Ecological assessment of cognitive functions in children with acquired brain injury: a systematic review

BACKGROUND

Childhood acquired brain injury (ABI) often leads to impairment in cognitive functioning, resulting in disabilities in both the home and school environment. Assessing the impact of these cognitive deficits in everyday life using traditional neuropsychological tests has been challenging. This study systematically reviewed ecological measures of cognitive abilities available for children with ABI.

METHOD

Eight databases were searched (until October 2011) for scales: (1) focused on ecological assessment of cognitive functioning; (2) with published data in an ABI population; (3) applicable to children up to 17;11 years of age; and (4) in English. The title and abstract of all papers were reviewed independently by two reviewers.

RESULTS

Database searches yielded a total of 12 504 references, of which 17 scales met the inclusion criteria for the review, focusing on executive functions (n = 9), memory (n = 3), general cognitive abilities (n = 2), visuo-spatial skills (n = 2) and attention (n = 1). Four tasks used observation of actual performance in a natural environment, five were proxy-reports and six were functional paper and pencil type tasks, performed in an office.

CONCLUSION

Overall, few measures were found; eight were still experimental tasks which did not provide norms. Executive functions were better represented in ecological assessment, with relatively more standardized scales available.

The ecological validity of the Rey-Osterrieth Complex Figure: predicting everyday problems in children with neuropsychological disorders

Despite its extensive use, the validity of the Rey Complex Figure in predicting everyday behavioral executive dysfunction displayed by children with various neuropsychological disorders is unknown. The copied figures of 263 children aged 6 to 17 years were rescored using an accuracy approach that measured visuospatial ability and three process approaches developed to measure executive functioning. Controlling for age and IQ, partial correlations between scores derived by all scoring methods and the parent ratings on an executive function inventory were zero. In contrast, all four scoring approaches were associated with parent ratings on questionnaires that indexed children's academic achievement, developmental status, and adaptive ability. The findings suggest that the ecological validity of the Rey Complex Figure for children with various central nervous system disorders is more associated with visual-motor integration skills than executive functioning.

Ecological validity of neuropsychological assessment in childhood traumatic brain injury

Empirical investigation of the degree to which testing predicts children's real-world functioning following traumatic brain injury (TBI) is sparse. This article reviews the research in neuropsychology, which offers only moderate correlations between test scores and everyday functioning. This line of research is hindered by several methodological issues: difficulty translating performance on standardized testing into real-world capacities, measurement of real-world functioning, developmental factors, and the influence of intervening variables in the natural environment. Ecologically valid assessment may require multiple data sources. More research is needed to respond effectively to questions about children's everyday functioning after traumatic brain injury.