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Parent and Provider Differences in Ratings of Mental Health and Neurodevelopmental Concerns in Children with
Jessica M Schwartzman1,2,3, Zachary J Williams4,5,6,7,8, Andrew E Molnar9
1Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. jstrendlab@gmail.com.
Insights
Children with neurologic disorders often have unmet mental health and neurodevelopmental needs. Agreement on these concerns is low among care teams, highlighting a need for improved assessment methods.
Area of Science:
- Pediatric Neurology
- Neurodevelopmental Disorders
- Child Psychology
Background:
- Children with neurologic disorders have higher risks for mental health and neurodevelopmental conditions.
- Current understanding often relies heavily on parent reports, potentially limiting comprehensive assessment.
- Accurate identification of these needs is crucial for timely intervention and support.
Purpose of the Study:
- To investigate the agreement among referring providers, parents, and pediatric neuropsychologists regarding mental health and neurodevelopmental concerns in children with neurologic disorders.
- To identify factors contributing to discrepancies in identifying these concerns.
- To inform improved assessment strategies for this vulnerable population.
Main Methods:
- Retrospective chart review of 129 youth (ages 9-17) with various neurologic disorders who underwent neuropsychological evaluation.
- Collection of qualitative and quantitative data from evaluation reports.
- Analysis of interrater agreement using kappa statistics and sensitivity measures.
Main Results:
- Over half of the youth exhibited unmet neurodevelopmental and mental health concerns.
- Low interrater agreement was found for mental health concerns (κ = .324) and better, though moderate, agreement for neurodevelopmental concerns (κ = .511).
- Referring providers (Se = .326) and parents (Se = .366) showed low sensitivity in identifying concerns.
Conclusions:
- There is a significant gap in the agreement among care team members regarding the identification of mental health and neurodevelopmental needs in children with neurologic disorders.
- Factors such as symptom severity and adaptive skills may influence the identification of these concerns.
- Enhanced methods are recommended to improve the comprehensive understanding and assessment of mental health and neurodevelopmental issues in this population.
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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