How We Work Now: Preliminary Review of a Pediatric Neuropsychology Hybrid Model in the Era of COVID-19 and Beyond

Abstract

Objective Although telehealth has become a central component of medical care in response to the coronavirus disease 2019 (COVID-19) pandemic, comprehensive pediatric neuropsychological assessment over virtual platforms lacks empirical efficacy. This paper presents: a) the results of a quality improvement project examining the feasibility of in-person evaluation in the context of safety measures that alter test standardization, b) the impact such changes had upon neuropsychological test scores, and c) how using a hybrid model of clinical service delivery affected access to care. Method We compared demographic and outcome variables between patients seen during the pandemic (N = 87) to a group of patients seen in our service immediately prior to COVID-19 (N = 87). A subset of those patients were case-matched for age and diagnosis (N = 39 per group). Children seen for neuropsychological re-evaluation during the pandemic (N = 10) were examined using pairwise comparison. Results Groups did not differ on age, sex, or FSIQ. Despite changes to standardized administration, no group differences were found for any selected neuropsychological test variables in the larger sample or subsamples. In fact, all variables were moderately to highly correlated in the re-evaluation subgroup. The hybrid model expedited feedback sessions and increased face-to-face (telehealth) feedbacks. Conclusions A hybrid model incorporating modified in-person testing and intake and feedback encounters via telehealth may be a feasible and effective way to provide pediatric neuropsychological services. These preliminary findings suggest such novel aspects of neuropsychological evaluation could represent an improvement over pre-COVID models, especially in rural settings.

Nonverbal Neurocognitive Assessment during the Coronavirus Disease of 2019 Pandemic: the Effect of Personal Protective Equipment

“…Clinical programming and research studies using nonverbal neurocognitive assessment can continue during a viral pandemic, such as COVID-19, where PPE is required. These findings build upon prior research indicating that neuropsychological testing can be done with PPE without significantly affecting test scores ( Lichtenstein et al., 2022b ).…”

Mask wearing during neuropsychological assessment negatively impacts performance on verbal tests in older patients.

“…As reviewed in the Introduction section, Lichtenstein et al (2022) did not find significant differences in performance on any of their neuropsychological tests in a pediatric sample, related to the use of COVID-19 assessment protocols such as masks and face shields. This was true for both DS Forward and the California Verbal Learning Test (the latter being similar to the AVLT).…”

“…Minimal research has studied how masks impact performance on neuropsychological assessment. Lichtenstein et al (2022) evaluated the effectiveness of a hybrid neuropsychological assessment model they adopted after COVID-19. They compared performance between a pre-COVID-19 ( N = 87) and post-COVID-19 ( N = 87) cohort of pediatric patients.…”

“…The Lichtenstein et al (2022) study was limited to a pediatric sample. It is important to study the effects of mask wearing in a wider range of patient ages, especially in older patients.…”

The impact of the COVID‐19 pandemic on families of children with medical complexity: A qualitative study of caregivers' experiences

“…As such, these patients experienced a worsening of existing health inequities and risked exacerbation of their existing chronic conditions (Cadwgan et al, 2022). Fortunately, telehealth options, many of which were ultimately determined to be feasible for families and staff, were introduced across many different specialties to allow these families to maintain access to necessary services (Jeste et al, 2020; Lichtenstein et al, 2022; Murphy et al, 2023; Onofri et al, 2021; Peterson et al, 2021).…”