Pediatric Neuropsychological Evaluations Research Articles

Moving it Forward: a Twenty-First Century Approach to Pediatric Neuropsychological Evaluation and the Importance of Integrating Neuroimaging Findings

Moving it Forward: a Twenty-First Century Approach to Pediatric Neuropsychological Evaluation and the Importance of Integrating Neuroimaging Findings

H - 56 Culturally-Responsive Neuropsychological Evaluations: Two Case Studies Demonstrating the Application of the ECLECTIC Framework in Pediatric Medical Populations.

This case series aimed to demonstrate the application of Dr. Daryl Fujii's ECLECTIC model to pediatric neuropsychological evaluations. The ECLECTIC model identifies a wide range of social and cultural factors (e.g., bilingual language development, economic factors, and social determinants) that are integrated to provide patient-centered, culturally responsive neuropsychological services. The application of the ECLECTIC model to pediatric evaluations will be reviewed. Two cases of pediatric patients with different levels of bilingualism (English/Spanish) and diagnoses of Spina Bifida (SB) will be presented. These cases will illustrate a range of cultural and social factors (including ethnic, linguistic, and economic factors) that impact a pediatric neuropsychological evaluation. Clinical considerations and practical solutions will be provided. The ECLECTIC model provides a framework for understanding and integrating social-cultural factors and the intersection of such factors in a pediatric neuropsychological evaluation. This is the first case series to demonstrate the use of the ECLECTIC model in a pediatric medical population. With the aim of reducing existing healthcare disparities, a social-cultural lens is critical to conducting a neuropsychological evaluation, formulating diagnoses and conceptualization, and offering relevant and patient/family-centered recommendations.

Culturally Informed Neuropsychological Evaluations in Pediatric Epilepsy: Evidence-Based Practice Considerations.

Epilepsy is one of the most common reasons for referral for a pediatric neuropsychological evaluation due its high prevalence in childhood and our well-established clinical role in tertiary care settings. Emerging evidence indicates that racial and ethnic minority populations experience increased epilepsy burden compared with White peers. Although there has been heightened recognition in our specialty regarding the dire need for culturally and linguistically responsive evaluations, the scientific evidence to support effective neuropsychological service delivery for bi/multilingual and bi/multicultural youth with epilepsy is comparatively scant and of poor quality. As a result, significant patient and clinical challenges exist, particularly in high stakes presurgical pediatric epilepsy evaluations of bi/multilingual and bi/multicultural children. Given that Spanish is the most common language spoken in the United States after English, this paper will focus on Spanish and English measures, but will provide evidence-based practice considerations that can inform practices with other non-English speaking communities. Cultural and linguistic factors that affect clinical decision-making regarding test selection, test interpretation, and feedback with families are highlighted. We offer a review of neuropsychological profiles associated with pediatric epilepsy as well as a flexible, multimodal approach for the assessment of linguistically and culturally diverse children with epilepsy based on empirical evidence and the clinical experiences of pediatric neuropsychologists from diverse backgrounds who work with children with epilepsy. Limitations to this approach are discussed, including the lack of available measures and resources for culturally and linguistically diverse pediatric populations. A case illustration highlights a culturally informed assessment approach.

Performance and Symptom Validity in Outpatient Pediatric Neuropsychological Evaluations

ABSTRACT This study aimed to clarify the value of using different types of validity measures in pediatric neuropsychological evaluations. We examined the relationship between performance (PVT) and symptom (SVT) validity tests as well as demographic variables and results from a screening test of learning and memory (i.e. Child and Adolescent Memory Profile [ChAMP]) in a mixed pediatric sample (n = 103). There was minimal overlap between PVT and SVT failures. Regression analyses demonstrated that PVT results, parental education, and history of special education were statistically significant predictors of ChAMP results, whereas SVT results were not.

