Clinical Neuropsychology Research Articles

Japanese Performance Profile on the WAIS-IV and Purported Cultural Influences.

The present exploratory study aimed to examine the potential impact of culture on cognitive skills and intelligence by comparing the Japanese Wechsler Adult Intelligence Scale-IV (WAIS-IV) (JW) subtests, IQs, and index scores to those of the U.S. WAIS-IV (USW). JW raw scores corresponding to a scaled score of 10 for each subtest were scored with USW norms. Subtest, index, and IQ scores were then calculated for each age range. The impact of education on scores was evaluated through ratio of educational attainment for each cohort of the Japanese and US samples. Japanese and US data were compared using one-sample t-tests. Correlations between subtest, index, and IQ scores and education were calculated. The USW sample performed higher than the JW sample on verbal comprehension subtests, while the JW sample demonstrated stronger performances in processing speed and perceptual reasoning subtests. However, all scores with the exception of Block Design, Matrix Reasoning, and Figure Weights were significantly associated with differential educational attainment between the two countries. Educational differences were linearly associated with age with the higher educational attainment for younger Japanese age groups and higher attainment for the older US cohorts. The present study demonstrates cognitive differences between Japan and the USA. Performance on the WAIS-IV subtest and composite measures are highly correlated with education. Cultural factors impacting the cognitive profile of the Japanese sample such as differences in worldview, customs, educational systems, and writing system, were proposed. Clinical neuropsychologists should take these aspects into account when administering and interpreting test results.

An improved diagrammatic procedure for interpreting and scoring the Wisconsin Card Sorting Test: An update to Steve Berry's 1996 edition.

The Wisconsin Card Sorting Test (WCST) is a popular neuropsychological test that is complicated to score and interpret. In an attempt to make scoring of the WCST simpler, Berry (The Clinical Neuropsychologist 10, 117-121, 1996) developed a diagrammatic scoring procedure, particularly to aid scoring of perseverative responses. We identified key limitations of Berry's diagram, including its unnecessary ambiguity and complexity, use of terminology different from that used in the standardized WCST manual, and lack of distinction between perseverative errors and perseverative responses. Our new diagrammatic scoring procedure scores each response one-by-one; we strongly suggest that the diagram is used in conjunction with the 1993 WCST manual. Our new diagrammatic scoring procedure aims to assist novice users in learning how to accurately score the task, prevent scoring errors when using the manual version of the task, and help scorers verify whether other existing computerized versions of the task (apart from the PAR version) conform to the Heaton et al. (1993) scoring method. Our diagrammatic scoring procedure holds promise to be incorporated into any future versions of the WCST manual.

Improving equivalent scores for clinical neuropsychology: a new method for regression model selection.

Equivalent Scores (ES) represent a statistical gold standard to obtain thresholds for clinical inference from normative data. The procedure to obtain ES requires a preliminary mandatory step: to perform a regression model selection to obtain adjusted scores that take into account age, education, and sex. The current article, starting from theoretical considerations, focuses on this step and proposes a new and improved regression model selection method. Results from data simulation show that the newly proposed method outperforms the current one on a wide range of simulation parameters and conditions, leading to better performance in classifying impaired or unimpaired performances, and more precise ES. The article is associated with an online app and R code to allow to easily apply the method to other normative data. This new model selection procedure can be easily incorporated also with other regression-based norm approaches.

New2Neuropsychology (N2N): An organization to promote diversity, equity, and inclusion in neuropsychology

