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Schwartzman JM, Williams ZJ, Molnar AE. Parent and Provider Differences in Ratings of Mental Health and Neurodevelopmental Concerns in Children with Neurologic Disorders. J Clin Psychol Med Settings 2024:10.1007/s10880-023-09990-0. [PMID: 38400951 DOI: 10.1007/s10880-023-09990-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/26/2024]
Abstract
Children with neurologic disorders face increased risks for mental health and neurodevelopmental conditions, with information often limited to parent report. To better understand mental health and neurodevelopmental needs in this population, a retrospective chart review of a convenience sample of children with neurologic disorders referred for a neuropsychological evaluation was conducted in the present study to explore interrater agreement between care team members (referring providers, parents, pediatric neuropsychologist). Qualitative and quantitative data were collected from the evaluation reports of 129 youth (9:0-17:11 years old; 51.2% of female sex) with neurologic disorders (i.e., 38.0% traumatic brain injury, 27.1% epilepsy, 14.7% premature birth, 7.8% pediatric cancer, 3.9% prenatal substance exposure, and 14.7% other) who completed an evaluation in 2019. Over half the youth were flagged for unmet neurodevelopmental and mental health concerns and analyses revealed low interrater agreement for mental health concerns (κ = .324), better agreement for neurodevelopmental concerns (κ = .511), and low sensitivity of referring providers (Se = .326) and parents (Se = .366). One-way analyses of variance uncovered important factors (e.g., symptom severity, adaptive skills) that may account for missed concerns. Findings guide recommendations to strengthen methods for understanding mental health and/or neurodevelopmental concerns in children with neurologic disorders.
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Affiliation(s)
- Jessica M Schwartzman
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- Division of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, 3250 Wilshire Blvd, Los Angeles, CA, 90010, USA.
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2200, Nashville, TN, 37212, USA.
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN, 37240, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - Andrew E Molnar
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2200, Nashville, TN, 37212, USA
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Cárdenas EF, Hill KE, Estes E, Ravi S, Molnar AE, Humphreys KL, Kujawa A. [Formula: see text] Neural and behavioral indicators of cognitive control in preschoolers with and without prenatal opioid exposure. Child Neuropsychol 2024; 30:329-347. [PMID: 37070372 PMCID: PMC11040227 DOI: 10.1080/09297049.2023.2196397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 03/21/2023] [Indexed: 04/19/2023]
Abstract
Prenatal opioid exposure is one consequence of the opioid epidemic, but effects on child development remain poorly understood. There is emerging evidence that children exposed to opioids in utero exhibit elevated emotional and behavioral problems, which may be partially due to alterations in cognitive control. Using multiple methods (i.e., neuropsychological, behavioral, and event-related potential [ERP] assessments), the present study examined differences in emotional, behavioral, and cognitive control difficulties in preschool-aged children with (n = 21) and without (n = 23) prenatal opioid exposure (Mage = 4.30, SD = 0.77 years). Child emotional and behavioral problems were measured with a caregiver questionnaire, indicators of cognitive control were measured using developmentally appropriate behavioral (i.e., delay discounting, Go/No-Go) and neuropsychological (i.e., Statue) tasks, and electroencephalogram was recorded to error and correct responses in a Go/No-Go task. ERP analyses focused on the error-related negativity (ERN), an ERP that reflects error monitoring, and correct-response negativity (CRN), a component reflecting performance monitoring more generally. Opioid exposure was associated with elevated difficulties across domains and a blunted ERN, reflecting altered cognitive control at the neural level, but groups did not significantly differ on behavioral measures of cognitive control. These result replicate prior studies indicating an association between prenatal opioid exposure and behavioral problems in preschool-aged children. Further, our findings suggest these differences may be partially due to children with prenatal opioid exposure exhibiting difficulties with cognitive control at the neural level. The ERN is a potential target for future research and intervention efforts to address the sequelae of prenatal opioid exposure.
