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Empirical Derivation and Validation of a Clinical Case Definition for Neuropsychological Impairment in Children and Adolescents

Published online by Cambridge University Press:  26 August 2015

Miriam H. Beauchamp*
Department of Psychology, University of Montreal, Montreal, Quebec, Canada Ste-Justine Hospital Research Center, Montreal, Quebec, Canada
Brian L. Brooks
Neurosciences program (Brain Injury and Rehabilitation), Alberta Children’s Hospital, Calgary, Alberta, Canada Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Department of Psychology, University of Calgary, Calgary, Alberta, Canada
Nick Barrowman
Department of Psychology, University of Calgary, Calgary, Alberta, Canada
Mary Aglipay
Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
Michelle Keightley
Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada Toronto Rehabilitation Institute, Toronto, Ontario, Canada
Peter Anderson
Behavioural Neurosciences & Consultation-Liaison program, Children’s Hospital of Eastern Ontario, Ottawa, ON Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
Keith O. Yeates
Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Department of Psychology, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Martin H. Osmond
Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
Roger Zemek
Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
Correspondence and reprint requests to: Miriam Beauchamp, Department of Psychology, University of Montreal, C.P. Succursale Centre-Ville, Montréal, Québec, Canada, H3C 3J7. E-mail:


Neuropsychological assessment aims to identify individual performance profiles in multiple domains of cognitive functioning; however, substantial variation exists in how deficits are defined and what cutoffs are used, and there is no universally accepted definition of neuropsychological impairment. The aim of this study was to derive and validate a clinical case definition rule to identify neuropsychological impairment in children and adolescents. An existing normative pediatric sample was used to calculate base rates of abnormal functioning on eight measures covering six domains of neuropsychological functioning. The dataset was analyzed by varying the range of cutoff levels [1, 1.5, and 2 standard deviations (SDs) below the mean] and number of indicators of impairment. The derived rule was evaluated by bootstrap, internal and external clinical validation (orthopedic and traumatic brain injury). Our neuropsychological impairment (NPI) rule was defined as “two or more test scores that fall 1.5 SDs below the mean.” The rule identifies 5.1% of the total sample as impaired in the assessment battery and consistently targets between 3 and 7% of the population as impaired even when age, domains, and number of tests are varied. The NPI rate increases in groups known to exhibit cognitive deficits. The NPI rule provides a psychometrically derived method for interpreting performance across multiple tests and may be used in children 6–18 years. The rule may be useful to clinicians and scientists who wish to establish whether specific individuals or clinical populations present within expected norms versus impaired function across a battery of neuropsychological tests. (JINS, 2015, 21, 596–609)

Research Articles
Copyright © The International Neuropsychological Society 2015 

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