Culturally-informed neuropsychological evaluations of patients with spina bifida: Application of the ECLECTIC framework to a complex pediatric medical condition.

Objective: The pediatric patient populations in the United States are becoming increasingly diverse in culture. In addition to medical factors, a variety of sociocultural factors (including educational systems, language, immigration status, etc.) can impact a child's cognitive development, performance on traditional neuropsychological measures, provider interactions, differential diagnosis, and recommendations. A culturally-informed neuropsychological evaluation aims to understand the impact of sociocultural factors and integrate them into the assessment approach. Fujii's ECLECTIC framework (acronym for Education & Literacy, Culture/Acculturation, Language, Economic Issues, Communication Style, Testing Situation, Intelligence Conceptualization, and Context of Immigration) can be used to guide culturally-informed neuropsychological evaluations of children with complex medical conditions. Method: Using the ECLECTIC framework, this paper describes clinical considerations and offers practical solutions for providing culturally-informed pediatric neuropsychology evaluations. Four diverse patients with spina bifida are reviewed. Results: The case presentations highlight the application of the ECLECTIC framework within a medically complex pediatric patient population. Conclusions: Spina bifida is one example of a pediatric medical population in which both medical and sociocultural factors can impact cognitive development and the evaluation process. The ECLECTIC framework defines a variety of sociocultural factors that can influence cognitive development and multiple aspects of a pediatric neuropsychological evaluation. Pediatric neuropsychologists should use the ECLECTIC framework to provide culturally-informed evaluations for our increasingly diverse patient populations.

Neurocognitive Functioning in Unoperated Adults with Chiari Malformation Type I.

OBJECTIVE: Adults with Chiari malformation type 1 (CM1) often report cognitive impairment. This cross-sectional study investigates the cognitive and emotional functioning of a sample of adults with CM1 who presented for neurosurgical evaluation prior to intervention. METHODS: A total of 36 participants (18 patients with CM1 and 18 healthy control subjects) completed a comprehensive neurocognitive battery of tests. RESULTS: Demographic variables (sex, age, handedness, and education) were not statistically significant between the groups. Measures of gross cognition (Mini-Mental State Examination and Repeatable Battery for the Assessment of Neuropsychological Status) were statistically significant between the groups. On a more focused assessment of neurocognitive abilities, the CM1 group performed significantly worse on measures of learning, memory, fluency, and figural copy. A high rate of clinical depression was seen in the CM1 group; however, this did not correlate with cognitive performance. CONCLUSIONS: The CM1 group displayed subtle learning, semantic fluency, and complex construction difficulties compared with healthy control subjects. Although not correlated with cognition, adults with CM1 are at high risk for clinical depression.