Neuropsychology reports for childhood brain tumor survivors: implementation of recommendations at home and school

Experiences of patients, parents, and healthcare professionals in the process of transitioning from hospital to community after inpatient pediatric rehabilitation among children with special health care needs

PURPOSE

Children with Special Health Care Needs (CSHCN) may experience disruptions in education due to extended hospitalizations. The purpose of this study was to describe how CSHCN experience educational supports during inpatient rehabilitation and identify the ongoing challenges when planning to return to school.

MATERIALS AND METHODS

Semi-structured focus groups were conducted with parents (n = 12), former patients (n = 20), and rehabilitation professionals (n = 8).

RESULTS

Through qualitative thematic analysis based on descriptive phenomenology, we developed three themes: 1) Inpatient educational support such as instruction and schoolwork helped reduce the learning loss during hospitalization. However, these supports were sometimes complicated by lags in school approvals and challenges in coordination between systems. 2) Transition planning involved establishing necessary services to support CSHCN's educational and healthcare needs at school re-entry. However, families reported limited information and guidance as key barriers. 3) Dynamic courses of school re-entry required continued support after discharge. The participants recommended that reassessment and adjustment of transition plans were often necessary to account for evolving developmental and educational needs but were not always received.

CONCLUSIONS

There is an ongoing need to improve communication between clinicians and educators, information for families, and long-term follow-up on the changing educational needs for CSHCN after rehabilitation.

Impact of text difficulty and visual emphasis on pediatric neuropsychological evaluation reports: The parent's perspective

Objective: Despite varying opinions, little research has examined how to best write pediatric neuropsychology reports. Method: This study gathered input from 230 parents on how text difficulty (reading level) and visual emphasis (bullets, underline, italics) affect report readability and utility. We focused on the most-read report section: summary/impressions. Each parent rated the readability and usefulness of a generic summary/impressions section written in four different styles. The four styles crossed text difficulty (high school-vs-collegiate) with use of visual emphasis (absent-vs-present). Results: Parents found versions with easier text to be more clearly written, easier to follow, and easier to find information (p<.001). Parents rated those with harder text to be overly detailed, complex, hard to understand, and hard to read (p<.001). Visual emphasis made it easier to find key information and the text easier to follow and understand - but primarily for versions that were written in difficult text (interaction p≤.026). After rating all four styles, parents picked their preference. They most often picked versions written in easier text with visual emphasis (p<.001). Conclusions: Findings support writing styles that use easier text difficulty and visual emphasis.

Teacher Perspectives of Pediatric Neuropsychology and Supporting Children With Chronic Health Conditions

OBJECTIVE

The goal of the present study was to examine teachers' perceptions of neuropsychological reports broadly and their preparedness to support the educational needs of students with chronic health conditions.

METHOD

Teachers were selected from across the United States using stratified random sampling. 280 teachers (76.2% female; 58.4% public school; 53.9% rural setting) completed an anonymous electronic survey via Qualtrics.

RESULTS

Half of the teachers were familiar with neuropsychology and previously read a neuropsychological report, which the majority found useful with a preference toward shorter reports. Most found listed recommendations to be appropriate, but half of teachers identified limited resources as a barrier to implementation. Teachers reported limited education, training, and comfort for providing accommodations to children with chronic health conditions, which was significantly lower for cancer, congenital heart disease, and sickle cell disease. Older teachers, more years of experience, and special education teachers demonstrated significantly higher levels of education, training, and comfort. Frequency of implementing accommodations was significantly negatively correlated with perceived burden and positively correlated with perceived benefit across most accommodations. Teachers reported a preference for single-page handouts and speaking directly to neuropsychologists about the specific learning needs of students with chronic health conditions.

CONCLUSIONS

Results highlight areas for future research and intervention regarding teacher's preparedness for working with children with chronic health groups and opportunities to improve communication between neuropsychologists and teachers to ultimately improve access to educational supports and overall quality of life of students with chronic health conditions.

