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Invited Symposium 4: Innovations in Infant, Toddler, and Young Child Neuropsychological Models of Care
- Natasha N. Ludwig, Peter Anderson, Gwendolyn Gerner, H. Gerry Taylor, Tricia Williams
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 775-776
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The neuropsychology of babies, toddlers, and young children is a rapidly evolving frontier within our discipline. While there is an inaccurate perception among referral sources that neuropsychological services are not useful before school-age, pediatric neuropsychologists are especially well-suited to identify delay or dysfunction in the years before school entry (Baron and Anderson, 2012). Patterns of neurodevelopmental strengths and weaknesses can be detected very early on in development and used to make inferences about brain-behavior relationships integral for guiding treatment across a number of medical and neurodevelopmental diagnoses. As such, there is a need to foster ongoing clinical interest and expertise and promote the utility of neuropsychological services within this age range. The INS BabIes, ToddlerS, and Young children (BITSY) SIG was recently developed to bring together scientists and clinicians from across the world who conduct research and provide neuropsychological services within this age range to foster collaboration and learning. A priority of the BITSY SIG is not only to promote awareness of the novel needs of this age range, but to consider historical and ongoing disparities in service access, representation in research, and neuropsychological practice. For this inaugural BITSY SIG symposium, four members of the SIG will discuss innovations in infant, toddler, and young child neuropsychological models of care. This topic was developed in direct response to survey results from the first BITSY SIG meeting held during INS 2022, indicating the need for the development and refinement of clinical approaches that incorporate diverse perspectives as well as training opportunities in models of care for very young children. As such, speakers will cover innovations in neuropsychological service models from the prenatal period to formative early years that are inclusive of diverse neurological and neurodevelopmental populations commonly served by neuropsychologists including spina bifida, prematurity, hypoxic-ischemic encephalopathy (HIE), congenital heart disease (CHD), autism (ASD) and attention-deficit/hyperactivity disorder (ADHD). The first talk will highlight the unique role of the neuropsychologist in prenatal and infant consultation, whereas the second talk will focus on the state of the field with regard to the utility of neuroimaging in neonatal populations and the integration of this tool in neuropsychological care. The third talk will discuss early screening and assessment models in a diverse range of conditions within an interdisciplinary setting. The final talk will illustrate a novel neuropsychological intervention designed with and for the empowerment of caregivers for young children impacted by neurological and neurodevelopmental conditions. The unifying theme across the talks is how unplanned discoveries and acute observations of children and families during the critical early years have led to these inclusive care models that prioritize family preferences, values, and culture. Upon conclusion of this course, learners will be able to:
1. Summarize several novel models of neuropsychological care for infants, toddlers, and young children.
2. Recognize ways in which neuropsychologists work within interdisciplinary teams to serve infants, toddlers, and young children and their families.
3. Apply these models of care to your conceptualization of the scope of neuropsychological services available for infants, toddlers, and young children.
35 Preliminary reliability of the Coma Recovery Scale, Revised (CRS-R) in children with a history of disorders of consciousness after acquired brain injury
- Natasha N Ludwig, Stacy Suskauer, Beth Slomine
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 143
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- Article
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Objective:
The Coma Recovery Scale-Revised (CRS-R) is the gold standard assessment of adults with disorders of consciousness (DoC); however few studies have examined the psychometric properties of the CRS-R in pediatric populations. This study aimed to demonstrate preliminary intra-rater and inter-rater reliability of the CRS-R in children with acquired brain injury (ABI).
Participants and Methods:Participants included 3 individuals (ages 10, 15, and 17 years) previously admitted to an inpatient pediatric neurorehabilitation unit with DoC after ABI who were followed in an outpatient brain injury clinic due to ongoing severe disability. ABI etiology included traumatic brain injury (TBI; n=2) and encephalitis (n=1). Study participation took place on average 4.6 years after injury (range 2-9). The Glasgow Outcome Scale-Extended, Pediatric Version (GOS-E Peds), a measure of outcome after pediatric brain injury, was administered as part of screening. Two participants were placed in the GOS-E Peds “lower severe disability” category (i.e., score of 6) and one was placed in the “upper severe disability” category (i.e., score of 5). The CRS-R includes 6 subscales measuring responsivity including Auditory (range 0-4), Visual (range 05), Motor (range 0-6), Oromotor/Verbal (range 03), Communication (range 0-2), and Arousal (range 0-3) with higher scores indicating higherlevel function. Subscales are totaled for a CRS-R Total score. Behaviors shown during the CRS-R are used to determine state of DoC [Vegetative State (VS), Minimally Conscious State (MCS) or emergence from a minimally conscious state (eMCS)] based on 2002 Aspen Guidelines. Participants were administered the CRS-R three consecutive times on the same day. Administrations were completed by two raters in this order: Rater 1 (1A), Rater 1 (1B) and Rater 2. Intra-rater reliability was deemed by percent agreement across the 6 subscales between Rater 1A and 1B. Inter-rater reliability was deemed by percent agreement across the 6 subscales between 1A and 2.
Results:Mean CRS-R Total score for Rater 1A was 22 (SD=1.73, range 20-23), Rater 1B was 22 (SD=1.73, range 20-23), and Rater 2 was 21.33 (SD=2.08, range 19-23). Intra-rater reliability was 100% and inter-rater reliability was 94% across all subscales. All participants were deemed eMCS at all 3 ratings.
Conclusions:Data from this very small sample of children suggests that the CRS-R demonstrates both intra-rater and inter-rater reliability in patients with a history of DoC after ABI. Given that all children were at the high end of the scale (eMCS), further research is needed with a larger sample of children with a range of states of DoC.