Objective To introduce New2Neuropsychology (N2N), an organization that seeks to increase recruitment of historically underrepresented minoritized (URM) students, and to examine preliminary data on N2N’s impact and effectiveness in increasing knowledge about neuropsychology for URM students. Method This paper reviews relevant literature on factors informing the development of N2N. We also present descriptive data on N2N’s impact to date, and results of pre- and post- surveys for presentations about neuropsychology delivered to 90 college students (mean age = 24.23, 64.4% juniors or seniors) between November 2021 – March 2023. Results N2N has reached >500 students in events across 27 schools and, with the American Academy of Clinical Neuropsychology, disseminated $84,000 in scholarships to URM students. N2N presentation attendees reported increased understanding of neuropsychology and the training pathway (ps < .001, Cohen’s ds = 0.94 − 1.73) and increased confidence in their ability to become neuropsychologists (p < .001, d = 0.41). There were no overall pre-post differences for interest in pursuing a career in neuropsychology (p > .05); however, a subset of students who reported low interest at baseline (n = 57) reported a statistically significant increase in their interest post-presentation (p < .01, d = 0.36). Conclusions To date, N2N has progressed toward its goal, showing preliminary success increasing knowledge about neuropsychology for URM students. With continued development and support, N2N seeks to transform the pathway to neuropsychology for URM students, expanding accessibility of N2N resources across diverse groups and connecting URM students to neuropsychology research and clinical experiences.

Surgical treatment of meningiomas improves neurocognitive functioning and quality of life – a prospective single-center study

Background and purposeEarly diagnosis and the refinement of treatment of patients with intracranial meningiomas have brought quality of life (QoL) and neurocognitive functioning as outcome measures into focus. The aim of this study is a comprehensive assessment of neurocognitive function, quality of life and the presence of depression in meningioma patients before and after surgery.MethodsPatients with MRI diagnosis of intracranial meningioma and indication for surgery were prospectively included. A clinical neuropsychologist performed neurocognitive assessments within 3 months before and 12 months after surgery. The test battery included investigation of selective and divided attention, verbal and figural memory, executive functioning, and word fluency. Self-report questionnaires to assess depressive symptoms, QoL, and disease coping were administered. Raw values and t-values were compared pre-and postoperatively. Outcome was stratified by tumor- and peritumoral brain edema (PTBE) volumes, postoperative resolution of PTBE and WHO grade. The study included 18 predominantly female patients (83%) with a median age of 59 years and mostly CNS WHO grade 1 meningiomas (83%).ResultsThere was a significant postoperative improvement in the ability to selectively react under stress, in working memory and improved delayed reproduction of verbal and visual memory content. QoL improved regarding a reduction in physical problems, an improvement in energy, and social functioning. There was a trend towards worse preoperative scores in all tests, and greater postoperative improvement in patients with PTBE. Tumor volume had no effect on the measured outcome. The patients did not suffer from depressive symptoms before the surgery but improved postoperatively and most patients had an active, problem-oriented coping strategy.ConclusionResection of intracranial meningiomas leads to an improvement in multiple neurocognitive domains and QoL. There is a trend towards poorer preoperative neurocognitive functioning and greater postoperative improvement in patients with PTBE. Depression appears to play a minor role in the context of neurocognitive functioning and disease coping.

Bridging Experimental Neuroscience and Clinical Neuropsychology: Fluid Intelligence in Frontal Lobe Assessments

This viewpoint explores the gap between theoretical frameworks in experimental neuroscience and clinical neuropsychology. It highlights how John Duncan's theory of the Multiple Demand (MD) system, which links the frontal lobe to fluid intelligence (g), helps explain general performance on classical executive tests. However, it also discusses how traditional scores often fail to capture the complexity of behaviours associated with frontal lobe damage, and we suggest that developing improved scoring methods could be useful for integrating experimental and clinical neuropsychology insights.

Neuropsychological performance labels: do patients understand?

Objective: Descriptive labels to communicate performance are integral in neuropsychological reports. Although the American Academy of Clinical Neuropsychology (AACN) reached consensus on standardizing uniform labels of performance, consumer understanding of these labels is unclear. This pilot prospective cohort study evaluated patient, family member, and medical provider understanding of neuropsychological performance labels. Method: Patients (n = 62), family members (n = 31), and referral sources (n = 34) completed a 13-question survey evaluating the uniform label system and an alternative, patient-centered language system (PCL). Questions assessed label knowledge and associated percentiles and relative relationships between labels. Results: Patients had significantly higher accuracy on knowledge questions using PCL labels (54.8%) versus AACN labels (32.2%) as were families (51.6% versus 35.5%). When ranking labels, providers and patients were more accurate when using PCL labels compared to AACN labels, although no significant difference was seen in the family group. Generally, participants were more accurate in identifying highest/lowest scores using AACN labels and more accurate in identifying relatively higher and lower scores using PCL terminology. Conclusions: Results illustrate that current and alternative score labels may not be understandable for audiences who read and base decisions on neuropsychological reports. The findings highlight the need for further consideration of patient-centered language to improve understanding of neuropsychological score labels.