Integrative review of school integration support following pediatric cancer

PURPOSE

This study aims to understand parents' experiences of school integration support for their child's transition to K-12 schooling during or after cancer treatment.

METHODS

This integrative literature review used PubMed, CINAHL, PsycINFO, and Embase databases and included articles from January 2000 to July 2022 describing parent experiences with support from healthcare providers, school faculty/systems, and school integration programs. This review was guided by an adapted School Re-Entry Model and used constant comparison to identify common themes and guide synthesis. The Johns Hopkins Evidence and Quality Guide was used to appraise article quality and level of evidence.

RESULTS

Thirty-five articles were included in the final review: seventeen qualitative, fourteen quantitative, and four mixed or multi-method designs. Parents reported experiences receiving support from healthcare providers, school faculty/systems, school integration programs, and "other" sources. Parents reported both facilitators and barriers to communication, knowledge, and the process of receiving school integration support.

CONCLUSIONS

Parents found neuro/psychologists highly supportive but reported limited support from other healthcare providers. Most parents reported mixed experiences with school faculty and reported many barriers to school system support. Parents reported positive experiences with school integration programs; however, limited programs were available.

IMPLICATIONS FOR CANCER SURVIVORS

Future programs and research should focus on addressing identified barriers and facilitators of school integration support. Further work is also needed to understand a wider range of parent experiences during school integration.

Tele-Neuropsychology: From Science to Policy to Practice

OBJECTIVE

The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t).

METHOD

We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access.

RESULTS

The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology.

CONCLUSIONS

More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access.

School psychologists' perceptions of the effectiveness of neuropsychological evaluation reports

Referral sources and parents value the report following a neuropsychological evaluation. Nevertheless, key stakeholders have described pediatric reports as excessive in length and jargon. Recent research indicates that it is possible to modify pediatric neuropsychological reports that result in positive outcomes for key stakeholders and clinicians. Evaluating modified pediatric neuropsychological reports for other providers is necessary. School psychologists are key stakeholders who read and interact with such reports. This study assessed school psychologists' perceptions of a modified pediatric neuropsychological report. Forty-one school psychologists were randomly assigned to read either a traditional or modified version of a pediatric report and provide feedback via survey and qualitative questions. Results revealed that school psychologists' perceptions of a traditional and modified report were not significantly different. Qualitatively, respondents noted a disconnect between recommendations and school systems. These findings suggest that pediatric neuropsychologists can create shorter and more easily understood reports that do not impact the effectiveness for school psychologists. Future research should continue to evaluate perceptions of modified pediatric neuropsychological reports for additional key stakeholders. A better understanding of the disconnect between recommendations and their feasibility in schools, as well as barriers to increased interdisciplinary collaboration, is also essential for client care.

Improved parent self-efficacy following pediatric evaluation: Evidence for value of a telemedicine approach in psychological and neuropsychological assessment

Objective: While considerable inquiry is currently underway into the comparability of psychological test results obtained in onsite/in-person settings versus telemedicine settings, there has been less attention given to the comparability of the impact/outcome of the assessment process across settings. The current quality improvement study conceptualized impact/outcome according to the model of Austin et al. and sought to determine whether the prior finding of increased parent self-efficacy following onsite neuropsychological assessment was also observed when psychological and neuropsychological assessment was conducted via a telemedicine modality. Method: In the course of standard care delivery, ratings from Austin et al.'s four parent self-efficacy items were obtained at time 1 prior to patients' assessment visits and then again at time 2 either (1) following their last assessment/feedback visit (the Complete Assessment group; n = 157) or (2) in the middle of the assessment process prior to the last planned visit (the Incomplete Assessment group; n = 117). Results: Analyses revealed significant findings for time and time × group. Parent self-efficacy ratings improved over time in both groups, with significantly higher ratings in the Complete Assessment group at time 2. When compared to reference means from the in-person/onsite Austin et al. study, ratings from the current study found comparable improvement in parent self-efficacy achieved via telemedicine assessment in the Complete Assessment group. Conclusions: These data support the use of telemedicine based psychological and neuropsychological evaluation and provide preliminary evidence that the impact/outcome is comparable with in-person/onsite assessment.