Examining parent and clinician views of a hospital-based pediatric neuropsychological service: a Canadian perspective

ABSTRACT Understanding how pediatric neuropsychological evaluations support families and the child’s medical team is an important component of ensuring evidence-based care. For the first time within a Canadian context, we investigated the impact of neuropsychological assessments on parent knowledge, advocacy, and stress and the role of socioeconomic factors in parents’ perceptions of the assessment. Responses from referring clinicians were also examined. As part of a hospital quality improvement project, 91 parents of children between the ages of 3 and 17 years (M = 8y7m; SD = 4y1m) and 45 clinician consumers (clinical staff who use neuropsychological services) completed one of two online questionnaires in English: Parent Overall Assessment of Supports and Testing, or Clinician Overall Assessment of Supports and Testing. Most parents indicated the neuropsychological evaluation promoted understanding of their child’s cognitive profile and improved their ability to support their child at home and at school or in the community. Families characterized as being at higher social risk indicated that the evaluation led to more changes in how they approached their child at home than families with lower social risk status. Referring clinicians indicated neuropsychological reports were effective in communicating findings to them and patients/families. The most valuable sections of the report according to referring clinicians included the diagnosis/impression and recommendations sections. Parents and referral providers reported many benefits from the neuropsychological evaluation but also identified areas for service delivery improvement. Parent perceptions varied based on family and socio environmental factors, offering important targets for future research and clinical consideration.

Parent perceptions of pediatric neuropsychological evaluations: a systematic review

ABSTRACT To synthesize current knowledge of the impact of pediatric neuropsychological evaluations on child functioning, we conducted a systematic review of the literature on parents’ overall satisfaction with their child’s evaluation and perceptions of how helpful the evaluation was for understanding their child’s abilities and how useful the evaluation was for providing actionable information to elicit change. Parent satisfaction is important in this context because studies on healthcare consumption indicate a substantial relationship between patient satisfaction with services and implementation of recommendations and follow-up care. We followed PRISMA guidelines to conduct a systematic review of the literature on parent perception of pediatric neuropsychological evaluations for children aged 3–21 years. Using a set of predefined search terms, we identified 1,163 abstracts across PubMed, PsycINFO, Cochrane Library, and Web of Science electronic databases and included 12 studies in our qualitative synthesis. In general, parents reported high levels of satisfaction with their child’s evaluation. Feedback from the evaluation was helpful for understanding their child’s pattern of strengths and weaknesses and included useful information for obtaining support. Although parents did report improvement in their child’s functional participation in home, school, and community settings, they tended to rate the usefulness of the evaluation for eliciting change lower than their overall satisfaction with the evaluation or how helpful the evaluation was for understanding their child’s abilities. Additional effort appears to be needed for pediatric neuropsychological evaluations recommendations to result in durable, meaningful change in child functioning.

A Systematic Review and Meta-Analysis of the Utility of the Test of Memory Malingering in Pediatric Examinees

This is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) in pediatric examinees. It adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic literature search was conducted using PsycINFO and PubMed, reviewing articles from January 1997 to July 2019. Books providing data on pediatric validity testing were also reviewed for references to relevant articles. Eligibility criteria included publication in a peer-reviewed journal, utilizing a pediatric sample, providing sufficient data to calculate specificity and/or sensitivity, and providing a means for evaluating validity status external to the TOMM. After selection criteria were applied, 9 articles remained for meta-analysis. Samples included clinical patients and healthy children recruited for research purposes; ages ranged from 5 to 18. Fixed and random effects models were used to calculate classification accuracy statistics. Traditional adult-derived cutoffs for Trial 2 and Retention were highly specific (0.96-0.99) in pediatric examinees for both clinical and research samples. Sensitivity was relatively strong (0.68-0.70), although only two studies reported sensitivity rates. A supplemental review of the literature corroborated these findings, revealing that traditional adult-based TOMM cutoffs are supported in most pediatric settings. However, limited research exists on the impact of very young age, extremely low cognitive functioning, and varying clinical diagnoses. The TOMM, at traditional adult cutoffs, has strong specificity as a performance validity test in pediatric neuropsychological evaluations. This meta-analysis found that specificity values in children are comparable to those of adults. Areas for further research are discussed.

A-070 Parental Perception of the Utility of Pediatric Neuropsychological Evaluation: A Systematic Review

Abstract Objective Pediatric neuropsychological evaluations are intended to support children in their development and ability to function successfully in their everyday settings; however, limited efforts have been made to synthesize the available literature regarding the utility of these evaluations. To improve the impact of pediatric neuropsychological evaluations, a systematic review was conducted to identify components of the assessment and feedback process that are associated with parents’ perception of helpfulness (help parent understand child), usefulness (provide actionable information/elicit change) and overall parent satisfaction. Data Selection We followed PRISMA guidelines to conduct a systematic review of the literature to identify research on parental perception of the utility of pediatric neuropsychological evaluations for children aged 3–21 years. We searched PubMed, PsychINFO, Cochrane Library, and Web of Science databases using the terms “neuropsychology,” “pediatric,” “neuropsychological evaluation,” “neurodevelopmental disorders,” “perceived utility,” and “parental utility.” Data Synthesis We identified 1,029 abstracts and after full review included 9 articles in our qualitative synthesis. Conclusions Parents generally reported high levels of satisfaction with their child’s evaluation. The research has also suggested that parents find evaluations and feedback helpful for understanding their child’s pattern of strengths and weaknesses. Recommendations from the neuropsychologists provided useful information for obtaining support and eliciting change. Limitations of the studies reviewed included small sample size, variability in methods, and reduced generalizability of results.

