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Gallant C, Good D. Examining the role of neuropsychology in community-based pediatric mental health care. APPLIED NEUROPSYCHOLOGY: CHILD 2022; 12:104-121. [PMID: 35184633 DOI: 10.1080/21622965.2022.2038169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Numerous investigations have demonstrated a link between neuropsychological functioning and mental health. Children with a history of neurological compromise are more vulnerable to mental illness and there is a growing literature indicating that neurocognitive functioning predicts psychosocial outcomes in adulthood. However, not much is known about how neuropsychological information is utilized in community-based mental health care. Thus, we examined what neuropsychological information is available to pediatric centers and how neuropsychological functioning relates to treatment outcomes in these settings. Two content analyses were conducted to identify mental health indicators across different intake sources and these results were compared to a structured intake. Further, a series of standardized neurocognitive and neuroemotional measures were completed and these indices were correlated with treatment outcomes. Qualitative results confirmed that neuropsychological factors are often overlooked when utilizing current approaches and that observable symptoms are a primary focus of treatment. Additionally, neurocognitive deficits were associated with self-reported interpersonal difficulties and caregivers' reports of externalizing; however, only caregiver-reported externalizing challenges correlated with treatment outcomes. Importantly, neurocognitive challenges were associated with long-term treatment responses, suggesting that these factors may be an important therapeutic target. Collectively, these findings indicate a need to incorporate neuropsychological factors in pediatric mental health treatment.
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Affiliation(s)
- Caitlyn Gallant
- Department of Psychology, Brock University, St. Catharines, Canada
| | - Dawn Good
- Department of Psychology, Brock University, St. Catharines, Canada
- Centre for Neuroscience, Brock University, St. Catharines, Canada
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Medeiros NB, Fogliatto FS, Rocha MK, Tortorella GL. Forecasting the length-of-stay of pediatric patients in hospitals: a scoping review. BMC Health Serv Res 2021; 21:938. [PMID: 34496862 PMCID: PMC8428133 DOI: 10.1186/s12913-021-06912-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare management faces complex challenges in allocating hospital resources, and predicting patients' length-of-stay (LOS) is critical in effectively managing those resources. This work aims to map approaches used to forecast the LOS of Pediatric Patients in Hospitals (LOS-P) and patients' populations and environments used to develop the models. METHODS Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) methodology, we performed a scoping review that identified 28 studies and analyzed them. The search was conducted on four databases (Science Direct, Scopus, Web of Science, and Medline). The identification of relevant studies was structured around three axes related to the research questions: (i) forecast models, (ii) hospital length-of-stay, and (iii) pediatric patients. Two authors carried out all stages to ensure the reliability of the review process. Articles that passed the initial screening had their data charted on a spreadsheet. Methods reported in the literature were classified according to the stage in which they are used in the modeling process: (i) pre-processing of data, (ii) variable selection, and (iii) cross-validation. RESULTS Forecasting models are most often applied to newborn patients and, consequently, in neonatal intensive care units. Regression analysis is the most widely used modeling approach; techniques associated with Machine Learning are still incipient and primarily used in emergency departments to model patients in specific situations. CONCLUSIONS The studies' main benefits include informing family members about the patient's expected discharge date and enabling hospital resources' allocation and planning. Main research gaps are associated with the lack of generalization of forecasting models and limited reported applicability in hospital management. This study also provides a practical guide to LOS-P forecasting methods and a future research agenda.
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Affiliation(s)
- Natália B Medeiros
- Department of Industrial Engineering, Universidade Federal do Rio Grande do Sul, Av. Osvaldo Aranha, 99, 5° andar, Porto Alegre, 90035-190, Brazil
| | - Flavio S Fogliatto
- Department of Industrial Engineering, Universidade Federal do Rio Grande do Sul, Av. Osvaldo Aranha, 99, 5° andar, Porto Alegre, 90035-190, Brazil.