The Entity of Cerebellar Mutism Syndrome: A Narrative Review Centered on the Etiology, Diagnostics, Prevention, and Therapeutic Options

Cerebellar mutism syndrome (CMS), also known as posterior fossa syndrome, is an entity that entails a constellation of signs and symptoms which are recorded in a limited number of pediatric patients who have been operated on mainly for tumors involving the posterior cranial fossa, and more precisely, the region of the vermis. Medulloblastoma seems to constitute the most commonly recognized pathological substrate, associated with this entity. The most prevalent constituents of this syndrome are noted to be a, often transient, although protracted, language impairment, emotional lability, along with cerebellar and brainstem dysfunction. Apart from that, a definite proportion of involved individuals are affected by irreversible neurological defects and long-lasting neurocognitive impairment. A bulk of literature and evidence based on clinical trials exist, which reflect the continuous effort of the scientific community to highlight all perspectives of this complex phenomenon. There are several circumstances that intervene in our effort to delineate the divergent parameters that constitute the spectrum of this syndrome. In summary, this is implicated by the fact that inconsistent nomenclature, poorly defined diagnostic criteria, and uncertainty regarding risk factors and etiology are all constituents of a non-well-investigated syndrome. Currently, a preliminary consensus exists about the identification of a group of diagnostic prerequisites that are managed as sine qua non, in our aim to document the diagnosis of CMS. These include language impairment and emotional lability, as proposed by the international Board of the Posterior Fossa Society in their consensus statement. It is common concept that midline tumor location, diagnosis of medulloblastoma, younger age at diagnosis, and preoperatively established language impairment should be accepted as the most determinant predisposing conditions for the establishment of this syndrome. A well-recognized pathophysiological explanation of CMS includes disruption of the cerebellar outflow tracts, the cerebellar nuclei, and their efferent projections through the superior cerebellar peduncle. Despite the relative advancement that is recorded regarding the diagnostic section of this disease, no corresponding encouraging results are reported, regarding the available treatment options. On the contrary, it is mainly targeted toward the symptomatic relief of the affected individuals. The basic tenet of our review is centered on the presentation of a report that is dedicated to the definition of CMS etiology, diagnosis, risk factors, clinical presentation, and clinical management. Apart from that, an effort is made that attempts to elucidate the paramount priorities of the scientific forum, which are directed toward the expansion our knowledge in the era of diagnostics, prevention, and therapeutic options for patients suffering from CM, or who are at risk for development of this syndrome.

Cognitive performance of medulloblastoma tumour survivors related to the area of cerebellum damage

Background

The aim of the study was to determine the relationship between a damaged cerebellum area and the cognitive performance of medulloblastoma tumour survivors. Also, age-based differences in cognitive performance were tested.

Materials and methods

Magnetic resonance imaging (MRI) technique was used to obtain brain images of survivors. The cognitive performance was tested using Wechsler Intelligence Scale for Children Revised (WISC-R) and Wechsler Adult Intelligence Scale (WAIS). Statistical analysis was performed with highly robust permutation tests.

Results

There were two anatomical features strongly influencing the cognitive performance of survivors. The extension of the foramen of Luschka had a negative impact on the overall verbal IQ score and some non-verbal scales while the excision of the middle part of the vermis influenced scores in such scales as arithmetic and picture completing.

Conclusions

Children with postoperative damages in the area of the middle part of the vermis are more likely to suffer from cognitive dysfunctions after the end of the treatment.

