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Children with neurologic disorders face increased risks for mental health and neurodevelopmental conditions, with information often limited to parent report. To better understand mental health and neurodevelopmental needs in this population, a retrospective chart review of a convenience sample of children with neurologic disorders referred for a neuropsychological evaluation was conducted in the present study to explore interrater agreement between care team members (referring providers, parents, pediatric neuropsychologist). Qualitative and quantitative data were collected from the evaluation reports of 129 youth (9:0–17:11 years old; 51.2% of female sex) with neurologic disorders (i.e., 38.0% traumatic brain injury, 27.1% epilepsy, 14.7% premature birth, 7.8% pediatric cancer, 3.9% prenatal substance exposure, and 14.7% other) who completed an evaluation in 2019. Over half the youth were flagged for unmet neurodevelopmental and mental health concerns and analyses revealed low interrater agreement for mental health concerns (κ =.324), better agreement for neurodevelopmental concerns (κ =.511), and low sensitivity of referring providers (Se =.326) and parents (Se =.366). One-way analyses of variance uncovered important factors (e.g., symptom severity, adaptive skills) that may account for missed concerns. Findings guide recommendations to strengthen methods for understanding mental health and/or neurodevelopmental concerns in children with neurologic disorders. [ABSTRACT FROM AUTHOR]

Objective High demand for pediatric neuropsychological care has highlighted the time- and resource-intensive nature of traditional comprehensive evaluations. Emerging care models address these constraints by facilitating tiered neuropsychological services provided in various contexts, including multidisciplinary clinics (MDCs). We aim to demonstrate feasibility and acceptability of tiered neuropsychological care in MDCs through examples from a single institution. Methods A review of all current MDC practices at a tertiary pediatric care center was conducted to describe clinic workflow, services provided, and triage strategies. Pediatric neuropsychologists (n  = 5) and other health care providers (n  = 31) completed a survey focused on experience with neuropsychology consultation in MDCs. Results Neuropsychologists provided care in 11 MDCs, including universal monitoring with consultative interviews and questionnaires, as well as targeted screening. Neuropsychologists (89%) and other health professionals (100%) reported that tiered neuropsychological services improved patient care within MDCs. Other health professionals reported utilizing results from neuropsychology MDC care to inform their clinical approach (48–90%), referrals (58%), and treatment or surveillance decisions (55–71%). Conclusion Tiered neuropsychological care in pediatric MDCs is feasible, and provider experience ratings indicate high acceptability. Practical steps for development of MDCs are provided, including identifying teams, clinic goals and outcomes, operational logistics, and billing. [ABSTRACT FROM AUTHOR]

Patients with pediatric brain tumor (PBT) can have memory deficits due to tumor location, medical complications, and treatment. The main objective of this study was to investigate whether the California Verbal Learning Test-Children's Version (CVLT-C; 1994) and briefer Child and Adolescent Memory Profile (ChAMP; 2015) similarly identify such deficits. Seventy-five patients with PBT ages 8--16 (x = 13.1 years, SD = 2.1) were administered the ChAMP or CVLT-C. Rote verbal learning, long-term retrieval, and recognition were analyzed using standardized z-scores. Analyses of differences between measures did not reach statistical significance. Both measures indicated significant downward shifts across free retrieval trials from normative means, with scores approximately 1/3 (ChAMP) to 1/2 (CVLT-C) SD below means across learning and long-term retrieval trials. Scores on recognition trials did not differ significantly from the normative mean. Post-hoc analyses using a subset of the sample who received cranial irradiation (n = 45) similarly found no significant differences between memory measures. Additional post-hoc examination of proportion of participants falling within or below the "below average" range (≤8th percentile) revealed comparable performance between the two measures, whereas the proportion of participants falling at or below 1.5 SDs below the mean on retrieval trials was lower using ChAMP Lists as compared to the CVLT-C. Given the ChAMP is less demanding in terms of time and effort and utilizes more updated and representative normative data, this study supports the ChAMP as a useful tool to evaluate learning and memory within this population. [ABSTRACT FROM AUTHOR]

The incidence of pediatric solid organ transplantation (SOT) has increased in recent decades due to medical and surgical advances as well as improvements in organ procurement. Survival rates for pediatric kidney, liver, and heart transplantation are above 85% but patients continue to experience complex healthcare needs over their lifetime. Long-term developmental and neuropsychological sequelae are becoming increasingly recognized in this population, although preliminary work is limited and deserves further attention. Neuropsychological weaknesses are often present prior to transplantation and may be related to underlying congenital conditions as well as downstream impact of the indicating organ dysfunction on the central nervous system. Neuropsychological difficulties pose risk for functional complications, including disruption to adaptive skill development, social-emotional functioning, quality of life, and transition to adulthood. The impact of cognitive dysfunction on health management activities (e.g., medication adherence, medical decision-making) is also an important consideration given these patients' lifelong medical needs. The primary aim of this paper is to provide preliminary guidelines and clinical strategies for assessment of neuropsychological outcomes across SOT populations for pediatric neuropsychologists and the multidisciplinary medical team, including detailing unique and shared etiologies and risk factors for impairment across organ types, and functional implications. Recommendations for clinical neuropsychological monitoring as well as multidisciplinary collaboration within pediatric SOT teams are also provided. [ABSTRACT FROM AUTHOR]

Objective: Missed patient appointments have a substantial negative impact on patient care, child health and well-being, and clinic functioning. This study aims to identify health system interface and child/family demographic characteristics as potential predictors of appointment attendance in a pediatric outpatient neuropsychology clinic. Method: Pediatric patients (N = 6,976 across 13,362 scheduled appointments) who attended versus missed scheduled appointments at a large, urban assessment clinic were compared on a broad array of factors extracted from the medical record, and the cumulative impact of significant risk factors was examined. Results: In the final multivariate logistic regression model, health system interface factors that significantly predicted more missed appointments included a higher percentage of previous missed appointments within the broader medical center, missing pre-visit intake paperwork, assessment/testing appointment type, and visit timing relative to the COVID-19 pandemic (i.e. more missed appointments prior to the pandemic). Demographic characteristics that significantly predicted more missed appointments in the final model included Medicaid (medical assistance) insurance and greater neighborhood disadvantage per the Area Deprivation Index (ADI). Waitlist length, referral source, season, format (telehealth vs. in-person), need for interpreter, language, and age were not predictive of appointment attendance. Taken together, 7.75% of patients with zero risk factors missed their appointment, while 22.30% of patients with five risk factors missed their appointment. Conclusions: Pediatric neuropsychology clinics have a unique array of factors that impact successful attendance, and identification of these factors can help inform policies, clinic procedures, and strategies to decrease barriers, and thus increase appointment attendance, in similar settings. [ABSTRACT FROM AUTHOR]

The reliability of teleneuropsychology (teleNP) within pediatric populations, particularly those with low intellectual functioning (LIF; i.e., Intellectual Quotient <80), is largely unknown. This repeated-measures study compared performance on WISC-V and WAIS-IV subtests administered in-person before the COVID-19 pandemic and via teleNP during the pandemic in individuals with LIF versus broadly average (BA) intellectual functioning in a clinically referred pediatric cohort. Data were collected from a retrospective chart review of 35 pediatric patients who underwent in-person neuropsychological evaluation at an academic medical center before the pandemic (Mage = 10.10 years, SD = 2.93) and videoconference teleNP assessment during the pandemic (Mage = 13.47 years, SD = 2.88). Participants completed the Similarities, Matrix Reasoning, and Digit Span subtests from the WISC-V or WAIS-IV at both time points. After controlling for test–retest time interval, partial correlations showed relatively strong associations in test–retest performance across subtests in the whole sample and among the subset of LIF patients. Distribution of significant reliable change indices (RCI) between the LIF and BA groups were similar. Strong correlations were observed between performances on select Wechsler subtests administered in-person and via teleNP. Results lend initial support toward the utility of teleNP administration of these measures in children with a broad range of intellectual functioning. [ABSTRACT FROM AUTHOR]

The objective of this study was to validate the Attention, Memory, and Frontal-Executive Abilities Screening Test (AMFAST) in a sample of children, adolescents, and young adults with complex medical conditions characterized by frontal-subcortical dysfunction. Toward this goal, we first report on scoring corrections to the AMFAST for younger participants (ages 8–10), thereby expanding its use beyond the age range (i.e., ages 11+) that we had validated in our previous study. We then examined the diagnostic utility of the AMFAST at identifying different levels of neurocognitive dysfunction in a clinical sample of 61 children, adolescents, and young adults (ages 8–20) with complex medical conditions who also underwent comprehensive neuropsychological testing. We identified two AMFAST cutoff scores; one that optimally distinguished participants with significant neurocognitive dysfunction from non-impaired participants and another that differentiated participants with more subtle, mild neurocognitive dysfunction from non-impaired participants. These findings demonstrate that the AMFAST is a highly effective screening test that can be used to identify varying levels of frontal-subcortical deficits in younger patient populations. [ABSTRACT FROM AUTHOR]

Youth with Fontan circulation (Fontan) are at-risk for impairments in attention and executive functioning (EF) due to a confluence of genetic, prenatal, surgical, and medical risk factors. We sought to describe attention and EF in this population, measured via standardized performance-based tests and caregiver rating scales. We then examined how weaknesses in attention and EF were related to outcomes in other neurobehavioral domains, including adaptive behavior and academic achievement. Our sample included 93 youth with Fontan who were referred for neuropsychological evaluations as part of standard clinical care. The cohort as a whole measured between 0.18 to 0.99 standard deviations below normative means across domains of attention, EF, academic achievement, and intellectual ability. In addition, caregiver-reported concerns for attention, EF, anxiety, and depression were elevated, and approximately 0.35 to 0.85 standard deviations above normative means. Lastly, caregiver-reported adaptive behavior measured 0.93 to 1.24 standard deviations below normative values. Academic outcomes were differentially affected by demographic and attention/EF variables, while depression and caregiver-reported EF predicted adaptive behavior. Findings from this study underscore the importance of routine neuropsychological evaluation as part of comprehensive, multidisciplinary care for individuals with Fontan, with the goal of enhancing neurobehavioral and functional outcomes across the lifespan. [ABSTRACT FROM AUTHOR]

Objective: This paper offers a narrative overview of performance-based cognitive tests and behavior rating inventories that can be considered when working with Chinese youth in assessment settings. Methods: A total of 46 articles that focused on assessment tools and normative data in Chinese-speaking patients were reviewed. Based on the gaps in research and patterns of strengths/weaknesses across reviewed articles, we provide recommendations for selection of tests and norms while utilizing the ECLECTIC framework. Results: Our review of literature suggests extant research on neuropsychological tools for Chinese pediatric patients have largely been focused on translated or adapted measures. Findings highlight the need for the development of indigenous measures across multiple cognitive and behavioral domains to optimally integrate cultural considerations in the assessment process. Conclusions: Specifically, cultural factors that may impact test and norm selection, patients' test performance, and diagnostic considerations are discussed. Finally, gaps in literature are highlighted for future research directions. [ABSTRACT FROM AUTHOR]

Professional challenges have been documented in broad surveys of neuropsychologists. While previous surveyors have included pediatric neuropsychologists, few, if any, have specifically examined practices among those who primarily work in pediatric inpatient rehabilitation settings. Therefore, the aim of this study was to survey neuropsychologists in this setting. Thirty neuropsychologists from the U.S. and one from Canada that work in inpatient pediatric rehabilitation participated in an online survey. Most respondents (83.3%) billed for their inpatient time. Sixty-four percent indicated that payor type (private vs. public) affected services a moderate amount to a lot; this was primarily due to payor's influence on length of stay. Most providers had productivity expectations (66.7%). Among those that had productivity expectations, three-quarters used "hours billed;" 37.5% were solely or additionally tracked by relative value units (RVUs). The majority of respondents conducted some type of clinical data collection, usually for research purposes. With respect to professional identity, most respondents indicated positivity about their role. The top challenges endorsed were related to workload/ability to meet the patients' needs and billing/productivity. Issues related to billing and payor may influence aspects of pediatric inpatient rehabilitation neuropsychological care. Managing challenges related to billing and the time demands associated with providing inpatient services were top concerns for many respondents. Most sites surveyed were involved in data collection, usually for research purposes; increased data collection efforts are needed to aid with program development and evaluation and to demonstrate the added value of neuropsychological services from a patient care perspective. [ABSTRACT FROM AUTHOR]

