Tele-assessment of cognitive functions in children: a systematic review

Executive functions as predictors of learning prerequisites in preschool: A longitudinal study

INTRODUCTION

This study focuses on 'learning prerequisites', cognitive and non-cognitive skills crucial for school success, often measured in preschoolers. Executive Functions (EF), like inhibition and cognitive flexibility, are vital among these prerequisites. While EF's role in early literacy and numeracy is acknowledged, some components are often overlooked.

OBJECTIVE

The study aims to longitudinally explore the link between EF, assessed at the beginning of the preschool year and the learning prerequites, measured at the end of the same preschool year.

METHOD AND RESULTS

Evaluating 70 preschoolers (62.30 months, SD 4.55), results showed that certain EF measures predicted performance in literacy and numeracy tasks. Specifically, response inhibition predicted rhyme and syllable recognition, series completion, and cognitive flexibility predicted rhyme recognition. Moreover, EF, particularly response inhibition, correlated with overall metaphonology and pre-math abilities.

CONCLUSION

The findings suggest the importance of integrating EF enhancement in early educational interventions, aiding in selecting and optimizing EF skills crucial for later academic success.

Guidelines and best practices for assessing young children remotely

Given the recent rise in the use of remote assessments to collect data from young children, researchers and practitioners would benefit from guidance on best practices within the field. Based on our experiences with assessing over 600 preschoolers remotely, our research team provides a set of main principles to guide professionals to successfully create and operationalize systems for remote assessment. Guidelines include detailed information about how to choose a technology platform, select and use online assessments, and how to adapt traditional tasks for remote use. We also note the challenges inherent in using certain types of tasks, provide tips for scheduling remote sessions, and offer advice for how to promote children's engagement throughout the assessment process.

Semantic fluency in 3-6 years old preschoolers: which executive functions?

Semantic Fluency (SF) increases with age, along with the lexicon and the strategies to access it. Among the cognitive processes involved in controlling lexical access, Executive Functions (EF) play an essential role. Nevertheless, which EF, namely inhibition, working memory, and cognitive flexibility, are specifically tapped by SF during preschool years, when these basic EF components are developing and differentiating, is still unknown. The study had a two-fold aim: 1. to analyze in preschoolers the role of EF basic components on SF; 2. to investigate if EF mediated the effect of age on SF. A total of 296 typically developing preschoolers (M age = 57.86; SD = 9.91; month range = 33-74) were assessed with an SF task and EF tasks measuring the main EF basic components. Results showed that during preschool, response inhibition, working memory, and cognitive flexibility were significant predictors of SF, explaining 27% of its variance. Moreover, the effect of age on the SF task performance correlated with the improvement of these EF components. This study supports the importance of considering cognitive control processes in 3-6 year-old preschoolers as they underline important competencies for the child's development, such as the ability to quickly access vocabulary.

Chronotype, Time of Day, and Children's Cognitive Performance in Remote Neuropsychological Assessment

Research on the influence of chronotype and time of day (TOD) on cognitive performance, especially in children, is limited. We explored potential interactive effects, hypothesizing that performance differs when comparing preferred vs. non-preferred TOD. In total, 76 morning-type (MT = 37) or evening-type (ET = 39) children from the third and fourth grades (48.7% girls; M age = 8.05; SD age = 0.51), identified through the Children Chronotype Questionnaire, completed two 30-min neuropsychological assessment sessions via videoconference on the first (9:00) or last hour (16:00) of the school day. The protocol included neuropsychological tests targeting memory, language, and attention/executive domains. The results revealed an interactive effect of medium size between chronotype and TOD on a Rapid Alternating Stimulus (Naming) Task. MT and ET performed faster in asynchrony conditions (morning for ET; afternoon for MT). Additionally, ET outperformed MT in a Backward Digit Span Task, irrespective of TOD. TOD also influenced performance on an Alternating Verbal Fluency Task, with both MT and ET children performing better in the morning. These results underscore the importance of chronotype and TOD in children's cognitive performance, particularly in working memory and verbal fluency. Children assessed during non-preferred TOD exhibited better performance on some cognitive tasks, challenging the assumption that optimal times always yield superior results.