Base Rates of Performance Validity Test Failure Among Children and Young Adult Litigants with Histories of Elevated Blood Lead Levels

This study examined the base rate of performance validity test failure in a forensic sample of 66 children and young adults reporting neuropsychological injury due to elevated blood lead levels. Results indicated that 62% of the sample failed at least one performance validity test (PVT). In requiring two or more PVT failures for classification of performance invalidity, prevalence rates approached 50% in adolescents and young adults. In younger children, failing more than one PVT was uncommon although the base rate of performance invalidity may be a function of the limited PVTs available for this age group. These findings add to the accumulating evidence that assessment of performance validity is a necessary component of pediatric neuropsychological evaluations. The importance of including performance validity assessment in neuropsychological research is discussed, particularly when the research guides public health policies.

Pediatric neuropsychological evaluation via telehealth: Novel models of care

Objective: As the coronavirus pandemic extends across the globe, the impacts have been felt across domains of industry. Neuropsychology services are no exception. Methods for neuropsychological assessments, which typically require an in-person visit, must be modified in order to adhere to social distancing and isolation standards enacted in an effort to slow the pandemic. How can providers continue to meet the needs of patients referred for neuropsychology evaluations, while respecting federal and state guidelines for safety and ethical mandates? We offer a novel, tiered model of care, successfully implemented in response to mandated social distancing, in a large, pediatric neuropsychology program.Method: We describe the considerations and challenges to be addressed in transitioning a large neuropsychology department to a new model of care, including triaging referrals, developing –or rediscovering — types of services to meet the needs of a virtual patient population, and helping patients, parents, and providers to adjust to these new models.Conclusions: Lessons learned as a function of rapid changes in care models have implications for the field of neuropsychology as a whole as well as for future flexibility in meeting the needs of pediatric patients and their families.

A review of performance and symptom validity testing with pediatric populations

Growing recognition and concerns of non-credible performance in pediatric populations have led clinicians to investigate the utility of performance and symptom validity tests (PVT/SVTs) among children and adolescents. Yet current research has indicated that a minority of clinicians routinely utilize a free-standing PVT in pediatric neuropsychological evaluations. The current article investigates the rationale for using PVT/SVTs, and the impact that failure of such exams have on other neurocognitive tests. A review of common adult PVTs and their appropriateness for use with specific pediatric clinical populations is presented, as well as empirical evidence for evaluating embedded validity indicators. The limited literature on SVTs with youth is also reviewed and provides additional insight into symptom exaggeration. There are various reasons children would provide noncredible performance, many of which are different from adults. A review of how the clinician should handle this behavior in pediatric evaluations is provided and what patient populations may present with a higher base rate of failure. Finally, various approaches are offered on how to explain these results to children and their caregivers.

Do parents implement pediatric neuropsychological report recommendations?

Objective We explored parent-reported implementation rates of medical, home/community, and school recommendations following a pediatric neuropsychological evaluation, as well as demographic group differences in, and potential barriers to, recommendation implementation. Method Participants were 55 parents of children and adolescents who completed an outpatient neuropsychological evaluation in a university-based hospital neuropsychology clinic within 4 to 6 months prior to study participation. Participants were contacted by phone to complete a short interview regarding implementation of report recommendations. Results Slightly over half (52%) of all recommendations were implemented, with higher implementation rates of school (62%) and home/community recommendations (53%) than medical recommendations (40%). Results indicated significantly lower recommendation implementation for households with low income (particularly for medical recommendations). Reported reasons for not implementing recommendations included lack of time, lack of resources (geographical and financial), ambivalence about the need to implement the recommendation, not remembering the recommendation, confusion about how to implement the recommendation, and resistance from schools and teachers. Conclusions The results for this study provide information for pediatric neuropsychologists regarding rates of recommendation implementation, with differences identified based on type of recommendation and demographic factors. Further empirical investigation is indicated in order to determine practical, concrete steps to improve recommendation implementation.