A - 77 A Systematic Review of Current Diversity Representation in Neuropsychological Research

Abstract Objective This study investigated current representation of diverse samples in research published in four leading neuropsychology journals. Methods We reviewed 367 articles published in 2023 from Archives of Clinical Neuropsychology, Neuropsychology, Journal of the International Neuropsychological Society, and The Clinical Neuropsychologist. 34 review articles and 4 editorial/announcements were excluded leaving 321 articles coded for age, education, gender/sex, race/ethnicity, and sample country. Results Overall, 89.41% of studies reported gender/sex and 50.46% reported race/ethnicity. Out of 63 original articles that included European populations (e.g., France, Sweden, Denmark, etc.), 93.65% reported gender/sex and 12.7% reported race/ethnicity. Out of 172 original articles that included United States (U.S.) samples, 95.93% reported gender/sex and 80.23% reported race/ethnicity. Studies of U.S. samples reported the following average sociodemographic variables: education 14.94 years (SD = 3.72), age 50.32 years (SD = 21.39), gender/sex 48.09% female and 51.90% male, and race/ethnicity was 65.11% White, 6.64% Black/African American, 2.18% Asian, 1.06% American Indian/Alaskan Native, 0.43% Native Hawaiian/Pacific Islander, and 24.57% unknown/other/mixed race. Additionally, 9.82% of participants were Hispanic/Latino. Conclusions Roughly half of studies did not report on race/ethnicity and this was particularly notable for European samples with more homogeneous populations. Studies with U.S. samples had equitable gender/sex representation but participants were predominantly White and older middle aged. Inconsistencies in how studies stratified race/ethnicity resulted in a large percentage of individuals being classified as unknown/other/mixed. This review highlights the need for more diverse representation in neuropsychological research as Hispanic/Latino, Black/African American, and Asian groups were represented at half their actual numbers in the U.S. population (18.5%, 12.2%, and 5.9% respectively).

B - 112 Challenges and Opportunities for Training in a New Era in Neuropsychology: a Survey Study

Abstract Objective The field of neuropsychology is undergoing significant changes, especially as the Minnesota Update Conference (MUC) drafts are developed. In late 2023, a group of neuropsychology trainee-leaders, united through the Clinical Neuropsychology Trainee Forum (CNTF), surveyed trainees in the United States and Canada to better understand their needs and perception of the neuropsychology training climate. Method Survey items were written by a CNTF task force consisting of trainee-leaders from major neuropsychology organizations before being refined by four independent neuropsychologists, including two current neuropsychology postdoctoral fellowship training directors. The survey was distributed via listservs and social media. Results 220 respondents completed a majority of the survey, and they were primarily female (86%), White (71%), and training in the United States (92%). More than 75% of respondents reported satisfaction with their doctoral program, internship, and/or fellowship. Similarly, 90% and 73% of respondents, respectively, felt their opinions on the future of the field are listened to and/or valued in discussions with peers and supervisors/mentors. However, only 57% of respondents felt their opinions are valued by neuropsychology organizational leadership, and nearly 70% were uncertain or disagreed that trainees’ opinions were valued during the MUC draft development and review period. Conclusions Most neuropsychology trainees are satisfied with their training programs yet expressed concern about their opinions on the future of the field being heard by neuropsychology leadership. Trainee stakeholder engagement will be key to the vitality of neuropsychology in light of anticipated MUC Guidelines. Recommendations for supervisors, training directors, and neuropsychology organizational leadership will be discussed.