The Use of Telepractice to Administer Norm-Referenced Communication and Cognition Assessments in Children With Hearing Loss: A Rapid Review

PURPOSE

Telepractice administration of norm-referenced assessments of communication and cognition is relatively new, and evidence to support this practice for children with hearing loss is limited. This rapid review examines the validity, reliability, feasibility, and common features of telepractice-administered norm-referenced assessments of communication and cognition for children with hearing loss to determine whether results via telepractice-administration are usable.

METHOD

This rapid review was conducted in accordance with the Cochrane Collaboration Rapid Reviews Methods Group recommendations. Rayyan software was used for initial and full-text screening, and the Quality Assessment of Diagnostic Accuracy Studies was used to measure study quality.

RESULTS

Electronic databases searches identified two studies that met the eligibility criteria. The findings of this rapid review provide some evidence to indicate that results of norm-referenced assessments do not differ depending on test administration conditions or hearing group status. Although both studies were of sufficient quality, replicability of these studies is uncertain due to the limited description of telepractice administration procedures. Participants indicated that sound levels provided by inbuilt computer speakers were adequate for them to be able to participate in telepractice assessment.

CONCLUSION

Telepractice administration of the norm-referenced assessments in the included studies may be valid, reliable, and feasible; however, the generalizability of these findings to other norm-referenced assessments is uncertain due to the limited amount of research.

Comparing remote versus in-person assessment of learning skills in children with specific learning disabilities

Background

Interactive telemedicine applications have been progressively introduced in the assessment of cognitive and literacy skills. However, there is still a lack of research focusing on the validity of this methodology for the neuropsychological assessment of children with Specific Learning Disorder (SLD).

Methods

Seventy-nine children including 40 typically developing children (18 males, age 11.5 ± 1.06) and 39 children with SLD (24 males, age 12.3 ± 1.28) were recruited. Each participant underwent the same neuropsychological battery assessing reading accuracy, speed, and comprehension, writing, numerical processing, computation, and semantic numerical sense, twice (once during an in-person session (I) and once during a remote (R) home-based videoconference session). Four groups were subsequently defined based on the administration order. Repeated-measure-ANOVAs with assessment type (R vs. I testing) as within-subject factor and diagnosis (SLD vs. TR) and administration order (R-I vs. I-R) as between-subject factors, and between-group t-tests comparing the two assessment types within each time of administration, were run.

Results

No differences emerged between I and R assessments of reading accuracy and speed, numerical processing, and computation; on the contrary, potential biases against R assessment emerged when evaluating skills in writing, reading comprehension, and semantic numerical sense. However, regardless of the assessment type, the scores obtained with I and R assessments within the same administration time point overlapped.

Discussion

These results partially support the validity and reliability of the assessment of children's learning skills via a remote home-based videoconferencing system. Implementing telemedicine as an assessment tool may increase timely access to primary health care and to support research activity.

Cognitive pediatric tele-assessment: a scoping review

Cognitive tele-assessment (CTA) adoption has increased considerably recently, in parallel with the maturation of the digital technologies that enable it, and the push to move assessment to the online format during the COVID-19 pandemic in 2019. This mode of assessment stems from remote assessment applications that originated in general tele-medicine, where it was typically used for patient screening as part of an intervention. The development of remote tele-medicine was later adapted for CTA in adult populations in tele-neuropsychiatry and tele-psychology and is increasingly applied in experimental research in cognitive science research with adult and pediatric populations, and for remote academic assessment. Compared to in-person assessment, CTA offers advantages such as decreasing time and logistic costs and facilitating the assessment of remote or special needs populations. However, given the novelty of CTA, its technical, methodological, and ethical issues remain poorly understood, especially in cases where methods for assessment of adults are used in pediatric populations. In the current paper, we provide a scoping review on the evolution of remote tele-assessment from the years 2000 to 2021, to identify its main themes, methodologies, and applications, and then focus on the issues of assessment in pediatric populations. Finally, we present recommendations on how to address the challenges previously mentioned.

