Assessment Of Children Research Articles

Daily participation in preterm-born children: An exploratory and comparative study.

Preterm birth, particularly with lower gestational age and respiratory complications, can impact neurodevelopmental outcomes and participation in daily activities. Understanding how these children engage in everyday tasks, particularly from the perspective of their parents, is critical for assessing long-term health outcomes and quality of life. This study aims to assess parental perceptions of participation and daily performance in children born preterm, comparing early preterm infants with and without chronic lung disease, late preterms, and term-born children. A total of 48 children aged 7-11years (M=8.9, SD=1.1) were examined: 25 born at term (GA≥37.0weeks), 23 early preterms (GA≤30weeks) with bronchopulmonary dysplasia (BPD), 15 early preterms without BPD, and 21 late preterms (GA 34.0-36.6weeks). Daily functioning and participation were evaluated using the Behavioral Rating Inventory of Executive Function (BRIEF) and the Children's Assessment of Participation and Enjoyment (CAPE). While atypical executive function scores were more prevalent among early preterm children with BPD (14.2%), no statistically significant differences were found in participation across groups. Children with BPD participated in leisure activities at rates comparable to their full-term and preterm peers. Despite executive function impairments, children born preterm, including those with BPD, exhibited similar participation levels as full-term peers. These findings highlight the participation patterns, which may reflect potential compensatory strategies or other factors of preterm children in daily activities. Long-term monitoring of executive function is necessary, particularly in academic settings, to ensure ongoing support and interventions.

Development of the children's primitive reflex integration assessment scale

ObjectiveNon-integrated primitive reflexes (PRs) in children can lead to issues in motor function and psychological wellbeing, while prior studies have shown correlations between PR integration and neurodevelopmental disorders in children. However, measurement methods for PR integration remain unestablished. Therefore, in the present study, we describe the development of a measurement scale for PR integration, a novel assessment tool to evaluate PR integration in children.MethodsCombining a literature review, practical experience, and results of specialized group discussions, a preliminary draft of the Children's Primitive Reflex Integration Measurement Scale (CPRIMS) was formulated. Employing a convenience sampling method, participants were selected from first and second-grade students in three primary schools in Liaoning province, Shenyang city, from May to July 2023. Item Discrimination Method (IDM), Critical Ratio Method (CRM), and Internal Consistency Coefficient Method (ICCM) were used for item analysis of pilot testing data. For formal testing data, Cronbach's α assessed the reliability of the scale, while fit indices such as chi-square value/degrees of freedom (χ2/df), Root Mean Square Error of Approximation (RMSEA), and Comparative Fit Index (CFI), along with tests of construct validity, evaluated the scale's validity.ResultsOverall, 555 participants were selected, 234 children with a mean age of 7.59 ± 0.71 years participated in the pilot testing, while 321 children with a mean age of 7.73 ± 0.71 years participated in the formal testing. CPRIMS comprises seven dimensions and seventeen items, including the Moro reflex (MR), Asymmetrical Tonic Neck Reflex (ATNR), Symmetrical Tonic Neck Reflex (STNR), Tonic Labyrinthine Reflex (TLR), Spinal Galant Reflex (SGR), Spinal Perez Reflex (SPR), and Landau Reflex (LR), explaining 88.2% of the total variance. Confirmatory factor analysis revealed a good model fit (χ2/df = 1.631, RMSEA = 0.044, NFI = 0.950, CFI = 0.980, IFI = 0.932, TLI = 0.972). Cronbach's α coefficients for the seven dimensions ranged from 0.730 to 0.945, demonstrating strong reliability.ConclusionCPRIMS, which includes dimensions such as MR, ATNR, STNR, TLR, SGR, SPR, and LR, demonstrates strong reliability and validity, indicating that this measure could serve as a reliable and effective tool for assessing the integration levels of PRs in children aged 6 to 9 years old.

Feasibility, Acceptability, and Reliability of Remote Motor Assessment in Children With Canavan Disease.

