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Neuropsychological assessment of attention in children with spina bifida
Anja Vinck1, Reinier Mullaart, Jan Rotteveel
1Department of Medical Psychology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands. a.vinck@mps.umcn.nl.
Insights
Attention deficits in children with spina bifida with myelomeningocele (SBM) are often overestimated by traditional tests. Computerized assessments, which minimize cognitive and motor demands, reveal fewer differences, suggesting these tests are more reliable for evaluating attention in SBM patients.
Area of Science:
- Neuroscience
- Pediatric Psychology
- Developmental Disabilities
Background:
- Children with severe spina bifida (SBM) often exhibit attention deficits and share psychological traits with children with hydrocephalus from other causes.
- The impact of cognitive and visual-motor impairments on attention assessments in SBM patients remains unclear.
Purpose of the Study:
- To analyze attention functions in children with SBM using two distinct types of attention tests.
- To differentiate attention abilities from cognitive and motor demands by employing tests with varying cognitive and motor requirements.
Main Methods:
- The study included 31 children with SBM and shunted hydrocephalus and 20 children with spina bifida only (SB-only) as a comparison group.
- Participants, aged 6–15 years, were evaluated using traditional and computerized tests assessing focused attention, sustained attention, encoding, and distractibility/impulsivity.
- Cognitive and visual-motor impairments were considered, with IQ scores above 70 for most participants.
Main Results:
- Children with SBM scored lower on traditional attention tests compared to the SB-only group.
- When cognitive and visual-motor demands were reduced by computerized tasks, most attention differences between the groups diminished.
- Computerized attention tests showed no significant correlation with IQ scores or visual-motor skills, unlike traditional tests.
Conclusions:
- Traditional tests may provide a misleading assessment of attention in children with SBM due to their difficulties with associated cognitive and visual-motor tasks.
- Utilizing both traditional and computerized attention tests is recommended to accurately assess attention functions and control for confounding factors in this population.
Background:
Children with the severe form of spina bifida (SBM: spina bifida with myelomeningocele with accompanying hydrocephalus) may manifest attention deficits, and have a similar psychological profile to children with hydrocephalus due to other etiologies. It is unclear to what extent tests to assess attention in SBM are confounded by the accompanying cognitive or visual-motor impairments. The aim of this study was to analyse attention functions by administering two different types of attention tests, one with high and the other with low cognitive and motor requirements. This enabled the possible interaction between attention and cognitive and motor impairment to be assessed.
Methods:
The study group comprised 31 children with SBM with shunted hydrocephalus. Twenty children with SB-only formed a closely matched comparison group. Of these, 19 children with SBM and 18 with SB had a full-scale IQ (FSIQ) higher than 70. All had undergone spinal surgery and all children with SBM had been shunted within the first months of life. Between 6 and 15 years of age, the children were assessed on focused and sustained attention, encoding, and distractibility/impulsivity, using both traditional tests and computerized attention tests.
Results:
Compared to the SB group, attention scores of children with SBM were lower on the traditional tests, but when interfering cognitive and visual-motor requirements were eliminated using the computerised tasks, most differences disappeared. Furthermore, in contrast to traditional attention tasks, computerized tests showed no significant correlations with IQ-scores and visual-motor skills.
Conclusion:
Assessment of attention functions in children with SBM by traditional tests may be misleading, because this paediatric population with complex cerebral malformations has difficulty with the cognitive and visual-motor requirements. To control for these interactions, the use of both traditional and computerized attention tests is recommended.