Clinical utility of teleneuropsychology among pediatric patients with broadly average and low intellectual functioning

The reliability of teleneuropsychology (teleNP) within pediatric populations, particularly those with low intellectual functioning (LIF; i.e., Intellectual Quotient <80), is largely unknown. This repeated-measures study compared performance on WISC-V and WAIS-IV subtests administered in-person before the COVID-19 pandemic and via teleNP during the pandemic in individuals with LIF versus broadly average (BA) intellectual functioning in a clinically referred pediatric cohort. Data were collected from a retrospective chart review of 35 pediatric patients who underwent in-person neuropsychological evaluation at an academic medical center before the pandemic (Mage = 10.10 years, SD = 2.93) and videoconference teleNP assessment during the pandemic (Mage = 13.47 years, SD = 2.88). Participants completed the Similarities, Matrix Reasoning, and Digit Span subtests from the WISC-V or WAIS-IV at both time points. After controlling for test-retest time interval, partial correlations showed relatively strong associations in test-retest performance across subtests in the whole sample and among the subset of LIF patients. Distribution of significant reliable change indices (RCI) between the LIF and BA groups were similar. Strong correlations were observed between performances on select Wechsler subtests administered in-person and via teleNP. Results lend initial support toward the utility of teleNP administration of these measures in children with a broad range of intellectual functioning.

Tele-Assessment of Oral Personal Narratives in Arabic- and Hebrew-Speaking Children Using the Global TALES Protocol

INTRODUCTION

Tele-assessment (TA) has the potential to enhance access to speech therapy. This preliminary study aimed to investigate the impact of assessment mode (face-to-face [FTF] vs. TA) on the microstructure level and chosen topics of personal narratives produced by Arabic-speaking and Hebrew-speaking school-age children living in Israel. We also investigated whether performance variations, if evident, could be attributed to the children's language/culture.

METHODS

Eighty-nine 10-year-old children, 38 Arabic-speaking and 51 Hebrew-speaking, living in Israel, participated in this study. Forty participants were assigned to a TA group (via Zoom) and 49 to a FTF group. All participants were assessed using the Global TALES protocol, generating six personal narratives each. The narratives were analyzed regarding the following microstructural measures: total number of words, total number of utterances (TNU), number of different words, and mean length of utterance in words (MLU-W). Additionally, each narrative was categorized into a topic according to the Global TALES protocol.

RESULTS

The analysis revealed no significant main effect of assessment mode on any of the microstructure measures. However, a significant interaction effect between language/culture and assessment mode was found for TNU and MLU-W, with a significant main effect for TNU exclusively in the Arabic narratives, with the Arabic-speaking children producing more utterances through FTF compared to TA. Across language/culture groups, there was a significant effect of assessment mode on the chosen topic. Additionally, there were significantly higher scores in the Hebrew compared to the Arabic narratives in all microstructure measures, and language/culture also influenced the chosen topics.

CONCLUSIONS

The results support the feasibility of TA mode for assessing personal narratives in school-aged children, using the Global TALES protocol. However, the results also suggest that TA results may be affected by the language/culture of the narrator. Finally, the findings highlight the potential influence of TA on the chosen topics of personal narratives, perhaps due to a decrease in the quality of communication in TA.

A realist review of digitally delivered child development assessment and screening tools: Psychometrics and considerations for future use

BACKGROUND

Developmental screening improves the detection of developmental concerns, yet numerous children are not screened/assessed. Remote child developmental tool administration has been utilized to increase screening and assessment accessibility.

METHOD

We conducted a realist review to: (1) identify existing multi-domain child development assessment and screening tools for children 0-5 years; (2) review psychometric data on their digital (i.e., only administered remotely) administration; and (3) explore contextual factors relevant to their digital administration. We searched APA PsycInfo, MEDLINE, CINAHL, and ERIC to identify tools and papers on their psychometrics. We reference-searched included articles and searched Google for relevant grey literature.

RESULTS

Of 33 multi-domain child development tools identified in objective one, five tools (in five studies) were delivered digitally and compared to traditional (e.g., paper) delivery (i.e., objective two). Studies evaluated within-group equivalence reliability (k = 2) and between-group equivalence (k = 3). Within-group equivalence reliability was established for the Vineland Adaptive Behavior Scales, and domains (e.g., gross motor) of the Ages and Stages Questionnaires 2nd edition (ASQ-2) and Revised Prescreening Denver Questionnaire (R-PDQ). Between group equivalence was demonstrated for Developmental Neuropsychological Assessment, 2nd Edition (NEPSY-II) subtests and Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3) items. In another between group evaluation, web-based and paper versions of the ASQ-2 were deemed generally equivalent. Digital Bayley-3 inter-observer reliability ranged from 0.82 to 1.0. Examiner support, time, tool modifications, family resources, and comfort promotion supported digital administration.

CONCLUSION

Digitally delivered ASQ-2, R-PDQ, Vineland, and Bayley-3 and NEPSY-II components show promise for equivalence with traditional administration.