Which symptom assessments and approaches are uniquely appropriate for paediatric concussion?

OBJECTIVE: To (a) identify post-concussion symptom scales appropriate for children and adolescents in sports; (b) review evidence for reliability and validity; and (c) recommend future directions for scale development. DESIGN: Quantitative and qualitative literature review of symptom rating scales appropriate for children and adolescents aged 5 to 22 years. INTERVENTION: Literature identified via search of Medline, Ovid-Medline and PsycInfo databases; review of reference lists in identified articles; querying sports concussion specialists. 29 articles met study inclusion criteria. RESULTS: 5 symptom scales examined in 11 studies for ages 5-12 years and in 25 studies for ages 13-22. 10 of 11 studies for 5-12-year-olds presented validity evidence for three scales; 7 studies provided reliability evidence for two scales; 7 studies used serial administrations but no reliable change metrics. Two scales included parent-reports and one included a teacher report. 24 of 25 studies for 13-22 year-olds presented validity evidence for five measures; seven studies provided reliability evidence for four measures with 18 studies including serial administrations and two examining Reliable Change. CONCLUSIONS: Psychometric evidence for symptom scales is stronger for adolescents than for younger children. Most scales provide evidence of concurrent validity, discriminating concussed and non-concussed groups. Few report reliability and evidence for validity is narrow. Two measures include parent/teacher reports. Few scales examine reliable change statistics, limiting interpretability of temporal changes. Future studies are needed to fully define symptom scale psychometric properties with the greatest need in younger student-athletes.

Re-examining the factor structure of the Wide Range Assessment of Memory and Learning: implications for clinical interpretation.

The intercorrelation matrices of the standardization sample of the Wide Range Assessment of Memory and Learning (WRAML), a multi-component measure of memory functioning in children ages 5 to 17 years, were submitted to a hierarchical exploratory principal factor analysis (PFA). The PFA solutions were examined and compared with the published principal components analysis (PCA) solutions with the goal of examining the validity of the clinical scale configuration (Verbal Memory, Visual Memory, and Learning) proposed by the test authors. Results of the PFA differ from the PCA and do not provide statistical support for the existing three-scale structure nor the division between memory and learning. Specific factor loadings on the majority of sub-tests are higher than the common factor loadings indicating low shared variance. The low communalities together with the poor interpretability of the factor structure suggests that the subtests should be interpreted clinically as unique entities first and secondarily as factors. Theoretical and practical implications of the findings are discussed.