Mullen Scales of Early Learning Adaptation for Assessment of Indian Children and Application to Tuberculous Meningitis

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Introduction</jats:title> <jats:p>Tuberculous meningitis (TBM) results in significant morbidity and mortality among children worldwide. Associated neurocognitive complications are common but not well characterized. The Mullen Scales of Early Learning (MSEL), a well-established measure for assessment of neurodevelopment, has not yet been adapted for use in India. This study’s goal was to adapt the MSEL for local language and culture to assess neurocognition among children in India, and apply the adapted measure for assessment of children with TBM.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Administration of MSEL domains was culturally adapted. Robust translation procedures for instructions took place for three local languages: Marathi, Hindi and Tamil. Multilingual staff compared instructions against the original version for accuracy. The MSEL stimuli and instructions were reviewed by psychologists and pediatricians in India to identify items concerning for cultural bias.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>MSEL stimuli unfamiliar to children in this setting were identified and modified within Visual Reception, Fine-Motor, Receptive Language and Expressive Language Scales. Item category was maintained for adaptations of items visually or linguistically different from those observed in daily life. Adjusted items were administered to six typically developing children to determine modification utility. Two children diagnosed with confirmed TBM (ages 11 and 29 months) were evaluated with the adapted MSEL before receiving study medications. Skills were below age-expectation across visual reception, fine motor and expressive language domains.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>This is the first study to assess children with TBM using the MSEL adapted for use in India. Future studies in larger groups of Indian children are warranted to validate the adapted measure.</jats:p> </jats:sec>

Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial

“…While it was based on pre-trial modeling work [ 16 ], even higher doses may be more efficacious [ 14 ]. Fourth, assessing neurocognitive outcomes across a broad range of ages (0–12 years) and different culture settings using a single, consistently applied tool is challenging [ 8 , 17 , 26 , 41 ]. While MSEL was culturally adapted to trial settings, with systematic and longitudinal training of all testers in TBM-KIDS, other tools are needed to facilitate studies such as ours.…”

“…Possible, probable, definite, or no TBM status was assigned based on Consensus Research Definition ( Supplementary Table 1 ) [ 20 ]. Children underwent staging of disease severity by Medical Research Council scale [ 21 ], assessment of neurologic function by MRS [ 22 ], and neurocognitive assessment by MSEL at entry [ 17 , 23 ].…”

“…The primary safety outcome was grade 3 or higher adverse events (Division of AIDS Grading Table, version 2.1, March 2017). MSEL score, a secondary endpoint, was adapted for local use, as previously described [ 17 ], and available in Hindi, Marathi, Tamil, or Chichewa. Overall score and subscale scores were recorded.…”

“…We used the Modified Rankin Scale (MRS) to measure functional status. We adapted the Mullen Scales of Early Learning (MSEL) tool to assess neurocognitive status longitudinally [ 17–19 ]. Here we report results from TBM-KIDS, the first randomized clinical trial (RCT) of antimicrobials for children with TBM.…”

Association of Placental Pathology with Physical and Neuronal Development of Infants: A Narrative Review and Reclassification of the Literature by the Consensus Statement of the Amsterdam Placental Workshop Group

“…In a previous study using APWGCS criteria, we analyzed the pathology of 258 whole placentas from singleton pregnancies enrolled in the Hamamatsu Birth Cohort for Mothers and Children [ 27 ] and identified maternal vascular malperfusion (MVM) as a significant predictor of lower body weight and deciduitis as a significant predictor of a small ponderal index [ 28 ]. Moreover, some pathological findings, such as accelerated villous maturation, were significant predictors of lower Mullen Scales of Early Learning (gross motor, visual reception, fine motor, receptive language, expressive language) at 10, 14, 18, 24, 32, and 40 months [ 29 ], whereas others, such as fetal vascular malperfusion (FVM), were significant predictors of higher MSEL composite scores in relation to neurodevelopmental milestones [ 30 ]. In the present study, we hypothesized that reevaluating the previous literature by reclassifying their placental pathological statements using APWGCS criteria would provide insight into establishing placental pathology as a clinically useful predictor of infantile development.…”