| | - Miriam K Rocha
- Center of Engineering, Universidade Federal do Semi-Árido, Rua Francisco Mota Bairro, 572 - Pres. Costa e Silva, Mossoró, RN, 59625-900, Brazil
| | - Guilherme L Tortorella
- Department of Mechanical Engineering, The University of Melbourne, Melbourne, Australia.,IAE Business School, Universidad Austral, Buenos Aires, Argentina.,Department of Industrial Engineering, Universidade Federal de Santa Catarina, Campus Universitário Reitor João David Ferreira Lima, s/n°, Florianópolis, SC, 88040-900, Brazil
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Kavanaugh BC, Cancilliere MK, Fryc A, Tirrell E, Oliveira J, Oberman LM, Wexler BE, Carpenter LL, Spirito A. Measurement of executive functioning with the National Institute of Health Toolbox and the association to anxiety/depressive symptomatology in childhood/adolescence. Child Neuropsychol 2020; 26:754-769. [PMID: 31876232 PMCID: PMC10629577 DOI: 10.1080/09297049.2019.1708295] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Despite preliminary research, there remain inconsistent findings with regard to the role of executive functioning (EF) deficits in childhood anxiety and depression. This report examined the association of The National Institute of Health (NIH) Toolbox to clinical neuropsychological measures and to childhood, anxiety/depressive symptomatology. Methods: One-hundred eight children and adolescents completed the three EF measures from the NIH Toolbox (List Sorting Working Memory Test [LSWMT], Dimensional Change Card Sorting Test [DCCST], and Flanker Test of Attention and Inhibition [Flanker]) in an outpatient neuropsychology program. These tests were compared to established measures of EF in terms of linear correlations and detection of impairment. Heaton's Global Deficit Score (GDS) was utilized to calculate impairment. The Toolbox-EF measures were paired with parent-reported EF symptoms (Behavior Rating Inventory of Executive Function [BRIEF2]) to identify the role of EF in childhood anxiety/depressive symptomatology. RESULTS Toolbox-EF measures displayed medium sized correlations with their clinically comparable counterparts, and generally did not differ in their detection of impairment. Toolbox-GDS was associated with depression diagnosis and clinically significant child-reported anxiety and depressive symptoms. Together, Toolbox/BRIEF2 accounted for 26.8-30.9% of elevated depressive symptom variance, but only 13.2-14% of elevated anxiety symptom variance. Further, EF impairment was associated with depression across self report, parent report, and clinical diagnosis. DISCUSSION The NIH Toolbox-EF measures display comparable psychometric properties to clinically available EF measures in a pediatric (primarily psychiatric) neuropsychology setting. The Toolbox appears to display an appropriate ability to detect EF deficits secondary to self-reported depression in childhood.
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Affiliation(s)
- Brian C. Kavanaugh
- Department of Psychiatry & Human Behavior, Emma Pendleton Bradley Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Alexa Fryc
- Department of Psychology, University of Rhode Island, South Kingstown, RI, USA
| | - Eric Tirrell
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA
| | - Jane Oliveira
- Department of Psychiatry & Human Behavior, Emma Pendleton Bradley Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Lindsay M. Oberman
- Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA
| | - Bruce E. Wexler
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Linda L. Carpenter
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Gervasio M, Beatty A, Kavanaugh B, Cancilliere MK, Holler K. The association between neurocognition and sexual abuse within a children's psychiatric inpatient program. Clin Neuropsychol 2020; 36:189-206. [PMID: 32613898 DOI: 10.1080/13854046.2020.1781932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: The aim of this study was to understand the detrimental effects of sexual abuse on neuropsychological variables including child's intelligence, executive functioning (EF), and learning/memory within a pediatric inpatient population.Method: This study examined the effect of sexual abuse on children's intelligence, EF, and learning/memory by conducting a retrospective chart review for 144 children (aged 7-12) who completed a neuropsychological assessment during a psychiatric inpatient hospitalization. Of the 144 children, participants were matched two to one by gender and age, with one group (n = 52) categorized by reported sexual abuse and the other group (n = 92) categorized by no reported sexual abuse. The neuropsychological measures included the Wechsler Abbreviated Scale of Intelligence (WASI-I/II) or Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), Wide Range Assessment of Memory and Learning - Second Edition (WRAML-2): Story Memory Immediate/Delayed Recall and Delayed Recognition, Trail Making Test-B, Stroop Interference Test: Color-Word Condition, WRAML-2: Sentence Memory and Conners Continuous Performance Test-Second Edition.Results: Statistical analysis showed that participants with reported sexual abuse had significantly (p< .05) lower intelligence, EF, and learning/memory skills than those without reported sexual abuse. Only working memory and cognitive flexibility differences remained after controlling for clinical variables (e.g., PTSD, amount of total abuse types).Conclusions: These findings contributed to the limited research on the detrimental effects of sexual abuse in a pediatric inpatient population. They demonstrated a relationship between early sexual abuse and neuropsychological deficits, specifically executive function and IQ deficits.
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Affiliation(s)
- Maddi Gervasio
- Department of Psychiatry & Human Behavior, E. P. Bradley Hospital, East Providence, RI, USA
| | - Avery Beatty
- Department of Human Development and Family Studies, University of Rhode Island, Kingston, RI, USA
| | - Brian Kavanaugh
- Department of Psychiatry & Human Behavior, E. P. Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, East Providence, RI, USA
| | | | - Karen Holler
- Department of Psychiatry & Human Behavior, E. P. Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, East Providence, RI, USA
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