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Applying an Evidence-Based Assessment Model to Identify Students at Risk for Perceived Academic Problems following Concussion

Published online by Cambridge University Press:  01 December 2016

Danielle M. Ransom ,
Alison R. Burns ,
Eric A. Youngstrom ,
Christopher G. Vaughan ,
Maegan D. Sady  and
Gerard A. Gioia
Danielle M. Ransom
Affiliation:
University of Miami Miller School of Medicine, Miami, Florida
Alison R. Burns
Affiliation:
Children’s National Health System, Washington, DC George Washington University School of Medicine, Washington, DC
Eric A. Youngstrom
Affiliation:
University of North Carolina, Chapel Hill, North Carolina
Christopher G. Vaughan
Affiliation:
Children’s National Health System, Washington, DC George Washington University School of Medicine, Washington, DC
Maegan D. Sady
Affiliation:
Children’s National Health System, Washington, DC George Washington University School of Medicine, Washington, DC
Gerard A. Gioia*
Affiliation:
Children’s National Health System, Washington, DC George Washington University School of Medicine, Washington, DC
*
Correspondence and reprint requests to: Gerard Gioia, Chief, Division of Neuropsychology, Children’s National Medical Center, 15425 Shady Grove Road, Suite 350, Rockville, MD 20850. E-mail: ggioia@childrensnational.org
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Abstract

Objectives: The aim of this study was to demonstrate the utility of an evidence-based assessment (EBA) model to establish a multimodal set of tools for identifying students at risk for perceived post-injury academic problems. Methods: Participants included 142 students diagnosed with concussion (age: M=14.95; SD=1.80; 59% male), evaluated within 4 weeks of injury (median=16 days). Demographics, pre-injury history, self- and parent-report measures assessing symptom severity and executive functions, and cognitive test performance were examined as predictors of self-reported post-injury academic problems. Results: Latent class analysis categorized participants into “high” (44%) and “low” (56%) levels of self-reported academic problems. Receiver operating characteristic analyses revealed significant discriminative validity for self- and parent-reported symptom severity and executive dysfunction and self-reported exertional response for identifying students reporting low versus high academic problems. Parent-reported symptom ratings [area under the receiver operating characteristic curve (AUC)=.79] and executive dysfunction (AUC=.74), and self-reported ratings of executive dysfunction (AUC=.84), symptoms (AUC=.80), and exertional response (AUC=.70) each classified students significantly better than chance (ps<.001). Hierarchical logistic regression indicated that, of the above, self-reported symptoms and executive dysfunction accounted for the most variance in the prediction of self-reported academic problems. Conclusions: Post-concussion symptom severity and executive dysfunction significantly predict perceived post-injury academic problems. EBA modeling identified the strongest set of predictors of academic challenges, offering an important perspective in the management of concussion by applying traditional strengths of neuropsychological assessment to clinical decision making. (JINS, 2016, 22, 1038–1049)

Keywords

Brain injuryPost-concussion symptomsPediatricsReceiver operating characteristicAcademicsEvidence based practice
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 22 , Special Issue 10: Special Issue: Preclinical Prediction , November 2016 , pp. 1038 - 1049
Copyright
Copyright © The International Neuropsychological Society 2016 

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