Objective: The Pediatric Epilepsy Research Consortium (PERC) Epilepsy Surgery Database Project is a multisite collaborative that includes neuropsychological evaluations of children presenting for epilepsy surgery. There is some evidence for specific neuropsychological phenotypes within epilepsy (Hermann et al, 2016); however, this is less clear in pediatric patients. As a first step, we applied an empirically-based subtyping approach to determine if there were specific profiles using indices from the Wechsler scales [Verbal IQ (VIQ), Nonverbal IQ (NVIQ), Processing Speed Index (PSI), Working Memory Index (WMI)]. We hypothesized that there would be at least four profiles that are distinguished by slow processing speed and poor working memory as well as profiles with significant differences between verbal and nonverbal reasoning abilities. Participants and Methods: Our study included 372 children (M=12.1 years SD=4.1; 77.4% White; 48% male) who completed an age-appropriate Wechsler measure, enough to render at least two index scores. Epilepsy characteristics included 84.4% with focal epilepsy (evenly distributed between left and right focus) and 13.5% with generalized or mixed seizure types; mean age of onset = 6.7 years, SD = 4.5; seizure frequency ranged from daily to less than monthly; 53% had structural etiology; 71% had an abnormal MRI; and mean number of antiseizure medications was two. Latent profile analysis was used to identify discrete underlying cognitive profiles based on intellectual functioning. Demographic and epilepsy characteristics were compared among profiles. Results: Based on class enumeration procedures, a 3-cluster solution provided the best fit for the data, with profiles characterized by generally Average, Low Average, or Below Average functioning. 32.8% were in the Average profile with mean index scores ranging from 91.7-103.2; 47.6% were in the Low Average profile with mean index ranging from 80.7 to 84.5; and 19.6% were in the Below Average profile with mean index scores ranging from 55.0-63.1. Across all profiles, the lowest mean score was the PSI, followed by WMI. VIQ and NVIQ represented relatively higher scores for all three profiles. Mean discrepancy between indices within a profile was as large as 11.5 IQ points. No demographics or epilepsy characteristics were significantly different across cognitive phenotypes. Conclusions: Latent cognitive phenotypes in a pediatric presurgical cohort were differentiated by general level of functioning; however, across profiles, processing speed was consistently the lowest index followed by working memory. These findings across phenotypes suggest a common relative weakness which may result from a global effect of antiseizure medications and/or the widespread impact of seizures on neural networks even in a largely focal epilepsy cohort; similar to adult studies with temporal lobe epilepsy (Hermann et al, 2007). Future work will use latent profile analysis to examine phenotypes across other domains relevant to pediatric epilepsy including attention, naming, motor, and memory functioning. These findings are in line with collaborative efforts towards cognitive phenotyping which is the aim of our PERC Epilepsy Surgery Database Project that has already established one of the largest pediatric epilepsy surgery cohorts. [ABSTRACT FROM AUTHOR]

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Objective: The primary aim of this project was to apply systematic review methods to synthesize the literature on outcomes of pediatric neuropsychological services. The secondary aim was to use the results of the systematic review to identify gaps in the extant literature and describe priorities for future research. Method: We identified the relevant studies using a rigorous search strategy, collected data on methodological variables, assessed the risk of bias in the studies, summarized findings by topic and subtopic areas, identified strengths and weaknesses of the literature, and provided recommendations for future research. The outcomes measured were satisfaction, changes in resource or strategy utilization, and changes in symptoms or functioning (i.e. changes in child emotional, behavioral, cognitive, or academic problems, parent stress, or family functioning). Results: The final sources of data were 26 records, pertaining to a total of 974 children who received neuropsychological services. Parents were generally satisfied with services and reported high clinician empathy and increased level of knowledge, based on the evaluation. However, they reported less often that the neuropsychologist provided actual help. Informal home and school-based strategies were implemented more often than other types of recommendations. The research on changes in child symptoms and functioning was limited, but suggests improvements. Conclusions: This is the first systematic review of outcomes of pediatric neuropsychological services. Larger studies involving data collection at multiple time points are needed in order to further clarify mechanisms leading to outcomes and potential targets for improving them. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the reliability, validity, and responsiveness of the Chinese Learning Accomplishment Profile in China. Methods: 12,098 participants aged from 0 to 36 months from 30 provinces (mostly from Shanghai) in China were enrolled between 2013 and 2020. The reliability was reflected by Pearson correlation coefficients, Cronbach’s alpha coefficients and standard errors; the validity was shown by the coefficients between the dimensions, and we also evaluated the responsiveness as a supplement to the validity. Results: Reliability: in six domains among each subgroup, Pearson correlation coefficients between developmental age and chronological age ranged from 0.89 to 0.98, Cronbach’s alpha coefficients from 0.71 to 0.99, and standard errors from 0.15 to 2.76. Validity: after controlling for chronological age, the correlation coefficients between the dimensions were between 0.18 and 0.78, and most of them were below 0.70. Responsiveness: developmental age of all domains obtained via the Chinese Learning Accomplishment Profile system changed significantly (p < 0.001) with time (gap of 1–3 months), and the standardized response mean ranged from 0.66 to 2.45. Conclusions: The Chinese Learning Accomplishment Profile is suitable for assessing children’s development in Shanghai, but still needs confirmation when used in other provinces in China due to the great differences between regions in China. [ABSTRACT FROM AUTHOR]

The Memory Validity Profile (MVP) is a standalone performance validity test developed specifically for use with children. Prior research has demonstrated the MVP's strength in its ease of administration to children with a wide range of intellectual abilities. However, it has been found to lack sensitivity in detecting noncredible performance in select clinical populations using published cutoffs. The current study examines the MVP's performance in a diagnostically heterogeneous clinical sample and proposes a new cutoff for optimization of sensitivity and specificity. Archival clinical data were examined from 96 participants referred for a comprehensive neuropsychological evaluation (ages 6–18). Receiver operating characteristic analysis was used to assess the discriminative ability of MVP in detecting cases of noncredible performance defined as failures on both the Test of Memory Malingering and Reliable Digit Span. Using published cutoffs, the MVP demonstrated perfect specificity (100%) but suboptimal sensitivity (33.3%). Receiver operating characteristic analysis revealed strong discrimination using MVP Total score (AUC = 0.891 (p < 0.001)) and a MVP Total cut-score of ≤30 resulted in optimal sensitivity (89%) and specificity (63%). Our findings provide additional evidence that published MVP cutoffs may be too lenient to adequately capture instances of noncredible performance and indicate an MVP Total score cutoff of ≤30 may be more appropriate for use with heterogeneous clinical populations. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic has driven a radical shift in practice for services to be able to provide remote neuropsychological interventions for children, young people and their families. This survey aimed to understand the changes in the delivery of paediatric neuropsychological rehabilitation during and after the first national lockdown. It sought to explore what could be learned from experiences across services in the UK. Thirty-six members of the PNRSIG responded to the survey questions. These questions addressed change in the delivery methods of individual work with children, young people and families as well as work with schools. The survey included respondents' qualitative reflections on the adaptation to services. The discussion describes the implications for the future of service delivery with particular consideration of the access implications of remote service provision for vulnerable children and families. [ABSTRACT FROM AUTHOR]

The 15q duplication syndrome (dup15q) is due to the presence of at least one additional derived copy of the Prader–Willi syndrome/Angelman syndrome (PWS/AS) critical region that is approximately 5 Mb long within chromosome 15q11.2-q13.1. This report describes distinct roles of the origin of interstitial (int) dup15q underlining the critical importance of maternally active imprinted genes in the contribution to complete penetrance but different phenotypes of neuropsychotic disorders such as schizophrenia (SCZ) and autism spectrum disorder (ASD) in a Korean family. The proband’s mother as a consultant visited our hospital for her offspring’s genetic counseling and segregation analysis. She had two daughters diagnosed as SCZ or ASD and one son diagnosed as ASD. To resolve the potential genetic cause of SCZ and ASD in the proband and her sibling, whole genomic screening of chromosomal rearrangements by array-comparative genomic hybridization (CGH) was performed using SurePrint G3 Human CGH + SNP Microarray 4 × 180 K. Results of the array-CGH analysis revealed an interstitial duplication at 15q11.2-q13.1 (duplication size of 5.4 Mb) in the mother and her three offspring with SCZ or ASD. Our case, together with previous findings of high occurrence of psychotic disorder, suggest that maternally expressed gene product in the critical region of PWS/AS might mediate the risk of neurodevelopmental disorder (ASD) as well as psychotic disorder (SCZ). Multiple cytogenetic and molecular methods are recommended for investigating children with 15q11.2-q13.1 duplication and neuropsychotic disorders. [ABSTRACT FROM AUTHOR]

Objective: Children born very preterm (VPT; <32 weeks gestation) are at increased risk for long-term neurocognitive sequelae such as behavioral problems. These problems may be caused by disrupted brain development, particularly white matter abnormalities that affect network efficiency, as shown via diffusion magnetic resonance imaging (dMRI). There is evidence that short-term interventions for pediatric clinical populations can lead to behavioral improvements as well as associated neuroplasticity. Adapted from a previous parenting intervention for families of young children with traumatic brain injury, the novel Building Better Brains and Behavior (B4) program teaches responsive parenting skills for families of children born preterm. It is hypothesized that parent-reported externalizing symptoms will improve from pre- to postintervention and that these improvements will be mirrored by an increase in neural efficiency. Participants and Methods: VPT children between the ages of 3-8 with documented behavioral problems were recruited to participate in a single-arm pilot clinical trial. Families began with a baseline visit in which the Child Behavior Checklist (CBCL) was administered as a measure of behavior problems, and the child underwent dMRI. Parents then participated in the 7-session intervention integrating self-guided, online learning modules with live virtual coaching sessions with a therapist. Twenty three participants enrolled, 15 of which completed the intervention and baseline MRI scan; 4 children were excluded from analysis due to not meeting eligibility criteria, leaving 11 participants for analysis of intervention effects (8 males, Mage=5.42). At program completion, families returned for a follow-up that entailed another CBCL questionnaire and dMRI scan. Eight children completed the post-intervention scan and five were retained for analysis (4 males, Mage=5.83). Imaging data was analyzed using the Brain Connectivity Toolbox, which generated graph theoretical metrics to characterize the topological organization of anatomical networks. Results: A paired samples t-test showed significant reduction of externalizing behavior problems pre-intervention (M=61.12, SD=10.02) to post-intervention (M=55.00, SD=11.62; f(10)=3.09, p=0.01). At baseline, externalizing behavior problems were positively correlated with normalized clustering coefficient, r(10)=0.59, p=0.04, and small-worldness, r(10)=0.64, p=0.03. Change in externalizing symptoms pre- to post-intervention was positively correlated with baseline global efficiency, r(4)=0.94, p=0.02, and negatively correlated with mean local efficiency, r(4)=-0.89, p =0.03, and normalized characteristic path length, r(4)=-0.89, p=0.03. Conclusions: Preliminary results indicate that VPT children who exhibit higher levels of externalizing symptoms show higher normalized clustering coefficient (which is expected of networks with less integration), and higher small-worldness (which is unexpected). Greater behavioral improvements were associated with higher baseline characteristic path length as expected, but lower baseline global efficiency; this may indicate that children who had lower global efficiency to begin with benefitted from the intervention the most. Due to the small sample size and lack of corrections for multiple comparisons, these results are not definitive and further research is needed to elucidate associations between structural connectivity and behavioral intervention in children born very preterm. [ABSTRACT FROM AUTHOR]

