Long-term neuropsychological follow-up of young children with medulloblastoma treated with sequential high-dose chemotherapy and irradiation sparing approach.

High-dose chemotherapy (HDC) strategies were developed in brain tumor protocols for young children to prevent neuropsychological (NP) impairments associated with radiotherapy. However, comprehensive NP evaluations of these children treated with such strategies remain limited. We examined the long-term neurocognitive outcomes of young children (<6 years) with medulloblastoma, treated similarly, with a HDC strategy "according to" the chemotherapy regimen of the protocol CCG 99703. This retrospective study included young children less than 6 years of age at diagnosis of medulloblastoma treated from 1998 to 2011 at 7 North American institutions. Twenty-four patients who had at least one NP assessment post-treatment are the focus of the current study. Of 24 patients in this review, 15 (63%) were male and the mean age at diagnosis was 29.4 months (SD = 13.5). Posterior fossa syndrome (PFs) was reported in five patients (21%). Nine (37.5%) received radiotherapy (5 focal, 4 craniospinal). On average, children were assessed 3.5 years (SD = 1.8) post-diagnosis, and full-scale intellectual quotient (FSIQ) scores ranged from 56 to 119 ([Formula: see text]= 92; SD = 16.8). The majority of children (74%) had low-average to average NP functioning. Very young children treated with radiotherapy, who needed hearing support or with PFs had worse neurocognitive outcomes. Clinically significant deficits (<10th percentile) in at least one area of NP functioning were found in 25% of the children. NP data obtained from this sample of survivors of medulloblastoma in early childhood, all treated with sequential HDC and 1/3 with radiotherapy, describe NP functioning within average normal limits overall. However, almost 25% of children had significant deficits in specific domains.

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.

The effect of phonological neighborhood density on eye movements during reading.

Recent research has indicated that phonological neighbors speed processing in a variety of isolated word recognition tasks. Nevertheless, as these tasks do not represent how we normally read, it is not clear if phonological neighborhood has an effect on the reading of sentences for meaning. In the research reported here, we evaluated whether phonological neighborhood density influences reading of target words embedded in sentences. The eye movement data clearly revealed that phonological neighborhood facilitated reading. This was evidenced by shorter fixations for words with large neighborhoods relative to words with small neighborhoods. These results are important in indicating that phonology is a crucial component of reading and that it affects early lexical processing.

Phonological neighbors influence word naming through the least supported phoneme.

Recent research has shown that phonological neighborhood density facilitates naming latencies. In an attempt to extend this work, the authors evaluated the effect of phonological neighborhood distribution by comparing responding to words that consisted of 3 phonemes but differed in the number of phoneme positions that could be changed to form a neighbor (i.e., 2 vs. 3 positions). The results revealed that words in which all 3 positions could be changed to form a neighbor were named more rapidly than were words in which only 2 positions could be changed. The results show that this effect occurs due to a difference between the 2 groups of words in terms of their least supported phoneme (i.e., the phoneme position within a word with which the fewest neighbors overlap). The authors show that differences in terms of the number of neighbors for the least supported phoneme can also explain past research that indicates an effect of phonological neighborhood density on naming. The authors explain the results of this research using the dual-route cascaded model of reading aloud.

A survey of neuropsychologists' use of validity tests with children and adolescents.

A web-based survey of validity test use by North American neuropsychologists was conducted, with 282 participants meeting inclusion criteria. Respondents indicated that they use a median of one stand-alone performance validity test (PVT), one embedded PVT, and one symptom validity test (SVT) per pediatric assessment. The vast majority of respondents indicated they give at least one PVT (92%) and at least one SVT (88%) during each pediatric assessment. A meaningful difference in validity use (i.e., at least a medium effect size) was only found for those who engage in forensic work, with those clinicians giving more stand-alone PVTs than those who do not conduct forensic work. The most frequently used validity measures in pediatric assessments are presented, as are reasons participants reported for both using and not using validity tests. Limitations and qualitative comparisons to other surveys on validity test use with adults are discussed.

Performance on the Test of Memory Malingering in children with neurological conditions.

