Testing Our Children When the World Shuts Down: Analyzing Recommendations for Adapted Tele-Assessment during COVID-19

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.

The Experiences of Australian School Mental Health Professionals during COVID-19 Lockdowns

Young people have emerged as one of the most impacted groups from the COVID-19 pandemic and related restrictions to daily activities, with disruptions to schooling, social interactions, and connections. Simultaneously, students' access to school mental health professionals were restricted or modified. The aim of this paper was to identify how school mental health professionals supported and addressed the mental health needs of young people during COVID-19 restrictions in Australia. School mental health professionals were surveyed during the 2020 lockdowns using a questionnaire designed by researchers in the United States of America. The innovations school mental health staff adopted to support students during lockdowns and remote learning were presented, including telehealth services, digital resources, and the online training and support they received/provided. The barriers and facilitators to providing counselling and assessment services during lockdowns were identified, including issues with providing psychometric assessments during remote learning, and ethical concerns when delivering remote counselling to students. Recommendations have been included, which address how school mental health professionals could be supported to assess and treat young people during future pandemics and school restrictions.

Remote Assessment: Origins, Benefits, and Concerns

Although guidelines surrounding COVID-19 have relaxed and school-aged students are no longer required to wear masks and social distance in schools, we have become, as a nation and as a society, more comfortable working from home, learning online, and using technology as a platform to communicate ubiquitously across ecological environments. In the school psychology community, we have also become more familiar with assessing students virtually, but at what cost? While there is research suggesting score equivalency between virtual and in-person assessment, score equivalency alone is not sufficient to validate a measure or an adaptation thereof. Furthermore, the majority of psychological measures on the market are normed for in-person administration. In this paper, we will not only review the pitfalls of reliability and validity but will also unpack the ethics of remote assessment as an equitable practice.

A systematic review of the use of telehealth to facilitate a diagnosis for children with developmental concerns

BACKGROUND

Telehealth can reduce the gap between developmental concern and diagnosis. Evaluation of telehealth methods is needed for providers to make decisions about using telediagnostic assessments.

AIM

This systematic review examined telehealth in facilitating a diagnosis for children with developmental concerns and assessed 1) study characteristics and type of diagnostic evaluation; 2) comparison of telehealth technologies to in-person diagnostic methods; 3) feasibility and acceptability of telehealth technologies; and 4) methodological quality.

METHOD AND PROCEDURES

Peer-reviewed studies from PsycINFO, CINAHL, Web of Science, PubMed, Embase, and Cochrane published January 2000-July 2021 were searched using "telehealth" AND "developmental concern" AND "diagnosis". Data extraction included study characteristics, diagnostic evaluation, technology, diagnostic accuracy, feasibility, and acceptability. Methodological quality was assessed using NHLBI tools.

OUTCOMES AND RESULTS

Nine studies met inclusion. Children with suspected FAS, social-emotional concerns, suspected genetic conditions, and failed hearing screenings received a telediagnosis. Evaluations included dysmorphology, feeding, neurological, developmental, audiological, and psychiatric. Seven studies used videoconferencing in real-time and two used Store-and-Forward methods. High diagnostic agreement occurred between face-to-face and remote methods. Stakeholders reported high satisfaction and feasibility. Many of the studies were rated as fair quality.

CONCLUSIONS AND IMPLICATIONS

Findings underscore partnership models between local providers and remote specialists. Rigorous study designs with larger samples covering a wider range of developmental domains are needed to provide a stronger empirical base for providers.

Online Administration of the Test of Narrative Language-Second Edition: Psychometrics and Considerations for Remote Assessment

PURPOSE

Our aim was to evaluate the psychometric properties of the online administered format of the Test of Narrative Language-Second Edition (TNL-2; Gillam & Pearson, 2017), given the importance of assessing children's narrative ability and considerable absence of psychometric studies of spoken language assessments administered online.

METHOD

The TNL-2 was administered to 357 school-age children at risk for language and literacy difficulties as part of a randomized controlled trial, across three annual cohorts, at three time points (pretest, posttest, and 5-month follow-up). Cohort 3 students were tested using an online format at posttest and at follow-up. We compared the Cronbach's alpha internal consistency reliability of the TNL-2 online testing scores with in-person scores from TNL-2 normative data and Cohort 3 in-person testing at pretest, and interrater reliability for Cohort 3 across test points. In addition, we examined measurement invariance across test occasions and the criterion validity of the TNL-2, the latter based on its correlations with narrative sample measures (Mean Length of Utterance in words and the Monitoring Indicators of Scholarly Language rubric).

RESULTS

Internal consistency reliability, interrater reliability, and measurement invariance analyses of the online and in-person administration of the TNL-2 yielded similar outcomes. The criterion validity of the TNL-2 was found to be good.

CONCLUSIONS

TNL-2 psychometric properties from online administration were generally in the good range and were not significantly different from in-person testing. When administered online using standardized procedures, the TNL-2 is valid and reliable for use in assessing narrative language proficiency in school-age children at risk for language and learning difficulties.

Can the Rorschach be Administered Remotely? A Review of Options and a Pilot Study Using a Newly Developed R-PAS App

The ongoing COVID-19 pandemic has required psychologists to adopt measures like physical distancing and mask wearing, though other safety procedures such as travel restrictions or prohibitions on in-person practice and research have fostered the use of tele-health tools. In this article, we review options for using the Rorschach task via videoconference and provide preliminary data from using a new electronic app for remote R-PAS administration to determine whether the remote administration in an electronic form yields different information than in-person administration with the cards in hand. As a pilot study, our focus is on the "first factor" of all Rorschach scores, i.e., complexity. Data were collected from 60 adult Italian community volunteers, and statistical analyses evaluated the extent to which the average complexity score significantly departed from R-PAS normative expectations (SS = 100), accompanied by Bayesian likelihoods for supporting the null hypothesis. Results suggest that the general level of complexity shown by the test-takers when administered the Rorschach remotely with the new R-PAS app closely resembles that previously observed using "standard" in-person procedures. Tentative analyses of other R-PAS scores suggested normative departures that could be due to the effects of the app, testing at home, or responses to the pandemic. We offer recommendations for future research and discuss practical implications.