Decentralized clinical trials have many advantages including reducing travel burden, improving access, and reducing costs. However, there is limited knowledge to inform the development and implementation of remote motor assessment protocols in rare pediatric diseases. This study describes a rigorous method for transitioning from in-person to remote motor assessment of children with Canavan disease. Seven children with Canavan disease (mean age 2.5years; S.D.=1.0) and their caregivers completed four remote visits during a two-phase study. Clinical raters were trained to coach caregivers using remote administration protocols for key motor assessment tools. The feasibility, acceptability, and reliability of remote administration of the Gross Motor Function Measure-88, Hammersmith Infant Neurologic Exam Motor Milestones Part-2, Alberta Infant Motor Scale, and Infant Motor Profile were evaluated. In phase 1, remote assessment was feasible, with 95% (61 of 64) of motor assessments completed. Caregiver acceptability was high, with 86% of caregiver responses (n=95 of 111) supporting the remote administration protocol. In phase 2, inter-rater reliability (intraclass correlation coefficient or Fleiss kappa >0.75) was good to excellent in 15 of 20 final visit assessments. Intra-rater reliability was good to excellent in 18 of 20 pairs of assessments by visits 3 and 4. This study highlights the value and importance of a rigorous multiphased approach to the development and implementation of remote motor assessment protocols for pediatric rare disease studies. Findings from this study support the feasibility, acceptability, and reliability of remote motor assessment in children with Canavan disease.

A Study on the Implementation of Field-linked Early Childhood Assessment by Prospective Childcare Teachers based on Capstone Design

A Study on the Implementation of Field-linked Early Childhood Assessment by Prospective Childcare Teachers based on Capstone Design

Sex-specific DNA methylation signatures of autism spectrum disorder in newborn blood.

Autism spectrum disorder (ASD) comprises a group of neurodevelopmental conditions currently diagnosed by behavioral assessment in childhood, although neuropathology begins during gestation. A poorly understood male bias for ASD diagnosis is thought to be due to both biological sex differences and cultural biases against female diagnosis of ASD. Identification of molecular biomarkers of ASD likelihood in newborns would provide more objective screening and early intervention. Epigenetic dysregulation has been reported in multiple tissues from newborns who are later diagnosed with ASD, but this is the first study to investigate sex-specific DNA methylation signatures for ASD in newborn blood, an accessible and widely banked tissue. DNA methylation was assayed from ASD and typically developing (TD) newborn blood (discovery set n = 196, replication set n = 90) using whole genome bisulfite sequencing (WGBS). Sex-stratified differentially methylated regions (DMRs) were assessed for replication, comparisons by sex, overlaps with DMRs from other tissues, and enrichment for biological processes and SFARI ASD-risk genes. We found that newborn blood ASD DMRs from both sexes significantly replicated in an independent cohort and were enriched for hypomethylation in ASD compared to TD samples, as well as location in promoters, CpG islands and CpG shores. Comparing females and males, we found that most DMRs with sex differences amongst TD individuals were also found in ASD individuals, plus many additional DMRs with sex differences that were only found in those with ASD. Newborn blood DMRs from females were enriched for the X chromosome and both sexes showed significant overlap with DMRs from umbilical cord blood and placenta but not post-mortem cortex. DMRs from all tissues were enriched for neurodevelopmental processes (females) and SFARI ASD-risk genes (females and males). This study is primarily limited by sample sizes, particularly amongst females. Overall, we found a highly replicated sex-specific DNA methylation signature of ASD in newborn blood that showed support for the female protective effect and convergence with epigenetic and genetic signatures of ASD in newborns. These results demonstrate the utility of newborn blood in ASD screening and emphasizes the importance of sex-stratification in future studies.

Giftedness and the Overexcitability Rabbit-Hole Trap

Giftedness and Dabrowski's Theory of Positive Disintegration (TPD) have been firmly linked since the Columbus Group's 1991 statement on giftedness and asynchrony. The theory's overexcitabilities (OEs) factor has been the main association with giftedness. Although OEs include certain characteristics associated with giftedness, they also include negative aspects not found in research on gifted characteristics. Instead, those negative aspects May be signs of learning and other disorders, or of mental health issues. Because positive aspects of OEs have been shown to fit within the five-factor model of personality, and because the negative aspects May be signs of neurodiversity, I argue that the OE association with giftedness May be superfluous or even misleading. Three parents of gifted children are cited, revealing the consequences of receiving information about OEs with their children's assessment reports as the only guide for possible future problems. I offer suggestions, including replacing OE lists with research-based gifted characteristics.