B - 141 Research Review of Symptom and Performance Validity Tandem: Inventory of Problems-29 and Memory Module

Abstract Objective Consistent with the NAN expectations, the American Academy of Clinical Neuropsychology (Sweet et al., 2021) asserted that neuropsychologists should include symptom validity tests (SVT) and performance validity tests (PVT) to assess the credibility of psychological and cognitive complaints. Aligned with this declaration, the Inventory of Problems–29 (IOP-29), an SVT, and its Memory Module (IOP-M), a PVT based on the respondent’s recall of the IOP-29 items. Our objective is to evaluate the research support of these measures to discriminate credible from noncredible presentations. Data Selection Since the IOP was introduced in 2017, more than 20 peer-reviewed research studies on the IOP-29 and 10 studies including both the IOP-29 and IOP-M have been published with 4 meta-analyses or systematic reviews. These publications present various, commonly used statistical analyses of validity and efficacy, e.g., sensitivity and specificity, along with comparisons to other SVTs and PVTs. Data Synthesis In the quantitative research literature, the IOP-29 and IOP-M have demonstrated efficacy across countries and languages in discriminating credible from noncredible presentations related to psychosis, PTSD, depression, anxiety, and neuropsychological disorders. Conclusions These findings support adding this tandem to the multi-method evaluation of the credibility of mental health and neuropsychological presentations. The brevity of administering these two tests, i.e., approximately 20 minutes total, suggests that the cost–benefit might be strong. More research with biomarkers and specific neuropsychological disorders might be needed along with more publications for which the authors do not include the test developers.

On the Clinimetrics of the Montreal Cognitive Assessment: Cutoff Analysis in Patients with Mild Cognitive Impairment due to Alzheimer's Disease.

In the era of disease-modifying therapies, empowering the clinical neuropsychologist's toolkit for timely identification of mild cognitive impairment (MCI) is crucial. Here we examine the clinimetric properties of the Montreal Cognitive Assessment (MoCA) for the early diagnosis of MCI due to Alzheimer's disease (MCI-AD). Data from 48 patients with MCI-AD and 47 healthy controls were retrospectively analyzed. Raw MoCA scores were corrected according to the conventional Nasreddine's 1-point correction and demographic adjustments derived from three normative studies. Optimal cutoffs were determined while previously established cutoffs were diagnostically reevaluated. The original Nasreddine's cutoff of 26 and normative cutoffs (non-parametric outer tolerance limit on the 5th percentile of demographically-adjusted score distributions) were overly imbalanced in terms of Sensitivity (Se) and Specificity (Sp). The optimal cutoff for Nasreddine's adjustment showed adequate clinimetric properties (≤23.50, Se = 0.75, Sp = 0.70). However, the optimal cutoff for Santangelo's adjustment (≤22.85, Se = 0.65, Sp = 0.87) proved to be the most effective for both screening and diagnostic purposes according to Larner's metrics. The results of post-probability analyses revealed that an individual testing positive using Santangelo's adjustment combined with a cutoff of 22.85 would have 84% post-test probability of receiving a diagnosis of MCI-AD (LR+ = 5.06). We found a common (mal)practice of bypassing the applicability of normative cutoffs in diagnosis-oriented clinical practice. In this study, we identified optimal cutoffs for MoCA to be allocated in secondary care settings for supporting MCI-AD diagnosis. Methodological and psychometric issues are discussed.

Assessing Kurt Goldstein's lasting influence in the neuropsychology of language versus his use of aphasic symptoms as diagnostic insights into brain injuries.