Objective: Pediatric brain tumor survivors treated with proton radiation therapy (PRT) prior to 4 years of age are at high risk for poor cognitive and developmental outcomes. This cross-sectional study examined developmental outcomes and educational service utilization at follow-up in a cohort of pediatric survivors treated with PRT before the age of 4 years. Participants and Methods: A total of 46 patients (58.7% female, 93.5% White) were assessed using age-appropriate measures for executive, behavioral, and adaptive functioning. Mean age at PRT was 2.4 years (SD=0.9, range 1.0-3.9 years); mean age at follow-up was 7.0 years (SD=4.8, range 2.0-18.6 years). Mean follow-up interval was 4.57 years (SD=4.52, range 0.9-16.2 years). Diagnoses included ependymoma (n=26, 54.2%), medulloblastoma (n=7, 14.6%), craniopharyngioma (n=4, 8.3%), and a few other tumor types. Infratentorial tumors were most common (69.6%). Treatment included prior surgical resection (93.5%) and chemotherapy (60.9%). Posterior fossa syndrome was present in 10.9% (n=5). PRT field consisted of focal (n=41, 89.1%) or craniospinal irradiation (CSI) (n=5, 10.9%). The impact of demographic, diagnostic, and treatment-related factors was examined, including age at PRT, gender, time interval since PRT, radiation field, and tumor location, on intelligence quotient (IQ), adaptive skills, and executive functioning. Rates of impairment (T-scores >65) were calculated. The utilization of educational services was determined. Results: Mean IQ (SS = 97.6, SD=16.3), as well as mean global executive functioning (Mean T=53.4, SD=11.1) and adaptive skills (Mean SS = 92.5, SD=21.4), as assessed by parent rating scales (BRIEF; SIB), were in the average range. Despite mean scores being within the average range, a large proportion of patients demonstrated difficulties with social withdrawal (28.3%) and activities of daily living (28.3%) (BASC), and global executive dysfunction (17.4%) (BRIEF). Younger age at PRT was associated with lower global adaptive skills at follow-up (r=.39, p=.005), better activities of daily living (r=.53, p<.001), lower social skills (r=.43, p=.002), and more hyperactivity (r=-.37, p=.008), but not aggression, anxiety, depression, somatization, atypical behaviors, withdrawal, or attention problems. Longer follow-up interval was correlated with better activities of daily living (r=.46, p<.001), but more anxiety (r=.39, p=.006). Gender, SES, radiation field, history of hydrocephalus, and location of tumor were not significantly related to primary outcome variables. Posterior fossa syndrome was associated with lower adaptive skills (t=2.90, p=.003) and IQ (t=2.02, p=.026). Of those enrolled in school, 59% received special education services and/or accommodations (IEP n=18, Early Intervention n=6; 504 Plan n=3). Conclusions: Overall, PRT before age 4 years was associated with difficulties with withdrawal, adaptive skills, and executive functioning. Younger age at PRT was associated with lower adaptive functioning, lower social skills, and higher hyperactivity, but not with IQ, attention, mood, or anxiety. While a longer time interval since treatment was associated with improvement in activities of daily living, anxiety was increased, suggesting some late emotional effects. Furthermore, posterior fossa syndrome after surgery was related to lower adaptive skills and IQ. Attention problems were not indicated. Approximately half received school services/accommodations. Young children treated with PRT require proactive support and services to foster their developmental outcomes. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic has been a catalyst for a shift towards virtual forms of working, and specific support for the provision of virtual therapy (BPS, 2020). Remotely delivered therapy has known potential benefits, such as improving access to people living in underserved areas and for those who struggle to attend face-to-face appointments due to psychosocial, physical or geographical constraints. Those with neurological conditions frequently fall in these groups. Acceptance and Commitment Therapy (ACT) is an evidence-based psychological intervention which aims to improve the physical and mental health of people living with neurological conditions. However, there are several considerations to translating this into a virtual therapy for this clinical group that have not yet been thoroughly empirically evaluated. Such considerations include: fatigue, cognitive difficulties in the context of virtual communication, adaptations within the therapeutic alliance, and translation of dynamic and interactive therapeutic exercises within a virtual medium. This study aimed to describe the experiences of Clinical Psychologists delivering ACT remotely in the context of two randomised controlled feasibility and acceptability clinical trials for young people (aged 11 to 24) who have experienced a brain tumour or Tuberous Sclerosis Complex. Exploring therapist perceptions and experiences provides valuable insights into potential barriers and facilitators to engagement with remote ACT delivery. Participants and Methods: Clinical Psychologists who were trained to deliver ACT via videoconferencing were invited to take part in virtual interviews. The semi-structured interview guide aimed to draw on their experience of ACT training, supervision, remote delivery, and perceived impact of ACT. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Results: Five Clinical Psychologists were interviewed. Interview data were coded into broad themes around the experience of delivering ACT, engaging with remote systems, the wider perceived impact of ACT and the adaptability of ACT. ACT training was reported to be an effective, positive experience and the opportunity for regular peer and group supervision worked to solidify the training and support fidelity to the ACT processes. It was largely acknowledged that while remote delivery of the intervention did create some initial challenges to the therapeutic process, this approach created opportunity for the young people to access psychological support that they might not have been able to engage with due to logistical considerations. Clinical Psychologists also shared that training in and experience of delivering ACT had a positive and meaningful impact on their clinical practice and personal conduct. They also reported that ACT was adaptable to the needs of the young people in the clinical trials and felt appropriate to deliver in this context. Conclusions: This in-depth, qualitative study demonstrated the clinical promise of remotely delivered ACT. Clinical Psychologists viewed remotely delivered ACT as an appropriate, acceptable and feasible intervention for young people with experience of brain tumour and Tuberous Sclerosis Complex within the context of research, that would be generalisable to everyday clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Standardized assessment measures can provide data to inform a diagnosis of Autism Spectrum Disorder (ASD). Most measures assessing ASD characteristics rely on some degree of behavioral response to sound (e.g., responding to name, demonstrating listening response), and are often not appropriate for use with children who are Deaf and Hard of Hearing (DHH), especially with individuals who use signed languages. Few studies have reported on the Behavioral Assessment System for Children, Third Edition (BASC-3) for DHH children, and we aim to describe BASC-3 profiles in children with ASD who are DHH. Participants and Methods: Participants include eight DHH patients diagnosed with ASD through interdisciplinary team evaluations by developmental-behavioral pediatricians, speech-language pathologists, and neuropsychologists with expertise in DHH child development. Demographics include a mean age of 6.17 years, and 62.5% were Male. Self-reported racial distribution was 75% White, 12.5% Black and 12.5% declined to answer. Average Area Deprivation Index (marker of socioeconomic status) was 32.13%tile. As a part of the evaluation, parents rated their children using the BASC-3. Languages include spoken English (75%) and American Sign Language (25%). Relevant co-occurring neurodevelopmental/psychological diagnoses include Global Developmental Delay (n=1), Moderate Intellectual Disability (n=1), and Depression (n=1). Types of hearing loss include sensorineural (75%), conductive (12.5%), and mixed (12.5%). Three participants had different degrees of bilateral hearing loss in each ear: mild sloping-severe, moderate rising-mild (n=1), profound, moderate rising-normal level (n=1), and profound, moderate (n=1). Four participants had the same level of hearing loss in both ears: moderate-moderately severe (n=1), moderately severe-severe (n=1), severe-profound (n=1), and profound (n=1). One child had a unilateral moderate hearing loss. Technology utilized: unilateral hearing aid (n=2), bilateral hearing aids (n=2), unilateral cochlear implant (n=1), bilateral cochlear implants (n=2), and bimodal technology (n=1). BASC-3 scales of interest in this study were the developmental social disorders scale (DSD), Autism probability index (AUI), clinical scales, and adaptive scales. BASC-3 scores were standardized using General Combined norms and means were plotted. Results: BASC-3 mean scores on clinical scales were elevated (T>60) on Atypicality (M=71), Hyperactivity (M=63), Withdrawal (M=63), and Attention Problems (M=65) in children with ASD who are DHH in this sample. BASC-3 mean scores on adaptive scales were below threshold (T<40) on Social Skills (M=37), Functional Communication (M=39), and overall Adaptive Skills (M=39). DSD scores were in the at-risk (T>60<70) range for 2 out of 8 cases and clinically significant (T>70) for 5 out of 8 cases. The AUI was clinically significant for 2 out of the 3 cases within the age range for reporting AUI data. Conclusions: In this preliminary sample of DHH children with a confirmed diagnosis of ASD by comprehensive specialized interdisciplinary clinical evaluations, parent ratings on the BASC-3 were consistent with what is known about BASC-3 profiles in hearing children diagnosed with ASD. Our findings suggest it may be helpful to review the DSD, AUI, clinical scales, and adaptive skills scales profiles when assessing DHH children at risk for ASD. Further research, including a larger sample size and assessment of language differences among participants, is necessary. [ABSTRACT FROM AUTHOR]

Objective: Performance validity testing (PVT) is important in neuropsychological evaluations to ensure accurate interpretation of performance. While research shows children pass PVTs with adult cut-offs, PVTs are more commonly used with adults (Lippa, 2018). The Test of Memory Malingering (TOMM), a standalone PVT, is commonly used with adults and children (DeRight & Carone, 2015). The Reliable Digit Span (RDS), an embedded PVT derived from the Digit Span subtest of the Wechsler Intelligence Scales (Wechsler Intelligence Scale for Children-4th Edition, WISC-IV; Wechsler, 2003), is less commonly used with children (DeRight & Carone, 2015). RDS cut-off scores are associated with an increased rate of false positives in children, indicating mixed results regarding the clinical utility in pediatric populations (Welsh et al., 2012). Research shows that youth with a history of concussion (HOC) may demonstrate suboptimal effort for many reasons (e.g., external incentives, boredom, pressure), thus highlighting the need to investigate the utility of PVTs in this population (Araujo et al., 2014; DeRight & Carone, 2015). The present study aimed to examine the clinical utility of RDS in detecting poor effort on the TOMM in youth athletes with a HOC. Participants and Methods: Participants included 174 youth athletes aged 8 to 18 (20.1% female; 42.5% people of color (POC)) who completed a baseline neuropsychological battery that included the TOMM and WISC-IV Digit Span. Of the sample, 29 youth athletes reported a HOC (13.8% female; 37.9 POC). RDS was calculated for each Digit Span administration, and sensitivity (SN) and specificity (SP) were calculated for RDS when invalid performance was operationalized by a more stringent cut-off score of <49 to increase the SN of the TOMM Trial 1 (Stenclik et al., 2013). Receiver operator characteristics (ROC) curve analysis determined whether RDS performance accurately predicted participants' performance on the TOMM. Results: The ROC curve analysis resulted in an area under the curve (AUC) of just 0.427 for RDS. A cut-off score of <7 (as suggested by Kirkwood et al. (2011)) for RDS results in 100% SN, 8.3% SP, 5% positive predictive validity (PPV), and 95% negative predictive validity (NPV). However, a cut-off score of <9 for RDS results in 75% SN, 15% SP, 25% PPV, and 75% NPV. Conclusions: Little research shows the utility of different PVTs predicting children's performance on other PVTs, despite evidence that children with a HOC are vulnerable to variable or insufficient effort (Araujo et al., 2014; DeRight & Carone, 2015). In a sample of 29 youth athletes with a HOC, RDS predicted TOMM performance at rates worse than chance. While RDS has advantages as an embedded PVT, its limited ability to predict performance on a standalone PVT suggests interpreting with great caution. These findings highlight the importance of implementing multiple PVTs throughout testing to ensure accurate findings and interpretations, particularly in youth with a HOC. The small sample size is a limitation that possibly impacted the ability of RDS to predict TOMM performance. Further research is needed to understand the utility of RDS as a predictor of PVT performance in different populations. Replication of these findings with a larger sample size is needed to provide confirmatory evidence of poor predictive performance of the RDS. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the possibility of using the Figure Weights subtest of the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) as an embedded validity test (EVT). Participants and Methods: We conducted a retrospective cohort study of patients seen in the Johns Hopkins All Children's Hospital (JHACH) Neuropsychology program between 2015 and 2019. Patient age ranged from 6-15 years (median age 11 years). All patients were administered the WISC-V as a portion of their neuropsychological evaluation. The sample included 75 patients who were generally male (63%), White (77%), English dominant (97%), and right-handed (81%). Results: Effort determination based on RDS identified more patients as having invalid effort. Clinicians identified only 7% of patients with invalid effort; whereas, 16% of patients with invalid effort were identified using the WISC-V RDS. Although patients having valid effort generally performed better on all WISC-V subtests, no significant differences between groups were found. Over 90% of patients were able to get items 1-10 correct on the WISC-V Figure Weights subtest regardless of their effort determination. WISC-V Figure Weights item analysis showed participants in the invalid group sometimes answered more difficult questions correctly while failing easier items which supports inconsistent effort. Further statistical analyses, including discriminant validity tests, were unable to be completed given the study was underpowered due to significant disparity between effort groups. Conclusions: This study shows support for WISC-V Figure Weights subtest items 1-10 as an embedded EVT given these items were sufficiently easy to pass regardless of whether participant gave valid or invalid effort. As this is an exploratory study, results will need to be replicated in other pediatric samples. Additionally, the discriminant ability of the WISC-V Figure Weights subtest EVT will need to be further investigated. [ABSTRACT FROM AUTHOR]

Objective: Children with unilateral hearing loss (UHL) have difficulty hearing in noisy environments and localizing sounds, impacting learning and social opportunities across contexts. Using a visible device like a cochlear implant (CI) may improve functioning but can also create psychological risk. Audiological measures alone are insufficient for predicting social, emotional, educational, adaptive, and quality-of-life post-operative outcomes, which are highly variable in this population and can also be impacted by a secondary diagnosis. Extending beyond audition to consider the "whole child" through neuropsychological evaluation may produce a sharper picture of potential outcomes, with or without surgical/audiological intervention. Given recent FDA approval for CI in children with UHL, more are receiving this elective surgery despite difficulties predicting who will experience significant benefit. Here we describe neuropsychological profiles of children with UHL who underwent CI candidacy evaluation at a tertiary pediatric hospital. Participants and Methods: During pre-operative clinical care, CI candidates completed targeted neuropsychological evaluation to identify patient- and family-level factors that could impact CI use and outcomes from surgery. Cognitive, language, attention/executive, visuoperceptual/visuomotor, academic, adaptive, and emotional/behavioral functioning were assessed. Evaluations integrated history, observations, caregiver report forms, and performance-based test data. Results: 18 individuals were evaluated (age 7-months to 16-years). Most had left-sided UHL (67%) and were male (61%). Known hearing loss etiologies were congenital cytomegalovirus (n=5), enlarged vestibular aqueduct (n=1), traumatic brain injury (n=1), meningitis (n=1), cholesteatoma (n=1), neurofibromatosis type 1 (n=1), and Waardenburg syndrome (n=1). Indices of general cognitive ability were generally low average to average. Patterns of cognitive impairment were not restricted to language-based tasks (e.g., Beery VMI-6 range 56-109, M=89.42, SD=16.27). Standardized parent ratings of everyday executive functioning, social/emotional/behavioral functioning, and adaptive skills were collected. Eight (44%) had a behavioral health diagnosis: Attention Deficit Hyperactivity Disorder (n=2), Global Developmental Delay (n=2), Unspecified Neurodevelopmental Disorder (n=2), Autism Spectrum Disorder (n=1), and Depression (n=1). Thirteen (72%) received or will receive a CI, of whom 38% had a behavioral health diagnosis. Average Area Deprivation Index (a marker of socio-economic status) was lower for individuals who ultimately received CIs (M=18%tile) compared to those who did not (M=25%tile). Conclusions: There may be increased rates of neurodevelopmental/psychological conditions among children with UHL, especially when the etiology involves the central nervous system. Albeit preliminary, results align with findings from bilateral hearing loss samples. Findings highlight the importance of routine neuropsychological screening in children with UHL and close interdisciplinary collaboration for optimal outcomes. Socio-economic disparities among those who do and do not receive CI need further exploration as those who did not receive CIs tended to be from less resourced neighborhoods. Additional research is warranted to understand the full range of risk and protective factors for children with UHL and how these relate to outcomes for those who opt for cochlear implantation. [ABSTRACT FROM AUTHOR]