Optimising children's movement assessment batteries through application of motivational and attentional manipulations

An external focus of attention, enhanced expectancies, and autonomy support (i.e., OPTIMAL factors) are key factors to optimise motor performance and uncover latent movement capabilities. However, research on the combination of OPTIMAL factors, particularly in children's dynamic movement settings is limited. Therefore, this study examined the combined effects of OPTIMAL factors on children's performance on a dynamic movement assessment battery, hypothesising higher performance scores in the optimised version of the assessment battery versus standardised version of the assessment. Forty-nine children (15 boys, 34 girls; mean age 10.61 ± 1.38 years) completed the Dragon Challenge (DC) dynamic movement assessment battery. Performance was measured via a summation of movement process (technique), outcome, and time-to-completion scores (max score N = 54) with higher scores representing better performance. Participants completed a standardised and an optimised version of the DC in a counterbalanced fashion. For the latter, DC protocols were optimised via the provision of choice (autonomy support); external focus instructions augmented by simple knowledge statement, positive feedback and promotion of a growth mindset (Enhanced expectancies). Results indicate that motor performance (DC score) was better in the optimised (M = 31.08 ± 6.66) vs. standardised (M = 29.04 ± 5.88). The findings indicate that the combination of OPTIMAL factors can improve children's motor performance in dynamic movement settings and that standardised motor assessment may not reveal children's true movement capabilities.

Psychomotor development, emotional regulation, and executive functions in 2-years-old children after threatened preterm labour: a prospective cohort study.

A threatened preterm labour (TPL) represents an adverse prenatal event with potential long-term consequences on the offspring's neurodevelopment, regardless of prematurity condition. This study aimed to assess TPL's impact on children's psychomotor and socioemotional development at 2years of age. A cohort of mother-infants was recruited at the time of TPL diagnoses and followed up until 30months of children's corrected age. Participants were classified into three groups regarding gestational age at delivery: Full-term TPL (n = 35), Late Preterm TPL (n = 67), and Very Preterm TPL (n = 41). A Control group (n = 62) of mothers without TPL and their infants born at term completed the sample. Children's assessment was performed using the Ages & Stages Questionnaires for psychomotor development, the Early Childhood Behavior Questionnaire-Very Short Form for temperament, and the Behaviour Rating Inventory of Executive Function-Preschool Version for executive functions. Then, MANCOVAs were conducted to detect differences between groups. TPL children, regardless of delivery time, showed worse emotional regulation (ps < .03) and more inhibition problems (ps < .02) than control ones. In addition, Very preterm TPL children exhibited lower psychomotor development (ps ≤ .040), more difficulties in working memory (ps ≤ .002), and planification/organization (ps ≤ .003) domains. TPL per se may represent a risk factor for children's neurodevelopmental disturbances, specifically in emotional regulation and inhibitory control competencies, even in the absence of prematurity.

Comparison of Food Selection with the National School Lunch Program Meal Pattern Guidelines and Assessment of Children's Food Intake and Waste Using Digital Photography in a School Cafeteria.

Background: School lunch is an important nutritious food source for children. The National School Lunch Program (NSLP) meal patterns guidelines have been established to promote healthier school lunches. This pilot study compared food selection during lunch in a school cafeteria with the NSLP meal pattern guidelines. Food intake and waste were also examined in relation to food selection. Methods: In a cross-sectional design, data were collected from children in the 1st, 6th, and 10th grades from a school in the United States. The digital photography of foods method was used to assess children's food selection, intake, and waste at lunch over 3 weeks. Results were presented as percentage, frequency, and mean ± standard deviation. Results: About 48 children from 1st grade, 47 from 6th grade, and 50 from 10th grade participated each day. Food selection in these grades consistently fell below the NSLP guidelines, with 69%, 79.8%, and 86.9% of children selecting less than the guidelines for energy, respectively. On average, only 10.4% of children selected vegetables at or above the guidelines. About 41% of the selected energy, 43% of fruits, 43% of vegetables, and 56% of milk were discarded as plate waste across all grades. Conclusions: Selection of energy and vegetables was consistently below the NSLP guidelines, yet almost half of the selected fruits, vegetables, and milk were wasted by children. Initiatives to enhance meal quality and variety, along with nutrition education interventions and school policies, are needed to improve food selection and intake and reduce food waste.

Long-term characterization of behavior phenotypes in children with seizures: Analytic approach matters.