In the history of the neurological relationship between human behavior and brain function in Europe and North America, various perspectives on brain localization and holistic functioning have been addressed. One of the founding figures of modern neuropsychology, Professor Hans-Lukas Teuber (1916-1977) of the Massachusetts Institute of Technology, reminded the scholarly community of its negligence of preceding traditions in day-to-day research endeavors. Teuber particularly emphasized that during the development of the aphasiology field (1950s-1960s) even major figures, such as the German-American neurologist Kurt Goldstein (1878-1965), had been neglected in the scientific community's collective memory. This happened despite Goldstein's contributions to cortical blindness, vicarious brain functioning, and neurorehabilitation. The outcome of the debates regarding the neurology of language had to be incompletely relearned in later decades. Neuropsychological concerns regarding the relationship between cortical localizationism and functional holism have made recourse to Goldstein's work necessary for reviving historical answers for current conundrums. It is therefore opportune to review Goldstein's work in the light of the history of aphasiology. Contemporary scholarship has once more drawn research attention to the works of Goldstein along with Norman Geschwind (1926-1984) and his pupils. It has also resurrected the underlying research of Carl Wernicke (1848-1905). This review article explores deep and lasting questions regarding the positioning of Goldstein's holism among the contemporary holistic perspectives. It does so by firstly discussing Wernicke's traditional model of distributed localizationism. Secondly, it describes Goldstein's previous work in the German brain sciences. Thirdly, it examines his aphasiological contributions on both sides of the Atlantic. Fourthly, it addresses the advancement of a dynamic localizational perspective by Geschwind and his pupils. This article intends to render a historical analysis fruitful for those exploring modern-day problems in the neurology of aphasia and clinical speech neuropsychology.

Challenges and prospects in advancing clinical neuropsychology

In the ever-evolving field of clinical neuropsychology, significant methodological and conceptual limitations hinder progress. To ensure the continued relevance of this discipline amidst remarkable advancements in neuroscience, medicine, and methodology, these obstacles must be addressed. This opinion article identifies inherent limitations within current clinical neuropsychology, including issues such as multi-collinearity in neuropsychological assessments, lack of validated tools reflecting contemporary cognitive function models, and the use of divergent theoretical frameworks in evaluations, leading to a gap between theory and practice. The disconnect between behavior and biomarkers, particularly evident in neurodegenerative diseases but also relevant for other pathologies, together with the rise of genetic analyses, necessitate change. Methodological improvements are crucial for ensuring the discipline's future relevance. Looking ahead, key perspectives and challenges are outlined, emphasizing the need for a holistic approach to cognitive functioning and congruent tools, patient engagement in experimental studies, rectification of biases, and exploration of variables like personality. Training professionals to bridge the gap between practice and research is essential. By addressing these challenges, clinical neuropsychology can not only adapt to the evolving landscape but also shape it, ensuring a brighter future for the field.

The impact of a primary brain tumor diagnosis on caregivers: Insights from the patients’ perspective

PurposeThe diagnosis of a primary brain tumor (PBT) causes significant distress for the caregiver-patient dyad, warranting increased supportive care intervention. Although researchers have previously assessed caregivers’ perceptions of their own supportive care needs, no study to date has identified how patients perceive the caregiving experience and/or patients’ recommendations for integrating supportive care of caregivers in neuro-oncology. This qualitative study examined caregiver distress as well as caregiver supportive care needs from the patients’ perspective to inform future intervention development.MethodsAdults with PBT (N = 15; Mage = 45; 53% female; 93% White) were divided into four, 90-min focus groups moderated by a clinical neuropsychologist. Patients responded to semi-structured interview questions regarding various supportive care needs throughout the course of disease. Each discussion was transcribed and coded using thematic content analysis and NVivo software. Inter-rater reliability was excellent (MKappa = 0.92, range = 0.85–0.93).ResultsSeven distinct codes related to PBT caregivers emerged and were classified into two broader themes: Caregiver Impact (47% of coded content) and Caregiver Support (53% of coded content). Caregiver Impact refers to patients’ perspective of the practical and emotional demands of caregiving. Under Caregiver Support, patients cited a strong need for increased support of caregivers, including bereavement care, individual psychotherapy, and joint caregiver-patient dyad sessions.ConclusionPatients with PBT expressed profound concerns regarding the demands of caregiving and its impact on the well-being of their loved ones. Findings emphasize the need for comprehensive dyadic support in neuro-oncology throughout the disease trajectory to enhance the overall quality-of-life for both patients and their caregivers.