Objective: Rapid automatized naming (RAN) assesses pre-literacy and could be useful for assessing the effects of HIV infection on the development of literacy. Many children with HIV live in sub-Saharan Africa, but the RAN has not been well-studied there. Cultural differences in when children learn color names and in how they prioritize between accuracy and speed can affect RAN results. Typically, RAN and other cognitive functions (e.g., general intelligence, processing speed, working memory, attention) are strongly related. Our goal is to examine how RAN performance relates to neurocognitive function in sub-Saharan Africa and whether RAN performance could reveal the effect of HIV on pre-literacy. The current study examines the relationship between RAN performance and cognitive variables in both children living with HIV (CLWH) and healthy controls in Tanzania. Participants and Methods: 486 children (ages 3-8) were administered RAN Color and Object tasks as part of a larger longitudinal study in Dar es Salaam, Tanzania. All participants were also administered the Leiter International Performance Scale - 3rd Edition (Leiter-3), a test of nonverbal intelligence and general cognitive function. Binomial logistic regression examined the likelihood of completing a RAN task and included age, Leiter-3 composite standard scores, and HIV status. Multiple linear regression using the same predictors assessed factors associated with RAN completion time in children who completed the tests. SES and education were not included in the model specifications because they were not correlated with any RAN measures. Results: Only 40% of children could complete the RAN Color task, while 88% completed the Object task. Logistic regression models showed that age (p<0.001), Leiter-3 Nonverbal IQ (p<0.01), and Processing Speed (p<0.001) composite scores were all unique predictors of whether children would complete the RAN Color task. Age (p <0.001) and Nonverbal IQ (p<0.001) were predictors of completing of the RAN Object task. Of those who could complete the RAN Color task, multiple linear regression demonstrated that age (p<0.01), Leiter-3 Nonverbal IQ (p=0.01) and Processing Speed (p=0.001) composites predicted completion time, with the model accounting for 25% of the variance. For the RAN Object task, multiple linear regression indicated age (p<0.001), Leiter-3 Processing Speed (p=0.01) and Nonverbal Memory (p=0.01) composites, and living with HIV (p=0.01), predicted completion time, with the model accounting for 42% of the variance. Conclusions: Completion rates for RAN Color and Object tasks were low but improved with age. Consistent with brain maturation, increasing age and processing speed improved completion time, regardless of the RAN task. General cognitive ability predicted RAN Color performance, and Nonverbal Memory (encompassing attention, working memory, and retrieval) and HIV status additionally predicted RAN Object performance. Results extend research indicating RAN is distinct yet multifactorial, relying on various neurocognitive functions working together. Additionally, the relationship of HIV to RAN Object performance implies an overlap between the neurocognitive functions inherent in RAN and the neurocognitive weaknesses often reported in CLWH. These findings suggest cognitive vulnerabilities in CLWH may extend to literacy skills in sub-Saharan Africa, which requires further study. [ABSTRACT FROM AUTHOR]

Objective: To compare performances of matched groups derived from caregiver-reported ethnicity on measures of verbal comprehension and visual-spatial abilities, and to identify factors potentially related to differences. Participants and Methods: Participants included 159 English speaking children from 615 years of age who were referred for neuropsychological evaluation at a clinic in the southwestern region of the United States. Participants were matched across four groups based on caregiver-reported ethnicity, including American Indian (n = 41), Hispanic (n= 41), White (n = 41), and Other (i.e., Black, Asian; n = 36) categories. Propensity score matching was used to derive samples, with participants matched on age, caregiver-reported sex assigned at birth, and the full-scale intelligence quotient on the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V). Results: Using a dependent variable derived from subtracting the WISC-V Verbal Comprehension Index from the Visual-Spatial Index, significant differences across groups were found via a factorial analysis of variance model (p =.02, eta squared =.06). Achieved power was.82. Post-hoc analysis indicated significantly greater differences between verbal comprehension and visual-spatial abilities amongst participants of American Indian (mean difference = -6.61 standard score points) and Hispanic (mean difference = -6.66 standard score points) ethnicity relative to participants of White ethnicity (mean difference = 2.17 standard score points; p <.01). Differences did not relate to participant age or assigned sex. Conclusions: Greater differences between visual and verbal intellectual abilities were found amongst Hispanic and American Indian participants relative to White participants. Hispanic and American children tended to perform higher on visual spatial rather than verbal tasks, while the pattern was reversed for White children. Findings are congruent with previous research conducted using older versions of the WISC and continue to highlight potential issues related to the external validity of this measure in certain populations. This study contributes to the existing literature by replicating previous findings with the most recent iteration of the WISC in a referred sample. Current results continue to suggest that the WISC-V Verbal Comprehension Index may function more as a measure of English language ability rather than verbal intellectual ability. Given these findings, it is important that weaknesses in verbal comprehension amongst children of Hispanic or American Indian ethnicity be interpreted in this context when identified in clinical and research settings. Discrepancies between ethnic groups may relate broadly to cultural and systemic factors (e.g., differing patient/examiner characteristics, inequalities in access to education/intervention and healthcare, bilingualism/exposure to the English language). [ABSTRACT FROM AUTHOR]

Objective: Various forms of social media have been investigated as platforms for science and health communication, with a recent growing interest in TikTok. TikTok has more than one billion active users. Sixty-two percent of TikTok users are under the age of 29, making it a platform of particular interest when considering the impact of social media content dissemination in pediatric neuropsychology. Personal communication suggests that children, adolescents, and young adults internationally reference specific information from TikToks about attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), tic disorder, and specific learning disorders in the context of clinical neuropsychological assessment. Despite the emerging prevalence of TikTok observed clinically and discussed informally among clinicians, there has yet to be a synthesis of available empirical information of TikTok as a health communication platform for discussing neurodevelopmentally relevant conditions. Participants and Methods: A systematic review of research regarding TikTok and neurodevelopmentally relevant conditions was conducted using PRISMA guidelines. The following databases were searched: Ovid MEDLINE (to 20 July 2022), PsycINFO (to 20 July 2022), and PubMed (to 20 July 2022) using search terms TikTok AND ADHD OR autism OR tic OR learning disorder. Searches using search terms TikTok AND learning disability OR dyslexia OR dysgraphia OR dyscalculia were also conducted but were excluded as they yielded no results. Articles were eligible for inclusion if they presented original data (e.g., case series, descriptive analyses, etc.) related to information about neurodevelopmentally relevant conditions on TikTok. A final sample of 5 original papers met criteria for inclusion. Results: The systematic review sample included a mixture of clinical case series and empirical analyses using primary data from TikTok. Across publications, there was an emphasis on the prevalence of misinformation about disorders on TikTok, the frequency of atypical presentations of neurodevelopmental disorders on TikTok, and the potential for an iatrogenic impact on children and adolescents who view TikTok videos. Conclusions: Despite the increasing frequency with which patients access TikTok for health-related information, there is a relative dearth of published research on TikTok regarding neurodevelopmentally relevant conditions. This is in contrast to other health-related areas (e.g., there are a far greater number of published articles on TikTok and COVID-19 and dermatology compared to neuropsychological disorders). These findings suggest a missed opportunity for researchers and clinicians alike to engage with TikTok. Based on clinical experience and a review of the available literature, the following recommendations are provided and will be presented in-depth: 1. Clinicians should gain familiarity with virally spread information via TikTok, particularly as it relates to symptoms and presentations of neuropsychological and neurodevelopmental conditions. 2. Clinicians should explicitly assess for knowledge content and source regarding neuropsychological and neurodevelopmental conditions during intake and/or feedback in order to address misinformation and myths, validate lived experiences, and develop rapport with patients. 3. Clinicians and researchers should consider a strengths-based approach to TikTok usage that highlights the value of sharing resources, building community, and decreasing stigma. 4. Clinicians and researchers should be aware of information shared via TikTok as a potential concern for test security. [ABSTRACT FROM AUTHOR]

Objective: Children who suffer from brain insults (i.e., traumatic brain injury (TBI), chemotherapy and radiation treatment for brain tumors) are susceptible to late-emerging cognitive sequelae. Even with similar neurological risk variables, variability in long-term cognitive outcomes remains an area of investigation for researchers of acquired brain injury. Given the potential for genetic factors to influence response to chemoradiation, researchers have examined associations between germline, inherited, single nucleotide polymorphisms (SNPs), and neurocognitive outcomes for cancer survivors. Children who sustain an uncomplicated mild TBI generally recover without long-term neuropsychological consequences. However, TBI survivors have overlapping mechanism categories with cancer survivors through secondary injury variables that can be influenced by genomic variation (e.g., oxidative stress and neuroinflammation). Furthermore, the study of genomic vulnerability is limited in heterogenous groups of pediatric TBI survivors. This study aims to identify associations between genotype and long-term neurocognitive outcomes for acquired brain injury survivors by utilizing machine learning to uncover pathophysiological similarities and differences between groups. Participants and Methods: Fourteen brain tumor survivors, 139 traumatic brain injury survivors, and 63 healthy, age-matched controls completed the Letter N-back task to obtain performances on core neurocognitive skills (attention, working memory, and processing speed). Ten targeted genotypes were examined across five pathophysiological pathways (neurotransmission, oxidative stress, neuroinflammation, plasticity, growth and repair, and folate metabolism). Data were trained and tested utilizing three regression machine learning models. Mean estimated error and R2 were generated for each neurocognitive outcome. A feature importance score for models with positive variance was generated to determine how predictive a given SNP is for neurocognitive outcomes. Results: Genotype only accounted for a small amount of variance in cognitive outcomes when all clinical groups were combined. The mean absolute error for the best-fitting models from analyses where all groups were combined decreased when groups were examined separately; however, the differences in model R2 values were not significant. The relationship between brain tumor survivors and processing speed performance depended on genotype. Two SNPs had positive feature importance at the interaction level (rs58225473 and rs1801394). These SNPs are located on the CACNB2 and MTR genes and have functional consequences for neurotransmission and folate metabolism. Models of traumatic brain injury survivors did not explain positive variance and could not be examined for feature importance. Additionally, even when removing the only mechanism of action that should not be relevant for TBI survivors (folate metabolism polymorphisms), the TBI models still did not explain positive variance. Conclusions: Findings of the importance of two key SNPs on MTR and CACNB2 genes align with recent systematic reviews, which found associations between these polymorphisms and neuropsychological outcomes in more than one group or cohort of pediatric cancer survivors. Models for TBI survivors were limited by the heterogeneity of the group and ceiling effects on performance. An understanding of genetic vulnerabilities influenced by treatment and injury-related factors in acquired brain injury will inform our understanding of the developing and recovering childhood brain. The current study is an initial contribution to this goal and highlights the utility of machine learning methodology for future studies that examine the influence of genetic heterogeneity in pediatric acquired brain injury. [ABSTRACT FROM AUTHOR]

Objective: Pediatric brain tumor (PBT) survivors are at risk for speech (e.g., articulation, prosody, fluency) and language (e.g., vocabulary, grammar, narratives, pragmatics) difficulties (Hodges et al., 2020). It is important to understand what treatment and/or demographic factors are associated with language functioning soon after diagnosis, and what factors are associated with language functioning years after treatment completion. This study characterizes longitudinal language functioning for clinically referred PBT survivors diagnosed in early childhood. Participants and Methods: Participants were 48 PBT patients (54% supratentorial, 6% disseminated), 21% with NF-1, who were diagnosed by age 6 (M = 43.2 months, SD 24.5) and received tumor-directed intervention including surgery (85%), chemotherapy (69%), and/or radiation therapy (50%). Hearing concerns existed for 29% of the patients. Age at first neuropsychological evaluation was 2-15 years (M=7.6, SD=3.63), age at second neuropsychological evaluation was 5-19 years (M=12.04, SD=3.86), with an average of 4.42 years (SD=2.37) between evaluations. Patients were 63% male, 77% White, 94% non-Hispanic, and fluent English speakers. Verbal IQ, working memory, fluencies, comprehension, memory, and parent-reported functional communication outcomes were assessed as part of comprehensive batteries. Rates of weak performance (1 SD

Objective: Relative to their typically developing peers, autistic individuals experience greater difficulties in domains of functioning that are relevant to learning and adult outcomes, such as sensory sensitivities, anxiety, and social. However, little is known about how difficulties in these domains relate to the receipt of special education services as well as adult outcomes, such as vocational achievement. The current study sought to fill this gap by examining if difficulties in various learning-related domains as ascertained via the Learning Needs Screening Tool (LNST) were associated with historical special education receipt and vocational status. Participants and Methods: 400 autistic adults, recruited via the Simons Powering Autism Research (SPARK) participant registry Research Match service, participated in this study (40.5% male, mean age=28.9 years). All participants completed the LNST, which collects responses to 13 core questions about learning (such as challenges with memorization, note taking, spelling and identifying arithmetic signs), as well as 7 additional questions with checkbox and free response options, and yields a total score from 0-30. LNST item 14 and its response options (1-9) capture suspected causes of learning difficulties (e.g., 'too much noise or activity bothers me,' 'I get nervous taking tests'). These individual questions as well as the total of endorsed learning related challenges were then evaluated in relation to historical special education receipt ("yes" vs. "no") and vocational outcomes ("yes" vs. "no" engaging in 10+ hours of postsecondary education or employment without supports), as assessed via the Taylor Vocational Index. Results: Logistic regression was utilized to predict the dependent variables of interest. Models included sex assigned at birth and age in the first step as covariates. Then either the total of learning related challenges endorsed or the 9 individual learning-related challenges from the LNST were included as independent variables of interest. For historical special education receipt, two items - "It's hard for me to work by myself" (B =.78, p<.05) and "I get nervous taking tests" (B =.49, p<.05) were positively associated with a history of special education services. For vocational outcomes, the total learning related challenges (B = -.25, p<.001) as well as endorsement of one item -"It's hard for me to work by myself" (B = -.88, p=<.05) were associated with poorer vocational outcomes. Conclusions: These findings shed light on the possible learning-related challenges that are experienced by autistic adults. Further examination of the role these learning related challenges play in the receipt of special education and on vocational outcomes is warranted. In particular, difficulties with independence in work was related to both special education receipt and poorer vocational outcomes, indicating that it may be a fruitful area of focus for vocational training programs. [ABSTRACT FROM AUTHOR]