Behavioral problems in children with new onset epilepsies have been well established in the literature. More recently, the literature indicates the presence of unique behavioral patterns or phenotypes in youth with epilepsy that vary significantly in vulnerability and resilience to behavioral problems. This study contrasts the interpretation of behavioral risk as inferred from cross-sectional versus latent group analytic perspectives, as well as the presence, consistency, stability, and progression of behavioral phenotypes in youth with new onset epilepsy and sibling controls over 3 years. Three hundred twelve participants (6-16 years old) were recruited within 6 weeks of their first recognized seizure along with 223 unaffected siblings. Each child's behavior was recorded by parents and teachers frequently over 36 months using the Child Behavior Checklist (CBCL), and each child completed self-report measures of depression symptoms over 36 months. Measures were evaluated cross-sectionally and longitudinally to identify clusters with prototypical behavioral trajectories. Cross-sectional analyses exhibited a pattern of generalized and undifferentiated behavioral problems compared to sibling controls at baseline and prospectively. In contrast, latent trajectory modeling identified three distinct behavior phenotype clusters across all raters (parents, teachers, and youth) over baseline and longitudinal assessments. CBCL Cluster 1 (~30% of youth with epilepsy) exhibited behavior similar to/better than controls, Cluster 2 (~50%) exhibited moderate behavior issues, and Cluster 3 (~20%) exhibited the most pronounced/problematic behavior, falling into Achenbach's clinically relevant behavior range. Behavior within clusters remained stable and consistent. Teachers' and children's behavior assessments corresponded to these cluster groupings consistently over 36 months. Predictors of cluster membership include seizure syndrome type and social determinants of health. This study demonstrates the varying public health perspectives of behavioral risk in youth with epilepsy that result as a function of analytic approach as well as the presence of distinct latent behavioral trajectory phenotypes over time in youth with new onset epilepsy.

MR and Ultrasound Elastography for Fibrosis Assessment in Children: Practical Implementation and Supporting Evidence-AJR Expert Panel Narrative Review.

Quantitative MRI and ultrasound biomarkers of liver fibrosis have become important tools in the diagnosis and clinical management of children with chronic liver disease (CLD). In particular, MR elastography is now routinely performed in clinical practice to evaluate the liver for fibrosis. Ultrasound shear-wave elastography has also become widely performed for this purpose, especially in young children. These noninvasive methods are increasingly used to replace liver biopsy for the diagnosis, quantitative staging, and treatment monitoring of patients with CLD. Although ultrasound has the advantages of portability and lower equipment cost than MRI, available evidence indicates that MRI may have greater reliability and accuracy in liver fibrosis evaluation. In this AJR Expert Panel Narrative Review, we describe how, why, and when to use MRI- and ultrasound-based elastography methods for liver fibrosis assessment in children. Practical approaches are discussed for adapting and optimizing these methods in children, with consideration of clinical indications, patient preparation, equipment requirements, and acquisition technique, as well as pitfalls and confounding factors. Guidance is provided for interpretation and reporting, and representative case examples are presented.

Stability and predictability of Bayley Scales of Infant and Toddler Development: evidence from a south Indian birth cohort prospective study

ObjectivesThere is limited information about the stability and predictability of Bayley Scales of Infant and Toddler Development (BSID) assessing child development in low- and middle-income settings. The objective of the...

유아교육현장에서 교육과정평가 실행 지원방안 탐색: 함께 응답하며 나아가기

This study aims to explore support strategies for implementing curriculum assessment in the field of early childhood education. Whereas curriculum focus has continuously shifted towards learner-centered, learning-centered, and competency-based approaches, evaluation practices remain rooted in approaches that emphasize educational content and subject knowledge, relying on empirical evidence and objective facts. To this end, this study conducted multiple mini-interviews (MMI) with teachers, administrators, and supervisors to identify challenges in implementing curriculum assessments and to collaboratively find solutions. The collected data were analyzed in six phases following the thematic analysis method proposed by Braun and Clarke(2006). The findings were categorized into three themes: ‘knotting early childhood curriculum and assessment,’ ‘opening the possibilities for practicing curriculum assessment,’ and ‘going along with children and parents in curriculum assessment.’ First, several years after the implementation of the 2019 revised Nuri Curriculum, the questions emerging in the field of early childhood education concern the connections of the essence of early childhood education, curriculum literacy, and curriculum assessment and implementation, which are the complex and entangled ‘knots’. Second, for assessment to be integrated into curriculum implementation, it is essential to go beyond individual teacher practices and explore the possibilities within the relational context, including the cultural and structural atmosphere of the school. Third, if implementing the curriculum in educational settings is a long process of ‘correspondence’ with all beings, it is crucial to seek ways for children and parents as the subjects of curriculum assessment to move forward together in harmony. Based on the diverse educational experiences, current positions, and educational philosophies of the participants, this study offers academic and practical implications for implementing curriculum assessment that lightens the burden of evaluation and refocuses on ‘our classrooms, children, teachers, and communities.’

