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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Development of a Neuropsychological Service Pathway for School-Age Neonatal Follow Up: a Feasibility Pilot
Tricia S Williams1,2, Marin M Taylor1, Rivka R Green1
1Department of Psychology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
Insights
A new tiered assessment protocol for pediatric neuropsychology is feasible and acceptable to families. Screening measures effectively predicted consultation outcomes and intellectual functioning, improving efficiency in care.
Area of Science:
- Neuropsychology
- Pediatric Neurology
- Developmental Psychology
Background:
- Neuropsychological care is crucial for children with neonatal brain conditions, aiding learning and psychosocial development.
- Traditional assessments are time-consuming and resource-intensive, necessitating innovative and efficient methods.
- A need exists for precise and efficient assessment models in pediatric neuropsychology.
Purpose of the Study:
- To evaluate the feasibility and acceptability of a novel tiered assessment protocol for pediatric neuropsychological care.
- To determine the preliminary predictive validity of screening measures within this protocol.
- To optimize learning and psychosocial growth in children with neonatal brain conditions.
Main Methods:
- A tiered protocol involving consultation, psychoeducation, screening measures (cognition, learning, well-being), and virtual 1:1 consultation was co-designed with family advisors.
- Children aged 4-18 years and their caregivers were referred for evaluation.
- Outcomes included in-person testing, deferred assessment, or discharge, based on collaborative discussion; inter-clinician reliability and caregiver feedback were assessed.
Main Results:
- High response rate (94%) and completion rates (86.7%) indicate protocol feasibility and acceptability.
- Screening measures demonstrated predictive validity for consultation outcomes and child full-scale intellectual IQ (FSIQ).
- Inter-clinician agreement on outcomes was strong (90%), and caregiver feedback was positive regarding helpfulness and timeliness.
Conclusions:
- The tiered assessment protocol is a feasible, acceptable, and efficient approach to pediatric neuropsychological evaluation.
- Screening measures effectively predict outcomes, supporting precise and timely interventions.
- Integrating caregiver-partners in the evaluation process is vital for optimizing neuropsychological care pathways.
Objective:
Neuropsychological care benefits children with neonatal brain conditions by monitoring brain health and directing supports to optimize learning and psychosocial growth. Conventional assessments often are time and resource intensive; innovative, precise, and efficient assessment models are needed. This study examined 1) feasibility and acceptability of a tiered assessment protocol and 2) preliminary predictive validity of screening measures.
Method:
Children aged 4-18 years and their caregivers were referred for neuropsychological evaluation. A tiered protocol was co-designed with family advisors and included 3 steps: 1) invitation to consultation, including psychoeducation; 2) screening measures of cognition, learning, and well-being; and 3) virtual 1:1 consultation with a neuropsychologist/fellow. Collaborative caregiver-clinician discussion led to a) in-person testing, b) deferred assessment, or c) discharge. A portion (22%) of cases were reviewed independently to assess inter-clinician reliability. Caregiver feedback was gathered via survey. Multiple linear regression models assessed relationships between screening measures and 1) consultation outcome, and 2) child full scale intellectual IQ scores (FSIQ).
Results:
Of 104 families invited to participate, 98 (94%) responded: 9 (9.2%) declined services and 85 (86.7%) completed screening measures and consultation. After consultation, 50 (59%) proceeded to in-person testing, 17 (20%) deferred assessment, and 18 (21%) were discharged. Inter-clinician agreement on consultation outcome was strong (90%). Caregiver feedback reflected protocol feasibility and acceptability; comments described helpfulness of monitoring, and timeliness of process. Screening measures predicted outcomes of consultation and child FSIQ.
Conclusions:
Results illustrate importance of evaluating neuropsychological pathways with precision, efficiency and caregiver-partners in mind.
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