Lessons Learned: Achieving Consensus About Learning Disability Assessment and Diagnosis

The current paper describes the process used for developing the Guidelines for Diagnosis and Assessment of Children, Adolescents, and Adults with Learning Disabilities-Consensus Statement and Supporting Documents, and the rationale for some of the decisions. The guidelines were developed by a cross-sectoral working group of psychologists who achieved a consensus on the criteria for diagnosis and the assessment process. We outline key features of the guidelines, describe topics where the group achieved consensus quickly and topics for which there was considerable debate (e.g., intelligence testing, ability/achievement discrepancy, and processing deficits). The group members shared information with each other about topics such as the advantages of early assessment, the importance of formally assessing effort and motivation, and assessment of culturally and linguistically diverse individuals. We conclude with the lessons learned and professional challenges regarding contextual influences on LD assessment and diagnosis and dissemination of research to practitioners.

Factors that Influence Follow-Up Care for Families of Children with Acquired Brain Injury: A Scoping Review

PURPOSE

To describe factors that contribute to medical/rehabilitation service access following pediatric acquired brain injury (ABI) and identify gaps in the literature to guide future research.

MATERIALS & METHODS

The PRISMA framework for scoping reviews guided this process. Peer-reviewed journal databases were searched for articles published between 1/2008 and 12/2020, identifying 400 unique articles. For full inclusion, articles had to examine a variable related to the receipt or initiation of medical/rehabilitative services for children with ABI. Review articles and non-English articles were excluded.

RESULTS

Nine studies met full inclusion criteria. Included studies identified factors focused on four primary areas: understanding brain injury education/recommendations and ease of implementing recommendations, ease of scheduling and attending appointments, age/injury factors, and sociocultural factors. Well-scheduled appointments and simple strategies facilitated families' access to care and implementation of recommendations. An overwhelming number of recommendations, socioeconomic variables, and transportation challenges served as barriers for families and schools.

CONCLUSIONS

This scoping review offers several directions on which researchers can build to improve access to care and recommendation-implementation for families who have a child with an ABI. Enhanced understanding of these factors may lead to better service access, reduction of unmet needs, and enhanced long-term outcomes for children with ABI.

Educational Pain Points for Pediatric Brain Tumor Survivors: Review of Risks and Remedies

Evolving treatment paradigms have led to increased survival rates for children diagnosed with a brain tumor, and this has increasingly shifted clinical and research focus to morbidity and quality of life among survivors. Among unfavorable outcomes, survivors of pediatric brain tumors are at risk for academic failure and low educational attainment, which may then contribute to lower health related quality of life, lower income and vocational status, and a greater likelihood of dependence on others in adulthood. Several specific risk factors for lower educational performance and attainment have been investigated. These are typically examined in isolation from one another which clouds understanding of the full range and potential interplay of contributors to educational difficulties. This review integrates and summarizes what is known about the direct and indirect barriers to educational success and performance (i.e., educational pain points) to enhance clinician knowledge of factors to consider when working with pediatric brain tumor survivors. Specific barriers to educational success include neurocognitive difficulties, school absences, psychosocial challenges, challenges to knowledge and communication, and physical and sensory difficulties. Finally, we discuss the current state of educational interventions and supports and offer recommendations for future research to improve educational outcomes for pediatric brain tumor survivors.

I could have used a lot more help than I had: A qualitative systematic review and synthesis of families' experiences of paediatric brain tumour and schooling

BACKGROUND

Brain tumours are the most common and fatal of all solid tumours for children and adolescents. The effects of the tumour and treatment (chemotherapy, radiation, and/or surgery) results in significant disruptions to childhood development and large amounts of missed schooling. Among other challenges for families, this produces obstacles for children and adolescents to achieve and maintain academic performance and experience positive schooling encounters.

AIMS

We thus aimed to systematically identify and synthesize qualitative evidence on how families experience paediatric brain tumour from diagnosis and beyond with regards to their schooling and education to identify gaps in service delivery, research, and policy.

