF) impairments in PD. This study sought to do so in a sample of patients with PD (N = 31) who underwent deep brain stimulation (DBS) surgery for motor symptom treatment. Patients completed measures indicative of SR and EF including neurocognitive tests, heart rate variability (HRV), and self-report questionnaires to examine these constructs in PD. The highest prevalence of impairments were observed for total impulse control disorder (ICD) symptoms (74%), depressive symptoms (48%), verbal fluency (phonemic: 39%; semantic: 36%), mental flexibility (32%), and self-reported SR impairments (Metacognition: 32%; Behavioral Regulation: 29%). Correlations among theoretically related constructs (i.e., SR, EF) were modest and variable; challenging the idea that SR is a unitary construct for which different domains depend on a common resource. In patients with PD post-DBS, higher resting HRV, thought to be indicative of better autonomic functioning, was linked to better EF in some instances but not others and not significantly associated with self-report SR. Overall, patients with PD exhibit various extra-motor deficits, ranging from subtle to severe. Health care professionals working with patients with PD should recognize the presence of extra-motor deficits, particularly ICDs, and obstacles that might arise from such impairments in patients' daily lives.

    View details for DOI 10.1016/j.jpsychores.2018.05.007

    View details for Web of Science ID 000437386600007

    View details for PubMedID 29935753

  • Purpose in Life in ALS Patient-Caregiver Dyads: A Multilevel Longitudinal Analysis HEALTH PSYCHOLOGY Garcia, N. E., Morey, J. N., Kasarskis, E. J., Segerstrom, S. C. 2017; 36 (11): 1092–1104


    Eudaemonic positive psychological health (PPH), such as purpose in life (PIL), may be maintained more than hedonic PPH, such as quality of life (QOL), for patients with amyotrophic lateral sclerosis (ALS) and their caregivers across the disease course. Furthermore, patients' and caregivers' PPH may impact one another. The present study examined (a) PIL and QOL variance structures; (b) PIL and QOL trajectories from diagnosis, approaching death, with disease severity; and (c) between-dyad and within-dyad relationships for PIL and QOL in patients with ALS and their caregivers.PIL and QOL were assessed in patient-caregiver dyads (N = 110) up to 7 times over 18 months.Multilevel models revealed the proportion of variance attributed to stable between-person differences was higher for PIL (patients = 74%; caregivers = 76%) than QOL (patients = 60%; caregivers = 55%). PIL and QOL declined in relation to disease severity and time. For PIL, proximity to diagnosis and death moderated within-person change; decline was generally faster following diagnosis and approaching death. Longitudinal within-dyad relationships revealed that patients' fluctuations in PIL were mirrored in their caregiver and vice versa.PIL was more stable than QOL and was therefore a potential psychological resource for patients and caregivers. Critical periods-after diagnosis and approaching death-accompanied more rapid PIL decline. QOL was also impacted by proximity to critical periods. PIL within-dyad relationships may reflect a shared disease experience. Psychological intervention focused on enhancing purpose, particularly during critical periods, is a promising direction for future study. (PsycINFO Database Record

    View details for DOI 10.1037/hea0000507

    View details for Web of Science ID 000413338500010

    View details for PubMedID 28541074