Cultural and multicultural topics in Neuropsychology Journal titles from 2010-2020

Objective The values of a field are reflected in the science it publishes. The goal of this study was to present a historical analysis of the extent to which the field of clinical neuropsychology publishes journals with titles that address culture in the context of brain function and behavior between 2010 and 2020. Methods Titles from articles published in 13 neuropsychology journals from 2010–2020 were collected and coded with regard to culture and multicultural content. The aims of the study were to (1) determine how often cultural or multicultural topics were represented in journal titles, (2) determine if cultural or multicultural content in neuropsychology journal publication titles increased over time, and (3) to explore other neuropsychological content that was most and least likely to appear in publications pertaining to culture or multicultural issues. Results Results indicated that titles for publications in clinical neuropsychology journals with content relevant to cultural or multicultural neuropsychology represented 1.1% to 13.4% of titles across the 13 journals. The number of cultural/multicultural titles increased over time. The number of cultural/multicultural titles per journal was not significantly correlated with the journal impact factor. Normative data were addressed significantly more often in cultural/multicultural titles versus non-cultural/multicultural titles, whereas psychiatric issues were addressed significantly less often. Conclusions There are many actions that clinical neuropsychologists can take to increase the field’s attention to the effects of culture on brain function and behavior. It is vital to update our data from 2021 to the present, given the substantial increase in awareness of social justice issues that occurred since 2020.

Current Landscape of Child and Adolescent Psychology Internship Programs and Implications for Workforce Development.

Doctoral psychology internships play a key role in the development of the competencies of the clinical child and adolescent psychologist workforce needed to serve the increasing behavioral and mental health needs of children. This study surveyed 50 internship training directors regarding workforce needs, the structure of experiential internship components, and the organizational infrastructure and funding of internship programs that provide focused care to children and adolescents within medical settings. Findings suggest that internships most commonly occur within academic medical settings and include clinical child psychology, integrated care, pediatric psychology, neuropsychology, and developmental disabilities tracks. On average, sites had 6 interns, 3 tracks, and 4 major rotations per track. Training directors identified program funding to be the greatest barrier to sustaining internship programs. Currently, internships are funded through clinical revenue, grants, and organizational funds covering an average intern salary of $31,020 plus benefits as well as 0.3 FTE of a training director's time to administrate the program. The number of internship tracks within a single program was associated with greater administrative time for the training director. Implications for advocacy at the federal, state, profession, and institutional level to increase funding and decrease barriers to training are discussed.

QOL-19. THE SIBLING TOOLKIT: DEVELOPMENT OF A PSYCHOLOGICALLY-INFORMED TOOLKIT TO SUPPORT SIBLINGS OF CHILDHOOD CNS TUMOUR PATIENTS WITH LIMITED ACCESS TO FORMAL SERVICES

Abstract BACKGROUND There is a recognised gap in service provision addressing the psychological and social needs of siblings of children with a diagnosis of brain tumour. In the absence of funding to provide direct psychological service provision for siblings, a project development group was established to identify and advance alternative methods of delivering support. METHODS Funding for a two year sibling-needs project was sourced from UK child brain tumour charity Tom’s Trust and led by the Neuro-Oncology psychology service at the Great North Children’s Hospital (Newcastle, UK). A development group was established of clinical psychologists and neuropsychologists representing nine UK hospital Trusts and one former school teacher. Following a comprehensive priorities exercise a toolkit was developed to support siblings of children with brain tumours. Significant further stakeholder involvement, including input from the regional Young People’s Advisory Group, resulted in positive revision to the initial draft. RESULTS A 39 page toolkit was produced for the use of any adult involved in the sibling’s life. This psychologically-informed toolkit provides guidance and support for a caring but potentially uninformed adult, such as a teacher, community leader, or member of the wider family, to be able to offer support to siblings. Guidance is included to help the adult talk about cancer, know what common issues siblings face, and to think about how to safely and appropriately undertake supportive work with this age group. The kit is associated with a website link, allowing toolkit users to download worksheets and resources for use with the sibling. CONCLUSIONS Early feedback on the published toolkit is highly positive, suggesting that the toolkit is considered ‘comprehensive’, ‘accessible’, and ‘practical’. We believe that this toolkit offers the potential to bridge some of the gap in service provision to siblings of a child with brain tumour.

Long-term forgetting is independent of age in healthy children and adolescents.