METHODS

A protocol for this review was registered with PROSPERO (ID: CRD42020177165). Searches were conducted in Medline, CINAHL, PsycInfo, Embase, and Web of Science, and yielded 22 eligible papers (representing 17 studies). Data were extracted into NVivo12 and analysed by qualitative description.

RESULTS

We formed the following domain summaries: academic (perceived failure to keep up with peers and finding success where one could, the importance of encouragement for diagnosed children), social (the importance of friendships and the harm of bullying), and support (the defining factor in overall return-to-school experience, often not enough received from educational professionals and clinicians). Our review highlights the need for more comprehensive, individualized, and integrated support for diagnosed children to return to educational institutions, and for the need to address their social experiences, particularly with regards to bullying, potentially through a school-wide social and emotional learning approach.

CONCLUSION

Funding support, evidence-based guidelines, staff skill development, and clear communication structures across families, health care facilities, schools, and educational departments are essential to achieving this.

Neuropsychological assessment in pediatric oncology survivorship care: utilization of services, results of evaluation, and educational and behavioral health outcomes

PURPOSE

Neuropsychological evaluation has become a standard component of long-term follow-up care for survivors of pediatric cancer. The purpose of the present study was to examine access to, and benefits of, neuropsychological evaluation for survivors.

METHODS

A retrospective chart review was conducted on cancer survivors who were referred for neuropsychological evaluation from a multidisciplinary long-term follow-up (LTFU) clinic approximately 5 years following treatment cessation. Descriptive statistics were calculated, and t-tests and chi-square analyses were utilized to examine variables that may impact survivors' access to neuropsychological services.

RESULTS

One hundred seven survivors between 6 and 26 years old were referred for a neuropsychological evaluation. Referred male patients were less likely than female patients to schedule an evaluation. Consultation with a neuropsychologist in the LTFU clinic was related to more referrals but did not improve attrition rates (55%). Twenty-four percent of evaluated patients displayed severe cognitive impairment and 75% were diagnosed with a psychological disorder. Utilization of educational and behavioral health services did not significantly change following evaluation.

CONCLUSION

Survivors' utilization of neuropsychological services is lower for males than females. The presence of a neuropsychologist in a multidisciplinary team clinic can improve identification of survivors that may benefit from neuropsychological evaluation. Many survivors did not receive recommended services, suggesting patients and families may need additional supports following evaluation. Future research should focus on improving survivors' access to neuropsychological services and identifying barriers to receiving recommended services.

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

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.

Families' experiences of child and adolescent brain tumor: A systematic review and synthesis of qualitative research

OBJECTIVES

Brain tumors are the most common and fatal of all solid tumors for children and adolescents; those who survive live with long-term physical and emotional consequences, as do their families. We aimed to synthesize relevant qualitative evidence on families' experiences and psychosocial service needs across the lifespan to identify gaps in care delivery and research.

METHODS

Searches were conducted in Medline, CINAHL, PsycInfo, Embase, and Web of Science. Identified papers were assessed with the Joanna Briggs Institute Critical Appraisal Tool. Data were extracted into NVivo12 and analyzed by qualitative description and, where appropriate, thematic analysis.

RESULTS

The search yielded 628 papers, of which 40 (33 studies) were eligible (6%). Although the methodological quality of the papers was low, we identified concerns that were consistently reported over time and from different perspectives. Individual family members had varying psychosocial needs to be addressed within healthcare, schooling, and public policy. These include for survivor's mental health (particularly for body image), and to the disproportionate biopsychosocial burden faced by mother-caregivers.

CONCLUSIONS

Addressing the biological aspects of brain tumor cannot be our only focus. We have an obligation to provide services that meet the needs of families across diagnosis, treatment, survivorship, palliative care, and bereavement.