Objective: Children born preterm are at increased risk of deviation from the typical developmental trajectory. The probability of adverse developmental sequelae is increased in those with history of major perinatal complications. Retinopathy of prematurity (ROP) is a pathological disordered growth of retinal blood vessels occurring in very preterm neonates who require supplemental oxygen. ROP has been linked to intermittent hypoxemic events and blood gas derangements occurring in the Neonatal Intensive Care Unit (NICU), particularly in ventilated infants. Though presence and severity of ROP have been linked to neurodevelopmental impairment, little is known about the relationship between ROP severity and motor development in the preschool age. Because the same hypoxemic events and blood gas changes that lead to severe ROP may also lead to greater developmental deficits in motor control, we hypothesized that ROP severity will be inversely linked to the quality of motor functioning even in NICU graduates without neurological impairments. Participants and Methods: We included 95 preterm (23.6 - 33.6 weeks gestation) preschoolers (49 females, 44 members of twin pairs or triplets). The participants' age ranged from 3.3 - 4.1 years (adjusted for prematurity). ROP screening was conducted during NICU stay and rated from immature retina (0) to grade 4. Motor abilities were assessed with the Peabody Developmental Motor Scales (PDMS-2). Cases with diagnosed perinatal brain pathology (moderate to severe) or cerebral palsy were excluded from analyses. Results: We used linear mixed regression analyses with multiple gestation as a random factor. Severity of ROP was our predictor of interest, whereas socioeconomic status, sex, gestational age, and birth-weight SD served as covariates. Separate analyses were conducted using the PDMS-2 Total Motor, Fine Motor, and Gross Motor Quotients as dependent variables. ROP severity explained a unique portion of the variance in the Total Motor Quotient (F[1, 89] = 5.59, p =.02). Examination of the relationship between ROP severity and motor skill domains yielded a significant association for the Fine Motor Quotient (F[1, 89] = 6.19, p =.015) and a trend for the Gross Motor Quotient (F[1, 89] = 3.64, p =.06). Conclusions: The results of this study reveal that increase in ROP severity is linked to poorer motor skills in preterm-born preschoolers without major disabilities or perinatal diagnosis of moderate to severe brain pathology. This association was evident for both fine and gross motor skills, though only the relationship between ROP severity and the former motor index reached conventional statistical significance. Importantly, ROP severity accounted for a unique portion of the variance in motor performance, over and above the variance explained by other perinatal risk factors. This result is consistent with previous research findings indicating that ROP is linked to the occurrence of multiple, subtle hypoxemic events and 'exposure' to blood gas derangements during NICU stay in very preterm neonates who require respiratory support. [ABSTRACT FROM AUTHOR]

Objective: Pediatric acquired demyelinating syndromes (PADS) include a heterogeneous group of diagnoses, including acute disseminated encephalomyelitis (ADEM), neuromyelitis optica spectrum disorders (NMOSD), optic neuritis (ON) and transverse myelitis (TM). Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is often associated with demyelinating conditions, but may also present with encephalopathy without demyelinating lesions. Approximately 30% of patients diagnosed with MOGAD experience a relapse. Neurocognitive outcomes in PADS have reduced performance on tasks related to attention, processing speed, visual motor, and fine motor functioning. Psychosocial problems include anxiety, depression, and fatigue. Neurocognitive and psychosocial impacts of MOGAD events for the pediatric population are sparse. The current study sought to characterize neurocognitive sequelae from MOGAD (MAGAD+) compared to patients diagnosed with PADS without MOGAD (MOGAD-). Participants and Methods: Twenty children and adolescents (6–18 years) diagnosed with PADS were recruited using a clinic convenience sample of patients. Study participants completed a neurocognitive battery and parents completed questionnaires of behavioral and emotional functioning. Demographic and medical variables were collected via retrospective chart review. Chi square and t-test analyses were used to compare MOGAD+ and MOGAD- groups. Performance on neuropsychological and behavioral questionnaires were compared to established sex and age norms to assess the degree to which group means deviate from normative expectations. Results: MOGAD+ and MOGAD- groups did not significantly differ based on demographic, neurocognitive, or parent reported social and behavioral functioning. Neurocognitive testing documented mean scores that were in the average range between groups. Notable variability in performance was observed within both MOGAD+ and MOGAD- groups. Bilateral fine motor deficits, visual motor, visual perception attention, and executive functioning deficits were notable for the combined PADS group, with 30-50% performing >1.5 SD below the mean. The number of white matter lesions or hospital duration were not significantly associated with performance on neurocognitive measures. However, older age of onset of PADS was significantly correlated with lower performance on visual motor integration and visual perception tasks (r(18) = -.50 p =.026; r(18) = -.53 p =.016). Findings also revealed associations of shorter hospitalization stays with higher behavioral symptoms on a parent measure of social/behavioral functioning (r(18) = -.47 p =.037). Conclusions: Consistent with the PADS literature, relative to control norms, lower performance on tasks related to attention, executive functioning, visual motor, and fine motor skills, irrespective of MOGAD status, are observed in the current study. The variability of functioning and heterogeneity observed across PADS diagnoses warrants further study to better understand the impact of clinical course, treatment outcomes, and neuropsychological sequelae over time in this population. Higher behavioral distress with shorter hospital stays may indicate a potential opportunity for patient and family education preparing for return to home/community. The current study was limited by small sample size, variable time since hospitalization, and heterogeneous diagnoses within PADS that make it difficult to generalize findings. Future studies could prospectively follow patients over time to better understand the trajectory of recovery, identify predictors for relapse, and those at greatest risk of neurocognitive and behavioral deficits. [ABSTRACT FROM AUTHOR]

Objective: Traumatic brain injury (TBI) is a prevalent cause of long-term morbidity in children and adolescents and can lead to persistent difficulties with social and behavioral function. TBI may impact brain structures that support social cognition, social perception, and day-to-day social interactions—termed the social brain network (SBN). We examined differences in links among the SBN and regions of interest from other neural networks thought to support social outcomes, i.e., the default mode network (DMN) and salience network (SN). Furthermore, we examined how differences in co-activation among the SBN and these other key networks were associated with ratings of social and day-to-day adaptive outcomes. Participants and Methods: Participants included children and adolescents with moderate to severe TBI (msTBI; n=11, Mage=11.78, 6 male), complicated-mild TBI (cmTBI; n=12, Mage=12.59, 9 male), and orthopedic injury (OI; n=22, Mage=11.69, 15 male). Participants underwent resting-state functional MRI on a 3Tesla Siemens Prisma scanner. Parents rated their child's social and adaptive function on the Child Behavior Checklist (CBCL) and Adaptive Behavior Assessment System-Third Edition (ABAS-3). Resting-state connectivity was assessed using the CONN Toolbox, including preprocessing, denoising, and alignment to the participants' processed T1 MPRAGE sequence followed by seed-to-voxel analysis using a SBN mask and targeted regions of interest within the DMN and SN. Individual-level r-to-z correlations were extracted from resulting clusters of co-activation with the SBN mask and exported into SPSSv28.0 for integration with behavioral data. Results: One-way ANOVAs used to examine group differences in social and adaptive outcome revealed significant group differences in CBCL Social Competence (F =4.49, p =.019) and all composite scores on the ABAS-3 (F s=3.78 to 5.17, p s=.031 to.010). In each domain, children with msTBI were rated as having elevated difficulties relative to cmTBI or OI, whereas cmTBI and OI groups did not differ. Connectivity also differed significantly between groups, with children with OI demonstrating greater connectivity between the SBN and the anterior cingulate cortex of the SN (t =5.19, p (FDR)<.0001) and posterior cingulate cortex of the DMN (f =4.30, p (FDR)<.001) than children with msTBI. Children with cmTBI also showed greater connectivity between the SBN and left temporal pole of the DMN (t =7.45, p (FDR)<.000001) than children with msTBI. Degree of connectivity between the SBN and posterior cingulate was significantly positively correlated across all domains of adaptive function (r s=.451 to.504, p s=.010 to.003), whereas degree of connectivity between the SBN and left temporal pole was strongly positively related to Social Competence (a=.633, p =.006) and conceptual adaptive skills on the ABAS (A =.437, p =.037). Conclusions: Our findings provide insights into the neural substrates of social and adaptive morbidity after pediatric TBI, particularly msTBI, by linking alterations in connectivity among the SBN, DMN, and SN with measures of social and adaptive outcome. While the posterior cingulate was broadly associated with adaptive outcome, the temporal pole was particularly strongly associated with social competence. This may reflect the diverse functions and high degree of interconnectivity of the posterior cingulate, which contributes to various cognitive and attentional processes, relative to the strong amygdala/limbic connections of the temporal pole. [ABSTRACT FROM AUTHOR]

Objective: A common assumption to maximise cognitive training outcomes is that training tasks should be adaptive, with difficulty adjusted to the individual's performance. This has only been tested once in adults (von Bastian & Eschen, 2016). We aimed to examine children's outcomes of working memory training using adaptive, self-select and stepwise approaches to setting the difficulty of training tasks compared to an active control condition. Participants and Methods: In a randomised controlled trial (ACTRN 12621000990820), children in Grades 2-5 (7 to 11 years) were allocated to one of four conditions: adaptive working memory training, self-select working memory training, stepwise working memory training, or active control. An experimental intervention embedded in Minecraft was developed for teachers to deliver in the classroom over two weeks (10 x 20-minute sessions). The working memory training comprised two training tasks with processing demands similar to daily activities: backward span with digits and following instructions with objects. The control condition comprised creative building tasks. As part of a larger protocol, children completed at baseline and immediately post-intervention working memory measures similar to the training activities (primary outcome): backward span digits and letters versions, following instructions objects and letters versions. Primary analyses were intention-to-treat. Secondary analyses included only children who completed 10 sessions. Results: Of 204 children recruited into the study, 203 were randomised, with 95% retention at post-intervention. 76% of children completed all 10 training sessions. Comparisons between each working memory training condition and the active control on working memory measures were non-significant (f 2 = 0.00), with one exception. Children in the self-select condition on average performed 1-point better than the controls on the following instructions objects measure (p =.02, f 2 = 0.03). A pattern emerged that the self-select condition performed better on most measures. Conclusions: We found little evidence that an adaptive approach to setting the difficulty of training tasks maximises training outcomes for children. Findings suggest that working memory outcomes following training are limited and are not modulated by the approach to setting the difficulty of training tasks. This is consistent with findings from von Bastian & Eschen (2016), who also observed that the self-select condition (and not the adaptive condition) showed a slightly larger change in working memory performance following training than the control. It is helpful for clinicians to be aware that adaptive working memory training programs might not be superior in improving children's working memory, and the benefits of programs are limited. [ABSTRACT FROM AUTHOR]

Objective: Survivors of childhood ALL treated with CNS-directed chemotherapy are at risk for neurocognitive deficits that emerge during treatment and impact functional and quality of life outcomes throughout survivorship. Neurocognitive monitoring is the recommended standard of care for this population; however, information on assessment timing and recommendations for assessment measures are limited. We examined the role of serial neurocognitive monitoring completed during protocol-directed therapy in predicting parent-reported neurocognitive late effects during survivorship. Participants and Methods: Parents of 61 survivors of childhood ALL completed a semi-structured survey focused on parent perspective of neurocognitive late effects as part of a quality improvement project. Survivors completed protocol-directed treatment for newly diagnosed ALL on two consecutive clinical trials (St. Jude Total Therapy Study 15, 47.5%; Total Therapy 16, 52.5%). The majority of survivors were White (86.9%), 52.5% were male, and 49% were treated for low risk disease. Mean age at diagnosis was 7.77 years (standard deviation [SD] = 5.31). Mean age at survey completion was 15.25 years (SD = 6.29). Survivors completed neurocognitive monitoring at two prospectively determined time points during and at the end of protocol-directed therapy for childhood ALL. Results: During survivorship, parents reported that 73.8% of survivors experienced neurocognitive late effects, with no difference in frequency of endorsement by protocol (p =.349), age at diagnosis (p =.939), patient sex (p =.417), or treatment risk arm (p =.095). In survivors with late effects, 44.3% sought intervention in the form of educational programming (i.e., 504 or Individualized Education Program). Among the group with late effects, compared to those without educational programming, those with educational programming had worse verbal learning (CVLT Trials 1-5 Total, Mean[SD]; T = 56.36 [11.19], 47.00 [10.12], p =.047) and verbal memory (CVLT Short Delay Free Recall, Z = 0.86 [0.67], -0.21 [1.01], p =.007); Long Delay Free Recall, Z = 0.91 [0.92], -0.25 [1.25], p =.020) during therapy. Compared to those without educational programming, survivors with educational programming had lower estimated IQ (SS = 109.25 [13.48], 98.07 [15.74], p =.045) and greater inattention [CPT Beta T = 56.80 [13.95], 75.70 [22.93], p =.017) at the end of therapy. Conclusions: Parents report that nearly three quarters of children treated for ALL with chemotherapy only experience neurocognitive late effects during early survivorship, with no difference in frequency by established risk factors. Of those with late effects, nearly half required educational programming implemented after diagnosis, suggesting a significant impact on school performance. Results from neurocognitive monitoring beginning during therapy has utility for predicting educational need in survivors experiencing late effects. Our findings provide direction on the timing and content of neurocognitive monitoring, which is the recommended standard of care for childhood cancer patients treated with CNS-directed therapy. [ABSTRACT FROM AUTHOR]