Despite increasing interest in the use of performance validity tests with youth, relatively little is known about how children and adolescents with neurological diagnoses perform on these measures. The purpose of this study was to examine performance on the Test of Memory Malingering (TOMM) in a general pediatric neurologic sample. Data were obtained from 266 consecutive patients (mean age = 13.0, SD = 3.7, range = 5-18) referred for a neuropsychological assessment in a tertiary care pediatric hospital. As part of a broader neuropsychological battery, patients were administered the TOMM. In this sample, 94% of children passed the TOMM. Pass rate was 87% for 5-7 year-olds but was ≥ 90% for all other ages. Children with a history of stroke had the lowest pass rate (86%), with other diagnostic groups scoring ≥ 90%, including epilepsy, traumatic brain injury, and hydrocephalus. Lower TOMM performance was related to slower processing speed and weaker memory performance. The results support using the TOMM with children and adolescents who have neurological diagnoses. Caution may still be warranted when interpreting scores in those who are younger and/or who have more significant cognitive difficulty.

Embedded Performance Validity on the CVLT-C for Youth with Neurological Disorders.

Embedded validity measures can screen for possible noncredible performance, but there is a paucity of literature with youth who have neurological disorders. The purpose of this study is to examine the California Verbal Learning Test, Children's Version (CVLT-C) recognition discriminability (RD) score as an embedded validity marker in a sample of youth with neurological diagnoses. Youth between 5-16 years old (N = 294; mean age = 11.3, SD = 3.4) completed the CVLT-C and the Test of Memory Malingering (TOMM). Overall, 5.4% (n = 16) scored below the established cutoff on the TOMM; they were younger, had lower intellectual abilities, and worse performance on nearly all CVLT-C scores than those who scored above the TOMM cutoff. Using the CVLT-C RD score of z ≤ -0.5 (Baker et al. 2004), our sample had a sensitivity = .81 and specificity = .67. Using z ≤ -3.0 provided sensitivity at .44 with specificity at .90. A lower cutoff score of z ≤ -3.0 for CVLT-C RD is necessary in youth with neurological diagnoses.

Meta-analytic methods and the importance of non-TBI factors related to outcome in mild traumatic brain injury: response to Bigler et al. (2013).

Bigler et al. (2013, The Clinical Neuropsychologist) contend that weak methodology and poor quality of the studies comprising our recent meta-analysis led us to miss detecting a subgroup of mild traumatic brain injury (mTBI) characterized by persisting symptomatic complaint and positive biomarkers for neurological damage. Our computation of non-significant Q, tau(2), and I(2) statistics contradicts the existence of a subgroup of mTBI with poor outcome, or variation in effect size as a function of quality of research design. Consistent with this conclusion, the largest single contributor to our meta-analysis, Dikmen, Machamer, Winn, and Temkin (1995, Neuropsychology, 9, 80) yielded an effect size, -0.02, that was smaller than our overall effect size of -0.07 despite using the most liberal definition of mTBI: loss of consciousness less than 1 hour, with no exclusion of subjects who had positive CT scans. The evidence is weak for biomarkers of mTBI, such as diffusion tensor imaging and for demonstrable neuropathology in uncomplicated mTBI. Postconcussive symptoms, and reduced neuropsychological test scores are not specific to mTBI but can result from pre-existing psychosocial and psychiatric problems, expectancy effects and diagnosis threat. Moreover, neuropsychological impairment is seen in a variety of primary psychiatric disorders, which themselves are predictive of persistent complaints following mTBI. We urge use of prospective studies with orthopedic trauma controls in future investigations of mTBI to control for these confounding factors.

A meta-analysis of neuropsychological outcome after mild traumatic brain injury: re-analyses and reconsiderations of Binder et al. (1997), Frencham et al. (2005), and Pertab et al. (2009).

The meta-analytic findings of Binder et al. (1997) and Frencham et al. (2005) showed that the neuropsychological effect of mild traumatic brain injury (mTBI) was negligible in adults by 3 months post injury. Pertab et al. (2009) reported that verbal paired associates, coding tasks, and digit span yielded significant differences between mTBI and control groups. We re-analyzed data from the 25 studies used in the prior meta-analyses, correcting statistical and methodological limitations of previous efforts, and analyzed the chronicity data by discrete epochs. Three months post injury the effect size of -0.07 was not statistically different from zero and similar to that which has been found in several other meta-analyses (Belanger et al., 2005; Schretlen & Shapiro, 2003). The effect size 7 days post injury was -0.39. The effect of mTBI immediately post injury was largest on Verbal and Visual Memory domains. However, 3 months post injury all domains improved to show non-significant effect sizes. These findings indicate that mTBI has an initial small effect on neuropsychological functioning that dissipates quickly. The evidence of recovery in the present meta-analysis is consistent with previous conclusions of both Binder et al. and Frencham et al. Our findings may not apply to people with a history of multiple concussions or complicated mTBIs.