In clinical neuropsychology, the phenomenon of accelerated long-term forgetting (ALF) has advanced to be a marker for subtle but clinically relevant memory problems associated with a range of neurological conditions. The normal developmental trajectory of long-term memory, in this case, memory recall after 1 week, and the influence of cognitive variables such as intelligence have not extensively been described, which is a drawback for the use of accelerated long-term forgetting measures in pediatric neuropsychology. In this clinical observation study, we analyzed the normal developmental trajectory of verbal memory recall after 1 week in healthy children and adolescents. We hypothesized that 1-week recall and 1-week forgetting would be age-dependent and correlate with other cognitive functions such as intelligence and working memory. Sixty-three healthy participants between the ages of 8 and 16 years completed a newly developed auditory verbal learning test (WoMBAT) and the WISC-V intelligence test (General Ability Index, GAI). Using these tests, 1 week recall and 1 week forgetting have been studied in relation to GAI, verbal learning performance, and verbal working memory. Neither 1-week recall nor 1-week forgetting seems to be age-dependent. They are also not significantly predicted by other cognitive functions such as GAI or working memory. Instead, the ability to recall a previously memorized word list after 7 days seems to depend solely on the initial learning capacity. In the clinical setting, this finding can help interpret difficulties in free recall after 7 days or more since they can probably not be attributed to young age or low intelligence.

Barriers to the use of Methylphenidate in Pediatric Neuro-oncology Services.

Survivors of childhood CNS tumors are at a significant risk of chronic and multifaceted neurocognitive late effects. Recent findings indicate the potential utility of methylphenidate in addressing neurocognitive and academic plateauing and improving quality-of-life outcomes in this clinical population. However, the prescription of methylphenidate in neuro-oncology services remains inconsistent. To explore the neurocognitive assessment and rehabilitative interventions (including the use of methylphenidate) offered to survivors of childhood CNS tumors within mainland UK. We used a semi-structured questionnaire to gather qualitative data from clinical psychologists and neuropsychologists within National Health Service pediatric neuro-oncology principal treatment centers (PTCs) during May 2018. Thematic analytical methods were used to explore themes within the collected data. Eleven (58%) of the 19 PTCs returned the completed questionnaire. Respondents reported inadequate resource of psychology in many pediatric neuro-oncology PTCs, which limited the provision of methylphenidate to a restricted proportion of the patient group (i.e., those with the most profound neurocognitive difficulties). Respondents reported an interest in exploring the utility of methylphenidate in their patient group yet described a lack of appropriate evidence of its efficacy. In addition, respondents highlighted the need for the provision of accessible research summaries and treatment protocols addressing the use of methylphenidate. We anticipate that national collaboration between clinicians and researchers working in the cancer survivorship field will support the advancement of interventions such as methylphenidate for the growing clinical population of survivors of childhood CNS tumors.

Childhood Apraxia of Speech: A Descriptive and Prescriptive Model of Assessment and Diagnosis.

Childhood apraxia of speech (CAS) represents a significant diagnostic and therapeutic challenge within the field of clinical neuropsychology, characterized by its nuanced presentation and multifactorial nature. The aim of this study was to distil and synthesize the broad spectrum of research into a coherent model for the assessment and diagnosis of CAS. Through a mixed-method design, the quantitative phase analyzed 290 studies, unveiling 10 clusters: developmental apraxia, tabby talk, intellectual disabilities, underlying speech processes, breakpoint localization, speech characteristics, functional characteristics, clinical practice, and treatment outcome. The qualitative phase conducted a thematic analysis on the most cited and recent literature, identifying 10 categories: neurobiological markers, speech motor control, perceptual speech features, auditory processing, prosody and stress patterns, parent- and self-report measures, intervention response, motor learning and generalization, comorbidity analysis, and cultural and linguistic considerations. Integrating these findings, a descriptive and prescriptive model was developed, encapsulating the complexities of CAS and providing a structured approach for clinicians. This model advances the understanding of CAS and supports the development of targeted interventions. This study concludes with a call for evidence-based personalized treatment plans that account for the diverse neurobiological and cultural backgrounds of children with CAS. Its implications for practice include the integration of cutting-edge assessment tools that embrace the heterogeneity of CAS presentations, ensuring that interventions are as unique as the children they aim to support.