A Scoping Review of Communicating Neuropsychological Test Results to Patients and Family Members

Feedback of neuropsychological test results to patients and family members include psychoeducation and implications for daily life. This scoping review aimed to provide an overview of the literature on neuropsychological feedback and to offer clinical recommendations. In accordance with formal scoping review methodology, PubMed, PsycInfo, Web of Science, CINAHL, and Embase databases were searched. Studies were included if they reported on neuropsychological feedback, if full papers were available, and if they included human participants. All languages were included, and no limit was placed on the year of publication. Of the 2,173 records screened, 34 publications met the inclusion criteria. Five additional publications were included after cross-referencing. An update of the search led to the inclusion of two additional papers. Of these 41 publications, 26 were research papers. Neuropsychological feedback is provided for a wide spectrum of diagnoses and usually given in-person and has been related to optimal a positive effect on patient outcomes (e.g. increase the quality of life). Most papers reported on satisfaction and found that satisfaction with an NPA increased when useful feedback was provided. However, information retention was found to be low, but communication aids, such as written information, were found to be helpful in improving retention. The current review demonstrated the benefits of neuropsychological feedback and that this should be part of standard clinical procedures when conducting a neuropsychological assessment. Further research on the benefits of neuropsychological feedback and how to improve information provision would enrich the neuropsychological literature.

[Formula: see text]Parent perceptions of pediatric neuropsychological evaluations: a systematic review

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.

Outcomes of pediatric neuropsychological services: A systematic review

OBJECTIVE

The primary aim of this project was to apply systematic review methods to synthesize the literature on outcomes of pediatric neuropsychological services. The secondary aim was to use the results of the systematic review to identify gaps in the extant literature and describe priorities for future research. Method: We identified the relevant studies using a rigorous search strategy, collected data on methodological variables, assessed the risk of bias in the studies, summarized findings by topic and subtopic areas, identified strengths and weaknesses of the literature, and provided recommendations for future research. The outcomes measured were satisfaction, changes in resource or strategy utilization, and changes in symptoms or functioning (i.e. changes in child emotional, behavioral, cognitive, or academic problems, parent stress, or family functioning). Results: The final sources of data were 26 records, pertaining to a total of 974 children who received neuropsychological services. Parents were generally satisfied with services and reported high clinician empathy and increased level of knowledge, based on the evaluation. However, they reported less often that the neuropsychologist provided actual help. Informal home and school-based strategies were implemented more often than other types of recommendations. The research on changes in child symptoms and functioning was limited, but suggests improvements. Conclusions: This is the first systematic review of outcomes of pediatric neuropsychological services. Larger studies involving data collection at multiple time points are needed in order to further clarify mechanisms leading to outcomes and potential targets for improving them.

Barriers to Schooling in Survivorship: The Role of Neuropsychological Assessment

PURPOSE

Pediatric cancer survivorship rates continue to improve, although disease- and treatment-related neurocognitive impacts substantively affect survivors' educational access and availability for learning. Receiving formal educational supports substantially improves survivors' academic progress and graduation rates; however, parents of survivors report obtaining such support is stressful, in part due to limited knowledge on their part and that of their oncology providers.

METHODS

Parents (N = 195) of pediatric survivors across the United States were surveyed to explore specific barriers to obtaining appropriate educational supports and the facilitating role of the oncologist.

RESULTS

Parent-reported barriers included limited access to formal educational supports, under-referral to neuropsychology services, and need for more information about available supports and how best to advocate for these, when needed. Not only were few survivors (35.4%) referred for neuropsychological evaluation, standard of care for many pediatric survivors, but survivors were more than five times more likely to be retained in grade compared with the national retention rate. When obtained, parents reported that the neuropsychological consultation and associated report were helpful in increasing their own understanding and addressing barriers to obtaining adequate supports for their children.

CONCLUSION

Given the important role of neuropsychological evaluation for survivors and their families, bringing referral rates more in line with national guidelines represents a critical target for oncologists. With adequate training in relevant issues, the oncologist is positioned to be a key support to survivors and their families in ensuring access to neuropsychological services and reducing barriers to an appropriate education.

