The role of the Neuropsychologist across the stages of recovery from acquired brain injury: a summary from the pediatric rehabilitation Neuropsychology collaborative.

Neuropsychologists working in a pediatric neurorehabilitation setting provide care for children and adolescents with acquired brain injuries (ABI) and play a vital role on the interdisciplinary treatment team. This role draws on influences from the field of clinical neuropsychology and its pediatric subspecialty, as well as rehabilitation psychology. This combination of specialties is uniquely suited for working with ABI across the continuum of recovery. ABI recovery often involves a changing picture that spans across stages of recovery (e.g., disorders of consciousness, confusional state, acute cognitive impairment), where each stage presents with distinctive characteristics that warrant a specific evidence-based approach. Assessment and intervention are used reciprocally to inform diagnostics, treatment, and academic planning, and to support patient and family adjustment. Neuropsychologists work with the interdisciplinary teams to collect and integrate data related to brain injury recovery and use this data for treatment planning and clinical decision making. These approaches must often be adapted and adjusted in real time as patients recover, demanding a dynamic expertise that is currently not supported through formal training curriculum or practice guidelines. This paper outlines the roles and responsibilities of pediatric rehabilitation neuropsychologists across the stages of ABI recovery with the goal of increasing awareness in order to continue to develop and formalize this role.

Pediatric mTBI during the COVID-19 pandemic: considerations for evaluation and management.

The COVID-19 pandemic has changed healthcare utilization patterns and clinical practice, including pediatric mTBI evaluation and management. Providers treating pediatric mTBI, including neuropsychologists, have a unique role in evaluating and managing an already complex injury in the context of the COVID-19 pandemic with limited empirically based guidelines. In the present paper, we review usual, evidence-based pediatric mTBI care, highlight changes experienced by healthcare providers since the onset of the pandemic, and provide possible considerations and solutions. Three primary challenges to usual care are discussed, including changes to post-injury evaluation, management, and treatment of persistent symptoms. Changing patterns of healthcare utilization have created unique differences in mTBI identification and evaluation, including shifting injury frequency and mechanism, reluctance to seek healthcare, and increasing access to telemedicine. Typical injury management has been compromised by limited access to usual systems/activities (i.e., school, sports, social/leisure activities). Patients may be at higher risk for prolonged recovery due to pre-injury baseline elevations in acute and chronic stressors and reduced access to rehabilitative services targeting persistent symptoms. Considerations and solutions for addressing each of the three challenges are discussed. Neuropsychologists and other pediatric healthcare providers will need to continue to flexibly adapt to the changing needs of youth recovering from mTBI through the duration of the pandemic and beyond. Consistent with pre-pandemic consensus statements, neuropsychologists remain uniquely qualified to evaluate and manage mTBI and provide an increasingly integral role as members of multidisciplinary teams in the context of the global pandemic.Abbreviations: AAP: American Academy of Pediatrics; CDC: Centers for Disease Control and Prevention; COVID-19: coronavirus disease 19; ED: emergency department; mTBI: Mild traumatic brain injury.

Pediatric Teleneuropsychology: Feasibility and Recommendations.

OBJECTIVE: Teleneuropsychology (TeleNP) is a growing and promising practice within the telemedicine landscape that has been well established within the adult neuropsychology literature. This project aimed to demonstrate the feasibility of TeleNP in a pediatric clinical population and disseminate clinical decision-making procedures to guide best practices for pediatric TeleNP. METHOD: This project conducted during the 2019 coronavirus (COVID-19) pandemic reflects the largest clinical cohort to date of TeleNP in a pediatric population (N = 129). Data were gathered retrospectively from patients who were rescheduled from in-person assessment to TeleNP between March to June 2020. RESULTS: TeleNP was an accessible option for most patients and families, with no differences in demographic variables in patient appointment attendance, whether testing was conducted, and whether the patient was referred for face-to-face follow-up. Patients using laptops/desktops were more likely to undergo remote test administration in comparison with patients using phones/tablets (χ2 = 23.83, p < .002). Sixty-three percent of the sample were referred for a face-to-face follow-up assessment. CONCLUSIONS: TeleNP is feasible in a pediatric clinical population ranging to begin the process of differential diagnosis and treatment planning. Pediatric TeleNP may be most efficacious as a screening procedure due to limited measures suited for remote administration and behavioral challenges interfering with testing requiring in-person follow-up. TeleNP screening as standard practice for patients who do not require a full, traditional neuropsychological battery may provide a more efficient care model, with more patients able to be seen using shorter batteries with less wait time.

Test of variables of attention performance among ADHD children with credible vs. non-credible PVT performance.

The assessment of effort is a crucial step in the evaluation of children and adolescents who present with symptoms of an Attention-Deficit/Hyperactivity Disorder (ADHD). Studies with adults have found that a large percentage of individuals claiming to have ADHD fail performance validity measures. In children, failure on PVT measures is associated with lower scores on a wide array of neuropsychological measures. The current study examined the performance of 50 children diagnosed with ADHD on the basis of whether they passed (N = 25) versus failed (N = 25) a standalone PVT, on the Test of Variables of Attention (TOVA), the Wisconsin Card Sorting Test - 64 (WCST) and the Tower of London: Drexel (TOL). Subjects who failed one or more PVTs scored significantly below those who passed, on the Omission scores of the TOVA and on several dimensions of the WCST. No significant differences were found on the TOL scores. Specifically, subjects who failed PVTs scored more than two standard deviations below the mean on the first half TOVA Omission errors score, whereas those who passed PVTs scored within the Average range. It is proposed that first half Omission scores on the TOVA may represent an embedded measure of effort.