Facilitating Transitions to Adulthood in Pediatric Brain Tumor Patients: the Role of Neuropsychology.

PURPOSE OF REVIEW: Transition-age patients with history of a pediatric brain tumor are at significant risk for difficulties transitioning to adulthood. We review current transition models and the potential role of neuropsychology in the transition process for adolescent and young adult brain tumor survivors. RECENT FINDINGS: Several recently developed healthcare transition models include consideration of patients' cognitive and functional capacities, yet currently available transition readiness tools are limited in scope and do not possess adequate normative data across pediatric medical populations. We explore the potential utility and added benefit of systematically incorporating neuropsychology in the transition process for pediatric brain tumor survivors. The literature supports increased evaluation and intervention targeted at psychosocial barriers to transition. Based on these findings, we propose a family-centered and multidisciplinary care model that promotes both medical and broader psychosocial transition processes. Neuropsychology is ideally suited to assess the wide-ranging areas encompassed in transition readiness and to facilitate the transition process.

Initial validation of the Pediatric Automated Neuropsychological Assessment Metrics for childhood-onset systemic lupus erythematosus.

OBJECTIVE: To evaluate the concurrent validity and diagnostic accuracy of the pediatric Automated Neuropsychological Assessment Metrics (Ped-ANAM) when used in childhood-onset systemic lupus erythematosus (SLE). METHODS: Formal neuropsychological testing and the Ped-ANAM were performed on 27 children with SLE who had not been previously diagnosed with neuropsychiatric SLE. Performance when completing the 10 Ped-ANAM tests was based on accuracy (AC), mean time to correct response, coefficient of variation of the time required for a correct response (CVc), and throughput. Formal neuropsychological testing was used as a criterion standard for diagnosing neurocognitive dysfunction (NCD; yes/no). RESULTS: NCD was common and present in 16 (59%) of 27 participants. Ped-ANAM performance parameters were often moderately correlated with the Z scores on formal neuropsychological testing. The NCD group differed significantly (P < 0.05) from the normal cognition group in 3 Ped-ANAM tests: CVc with mathematical processing (MTH-CVc), AC with continuous performance test (CPT-AC), and CVc with spatial processing (SPD-CVc). Areas under the receiver operating curves (AUCs) ranged between 0.75 and 0.84 when each of these parameters (CPT-AC, MTH-CVc, SPD-CVc) was used to identify NCD independently. The AUC was improved to 0.96 for the combined assessment. CONCLUSION: The Ped-ANAM has concurrent validity when used in children with SLE. Initial validation suggests that the Ped-ANAM could be a useful screening tool for NCD in children with SLE.

Academic and cognitive abilities in children of parents with bipolar disorder: a test of the nonverbal learning disability model.

It has been hypothesized that children who are at genetic risk to develop bipolar disorder demonstrate deficiencies consistent with the syndrome of nonverbal learning disabilities (NLD); however, this hypothesis has never been tested directly. In the present study, a group of at-risk children (AR group; N = 28) was compared to a demographically matched control group of children of healthy parents (HC group; N = 24) for evidence of a constellation of features associated with NLD. Some characteristic features of NLD were evident, including significant Verbal IQ (VIQ) > Performance IQ (PIQ) discrepancies and psychomotor deficits. However, academic deficiencies in mechanical arithmetic relative to reading and spelling abilities were not demonstrated. These findings replicate and extend the current literature on the cognitive functioning of children of parents with Bipolar disorder (BPD). The results, however, do not support the presence of NLD in these children.