The corpus callosum is the largest transverse white matter fiber tract connecting the two hemispheres of the brain. It plays an essential role in the interhemispheric transfer and bihemispheric coordination involved in perception and sensory-motor integration, as well as higher level cognition (e.g., memory, executive functioning). The corpus callosum forms prenatally (10-15 weeks gestation) and continues to develop through early adulthood. Damage to the corpus callosum throughout the lifespan, but especially later in life, can result in sensory and motor coordination deficits and produces disconnection syndromes. However, individuals born with a partial or fully absent corpus callosum, known as Agenesis of the Corpus Callosum (ACC), do not exhibit a full disconnection syndrome and may, in fact, demonstrate many intact skills including broadly average intellectual abilities. Agenesis of the corpus callosum (ACC) is a relatively common congenital brain malformation that occurs in 1 out of ∼4000 live births (Glass, Shaw, Ma, & Sherr, 2008; Paul et al., 2007). There is significant heterogeneity in outcomes for these individuals, often related to the presence of additional neuropathology, and the presence of co-occurring medical and genetic conditions. In adults for whom ACC is the primary neurological finding, there is a core constellation of cognitive symptoms that include reduced interhemispheric transfer, slowed processing, and difficulty with complex novel problem solving (Brown & Paul, 2019). There is also an elevated likelihood of autism spectrum disorders in this population as well (Paul et al, 2014). Modern ultrasound technology facilitates diagnosis of ACC in utero, offering a unique opportunity to study these individuals' development from infancy. However, no studies to date have examined early development in this population using validated measures, leaving neuropsychologists, neurologists and primary care providers to make educated guesses about what families should expect and appropriate therapies/treatment. This symposium presents a series of studies examining the early development of individuals with primary ACC across domains including language, adaptive skills, autism symptomology, and temperament/anxiety. We will provide the first in-depth prospective characterization of development in ACC relative to typically developing children at 6, 12, 18 and 24 months and discuss what these findings reveal about brain development and plasticity more broadly (e.g. how does early disruption in interhemispheric connection impact cognitive development across key domains?). Finally, while ACC is defined specifically by corpus callosum anatomy, the corpus callosum has been implicated in other neurodevelopmental conditions (Paul, 2011). Utilizing extant comparison, we also assess how early development in ACC both overlaps and differs from two monogenic conditions (e.g. Fragile X and Down Syndrome) and a developmental behavioral diagnoses (e.g. autism) and discuss how early disruptions in interhemispheric transfer may contribute to shared behavioral phenotypes in these conditions. [ABSTRACT FROM AUTHOR]

Objective: Accumulating evidence suggests that corpus callosum development is critically involved in the emergence of behavioral and cognitive skills during the first two years of life and that structural abnormalities of the corpus callosum are associated with a variety of neurodevelopmental disorders. Indeed by adulthood ∼30% of individuals with agenesis of the corpus callosum (ACC), a congenital condition resulting in a partial or fully absent corpus callosum, exhibit phenotypic features consistent with autism spectrum disorder (ASD). However, very little is known about developmental similarities and/or differences among infants with ACC and infants who develop ASD. This study describes temperament in infants with ACC during the first year of life in comparison with a neurotypical control group. Additionally, it examines the potential contribution of disrupted callosal connectivity to early expression of temperament in ASD through comparison to children with high familial likelihood of ASD. Participants and Methods: Longitudinal ratings of positive and negative emotionality were acquired at 6 and 12 months on the Infant Behavior Questionnaire-Revised across four groups of infants: isolated complete and partial ACC (n=104), high familial likelihood of ASD who do and do not have a confirmed ASD diagnosis (HL+ n=81, HL- n=282), and low-likelihood controls (LL- n=152). Results: Overall, the ACC group demonstrated blunted affect, with significantly lower positive and negative emotionality than LL controls at both timepoints. Specifically, the ACC group exhibited lower activity and approach dimensions of positive emotionality at both timepoints, with lower high-intensity pleasure at 6 months and lower vocal reactivity at 12 months. On negative emotionality subscales, the ACC group exhibited lower distress to limitations and sadness at both timepoints, as well as lower falling reactivity at 6 months. The ACC and HL groups did not differ significantly on positive emotionality at either timepoint. However, negative emotionality was lower in the ACC group than the HL- group at both timepoints and lower than the HL+ group at 12 months, with lower distress to limitations and sadness ratings than both HL groups at both timepoints. Conclusions: These findings highlight the importance of interhemispheric connections in facilitating active engagement and pursuit of pleasurable activities during the first year of life, as well as expression of sadness and distress to limitations. Notably, similarities between infants with ACC and infants at elevated familial risk of ASD suggest that disrupted callosal connectivity may specifically contribute to reductions in positive emotionality. [ABSTRACT FROM AUTHOR]

Objective: Agenesis of the Corpus Callosum (ACC), a congenital disorder in which the corpus callosum partially or completely fails to develop properly, occurs in ∼1 in 4,000 live births. ACC has been identified as a major risk factor for receiving an Autism Spectrum Disorder (ASD) diagnosis (∼10% diagnosis rate, as compared to 2.3% in the general population), but little is currently known about behavioral and social development during infancy and early childhood in this disorder. In this study we aim to 1) characterize the manifestation of autistic features in 24-month-old children (a common age for early diagnosis of ASD) with ACC and a convenience sample of age matched comparison children from the community, and 2) determine if parent reports of autistic features during the first year of life are associated with reciprocal social behavior and autistic traits at 24-months of age in children with ACC. Participants and Methods: Parents of infants who had received a diagnosis of ACC completed the Parent Rating of Communication, Emotion, and Social Skills (PROCESS) for their child at 6, 12, and 24-months of age, and the video-referenced rating of reciprocal social behavior (vrRSB) at 24-months of age. Comparison data were obtained from a convenience community sample in Minnesota. Aim 1). The distributions of PROCESS total scores at 24-months were compared between the ACC group (n=43) and control group (n=1058) via a 2-tailed t-test. Likewise, distributions of reciprocal social behavior (RSB) scores at 24 months were compared between ACC (n=72) and controls (n=1438) via a 2-tailed t-test. Aim 2). A partial Pearson Correlation was conducted between ACC participants' 6-month PROCESS scores and 24-month RSB (n=18) scores, as well as between their 12-month PROCESS and 24-month vrRSB (n=37) scores, controlling for child sex. Results: Aim 1). At 24 months of age, children with ACC are reported to have significantly higher PROCESS scores (t = 3.73, df = 42.67, p <.001), and RSB (t = 4.89, df = 88.38, p <.001) scores than comparison toddlers, indicating an elevated presentation of behaviors associated with autistic features. Aim 2). No correlation was found between participants' 6-month PROCESS and 24-month RSB scores (r(16) =.39, p =.12). A relatively strong correlation (r(35) =.60, p <.001) was found between participants' 12-month PROCESS and 24-month RSB scores. Conclusions: As early as two years of age, children with ACC display a heightened presentation of autistic features compared to typically developing controls. Additionally, reports of social behaviors related to ASD at 24-months are correlated with reports of autistic features at 12-months of age. This evidence indicates that children with ACC who are at a higher likelihood for being diagnosed with ASD may be identified as early as 12-months old. Formulating and leveraging an early identification methodology is imperative for this population with an already elevated risk for ASD, as providing early interventions leads to improved outcomes later in life. [ABSTRACT FROM AUTHOR]

Objective: Differences in adaptive functioning present early in development for many children with monogenic (Down Syndrome, Fragile X) and neurodevelopmental disorders. At this time, it is unclear whether children with ACC present with early adaptive delays, or if difficulties emerge later as functional tasks become more complex. While potential delays in motor development are frequently reported, other domains such as communication, social and daily living skills are rarely described. We used a prospective, longitudinal design to examine adaptive behavior from 6-24 months in children with ACC and compared their trajectories to those with monogenic and neurodevelopmental conditions. Participants and Methods: Our sample included children with primary ACC (n= 27-47 depending on time point) whose caregivers completed the Vineland Adaptive Behavior Scales-Interview 3rd Edition, via phone at 6, 12, 18 and 24 months. Comparison samples (using the Vineland-2) included children with Down Syndrome (DS; n = 15-56), Fragile X (FX; n = 15-20), children at high familial likelihood for autism (HL-; n=192-280), and low likelihood (LL; no family history of autism and no developmental/behavioral diagnosis; n = 111196). A subset of the HL children received an autism diagnosis (HL+; n = 48-74). The DS group did not have an 18-month Vineland. Results: A series of linear mixed model analyses (using maximum likelihood) for repeated measures was used to compare groups on three Vineland domains at 6, 12, 18 and 24 month timepoints). All fixed factors (diagnostic group, timepoint, and group X timepoint interaction) accounted for significant variance on all Vineland domains (p <.001). Post hoc comparisons with Bonferroni-correction examined ACC Vineland scores compared to the other diagnostic groups at each timepoint. At 6 months, parent-ratings indicated the ACC group had significantly weaker skills than the LL group in Communication and Motor domains. At 12, 18 and 24 months, ratings revealed weaker Communication, Daily Living and Motor skills in the ACC group compared to both the LL and HL- groups. Compared to the other clinical groups, the ACC group had stronger Socialization and Motor skills than Fragile X at 6 months, and at 24 months had stronger Communication and Socialization skills than both the DS and FX groups, as well as stronger Socialization than the HL+ group. Conclusions: Compared to children with low likelihood of ASD, children with primary ACC reportedly have weaker Communication and Motor skills from 6 to 24 months, with weakness in Daily Living Skills appearing at 12 months and all differences increase with age. Compared to Fragile X, the ACC exhibited relative strengths in socialization and motor skills starting at 6 months. By 24 months, the ACC group was outperforming the monogenic groups on Socialization and Communication. In general, the ACC scores were consistent with the HL+ sample, except the ACC group had stronger Social skills at 18 and 24 months. The results clearly inform the need for early intervention in the domains of motor and language skills. Additionally, as we know that children with ACC are at increased risk for social difficulties, research is needed both using more fine-grained social-communication tools, and following children from infancy through middle childhood. [ABSTRACT FROM AUTHOR]

Objective: Radiotherapy for pediatric brain tumor is associated with reduced white matter structural integrity and neurocognitive decline. Superior cognitive outcomes have been reported following proton radiotherapy (PRT) compared to conventional photon radiotherapy (XRT), presumably due to sparing of healthy brain tissue. This study examined long-term white matter change and neuropsychological performance in pediatric brain tumor survivors treated with XRT vs. PRT. Participants and Methods: Pediatric brain tumor survivors treated with either XRT (n = 10) or PRT (n = 12) underwent neuropsychological testing and diffusion weighted imaging > 7 years following radiotherapy. A healthy control group (n = 23) was also recruited. Groups had similar demographic characteristics, except for handedness (p =.01), mean years of age at testing (XRT = 21.7, PRT = 16.9, Control = 15.5; p =.01), and mean years since radiation (XRT =14.7, PRT = 8.9, p <.001). Age and handedness were selected as covariates; analyses were not adjusted for time since radiation due to redundancy with treatment group (i.e., standard of care transitioned from XRT to PRT in 2007). Participants completed age-appropriate versions of the Weschler Intelligence Scales (WAISIV/WISC-IV/WISC-V) and the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI and Motor Coordination subtests). Tractography was conducted using automated fiber quantification (AFQ), and fractional anisotropy (FA) was extracted from 12 tracts of interest. Linear mixed models were used to summarize group differences in FA, with tracts nested within subjects. Neuropsychological performance and tract-level FA were compared between groups using analysis of covariance (ANCOVA). Pearson correlation was used to examine associations between cognitive functioning and tract-level FA. Results: Across all tracts, FA was significantly lower in the XRT group than the PRT group (t(514) = -2.58, p =.01), but did not differ between PRT and Control groups (t(514) =.65, p =.51). For individual tracts, FA differed significantly between treatment groups (XRT < PRT) in the left inferior fronto-occipital fasciculus (IFOF), right IFOF, left inferior longitudinal fasciculus (ILF) and right uncinate (all t < -2.05, all p <.05). No significant differences in FA were found between PRT and Control participants for any tract. All neuropsychological scores were significantly lower for XRT than PRT patients (all p <.03), while PRT and Control groups performed similarly on these measures (all p >.19). Cognitive functioning was most consistently associated with FA of the corpus callosum major forceps (4/7 domains; all r >.33, all p <.04) and the left ILF (4/7 domains; all r >.37, all p <.02). Conclusions: Both white matter integrity and neuropsychological performance were generally reduced in patients with a history of XRT, but not in those who received PRT. The PRT group was similar to healthy control participants with respect to both FA and cognitive scores, suggesting improved long-term outcomes compared to patients receiving XRT. This exploratory study is the first to provide direct support for white matter integrity as a mechanism of cognitive sparing in PRT. Future work with larger samples is necessary to replicate these findings. [ABSTRACT FROM AUTHOR]