The AI-driven age detection in children's drawings: a deep learning approach for late childhood assessment

The AI-driven age detection in children's drawings: a deep learning approach for late childhood assessment

Happy childhood: the search for an informative system of characteristics through the prism of eventfulness

The results of a study devoted to identifying the potential of using information about childhood events to explain the subsequent perception of childhood as a happy one are presented. Based on the assumption that the specificity of the eventfulness of the very first stage of life can determine the existence of groups with happy and unhappy childhood according to subjective estimates, a selection of childhood events has been made that most allow differentiating those who evaluate their childhood as happy and unhappy. As an empirical basis, the results of a survey of representatives of a youth group who have crossed the age of majority or are on its border are used. Among the 100 initial childhood events for analysis, groups of life episodes were identified, the presence and age of occurrence of which are associated with a retrospective assessment of childhood as happy. These are events related to the manifestation of subjectivity and its recognition by adults; consumer and financial socialization ; establishing relationships with peers and parents; independent movements and mobility; a variety of leisure practices and prosocial behavior; some manifestations of infantilism; the absence or later onset of certain traumatic events, deviant behavior practices, actions to change appearance. The listed groups of life episodes form the basis of an informative system of characteristics of a subjectively prosperous childhood and can be used in the future to implement models of multidimensional analysis.

Assessment of Children and Adolescents’ Admissions to Pediatric Psychiatric Emergency Department

Objective Emergencies in child and adolescent psychiatry are prevalent, and pediatric psychiatric emergency departments play a crucial role in acute intervention during mental health-related crises. This retrospective cross-sectional study aimed to analyze the characteristics of children and adolescents who were admitted to a pediatric psychiatric emergency department. Method The data were collected from the records of 8803 patients (females 56.6%, Mage = 15.07 ± 2.6) admitted to our pediatric psychiatry emergency department between 2014 and 2021. Diagnoses were made using the International Statistical Classification of Diseases, 10th Revision. We used descriptive statistics to determine patient characteristics and conducted a regression analysis to compare the changes in the admissions numbers by the year. Results It was found that depressive disorder was the highest psychiatric diagnosis, with a percentage of 21.4%. Depressive disorder, autism spectrum disorder, and obsessive-compulsive disorder have shown an increase over the years. In 2020, with the onset of the COVID-19 pandemic, psychiatric admissions reached their lowest level. The percentage of hospitalizations was 21.1% for the total of all years. No significant change was found in the total number of admissions, sex, and age. Conclusions The number of admissions for female adolescents who were diagnosed with depressive disorder to our pediatric psychiatry emergency department is shown to be high. The fact that these patients seek help more frequently should be taken into consideration during the planning of mental health services for outpatient and inpatient clinics as well as pediatric psychiatry emergency services.

Use of Telehealth in Autism Spectrum Disorder Assessment in Children: Evaluation of anOnline Diagnostic Protocol Includingthe Brief Observation of Symptoms of Autism.

The COVID-19 pandemic revealed the need to develop the field of remote assessment for autism spectrum disorders (ASD). The purpose of the study was to evaluate an online assessment protocol that includes the Brief Observation of Symptoms of Autism (BOSA). The online protocol consisting of BOSA and the Autism Diagnostic Interview-Revised (ADI-R) was administered by experienced examiners to 29 children with suspected ASD. The participants were then evaluated by clinical psychologists in a standard clinical setting using the Autism Diagnostic Observation Schedule-2 (ADOS-2) and other methods, and the ASD diagnosis was confirmed or ruled out. The results show substantial to moderate inter-rater agreement between the online and face-to-face raters with the value of Cohen's Kappa = 0.66 (P < 0.001); this corresponds with 79.8% agreement. The sensitivity of the protocol was approx. 94.7%, the specificity was 70%, the positive predictive value was 85.7%, and the negative predictive value was 87.5%. Further, direct false positive or false negative diagnostic conclusions based on the online protocol were absent when the possible conclusion of "I cannot decide" was included. The items B9 Showing, B10 Spontaneous Initiation of Joint Attention, B1 Unusual Eye Contact, B3 Facial Expressions Directed to Others, and C2 Imagination/Creativity were shown to be well observable in BOSA when related to ADOS-2 scoring. The results indicate that the protocol consisting of BOSA and ADI-R administered by an experienced examiner is a promising combination of tools for remote autism assessment.