Changes in child functioning pre-to post-neuropsychological evaluation

ABSTRACT Although a key goal of neuropsychological evaluation is to improve patient outcomes, research regarding changes in child functioning following neuropsychological evaluation is very limited. This project examined changes from before neuropsychological evaluation to several months afterward in parent report of their child’s functioning and ability to participate across home, school, and community settings. Fifty-one parents of children and adolescents receiving their first outpatient neuropsychological evaluation completed questionnaires prior to initial parent interview and following the final report (of n = 162 who were mailed the follow-up questionnaire). Parents rated their perception of the severity of their child’s problems, their child’s ability to participate, and satisfaction with the child’s ability to participate across school, home, and community domains. Analysis utilized MANOVA with bootstrapping to obtain standard errors and false discovery rate to control Type-1 errors. Parents reported a significant decrease in the severity of problems related to academic progress (p = .034) and overall severity of problems (p = .028) at follow-up. There was no significant change in the rated severity of the child’s problems with peers or family. Parents reported significant increases in their child’s ability to participate, and parent satisfaction with child participation, in school (ps<.001), at home (ps<.01), and in the community (ps<.001). Although this observational study cannot definitively show cause-and-effect, findings support the utility of pediatric neuropsychological evaluations in facilitating child functioning. These findings dovetail with prior work suggesting that such evaluations can increase parents’ understanding of their child, awareness of care options, and efficacy in pursuing those options.

C-66 Limited Access to Pediatric Neuropsychological Evaluations for Non-English Speakers

Abstract Objective The aim of this empirical study was to examine the accessibility of pediatric neuropsychological evaluations in the state of Arizona for non-English speaking children. To date, there is very limited research that analyzes the accessibility of neuropsychological evaluations. Diversity variables, such as primary language, can negatively impact assessment scores (Norbury &amp; Sparks, 2013), leaving diverse individuals at risk of misdiagnosis when an assessment is not conducted in one’s primary language, nor normed on similar individuals (Mindt et al., 2008). The Center for Immigration Studies (2017) found 28% of school-age children in Arizona speak a foreign language, warranting a need for culturally-appropriate evaluations. Method Arizona pediatric neuropsychologists in non-hospital settings were identified via electronic resources: AzNS, AAPdN, AzPA, CSN, and AACN provider lists; LinkedIn; Google search. Participants met criteria for inclusion if “pediatric neuropsychological” evaluations were provided by a neuropsychologist on staff. “Pediatrics” is defined as 0-17. Neuropsychologists were contacted directly via phone for survey participation; verbal informed consent was obtained. Results Seventeen pediatric neuropsychologists were found in the state of Arizona, and 52.9% consented to participate in the survey (n = 9). All participants (100%, n = 9) stated they provide evaluations in English only, and refer-out for non-English evaluations. Conclusions There is a severe disparity in the access to care with respect to availability of culturally-appropriate evaluations in Arizona: a state with a large population of non-English speakers. The current study adds to the limited literature in this area, and sets the stage for continued professional advocacy efforts. Goals for future national research is critically discussed.

Evolution of parental knowledge and efficacy across the pediatric neuropsychological evaluation process

Objective: The handful of studies examining parent satisfaction after pediatric neuropsychological evaluations have focused on post-evaluation appraisals. By examining parent experiences across the course of their child’s evaluation, this study aimed to provide important insights into how and when parents experience changes in knowledge, understanding of care options, and efficacy during evaluation process.Method: Parents of youth receiving neuropsychological evaluation completed questionnaires at four time points (prior to evaluation [n = 363], day of testing [n = 300], prior to feedback [n = 250], and post-report [n = 99]). Parents rated aspects of their knowledge and efficacy regarding their child’s functioning. Parents also rated their perception of the neuropsychologist, medical provider, and school along the same domains. The resulting longitudinal data were analyzed using structural equation modeling and ANCOVA. Although primary analyses focused on the entire sample, differences between first-time evaluations and re-evaluations were also examined.Results: Families receiving an initial evaluation showed lower ratings in knowledge, awareness of options, and efficacy at the beginning of the evaluation and a significant increase in ratings by the end of the evaluation. Families returning for re-evaluation showed higher initial ratings that changed comparatively little during the evaluation. Parents receiving initial evaluations also perceived increased knowledge of their child by medical providers and school.Conclusion: The study supports the clinical assumption that parents gain knowledge about their child and treatment options during a neuropsychological evaluation. The difference between initial and re-evaluation warrants further study. Studying the process and experience of neuropsychological evaluation may provide more nuanced findings than post hoc satisfaction measures.

