To confirm your appointment, please press one: Examining demographic and health system interface factors that predict missed appointments in a pediatric outpatient neuropsychology clinic.

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.

Association Between Neighborhood Deprivation and Child Cognition in Clinically Referred Youth.

OBJECTIVE: When socioeconomic status is measured at the individual and/or family level, it has long been associated with cognition in children. However, the association between neighborhood deprivation, an index of community-level socioeconomic status, and child cognition is not fully understood. The goal of this study was to investigate (1) the relationship between neighborhood deprivation and child cognitive functioning and (2) whether child age moderates the relationship between cognitive functioning and neighborhood deprivation. METHODS: This study included 9878 children, ages 3 through 17 years (M = 10.4 yrs, SD = 3.4 yrs). Data were gathered from children referred for and evaluated at an urban, outpatient neuropsychology assessment clinic between 2006 and 2022, located in the Mid-Atlantic region of the United States. Neighborhood socioeconomic status was measured at the census block level using the Area Deprivation Index composite. RESULTS: There was a 20-point median difference in overall intelligence between the neighborhoods with the lowest and highest levels of deprivation. Overall intelligence and verbal comprehension, compared with working memory, fluid reasoning, and processing speed, demonstrated the strongest negative association with neighborhood deprivation (all p < 0.05). Older children had lower overall intelligence scores compared with younger children in neighborhoods with high levels of deprivation ( p < 0.01), suggesting a cumulative influence of poverty exposure. CONCLUSION: This study demonstrates the stark disparities in child cognitive functioning across levels of neighborhood deprivation. Findings support the importance of access to early interventions and services that promote intellectual growth and verbal capacity among children who live in neighborhoods with great deprivation.

Can We Expand the Pool of Youth Who Receive Telehealth Assessments for ADHD? Covariates of Service Utilization.

BACKGROUND: During the COVID-19 pandemic, telehealth became widely utilized for healthcare, including psychological evaluations. However, whether telehealth has reduced or exacerbated healthcare disparities for children with Attention-Deficit/Hyperactivity Disorder (ADHD) remains unclear. METHODS: Data (race, ethnicity, age, insurance type, ADHD presentation, comorbidities, and distance to clinic) for youth with ADHD (Mage = 10.97, SDage = 3.42; 63.71% male; 51.62% White) were extracted from the medical record at an urban academic medical center. Three naturally occurring groups were compared: those evaluated in person prior to COVID-19 (n =780), in person during COVID-19 (n = 839), and via telehealth during COVID-19 (n = 638). RESULTS: Children seen via telehealth were significantly more likely to be older, White, have fewer comorbid conditions, and live farther from the clinic than those seen in person. CONCLUSIONS: The current study suggests that telehealth has not eliminated barriers to care for disadvantaged populations. Providers and institutions must take action to encourage telehealth use among these groups.

Does Assessment Format Matter? A Comparison of In-Person Versus Teletesting Scores for Youth with ADHD.

OBJECTIVE: This study examined test score equivalency between traditional in-person assessment and teletesting among youth diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). METHOD: In all, 896 youth with ADHD, ages 5-21 years, were administered cognitive, academic achievement, and verbal fluency measures via either teletesting (n = 448) or traditional in-person assessment (n = 448). The teletesting and in-person groups were matched on age, sex, and insurance type (as a proxy for income). RESULTS: Results indicated no significant differences in test scores obtained via in-person and teletesting evaluations across all examined measures. CONCLUSION: Clinically referred youth with ADHD perform similarly on measures of cognitive functioning, academic achievement, and verbal fluency, regardless of whether these measures are administered in-person or via teletesting. While additional evidence for equivalent psychometric properties of neuropsychological instruments administered remotely is needed, this study offers support for the validity of remote administration among youth with ADHD.

Using latent profile analysis to evaluate the utility of a DSM-5 symptom checklist in screening children for autism spectrum disorder.