Long-term cognitive deficits in pediatric low-grade glioma (LGG) survivors reflect pretreatment conditions-report from the German LGG studies

Background

Disease and treatment contribute to cognitive late effects following pediatric low-grade glioma (LGG). We analyzed prospectively collected neuropsychological data of German pediatric LGG survivors and focused on the impact of hydrocephalus at diagnosis, neurofibromatosis type 1 (NF1) status, and extent of surgery.

Methods

We used the Neuropsychological Basic Diagnostic screening tool based on the Cattell-Horn-Carroll model for intelligence and the concept of cross-battery assessment at 2 and 5 years from diagnosis for 316 patients from the German pediatric LGG study and LGG registry (7.1 years median age; 45 NF1; cerebral hemispheres 16%, supratentorial midline 39%, infratentorial 45%). Hydrocephalus was classified radiologically in 137 non-NF1 patients with infratentorial tumors (95/137 complete/subtotal resection).

Results

Patients with NF1 versus non-NF1 exhibited inferior verbal short-term memory and visual processing (P < .001-.021). In non-NF1 patients, infratentorial tumor site and complete/subtotal resection were associated with sequelae in visual processing, psychomotor speed, and processing speed (P < .001-.008). Non-NF1 patients without surgical tumor reduction and/or nonsurgical treatment experienced similar deficits. Degree of hydrocephalus at diagnosis had no further impact. Psychomotor and processing speed were impaired comparably following chemo-/radiotherapy (P < .001-.021). Pretreatment factors such as NF1 or tumor site were relevant at multivariate analysis.

Conclusions

All pediatric LGG survivors are at risk to experience long-term cognitive impairments in various domains. Even surgical only management of cerebellar LGG or no treatment at all, that is, biopsy only/radiological diagnosis did not protect cognitive function. Since pattern and extent of deficits are crucial to tailor rehabilitation, neuropsychological and quality of survival assessments should be mandatory in future LGG trials.

Perspectives on neuropsychology and clinical care in paediatric and adolescent medicine

As a child and adolescent neuropsychology service based within a paediatric psychology team at a large teaching hospital, we meet children and young people across the age range who experience cognitive impairment as a result of long-term health conditions or traumatic brain injury. We have a remit of providing a neuropsychological assessment and report. Typically, a neuropsychology report includes recommendations for home and for school. However, research suggests that their uptake is variable and depends on the understanding and resources of families and school systems. As a stretched service, we have very limited capacity to follow the work through to the extent that we might like. Therefore, we are always seeking effective ways to support the ongoing adaptation and implementation of the assessment recommendations in the child's various day-to-day contexts. We address both the cognitive functioning and the psychological well-being of the child as a unified whole. Drawing on systemic ideas influences our communications with children, families, schools and the medical teams in ways which help bridge the gap between hospital-based assessment and everyday life. This article describes how we are integrating our systemic and neurodevelopmental perspectives to make the assessment and the findings a meaningful intervention in themselves. We consider ways of sharing neuropsychology findings which promote the child's psychological well-being in their different contexts: hospital, home, school, community and culture.

Post-operative cerebellar mutism syndrome: rehabilitation issues

INTRODUCTION

Tumors of the cerebellum are the most common brain tumors in children. Modern treatment and aggressive surgery have improved the overall survival. Consequently, growing numbers of survivors are at high risk for developing adverse and long-term neurological deficits including deficits of cognition, behavior, speech, and language. Post-operative cerebellar mutism syndrome (pCMS) is a well-known and frequently occurring complication of cerebellar tumor surgery in children. In the acute stage, children with pCMS may show deterioration of cerebellar motor function as well as pyramidal and cranial neuropathies. Most debilitating is the mutism or the severe reduction of speech and a range of neurobehavioral symptoms that may occur. In the long term, children that recover from pCMS continue to have more motor, behavioral, and cognitive problems than children who did not develop pCMS after cerebellar tumor surgery. The severity of these long-term sequelae seems to be related to the length of the mute phase.