Neurophysiological Assessment in Children with Vocal Fold Paralysis: A Tertiary Center Experience.

The aim of this study is to report on experience acquired during the laryngeal electrophysiological assessment with Co-MEP and L-EMG in pediatric patients with acquired, congenital, and syndromic vocal fold paralysis (VFP), and correlate our findings with patients' characteristics, their comorbidities, and VFP etiology. Pediatric patients with suspected or previously diagnosed unilateral or bilateral VFP underwent electrophysiological records under general anesthesia; corticobulbar motor-evoked potentials (Co-MEPs) and laryngeal electromyography (L-EMG) of thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles were recorded. Statistical analysis revealed a statistically significant correlation between early gestational age at childbirth and TA muscle intensity (p = 0.002) and PCA muscle intensity (p = 0.002); tracheostomy presence and TA muscle intensity (p = 0.002) and PCA muscle intensity (p = 0.002); presence of genetic anomalies with intensity and latency for TA muscle and latency for PCA muscle (TA latency p = 0.015, TA intensity p = 0.021, PCA latency p = 0.035); congenital presentation of VFP and an increased intensity for TA muscle (p = 0.04); latency and intensity for TA muscle (p = 0.024); TA muscle intensity and PCA intensity (p = 0.005). Intraoperative Co-MEPs and L-EMG are two complementary tools for evaluating the functional integrity of the structures involved in conveying signals from the motor cortex to TA and PCA muscles in children with vocal fold paralysis. Further studies are needed to establish their ability to predict the recovery of VF mobility, which could potentially lead to decannulation. Level 4 Laryngoscope, 2024.

Do Confidence Ratings Reactively Modify Children's Academic Assessment Performance? Negative Answer from a Three-Year Longitudinal Study.

The reactivity effect of metacognitive judgments on first-order task performance has received increased research attention. Previous studies showed that soliciting retrospective confidence ratings (CRs) reactively enhances task performance itself, such as performance in decision making and reasoning tasks, especially for those with high self-confidence. It remains unknown whether CRs can improve students' academic assessment performance in real educational settings. The current study recruited 795 fourth-grade elementary school children to explore if making CRs reactively affects students' academic assessment performance in two main subjects (i.e., Chinese Language and Mathematics). The data were collected across six waves with half-year intervals. From Wave 2, children either provided (CR group) or did not provide CRs (no-CR group) when completing standardized academic assessments. The results showed Bayesian evidence supporting the claim that making CRs does not influence children's academic assessment performance (both the average performance across waves 2-6 and the performance in each wave) in both subjects. Furthermore, children's self-confidence did not moderate the reactive influence of CRs. The results from multilevel regression analyses re-confirmed the above conclusions. Possible explanations for the absence of the reactivity effect of CRs on children's academic assessment performance are discussed.

A - 44 Value of Repeat Neuropsychological Assessments in Children with Complex Birth and Neurological Injuries

Abstract Objective Extremely low birth weight, in-utero insult, and PVL are associated with an array of neurodevelopmental complications. PVL is most common in very premature. Associated complications in this case study include diffuse demyelination, cerebellar atrophy, and arthrogryposis. Data from serial assessments reveal preservation of intelligence, decoding, and social skills. Implications for the role of repeat assessments in guiding education and intervention are discussed. Method The subject was an 18-year-old male with extremely low birth weight, in-utero insult, PVL, cerebellar atrophy, delayed myelination, and arthrogryposis. His presentation also included craniosynostosis. Three outpatient neuropsychological assessments were completed over eight years. Assessments included measures of intellectual, academic, neurocognitive, and emotional functions. Results Despite multiple physical and neurological impairments, assessments revealed preserved verbal and nonverbal intelligence, phonemic awareness, computation skills, and social cognition. Deficits were evident in processing speed, rapid naming, math fluency, word fluency, working memory, and executive functions. Academic strengths were evident in reading and written expression. Checklists revealed inattention and impulsivity with strengths in social cognition (See data tables). Conclusions This study demonstrates both variability in outcome following a complex birth history and neurological history and the value of repeat neuropsychological assessments. Assessment data was used to identify and build upon preserved skills and focus intervention strategies. Maintained verbal and nonverbal reasoning skills, in the context of strong social cognition, significantly contributed to progress, self-esteem, and future goals. Repeat neuropsychological assessment is well-suited for such cases. Access to such assessments is critical and should be regarded as medically necessary to guide intervention and promote positive outcomes.