Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Division of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, 3250 Wilshire Blvd, Los Angeles, CA, 90010, USA.
J Clin Psychol Med Settings. 2024 Sep;31(3):526-536. doi: 10.1007/s10880-023-09990-0. Epub 2024 Feb 24.
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.
患有神经障碍的儿童面临着更高的心理健康和神经发育障碍风险，而这些信息往往仅限于家长报告。为了更好地了解这一人群的心理健康和神经发育需求，本研究对接受神经心理评估的神经障碍儿童进行了便利样本的回顾性图表审查，以探讨护理团队成员（转介提供者、父母、儿科神经心理学家）之间的评分者间一致性。从 2019 年接受评估的 129 名神经障碍青年（9:0-17:11 岁；51.2%为女性）的评估报告中收集了定性和定量数据，这些青年患有神经障碍（即 38.0%创伤性脑损伤、27.1%癫痫、14.7%早产、7.8%儿科癌症、3.9%产前物质暴露和 14.7%其他）。超过一半的青年被标记为存在未满足的神经发育和心理健康问题，分析显示心理健康问题的评分者间一致性较低（κ=0.324），神经发育问题的一致性较好（κ=0.511），转介提供者（Se=0.326）和父母（Se=0.366）的敏感性较低。单因素方差分析揭示了可能导致漏诊的重要因素（例如，症状严重程度、适应技能）。研究结果为加强了解神经障碍儿童心理健康和/或神经发育问题的方法提供了建议。
