Pediatric Teleneuropsychology: Feasibility and Recommendations

Abstract

Objective Teleneuropsychology (TeleNP) is a growing and promising practice within the telemedicine landscape that has been well established within the adult neuropsychology literature. This project aimed to demonstrate the feasibility of TeleNP in a pediatric clinical population and disseminate clinical decision-making procedures to guide best practices for pediatric TeleNP. Method This project conducted during the 2019 coronavirus (COVID-19) pandemic reflects the largest clinical cohort to date of TeleNP in a pediatric population (N = 129). Data were gathered retrospectively from patients who were rescheduled from in-person assessment to TeleNP between March to June 2020. Results TeleNP was an accessible option for most patients and families, with no differences in demographic variables in patient appointment attendance, whether testing was conducted, and whether the patient was referred for face-to-face follow-up. Patients using laptops/desktops were more likely to undergo remote test administration in comparison with patients using phones/tablets (χ2 = 23.83, p < .002). Sixty-three percent of the sample were referred for a face-to-face follow-up assessment. Conclusions TeleNP is feasible in a pediatric clinical population ranging to begin the process of differential diagnosis and treatment planning. Pediatric TeleNP may be most efficacious as a screening procedure due to limited measures suited for remote administration and behavioral challenges interfering with testing requiring in-person follow-up. TeleNP screening as standard practice for patients who do not require a full, traditional neuropsychological battery may provide a more efficient care model, with more patients able to be seen using shorter batteries with less wait time.

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

“…Traditionally, neuropsychologists have relied upon in-person, paper and pencil testing due to a preponderance of research to support their use ( Hewitt, Rodgin, Loring, Pritchard, & Jacobson, 2020 ). Prior to the pandemic, more attention had been focused on incorporating technology through computer-based administration of measures and the potential role of telehealth in providing neuropsychological services ( Harder et al., 2020 ; Ransom et al., 2020 ). With the commencement of stay-at-home orders, social distancing protocols, and insurance reimbursement for telehealth services, a renewed emphasis has been placed on technology’s role in neuropsychological evaluations, and its limitations ( Hewitt et al., 2020 ; Ransom et al., 2020 ).…”

“…Thus, there is a continued need for research to support the validity of administering certain measures via telehealth, especially as their use has been expanded and increasingly relied upon in the current pandemic. In contrast, in the field of pediatric neuropsychology, telehealth is limited in its ability to replicate the traditional testing environment and subsequently has not been well investigated or utilized ( Ransom et al., 2020 ).…”

“…The advent of telehealth also has the potential to reduce travel burden and increase access for patients ( Ransom et al., 2020 ). A study conducted in a private practice setting prior to the pandemic supports the potential benefits of telehealth, demonstrating that brief neuropsychological screenings conducted via telehealth decreased time to diagnosis, and treatment and was financially feasible for patients ( Salinas, Edgar, Berrios Siervo, & Bender, 2020 ).…”

“…Further, using telehealth for triage assists in increasing the efficiency of the clinic, reduces waitlist length, and the overall potential to increase timely access to appropriate care ( Pritchard, Sweeney, Salorio, & Jacobson, 2020 ). The feasibility of using telehealth has increased since the beginning of the pandemic as there is increased guidance on how to use the technology ( Bilder et al., 2020 ) and reimbursement for the service ( Bilder et al., 2020 ; Hewitt et al., 2020 ; Ransom et al., 2020 ). One preliminary study ( Harder et al., 2020 ) suggested that telehealth-based neuropsychological testing was feasible and valid in pediatric patients with demyelinating disorders.…”

Transforming pediatric neuropsychology through video-based teleneuropsychology: an innovative private practice model pre-COVID-19

“…To illustrate, it is estimated that it takes children on average 2–3 years to receive a medical diagnosis after initial symptoms ( Garrido, Carballo, Artis, & Garcia-Retamero, 2018 ; Ringeisen, Oliver, & Menvielle, 2002 ), particularly when Spanish is the primary language ( Jimenez, Martinez Alcaraz, Williams, & Strom, 2017 ), leading to increased symptom severity, development of comorbidities, the need for more intensive treatments, as well as increased financial and family burden ( Estes et al., 2009 ). Potential barriers which can slow a patient’s presentation to treatment include provider shortage resulting in lengthy wait times ( Ransom et al., in press ), insurance barriers, and a dearth of accessible, and specialized providers (i.e., bilingual/bicultural neuropsychologists and/or those who sub-specialize in pediatric neuropsychology). In fact, only approximately 16% of neuropsychologists identify as specializing in pediatrics ( Postal et al., 2017 ; Sweet, Benson, Nelson, & Moberg, 2015 ).…”