Objective: Social determinants of health (SDOH) are social conditions (e.g., employment, access to healthcare, quality schools) which are shown by a growing body of literature to impact many health outcomes, including cognition. The development of community-level measures including the Child Opportunity Index (COI) have allowed for increased understanding of the resources and conditions in neighborhoods and their impact on children's health. Given the limited existing research on how neighborhood factors impact cognitive development, this study aimed to examine associations between neighborhood context (COI) and cognitive outcomes in children and adolescents who presented for neuropsychological evaluations. Participants and Methods: Participants included 4,633 youth (ages 2-22; M = 10.8 years; SD = 4.1 years; 63% Male; 33% with a medical condition involving the central nervous system [CNS]) living in the DC-VA-MD-WV Metro Area who presented to an outpatient clinic for evaluation and completed an intellectual functioning (IQ) measure (88% Weschler, 11% DAS, <1% Leiter, <1% RIAS). COI values were extracted from electronic medical records based on home address. COI values include an overall index and three domain scores in educational (educational access, quality, and outcomes), health/environment (access to healthy food, healthcare, and greenspace) and social/economic (income, employment, poverty); higher scores indicate higher opportunity. Using metro-based norms, children from all opportunity levels were represented (14% Very Low, 13% Low, 18% Moderate, 21% High, 34% Very High). Multiple regression analyses were conducted to examine main effect associations between COI and Full-Scale IQ (FSIQ), Verbal IQ (VIQ), and Non-Verbal IQ (NVIQ) and explore moderation of age, gender, and medical condition on these associations. Additional regression analyses examined these relationships for the three COI domains. Results: Controlling for age, gender, and medical condition, neighborhood opportunity was positively associated with cognitive function (FSIQ: ß=0.198; VIQ: ß=0.202; NVIQ: ß=0.148, p's <0.01). Models accounted for approximately 10-14% percent of the variance in cognitive outcomes (FSIQ: F[6,4476]=180.331), Adj.R2=0.138; VIQ: F[6,4556]=161.931), Adj.R2=0.124; NVIQ: F[6,4548]=123.893), Adj.R2=0.098). Age moderated the association between overall COI and cognitive outcomes (FSIQ: ß=0.005, p=0.018; VIQ: ß=0.005, p=0.043; NVIQ: ß=0.005, p<0.01) such that the association between neighborhood opportunity and cognitive outcomes was stronger at older ages, though this was a small effect. When examining subdomains of COI, cognitive outcomes were associated with educational (FSIQ: ß=0.094; VIQ: ß=0.099; NVIQ: ß=0.078, p's <0.01) and social/economic opportunity (FSIQ: ß=0.115; VIQ: B=0.121; NVIQ: ß=0.084, p's <0.01) but not health/environmental opportunity (FSIQ: ß=-0.001, p=0.991; VIQ: ß=-0.008, p=0.581; NVIQ: ß=-0.008, p=0.553). Medical diagnosis moderated the association between social/economic opportunity and FSIQ; there was a stronger association between IQ and COI in youth with a medical diagnosis (ß=-0.071, p<0.05). Conclusions: These findings demonstrate the importance of neighborhood factors, especially education and social/economic opportunities, on cognitive development. Children living in higher opportunity neighborhoods showed higher cognitive functioning. Older age and CNS-involved medical conditions were associated with higher risk in the context of reduced neighborhood opportunities. These findings emphasize the need for advocacy and other efforts to improve community resources (e.g., access to early childhood education) to address inequities in cognitive development. [ABSTRACT FROM AUTHOR]

Objective: Much of the pediatric concussion literature focuses on sports and recreation related injuries, while there is a relative paucity of research on the cognitive and psychological sequelae associated with assault. However, it is understood that children with assault-related injuries demonstrate a longer recovery time. This case series reviews the data of four teenagers who were administered cognitive, emotional, and behavioral screeners after sustaining an assault related concussion. Participants and Methods: Four pediatric female patients (ages 13,14,15,15) with a recent history of concussion due to physical assault presented for evaluation at a hospital-based concussion clinic. All four patients were administered a computerized cognitive screener as well as self-report measures for mood, anxiety, post-traumatic stress disorder (PTSD), and sleep disturbance. Results: All four of the pediatric cases reported significant symptoms of PTSD, depression, anxiety, and sleep disturbance. For all four patients, the most notable problems across cognitive performance measures were observed in the areas of simple and complex attention. Conclusions: Results of this case series revealed clinically significant anxiety, depression, PTSD-symptoms, and sleep disturbance in conjunction with poor simple and complex attention. These pediatric cases illustrate the potential link between assault-related concussions, emotional and behavioral symptoms, and cognitive functioning. Furthermore, assault-related concussions may elevate risk toward attentional problems associated with psychological distress. Early evaluation of PTSD and mood related symptomatology is suggested to best support treatment planning and recovery in this population. Future studies are needed to explore the nature of the relationship between cognitive and emotional sequelae in patients who present with assault-related concussions. [ABSTRACT FROM AUTHOR]

Objective: Children who sustain a mild traumatic brain injury (mTBI) are at increased odds of additive injury and continue to show altered motor performance relative to never-injured peers after being medically cleared (MC) to return to normal activities. There is a critical need to determine when children can return to activities without risk of short and long-term adverse effects, with research showing high reinjury rates for 3-12 months after RTP. The Physical and Neurological Examination for Subtle Signs (PANESS) measures subtle signs of motor impairment during gait, balance, and timed motor functions. Recent literature has demonstrated that PANESS timed motor function can distinguish between children medically cleared post-mTBI compared to never-injured controls. The present study examined performance on timed motor tasks in youth medically cleared from mTBI following medical clearance and 3-months later, compared to never-injured peers. Participants and Methods: 25 children (Mage=14.16, SD=2.46; Male=68%) were enrolled within 6 weeks of medical clearance from mTBI (Mdays post MC=33, SD=13.4, Range=2-59) along with 66 typically developing, never-injured controls (Mage=13.9, SD=2.22; Male=50%). Group differences were evaluated for the Timed Motor section of the PANESS at enrollment and at a 3-month follow-up (Mdays from enrollment to follow-up=95.90, SD=12.69, Range=62-129). This 3-month follow-up occurred on average 4 months after medical clearance (Mdays from MC to follow-up=130.08, SD=17.58, Range=92 - 164). The Timed Motor section includes Repetitive (foot tapping, hand patting, and finger tapping) and Sequential (heel-toe rocking, hand pronate/supinate, finger sequencing) raw time scores, measured in seconds. The Total Timed Motor Speed score is the combination of Repetitive and Sequential Movement and the side-to-side tongue item. Results: At 3-month follow-up, mTBI participants (M=67.55, SD=8.26, Range=53.66-83.88) performed worse than controls (M=63.09, SD=10.23, Range=39.86-100.51) on Total Timed Motor Speed, t(89)= 1.95, p<0.05), including when controlling for age and sex, F(1, 87)=4.67, p<0.05. At the same time point, mTBI participants (M=36.54, SD=5.47, Range=28.74-49.17) performed worse on Sequential Speed than controls (M=32.93, SD=6.1, Range=21.49-56.76), t(89)=2.59, p<0.01, including when controlling for age and sex, F(1, 87)=7.687, p<0.01). Although groups performed similarly on Sequential Speed at the initial time point, mTBI participants exhibited a trend of less improvement from initial to follow-up (MmTBI=-1.69, Mcontrol=-3.68, t(90)=1.445, p=0.076). Conclusions: Although groups did not significantly differ on Timed Motor Speed items at the initial time point, the mTBI group showed consistently lower scores than controls at both time points and less improvement over time. Results indicate that Total Timed Motor Speed, specifically Sequential Speed, may be a sensitive marker of persisting differences in high-level motor and cognitive learning/control in children who have been medically cleared after mTBI. More data are needed to evaluate these findings over a longer time period, and future studies should examine behavioral markers concurrently with physiologic brain recovery over time. [ABSTRACT FROM AUTHOR]

Objective: Patients with persistent post-concussion symptoms (PPCS) experience prolonged recovery (e.g., headache, fatigue, or dizziness) lasting >2 months post injury. These symptoms are thought to be maintained by several biopsychosocial factors including dysregulated stress responses, such as pain catastrophizing, that may drive behavioral avoidance and contribute to mood symptoms and cognitive difficulties. Conditions with similar symptomatology to PPCS (e.g., anxiety disorders, somatosensory disorders, chronic pain, etc.) also exhibit maladaptive thought patterns like pain catastrophizing as well as decrements in certain aspects of cognitive performance; however little is known about how pain catastrophizing might relate to neuropsychological performance in youth with PPCS. Therefore, the purpose of this study was to examine the relationship between pain catastrophizing and neuropsychological performance in youth participants with PPCS. Participants and Methods: A prospective case-control study design was used to examine 29 participants between the ages of 13 to 23. Participants were divided into two groups: 1) patients with PPCS (2-16 months post-injury; n = 15) and 2) age-matched, non-injured controls (n = 14). Participants completed the Pain Catastrophizing Scale (PCS) to determine degree of catastrophic thinking related to pain experience and the Beck Depression Inventory (BDI). Neuropsychological performance was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and a modified version of the Paced Auditory Serial Addition Test (PASAT) where performance was evaluated by total correct and error type (i.e., commission and omission) across 5 trials. ANCOVA was used to compare group differences in pain catastrophizing and neuropsychological tests scores while controlling for age and linear regressions examined the relationship between PCS total score and each neuropsychological test score while controlling for level of depression. Results: Overall, the PPCS group reported significantly higher levels of pain catastrophizing on the PCS compared to the control group (p < 0.01). For neuropsychological performance, the PPCS group scored significantly lower than the control group on List Learning (p < 0.01), Semantic Fluency (p < 0.05), and List Recall (p < 0.01) on the RBANS and made significantly higher omission errors (but not commission) on the PASAT(p <.01). Higher pain catastrophizing was also associated with poorer neuropsychological performance on the exact same tasks the PPCS group performed worse than controls. There was no significant interaction by group in the impact of PCS scores on neurocognitive performance. Conclusions: Compared to controls, youth PPCS patients reported higher levels of pain catastrophizing. Additionally, pain catastrophizing was associated with poorer neuropsychological performance. These findings suggest that increased pain catastrophizing after head injury could contribute to poorer cognitive performance in youth. As such, interventions that target maladaptive cognitive coping styles like pain catastrophizing may be especially helpful for patients with PPCS. [ABSTRACT FROM AUTHOR]

Objective: Extant literature suggests significant heterogeneity in recovery trajectories after experiencing a moderate to severe traumatic brain injury (TBI) during childhood (Moran et al., 2016). The Cognitive and Linguistic Scale (CALS) is a promising non-norm-referenced measure designed for serial monitoring within an inpatient rehabilitation setting that may optimize prediction of acute recovery and long-term neuropsychological functioning. To date, the CALS has primarily been examined in the context of injury characteristics such as severity and etiology (e.g., Slomine et al., 2016), and it is unclear what non-injury factors may be relevant to consider. Using archival data gathered from an inpatient pediatric neurorehabilitation program, this study examined associations between the CALS and select sociodemographic factors to better inform the clinical utility of the measure. Participants and Methods: Participants included 56 youth (46% BIPOC, 66% male) aged 2-17 years (M = 12.40, SD = 3.99) who were admitted for moderate to severe TBI to an inpatient rehabilitation program at a regional tertiary care children's hospital. Data extracted from medical records included demographic information (i.e., age at injury, sex, ethnoracial identity, address, initial Glasgow Coma Scale (GCS) rating, CALS at admission, and full-scale IQ (FSIQ) at discharge. GCS was used as a proxy for injury severity. Residential addresses were geocoded and area-level median income was used as a proxy for familial socioeconomic status (SES). A multiple regression model was utilized to parse the individual contributions of demographic variables) on initial CALS performance while accounting for injury severity. Parallel regression models were used to determine whether patient characteristics moderate the association between initial CALS performance and cognitive functioning at discharge. Results: Preliminary analyses demonstrated that there were no significant associations between GCS and demographic variables, ps >.05. Patient age at injury was significantly associated with CALS total score at admission above and beyond injury severity and other demographic characteristics, t (31) = 2.55, p =.016, such that older age was associated with higher initial CALS scores. Results of moderator analyses between CALS and patient characteristics showed a significant main effect of injury severity, such that higher GCS was associated with higher FSIQ at discharge across models, ps <.05. No significant interactions were identified. Conclusions: These findings provide additional evidence for the generalizability of the CALS and further characterize its associations with non-injury factors, which is important for better understanding aspects that contribute to recovery trajectories and outcomes after moderate to severe TBI. Given the longstanding challenges in regard to the validity of neuropsychological assessment for diverse groups, it is critical to explicitly examine cultural context when considering the clinical utility of a measure. A limitation of the current study is the utilization of broad demographic information due to limited availability of sociocultural data. Future research should examine more granular and culturally-specific variables that may impact CALS performance (e.g., educational attainment, linguistic considerations), beyond using broad-based demographic data as a proxy for sociocultural factors. Another important next step is to utilize serial administrations of the CALS to examine the impact of sociocultural factors on recovery trajectories following TBI. [ABSTRACT FROM AUTHOR]