Objective: Currently available screening measures for Autism Spectrum Disorder (ASD) typically do not reflect DSM-5 diagnostic criteria and generally have weak positive predictive values. These factors result in missed opportunities for early intervention, delays in diagnosis, and contribute to inefficient usage of healthcare resources by inadequately discerning those in need of comprehensive assessment. This study examined a DSM-5 ASD symptom checklist to determine whether parent-report response patterns could accurately identify which children received an ASD diagnosis. Method: Data were examined from 376 ASD evaluations in a three-year period. Latent profile analysis was used to determine if subgroups could be identified according to parent response patterns, and network analysis was implemented to examine the relationship among DSM-5 ASD criteria within each latent profile. Results: A four-profile model was best supported based on fit indices and high probability classifications. The model was largely a product of how parents responded regarding their child's sensory behavior and minimally reflected other symptomatology. Subsequent network analyses by profile indicated weak coherence among DSM-5 symptoms within all profiles. Overall, direct assessment of DSM-5 criteria based on parent report did not add diagnostic value beyond that reflected in base rates. Conclusions: Although continued refinement of ASD screening tools is needed to improve accuracy of referrals for evaluations and reduce wait time for diagnosis, this study continues to support the need for behavioral observation and formal assessment by trained clinicians. Continued development of sensitive and specific screening tools, likely with embedded behavioral and/or objective observation, is needed.

Education and training guidelines for psychological assessment in health service psychology.

While recent survey findings suggest graduate programs in health service psychology (HSP) are allocating the same or increased time to education and training in psychological assessment over the last two decades, there is a lack of clear guidance for programs to implement practices associated with quality education and training. These Guidelines (found in full at https://www.apa.org/about/policy/guidelines-assessment-health-service.pdf) were developed to address this critical need. Developed by a task force of the American Psychological Association Board of Educational Affairs in 2018 and 2019, the Guidelines serve to inform faculty/supervisors, students, and the public as to quality practices associated with graduate education and training in psychological assessment. They are organized around seven domains: theory; psychological assessment process; psychometrics; tests and methods; ethics, legal issues, and professionalism; diversity; and supervision. These domains are drawn from a review of the scholarly literature on psychological assessment, as well as graduate psychology education and training. The domains and their associated Guidelines are interdependent, and, while some overlap exists among them, they should be considered in their entirety. While a summary of each section is provided in the present article, the full explanation of each domain is presented in the actual Guidelines document. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

More than Leisure: Organized Activity Participation and Socio-Emotional Adjustment Among Adolescents with Autism Spectrum Disorder.

Adolescents with high-functioning Autism Spectrum Disorder (HFASD) experience difficulties with socio-emotional adjustment, including compromised friendships, feelings of loneliness, and depression. Using a sample of 127 adolescents with HFASD and their parents, this study is first to examine: (1) relations between organized activity (OA) involvement and adjustment and (2) whether these relations were moderated by social impairment and executive functions. Results indicated that greater intensity, breadth, and academic OA involvement were associated with fewer depressive symptoms. OA intensity was also associated with less loneliness. For adolescents with better emotional control, greater intensity was associated with better friendship quality. Results suggest that for adolescents with HFASD, more involvement in OA is associated with better socio-emotional adjustment even after accounting for risk factors.

Relations Between Executive Functions, Social Impairment, and Friendship Quality on Adjustment Among High Functioning Youth with Autism Spectrum Disorder.

High functioning adolescents with Autism Spectrum Disorder (ASD) often have adjustment difficulties, specifically loneliness and depression. To better understand contributing factors, the current study evaluated associations between several Executive Function (EF) domains, social impairment, and friendship quality on depressive symptoms and loneliness in this population. Participants included 127 high functioning ASD adolescents and a parent/caregiver. Results indicated significant levels of parent-reported EF impairment which were positively correlated with increased levels of loneliness and depressive symptoms. Social impairment was identified as a significant mediator between all studied EF domains and adjustment, while friendship quality only partially mediated the relation between emotional control and loneliness. These results have implications for treatments focusing both on social skills and adjustment in adolescents with ASD.

Social-emotional adjustment and pet ownership among adolescents with autism spectrum disorder.

Adolescents with Autism Spectrum Disorder (ASD) often experience poor social-emotional adjustment and interactions with peers, but taking care of a family pet may serve as a buffer. This study utilized 81 parent-adolescent dyads to examine how dimensions of pet ownership (responsibility, comfort, companionship) may be associated with social-emotional adjustment (depression, loneliness, friendship quality) among adolescents with ASD, as well as how social impairments may influence these relations. Results revealed that adolescents who took more responsibility for their pet exhibited fewer depressive symptoms. Additionally, parents of more socially impaired adolescents reported better friendship quality than less socially impaired adolescents. Findings suggest taking care of a pet may facilitate better social-emotional adjustment among adolescents with ASD.