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Affiliation(s)
- Emilia F. Cárdenas
- Vanderbilt University, Peabody College of Education and
Human Development, 2201 West End Avenue, Nashville, TN, USA 37203-5721
| | - Kaylin E. Hill
- Vanderbilt University, Peabody College of Education and
Human Development, 2201 West End Avenue, Nashville, TN, USA 37203-5721
| | - Elizabeth Estes
- Vanderbilt University, Peabody College of Education and
Human Development, 2201 West End Avenue, Nashville, TN, USA 37203-5721
- University of Michigan, School of Social Work, 1080 South
University Avenue Ann Arbor, MI, USA 48109-1106
| | - Sanjana Ravi
- Vanderbilt University, Peabody College of Education and
Human Development, 2201 West End Avenue, Nashville, TN, USA 37203-5721
| | - Andrew E. Molnar
- Vanderbilt University Medical Center, Psychiatry and
Behavioral Sciences, 1211 Medical Center Drive, Nashville, TN, USA 37232-2102
| | - Kathryn L. Humphreys
- Vanderbilt University, Peabody College of Education and
Human Development, 2201 West End Avenue, Nashville, TN, USA 37203-5721
| | - Autumn Kujawa
- Vanderbilt University, Peabody College of Education and
Human Development, 2201 West End Avenue, Nashville, TN, USA 37203-5721
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Berl MM, Koop JI, Ailion A, Bearden DJ, Boyer K, Cooper CM, Decrow AM, Duong PH, Espe-Pfeifer P, Gabriel M, Hodges E, Marshall DF, McNally KA, Molnar AE, Olsen EK, Ono KE, Patrick KE, Paul BM, Romain J, Sepeta LN, Stilp RLH, Wilkening GN, Zaccariello M, Zelko F, Perry MS. Leveraging expertise and optimizing clinical research: Initial success of a pediatric epilepsy surgery collaborative. Epilepsia 2023. [PMID: 36897767 DOI: 10.1111/epi.17579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE Improve data-driven research to inform clinical decision-making with pediatric epilepsy surgery patients by expanding the Pediatric Epilepsy Research Consortium Epilepsy Surgery (PERC-Surgery) Workgroup to include neuropsychological data. This article reports on the process and initial success of this effort and characterizes the cognitive functioning of the largest multi-site pediatric epilepsy surgery cohort in the United States. METHODS Pediatric neuropsychologists from 18 institutions completed surveys regarding neuropsychological practice and the impact of involvement in the collaborative. Neuropsychological data were entered through an online database. Descriptive analyses examined the survey responses and cognitive functioning of the cohort. Statistical analyses examined which patients were evaluated and if composite scores differed by domain, demographics, measures used, or epilepsy characteristics. RESULTS Positive impact of participation was evident by attendance, survey responses, and the neuropsychological data entry of 534 presurgical epilepsy patients. This cohort, ages 6 months to 21 years, were majority White and non-Hispanic, and more likely to have private insurance. Mean intelligence quotient (IQ) scores were below to low average, with weaknesses in working memory and processing speed. Full-scale IQ (FSIQ) was lowest for patients with younger age at seizure onset, daily seizures, and magnetic resonance imaging (MRI) abnormalities. SIGNIFICANCE We established a collaborative network and fundamental infrastructure to address questions outlined by the Epilepsy Research Benchmarks. There is a wide range in the age and IQ of patients considered for pediatric epilepsy surgery, yet it appears that social determinants of health impact access to care. Consistent with other national cohorts, this US cohort has a downward shift in IQ associated with seizure severity.
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Affiliation(s)
- Madison M Berl
- Department of Neuropsychology, Departments of Psychiatry and Behavioral Sciences, Children's Research Institute, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Jennifer I Koop
- Pediatric Neuropsychology, Children's Wisconsin, Medical College of Wisconsin Department of Neurology, Milwaukee, Wisconsin, USA
| | - Alyssa Ailion
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Donald J Bearden
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Katrina Boyer
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Crystal M Cooper
- Neurosciences Center, Cook Children's Medical Center, Jane and John Justin Institute for Mind Health, Fort Worth, Texas, USA
| | - Amanda M Decrow
- Division of Pediatric Psychology and Neuropsychology, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Priscilla H Duong
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Patricia Espe-Pfeifer
- Department of Psychiatry & Pediatrics, University of Iowa Hospitals and Clinics, Ames, Iowa, USA
| | - Marsha Gabriel
- Neurosciences Center, Cook Children's Medical Center, Jane and John Justin Institute for Mind Health, Fort Worth, Texas, USA
| | - Elise Hodges
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - David F Marshall
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelly A McNally
- Department of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Andrew E Molnar
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emily K Olsen
- Department of Pediatric Psychology, Oregon Health and Science University, Portland, Oregon, USA
| | - Kim E Ono
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kristina E Patrick
- Department of Neurology, Department of Neurosciences, Seattle Children's Hospital, University of Washington, Seattle, Washington, United States
| | - Brianna M Paul
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | | | - Leigh N Sepeta
- Department of Neuropsychology, Departments of Psychiatry and Behavioral Sciences, Children's Research Institute, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Rebecca L H Stilp
- Department of Pediatric Neurosurgery, Norton Neuroscience Institute, Louisville, Kentucky, USA
| | - Greta N Wilkening
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael Zaccariello
- Department of Psychiatry and Psychology, Division of Neurocognitive Disorders, Mayo Clinic, Rochester, Minnesota, USA
| | - Frank Zelko
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - M Scott Perry
- Neurosciences Center, Cook Children's Medical Center, Jane and John Justin Institute for Mind Health, Fort Worth, Texas, USA
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Boggs JE, Pullen A, Molnar AE, Hodges J, Reiss UM. Screening for inattention, hyperactivity and impulsivity in children with haemophilia: A quality improvement intervention. Haemophilia 2023; 29:210-218. [PMID: 36112768 DOI: 10.1111/hae.14656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/20/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Children with haemophilia have been reported with increased rates of inattention (IN) and hyperactivity/impulsivity (HI) and, therefore, are particularly vulnerable to poor social and academic outcomes. AIM To examine the benefit of utilizing a formal screening process for IN/HI in children with haemophilia during comprehensive clinic visits using a quality improvement approach. METHODS At a single haemophilia treatment centre, screening for psychosocial issues was expanded and formalised to include (1) the Conners 3rd Edition (Conners3) screening tool for IN/HI symptoms administered during the standard psychosocial assessment (SPA) by the social worker and school advocacy coordinator, (2) formal pathways to diagnosis and intervention as indicated including psychology consultation, psychological testing, or referral to community-based mental health professionals, and in-person advocacy assistance in the patient's community school. RESULTS Forty-four patients, age 9.9 ± 4.8 years (range 3-16) were targeted. The initial screening approach was modified to improve the communication with caretakers during assessments and streamline diagnostic pathways if no, moderate or significant behavioural concerns were identified. Eleven patients had pre-existing mental health diagnoses. Thirteen of the remaining 33 patients (39.4%) received a new mental health diagnosis, ADHD in 8/33 (24.2%). Of the total cohort, 54.5% were found to have a mental health diagnosis. The rate of ADHD (29.5%) was significantly higher than reported in the general population. CONCLUSION The described process, developed through a QI approach, allowed formal and objective screening for IN/HI, streamlined a pathway to diagnosis and intervention, and identified undiagnosed disabilities in children with haemophilia improving their access to services.