Feasibility and Initial Efficacy of an Adapted Telepractice Listening Comprehension Intervention for School-Aged Children with Autism

This study evaluates the feasibility and initial efficacy of an 11-week listening comprehension intervention, Building Vocabulary and Early Reading Strategies (BVERS) that was delivered remotely to 14 elementary-aged children with autism spectrum disorder. Children were randomly assigned to one of two groups: BVERS only, or BVERS with a parent instructional component (BVERS + PC). Results indicate that the intervention was feasible to implement. All parents were satisfied with intervention implementation, and 8 of 10 stated that they were satisfied with their child’s outcomes following the intervention. Results of a Wilcoxon signed-rank test showed growth in listening comprehension following the intervention, but no growth in narrative retell or vocabulary. There were no group differences in change scores from pre- to post-test.

Conducting oral and written language adapted tele-assessments with early elementary-age children with autism spectrum disorder

BACKGROUND AND AIMS

Due to the COVID-19 pandemic, tele-health has gained popularity for both providing services and delivering assessments to children with disabilities. In this manuscript, we discuss the process of collecting standardized oral language, reading, and writing tele-assessment data with early elementary children with autism spectrum disorder (ASD) and offer preliminary findings related to child and parent engagement and technology issues.

METHODS

The data presented are from pretest assessments during an efficacy study examining the electronic delivery of a listening comprehension intervention for children with ASD. Pretest sessions included a battery of standardized language, reading, and writing assessments, conducted over Zoom. The authors operationalized and developed a behavioral codebook of three overarching behavioral categories (parent involvement, child disengagement, and technology issues). Researchers coded videos offline to record frequencies of indicated behaviors across participants and assessment subtests.

RESULTS

Involvement from parents accounted for the highest number of codes. Children showed some disengagement during assessment sessions. Technology issues were minimal. Behavioral categories appeared overall limited but varied across participants and assessments.

CONCLUSIONS

Parent involvement behaviors made up approximately two-thirds of the coded behaviors. Child disengagement behaviors made up approximately one-fourth of the coded behaviors, and these behaviors occurred more frequently across many different participants (with lower frequencies but greater coverage across children). Technology problems specific to responding to assessment items were relatively uncommon.

IMPLICATIONS

Clear guidelines including assessment preparation, modification of directions, and guidelines for parents who remain present are among the implications discussed. We also provide practical implications for continued successful adapted tele-assessments for children with ASD.

Meeting the COVID-19 Deadlines: Choosing Assessments to Determine Eligibility

Timely identification of children with disabilities is required by federal special education law (Individuals with Disabilities Education Improvement Act, 20 U.S.C. § 1400, 2004). During COVID-19, school psychologists have been faced with the challenge of completing valid, comprehensive, and diagnostic assessments when traditional methods are not an option. Traditional methods of testing have become nearly impossible due to social distancing requirements; therefore, alternate methods need to be considered. These alternate methods may be unfamiliar to the practitioner and/or lack validation to use with confidence. This study offers a prospective guide to help practitioners make safe and valid test selection and interpretation decisions during a pandemic. Examples of assessments analyzed using this guide are provided for the reader. In addition, a case study is provided as an example.

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

Cognitive Tele-Assessment approach (CTA) has been widely used in adults for clinical, research, and screening purposes. In the last decades, it has been considered a useful tool for evaluating child development in both clinical and educational settings and new instruments for CTA in children have been developed. In comparison to In Person Assessment (IPA), CTA can have several advantages, such as increasing accessibility, cutting waiting lists, reducing time and travel costs, and assisting with infection control by minimizing face-to-face contact in times of pandemic. Nevertheless, several issues related to the feasibility and reliability of using CTA to evaluate cognitive development are still open. The present systematic review has a twofold aim: 1. to describe the cognitive functions that are most frequently measured by CTA in children, the procedures used, and the characteristics of the samples investigated; 2. to investigate the agreement between CTA and IPA scores in children.In the present systematic review, 23 studies using CTA in children, with typical or atypical development, have been selected and analyzed. Results support the similarities in performance scores between IPA and CTA and good compliance by children and their families in participating in CTA. Nonetheless, most studies suggest that several methodological precautions must be taken to manage technical and procedural characteristics that may represent challenges for CTA of children. Suggestions for a correct use of CTA, factors affecting the validity of the results and directions for future research are discussed.

Operating a University Counseling and School Psychology Training Clinic in a Global Pandemic

The COVID-19 global pandemic has shaken the status quo including the way university counseling and assessment centers provide training to graduate students and psychological services to the community. The pandemic brought high levels of uncertainty and contradictory telehealth guidelines across organizations. Guidelines related to telehealth assessment services were especially challenging to navigate. Center directors worked collaboratively with faculty and campus leadership to follow best practices and mitigate training and service disruptions to the best of their ability. The tension created by the pandemic offered an opportunity for centers to challenge long-standing practices, experiment with new practices, and ultimately enhance their programs. This paper offers reflections on our experiences in following best practice guidelines for telehealth counseling and psychoeducational assessment service delivery within a university counseling and diagnostic training center. Training considerations for directors and faculty affiliated with counseling and diagnostic training centers are provided.