Objective: Motor impairments are one of the most common adverse outcomes after pediatric arterial ischemic stroke (AIS), affecting approximately half of survivors. The development of motor and cognitive skills is closely interrelated, and they share common neural substrates. The objective of this study was to examine whether motor functioning after the acute phase of stroke is associated with school-age intellectual abilities. We also examined associations between concurrent motor functioning and intellectual abilities. Finally, we explored clinical features associated with motor impairments. Participants and Methods: Participants were 64 children, 34 childhood AIS (Meanage= 11.90[2.38]); 30 perinatal AIS (Meanage= 8.75[2.22]), from the Children's Stroke Program at SickKids Hospital. Motor functioning was assessed with the Pediatric Stroke Outcome Measure sensorimotor subscale at two timepoints, Time 1 or early recovery (childhood group between 30 days post-stroke to 1 year; perinatal group between 2-5 years of age) and Time 2, closest to neuropsychological testing. Intellectual abilities were measured using the Wechsler Intelligence Scale for Children 4th or 5th edition. Associations between motor and intellectual functioning were examined separately in childhood and perinatal AIS groups. Clinical features associated with motor impairment were examined across the full sample. Results: Motor functioning during early recovery was significantly associated with processing speed (r= -.391, p=.036) in the perinatal group and with overall intellectual functioning (r= -.414, p=.018) verbal intellectual abilities (r= -.444, p=.011), working memory (r=.393, p=.026), and processing speed (r= -.351, p=.042) in the childhood group. There were no associations between concurrent motor and intellectual functioning in the perinatal group, and only with processing speed (r= -.525, p=.002) in the childhood group. When motor functioning was dichotomized as no/mild motor deficit and moderate/severe motor deficit at Time 1, children in the perinatal group with moderate/severe motor deficit had significantly lower perceptual reasoning scores (f[28]= 2.15, p=.040) and participants in the childhood group with moderate/severe motor deficit had significantly lower perceptual reasoning (f[32]= 2.35, p=.025) and processing speed (f[32]= 2.14, p= 0.41) scores. There were no differences between no/mild and moderate/severe motor deficit groups for either perinatal or childhood AIS at Time 2. Clinical features associated with moderate/severe motor deficit at Time 1 were cortical+subcortical infarcts, large lesions, presenting with hemiparesis and seizures at time of neuropsychological assessment, and accessing occupational therapy and physical therapy. Conclusions: Results suggest that motor functioning during early stroke recovery is associated with intellectual outcome, whereas motor functioning at time closest to neuropsychological assessment is not. This may be related neuroplastic changes post-injury, likely in frontal-subcortical connections, that result in observable motor deficits after stroke and affect subsequent hierarchal brain maturational processes thereby impacting later cognitive outcome. Different patterns of associations between motor functioning and specific intellectual abilities in perinatal and childhood groups suggest possible age-mediated effects on this relationship. [ABSTRACT FROM AUTHOR]

Stroke is an important cause of acquired brain injury in youth and a significant source of childhood disability. Up to 80% of survivors suffer long-term neurological deficits, including impairments across a range of neuropsychological domains. An improved understanding of neuropsychological outcomes is key to optimizing clinical care, improving evaluation of prognosis, and developing effective rehabilitation and intervention strategies. The proposed symposium will begin with a literature review on neuropsychological outcomes following pediatric stroke. Next, four studies will be presented, each posing distinct and complementary research questions regarding predictors of outcomes. The roles of both clinical (e.g., lesion size, motor impairment, inflammatory response) and environmental factors (e.g., socioeconomic status, family functioning) will be explored regarding cognitive, social-emotional, and behavioral outcomes. The symposium will end with a Q&A period. Attendees will leave with an in-depth understanding of recent trends and scientific advances in research on neuropsychological outcomes in pediatric stroke, which should inform clinical practice and research directions. The first presentation examines predictors of neuropsychological outcomes following pediatric stroke. Findings have often conflicted, and more research is needed to disentangle the effects of predictors on specific domains. Explored predictors include: age at stroke; stroke subtype (hemorrhagic vs. ischemic); lesion location; lesion size; time since stroke; neurologic severity; seizure disorder; and socioeconomic status. This study examines the impact of these predictors on distinct neuropsychological domains. The next presentation addresses associations between neuropsychological outcomes and motor functioning following pediatric stroke. The development of cognitive and motor skills is interrelated and they share common neural substrates. In other populations, motor functioning predicts intellectual ability, and brain connectivity underlies this association. This study investigates associations between motor functioning and global neuropsychological outcomes in children with stroke and explores clinical features associated with motor impairments. The third presentation explores mental health outcomes. Neuropsychological deficits can hinder academic advancement and social-emotional development and may place youth at increased risk for psychological concerns. An increased focus on mental health is warranted given that psychosocial and behavioral issues are often the most concerning problems for parents and teachers. This study uses a qualitative paradigm to shed light on lived experience of youth with stroke with a focus on mental health, relationships, and social competence. The fourth presentation consists of a systematic review exploring the association between inflammatory response and neuropsychological outcome. Stroke induces an inflammation in the central and peripheral nervous systems, and high levels of inflammatory markers following stroke have been associated with poorer cognitive outcomes. This study reviews the state of research on this topic with a focus on pro-inflammatory cytokines and c-reactive protein. The symposium topics covered lie at the heart of the INS mission to study brain-behavior relationships using a multidisciplinary lens, with an emphasis on sharing and applying scientific knowledge. The symposium seeks to inform professionals working with youth with stroke about cutting-edge research, clinically applicable and novel insights, and ideas for future research directions. In this way, our symposium contributes to evidence-based care and the advancement of research. [ABSTRACT FROM AUTHOR]

Objective: Anti-W-methyl-D-aspartate receptor encephalitis (ANMDARE) is a rare and progressive neurological autoimmune disease that disproportionally affects pediatric patients (Yeshokumar et al., 2022). Patients diagnosed with ANMDARE experience a host of neurocognitive and psychiatric sequelae, but data on the rate of recovery are generally mixed (Wilkinson-Smith et al., 2022). Misdiagnosis of ANMDARE is common and may complicate recovery given the progressive nature of the syndrome (Shimoyama et al., 2016); thus, knowledge of the etiology may result in enhanced resolution of symptoms. The current study assessed the rate of functional recovery for pediatric patients diagnosed with ANMDARE and admitted to an inpatient rehabilitation program. Specifically, we hypothesized that patients with idiopathic autoimmune encephalitis (IAE) would have a protracted rate of acute recovery compared to patients diagnosed with ANMDARE. Participants and Methods: The current study included archival data of pediatric patients (W=10) aged 3-16 years (M=12.39, SD=4.97) admitted to an inpatient rehabilitation program at a metropolitan academic medical center between 2017-2022; of these patients, 7 were characterized as having IAE, 5 were female-at-birth, and 7 were of Hispanic/Latine origin. The Functional Independence Measure for Children (WeeFIM; Msall et al., 1994) domain scores (i.e., cognition, self-care, mobility, motor) were utilized to assess acute recovery. Welch's f-tests were analyzed separately at admission and discharge between etiological conditions (i.e., idiopathic vs. known) for each WeeFIM domain. Subsequently, change scores were calculated across the length of inpatient stay for each WeeFIM domain, and Welch's f -tests determined statistical differences in change scores between etiological conditions. Results: Contrary to predictions, WeeFIM self-care domain scores were significantly higher at inpatient admission for patients with IAE (M =27.57) as compared to patients with ANMDARE (M=13.00), f(7) = 1.95, p <.05; trending differences were also found in admission scores on the WeeFIM motor domain between IAE (M =43.86) and ANMDARE (M=24.00) diagnostic groups, f(6) = 1.71, p =.07. Consistent with predictions, patients with ANMDARE generally had an appreciable acute recovery as compared to patients with IAE. Specifically, trending differences were found in change scores on the WeeFIM self-care domain between IAE (M=10.29) and ANMDARE (M=30.33) diagnostic groups, f(6) = -1.64, p =.05. Likewise, trending differences were found in change scores on the WeeFIM motor domain between IAE (M=21.43) and ANMDARE (M=47.67) diagnostic groups, f(5) = -1.82, p =.06. No significant or trending differences were observed at discharge. Conclusions: Results have implications for optimizing the assessment and treatment of pediatric patients diagnosed with autoimmune encephalitis. Specifically, patients with ANMDARE may have a more severe initial presentation yet improved recovery course compared to patients characterized as idiopathic during their inpatient stay, particularly in motor and self-care functional domains; data highlights the importance of inpatient rehabilitation for patients diagnosed with ANMDARE. Current limitations include small sample sizes across diagnostic groups, likely due to the rarity of the disease. It is recommended that future research investigate the prognosis of pediatric patients diagnosed with autoimmune encephalitis longitudinally, at follow-up and across the lifespan. [ABSTRACT FROM AUTHOR]

Objective: Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) is a complex, yet treatable autoimmune disorder characterized by a fairly abrupt onset of a constellation of symptoms attributable to diffuse brain dysfunction (Tarantino et al., 2021). Despite the potential for a severe disease course, most patients have a favorable outcome with substantial recovery (Dalmau et al., 2011; Titulaer et al., 2013). Nevertheless, there is limited literature discussing the long-term outcomes in patients with anti-NMDARE, particularly in pediatric patients. The primary objective of this study is to examine and describe behavioral, emotional, adaptive, and executive functioning outcomes in pediatric and young adult patients with this disease. This study also sought to provide information on the perceived health-related quality of life (HRQoL) of patients and their parents and investigate the impact of anti-NMDARE on parents and family functioning. Participants and Methods: All individuals known to have been diagnosed and treated for anti-NMDARE at The Children's Hospital of Philadelphia (CHOP) between January 1, 2005, and October 1, 2020, were contacted with both patients and their parents/guardians invited to participate. Eighteen pediatric patients between the ages of 6 and 26 and/or their parents/caregivers participated in the study. Of the 18 patients represented in the sample, 50% were white/Caucasian, and 67% were female. The mean duration of time since symptom onset was 7.1 years. Primary outcomes were measured through standardized questionnaires of emotional, behavioral, and adaptive functioning (BASC-3) and executive functioning (BRIEF2 or BRIEF-A). Secondary outcomes related to family functioning and HRQoL were measured through (PedsQL™ and PedsQL™ Family Impact Module.) Results: All aggregate T-scores for the BASC and BRIEF placed children with anti-NMDARE within an age-appropriate range regarding behavioral, emotional, adaptive, and executive functioning outcomes. Children with anti-NMDARE were not found to have lower HRQoL compared to their healthy same-age peers. Moreover, parents of children with anti-NMDARE did not endorse a prolonged impact of this illness on family functioning and adjustment. Conclusions: This study aimed to better understand the neurobehavioral profile and the long-term outcomes of children diagnosed with anti-NMDARE, with the ultimate goal of advancing understanding of this encephalitis. Consistent with findings from several reviewed studies on long-term follow-up, the present study suggests that most children with a history of anti-NMDARE show good functional recovery over time. However, data on the neurobehavioral sequelae, quality of life, and adaptive behavior in patients diagnosed with anti-NMDARE are still sparse, especially at pediatric age. In order to understand and learn to manage the needs of patients with anti-NMDARE, particularly regarding the impact this disease can have on daily life and school performance, additional neuropsychological research involving larger samples, longitudinal studies, and increased methodological consistency is required. [ABSTRACT FROM AUTHOR]

Objective: Children with congenital heart disease (CHD) have increased likelihood for Autism Spectrum Disorder (AuSD; Sigmon, Kelleman, Susi, Nylung & Oster, 2020). Even those not meeting full criteria remain at greater risk for problems with social processing/communication (Cassidy et al, 2018). The current study examined what symptoms indicative of potential AuSD were qualitatively reported by parents, and what symptoms were noted behaviorally by clinicians. These behaviors may be targets for both further clinical inquiry and intervention. Participants and Methods: A retrospective chart review of CHD patients seen for neuropsychological assessment between the ages of 6-18 years and between 2016-2021 was conducted. The final sample included 88 patients (Ethnicity: 14% Hispanic; Race: 76% White, 17% Black/African American, 5% Asian, 1% Native American, 1% Unknown). A coding system for AuSD symptoms was derived by the authors, who are experienced in AuSD diagnosis and assessment, based on DSM-5 criteria. A comprehensive list of behaviors consistent with each symptom category was generated, and assessment reports were subsequently reviewed noting the presence, absence or "no mention" of each symptom. A second coding system was derived to assess for AuSD symptoms documented in each report's behavioral observations. Three pediatric neuropsychologists, one post-doctoral fellow, and one psychometrist were coders, with very good reliability (k=.854 (95% CI,.827 to.881), p <.0001). Results: Twelve patients (14%) were diagnosed with AuSD. Age of diagnosis ranged from 3-14 years (M=7.82, SD=3.92). Main concerns parents expressed included difficulty with reciprocal conversation (75%), making friends (75%), initiating and maintaining social interactions (67%), and restrictive/intense interests (58%). During testing, providers noted variable eye contact (67%), appropriate responses to questions but minimal social conversation (67%), and exaggerated prosody (42%). Of those who did not have an AuSD diagnosis, the most frequent parent concerns included difficulty making friends (38%), difficulty initiating or maintaining social interactions (33%), atypical affect (25%), and restrictive/intense interests (18%). In this sample, providers noted concerns with answering questions but not maintaining conversation (26%), flat affect (16%), loud (17%) or soft (21%) speech volume, and socially immature behaviors (10%). Within this No Diagnosis group, general social concerns were highly correlated (point biserial) with more specific autism symptoms (e.g., intense interests, difficulty with transitions, sensory sensitivities r =.986 -.784), although most often the presence or absence of these concerns were not documented. Conclusions: We examined qualitative parent-reported and provider-observed behaviors indicative of potential AuSD as detailed in a comprehensive neuropsychological evaluation report. Behaviors in children with formal AuSD diagnoses were consistent with that diagnosis, based on both parent and provider description. Of note, in children without AuSD, though, both parents and providers reported AuSD-like concerns (e.g., social communication/interaction problems, atypical interests, atypical affect, atypical speech volume) in a large minority of children. It is important that if general social concerns are present, that providers follow-up on, and document, a broader constellation of AuSD symptoms. These behaviors deserve further exploration and study within the CHD population and are important areas of inquiry in any clinical evaluation, as they should directly inform intervention. [ABSTRACT FROM AUTHOR]