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Affiliation(s)
- Jacklyn E Boggs
- Department of Hematology, St. Jude Children's Research, Hospital, Memphis, Tennessee, USA
| | - Amanda Pullen
- Department of Social Work, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew E Molnar
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason Hodges
- Department of Hematology, St. Jude Children's Research, Hospital, Memphis, Tennessee, USA
| | - Ulrike M Reiss
- Department of Hematology, St. Jude Children's Research, Hospital, Memphis, Tennessee, USA
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Harman JL, Molnar AE, Jacola LM, Corr A, Scott A, Potter B, Schwartzberg S, Boyer H, Greear J, Willard VW. Establishing a hospital-based early intervention program for young children with cancer: A quality improvement initiative. Clinical Practice in Pediatric Psychology 2020. [DOI: 10.1037/cpp0000375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cox LE, Kenney AE, Harman JL, Jurbergs N, Molnar AE, Willard VW. Psychosocial Functioning of Young Children Treated for Cancer: Findings From a Clinical Sample. J Pediatr Oncol Nurs 2018; 36:17-23. [DOI: 10.1177/1043454218813905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Many pediatric cancers are diagnosed in early childhood, a time of significant growth and development that lays the foundations for overall adjustment and functioning. The objective of this article was to characterize the psychosocial functioning of young children with cancer. Method: Data from a sample of young children with cancer ( N = 92) who completed a psychological evaluation that included the Behavior Assessment Scale for Children–second edition (BASC-2) parent report were abstracted from the medical record. Patients were primarily White (70.7%), male (54.3%), and 4.81 ± 0.89 years old at evaluation. Most were treated for brain tumors (64.1%). Results: Overall group means on each of the BASC-2 subscales were within normal limits, though significantly more patients than expected had elevated scores on the Internalizing and Behavioral Symptoms indexes. Patients who were on-treatment had higher mean overall Internalizing Problems scores, as well as greater Anxiety and Somatization scores, than those who were off-treatment (Wilks’s λ = 0.75, p < .001). Patients treated for brain tumors had lower mean Activities of Daily Living scores than those with other diagnoses ( F = 15.81, p < .001). Conclusions: Findings from this clinically referred sample indicate that while most young children with cancer are doing well psychosocially, approximately 20% to 30% demonstrated difficulties in at least one area. Findings support the need for monitoring of young children with cancer as well as appropriate intervention services.
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Affiliation(s)
- Lauren E. Cox
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ansley E. Kenney
- St. Jude Children’s Research Hospital, Memphis, TN, USA
- University of Memphis, Memphis, TN, USA
| | | | - Niki Jurbergs
- St. Jude Children’s Research Hospital, Memphis, TN, USA
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Harman JL, Molnar AE, Cox LE, Jurbergs N, Russell KM, Wise J, Willard VW. Parent-reported executive functioning in young children treated for cancer. Child Neuropsychol 2018; 25:548-560. [DOI: 10.1080/09297049.2018.1503647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jennifer L. Harman
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Andrew E. Molnar
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Lauren E. Cox
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Niki Jurbergs
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kathryn M. Russell
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Jillian Wise
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Victoria W. Willard
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Molnar AE. Joel T. Nigg.What Causes ADHD? Understanding What Goes Wrong and Why. New York: Guilford Publications, 2006, 422 pp. ISBN 1-59385-297-3. $42.00 (hardcover). Dev Neuropsychol 2007. [DOI: 10.1080/87565640701361138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Molnar AE. The Amnesias: A Clinical Textbook of Memory Disorders. Dev Neuropsychol 2007. [DOI: 10.1080/87565640701190866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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