AIM OF THIS NARRATIVE REVIEW

The impact of pCMS on patients and families cannot be overstated. This contribution aims to discuss the present knowledge on the natural course, recovery, and rehabilitation of children with pCMS. We suggest future priorities in developing rehabilitation programs in order to improve the long-term quality of life and participation of children after cerebellar tumor surgery and after pCMS in particular.

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.

Bridging gaps in care for children with acquired brain injury: Perceptions of medical and educational service providers

PURPOSE

Significant gaps in service delivery for children with acquired brain injury exist between healthcare and educational systems, such as the lack of coordinated efforts to transfer rehabilitation strategies to school settings. This paper attempts to address these issues and offer recommendations to bridge these gaps in care.

METHODS

The American Congress of Rehabilitation Medicine (ACRM), Brain Injury-Interdisciplinary Special Interest Group (BI-ISIG), Pediatric-Adolescent Task Force constructed and disseminated a survey to medical rehabilitation (N= 44) and education professionals (N= 40). Responses were analyzed quantitatively and qualitatively, achieving > 85% inter-coder reliability.

RESULTS

Results highlighted differences between groups in methods for seeking new information, opinions on advocacy needs, and differing priorities given to various resources.

CONCLUSIONS

These discrepancies have important implications for improved collaboration needed for assuring an appropriate continuum of service for this population. Recommendations include: 1) providing education and training regarding brain injury in the most cost-effective ways utilizing technology that crosses the barriers identified and reaches people in multiple settings; 2) direct and active communication between medical and educational professionals; and 3) developing an interdisciplinary Community of Practice to help bridge medical rehabilitation and school systems.

Concordance of parent-, teacher- and self-report ratings on the Conners 3 in adolescent survivors of cancer

Survivors of childhood cancer are at risk for attention problems. The objectives of this study were to assess concordance between parent-, teacher-, and self-report ratings on a measure of attention (Conners Rating Scales, 3rd ed.; Conners, 2008) in adolescent survivors of childhood cancer and to examine associations with a performance-based task. The Conners 3 was completed by 80 survivors of pediatric cancer (39 brain tumor, 41 acute lymphoblastic leukemia; ages 12–17; at least 1 year posttreatment; 51.3% male) as well as their parents and 1 teacher. In addition, survivors completed a continuous performance test. Parents and teachers demonstrated moderate agreement on most subscales; however, agreement was weaker than would be expected based on the normative sample. Agreement between self- and proxy ratings was more variable. The strongest associations for all raters were observed on the Learning Problems subscale. There were significant mean differences between parent and teacher ratings, with parents reporting more problems across subscales. Only self-ratings of Inattention were significantly associated with the continuous performance test (omission errors). Agreement across raters in assessment of attentional functioning in adolescent survivors of childhood cancer is modest. Findings support the need to obtain multiple ratings of behavior, including both proxy- and self-report, when assessing youth with cancer, particularly adolescents.

A Qualitative Synthesis of Families' and Students' Hospital-to-School Transition Experiences Following Acquired Brain Injury

Acquired brain injury (ABI) is one of the greatest causes of death and disability among children in Canada. Following ABI, children are required to transition back to school and adapt to the physical, cognitive, behavioral, social, and emotional demands of the school environment. We conducted a qualitative systematic review of students' and parents' experiences of the transition back to school following ABI. We identified 20 articles that met our inclusion criteria. Six themes emerged: (a) lack of ABI-specific education for families and professionals, (b) communication-related factors as a facilitator and/or barrier to transition, (c) emotional focus, (d) peer relationships, (e) supports, and (f) ABI sequelae in the classroom. Students' and families' personal motivations and abilities and the support they receive in their environment affect their experiences of transitioning back to school and the disrupted occupations they face.