School-based multi-tiered systems of support (MTSS): An introduction to MTSS for neuropsychologists

ABSTRACTWhen completing pediatric neuropsychological evaluations, it is important for clinicians to incorporate data from children’s school environments. Today, the educational data available to neuropsychologists have resulted from the utilization of multi-tiered systems of support (MTSS) within schools; however, practitioners may lack knowledge and/or training in this school-based approach to assessment and intervention. Better understanding of MTSS may aid pediatric neuropsychologists in their interpretation and use of educational data commonly provided by schools. Thus, the purpose of this article is to provide an overview of school-based MTSS and explain how knowledge about MTSS can inform neuropsychological evaluations. Specifically, practical implications for record reviews, recommendation development, and consultation with schools will be discussed.

The Importance of Performance Validity Assessment in Pediatric Neuropsychological Evaluations

The two cases presented highlight the importance of performance validity measures as a component of pediatric neuropsychological practice. While such measures are commonly used in forensic situations, there is a need for a greater acceptance and utilization of performance validity measures in routine clinical pediatric neuropsychological evaluations, as well as other assessment situations involving children (e.g., psychoeducational evaluations). The statement by an examiner that the data from an evaluation are valid and reliable based upon their subjective impressions is no longer sufficient in any pediatric evaluation, be it for clinical diagnosis, treatment planning, educational purposes, or forensic opinions.

Neuropsychological Profile of Hemiplegic Migraines: A Pediatric Case Study

The clinical interview is an important part of a pediatric neuropsychological evaluation. Investigating the history of symptoms, the family, and genetic factors can often clarify etiological information. This manuscript will review a case of a 12 year old girl (HA) who has a family history of migraine headaches, but had previously been diagnosed and treated as a child with multiple mild grade 1 concussions. These suspected concussions were purportedly resulting in infrequent, but intermittent hemiplegic migraines. Specifically, HA suffered Hemiplegic Migraines which involved right dominant hand hemiplegia and significantly altered level of consciousness for approximately 12-24 hours, resulting in a full return to physical and cognitive functioning post recovery. Medical records revealed practitioners did not explore family history or the sequence of events leading up to the migraines. There were even questions in the medical reports suggesting the hemiplegia may have reflected a conversion disorder. However, a thorough clinical interview including family history and neuropsychological, this case appears to show that HA has hemiplegia migraines along with neurocognitive impairments very consistent with previously published cases. Moreover her pattern of performance showed significant score variability and impairments on multiple largely left hemisphere and executive functioning tasks. Her specific cognitive impairments included a variety of left hemisphere cognitive skills (verbal comprehension, reading, bilateral executive deficits) as appears to suggest multifocal left hemisphere cerebral dysfunction.

Private Pediatric Neuropsychology Practice Multimodal Treatment of ADHD: An Applied Approach

As neuropsychologists and psychologists specializing in the assessment and treatment of pediatric mental health concerns, one of the most prominent diagnoses we encounter is attention-deficit hyperactivity disorder (ADHD). Following a pediatric neuropsychological evaluation, parents often request recommendations for treatment. This article addresses our approach to the treatment of ADHD from the private practice perspective. We will review our primary treatment methodology as well as integrative and alternative treatment approaches.

Utility of TOMM Trial 1 as an Indicator of Effort in Children and Adolescents

Although measuring test compliance in a pediatric neuropsychological evaluation is important, increasing demands on clinicians' time and the need for efficiency during assessments may make it difficult to routinely include effort testing. This study investigated whether performance on Trial 1 of the Test of Memory Malingering (TOMM) is predictive of overall performance in children and adolescents with neurological disorders. Participants included 53 children and adolescents between six and 19 years (mean age = 12.4, SD = 4.1) who were followed through a neurology clinic at a tertiary care hospital. Several cutoff scores were examined, with the goal of maximizing positive predictive (accurate detection of failure on the TOMM) and negative predictive (accurate detection of passing the TOMM) values. Every participant who scored ≥36 on Trial 1 (n = 50) went on to pass the TOMM. This study is the first step in providing evidence that performance on Trial 1 might be used as a quick screening measure of overall performance on the TOMM in children and adolescents. Further research on this topic is warranted.