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[00:00:00] Hello everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This podcast is brought to you by PAR.

Use the Feifer Diagnostic Achievement Test to hone in on specific reading, writing, and math learning disabilities, and figure out why academic issues are occurring. Learn more at parinc.com\feifer.

Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I just keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and entering the code [00:01:00] “testing”.

All right, everybody, welcome back to another clinical episode. Today’s episode is going to be a little bit different than other clinical episodes because I’m not interviewing a guest today or speaking on any specific topic. What I am doing is summarizing three articles from the field of neuropsychology. If you have trouble keeping up on research like I do, this will hopefully provide a little glimpse into some fairly recent topics that have caught my interest.

Here are the three articles that I focus on during the episode. All of these are available for free at this point and linked in the show notes.

The first one: Best Practices and Methodological Strategies for Addressing Generalizability in Neuropsychological Assessment.

The second article: Tele-neuropsychological Assessment of Children and Young People: A Systematic Review.

The last one is A systematic review and meta-analysis of the evidence on learning during the COVID-19 pandemic.

[00:02:00] Like I said, all of these are topics that caught my interest and hopefully yours as well.

Now, before we get to the episode itself, I will, as always, extend an invitation to any of you who may want some support in your testing practices. You can go to thetestingpsychologist.com/consulting, check out the options, and reach out, schedule a call and we’ll chat and see if any of those options make sense for you. I’d love to support you if it makes sense.

All right everyone, let’s jump to this research summary.

All right. As we get into the research summary here, two caveats. This is just a summary. I am not going to [00:03:00] dive deep into the methodology or quote these articles word for word or anything like that. I’m just providing a summary. Now, I did try to find articles that were published in reputable journals and had either meta-analytic qualities or otherwise fairly defensible. So I’m sure you could go back and pick some of these articles apart and I am going to try to summarize as best I can.

Article 1: Best Practices and Methodological Strategies for Addressing Generalizability in Neuropsychological Assessment.

Side note, before we even get started. What are these article titles? I understand what’s going on here and people are trying to keep them as short as possible, but my gosh, it’s a mouthful.

Okay. Article 1. This article delves into the notable issue of [00:04:00] generalizability in assessment, particularly within neuropsychological assessment and pediatric neuropsychology. It highlights the enduring challenge of making sure that study findings and assessments are applicable across diverse demographic groups, and it emphasizes the critical importance of considering participant demographics in research.

The NIH, National Institutes of Health, has reinforced the need to disaggregate data by race, ethnicity, and gender yet studies continue to show a predominantly white sample or predominance of white participants in samples, and it undermines the generalizability of findings.

This seems like an article that we would be discussing, gosh, I don’t know, maybe in the 60s, but [00:05:00] no, this is 2023 and we’re still struggling with this issue.

It looks into the historical considerations in psychology and neuropsychology and underscores the longstanding issues of misrepresentation and mistreatment of stigmatized or marginalized groups and the resulting medical mistrust and treatment disparities that resulted. It reflects on again, the historical use of intelligence testing and its contribution to harmful practices like eugenics, and highlights the need for current assessments to be critically evaluated for generalizability and fairness among other things.

The authors discuss the importance of generalizability, which they define as the extent to which research findings can be applied across different populations and contexts. They argue for the integration of diverse samples and the thorough reporting of sample characteristics to enhance the generalizability of [00:06:00] research and also explore methodological considerations for improving generalizability including the use of demographic norm adjustments and the practice of examining sociocultural or socio-contextual factors that impact assessments.

Some specific strategies are recommended to advance generalizability in pediatric neuropsychology in particular. These include increasing sample and researcher diversity, employing novel recruitment strategies, and using inclusive measures for demographic data collection. Analytic approaches like testing for group differences and evaluating the reliability of tests are also discussed to address potential biases and enhance the validity of findings. The article also includes suggestions for applying findings to clinical practice, emphasizes the need [00:07:00] for cultural competency and an understanding of the socio-historical background of clients.

The evaluation of measures like the TOMM, for example, is used as an example to illustrate the application of generalizability considerations in practice. That’s a little bit of a surprise to me. I was not aware that the TOMM is held up as an example of these practices.

Now, we have talked about this kind of thing on the podcast a little bit in some of the discussions with test publishers like Pearson and PAR. They both touched on the challenges of recruiting a diverse sample, which is one aspect of generalizability, and at the same time, talked about their ongoing efforts to recruit more representative and diverse samples.

The article underscores the [00:08:00] ongoing challenges, it proposes comprehensive strategies to improve the generalizability of research in neuropsychological testing, and as you might expect, calls for a multifaceted approach involving methodological rigor, inclusivity, and cultural competency to make sure that research findings are relevant and fair for all.

General thoughts on this article.

I like the attention that it’s calling to this topic. It is a hugely important topic and one that many folks are focusing on intently as usual with some of these articles, right? I don’t want to knock the research, of course, but I feel like many articles are short on specific examples or short on specific implementation. I would love to have some ideas on how to more literally reach these [00:09:00] groups that we are trying to represent and research and our assessment measures. So those are my thoughts on Article 1.

Article 2:Tele-neuropsychological Assessment of Children and Young People: A Systematic Review. I’ll tell y’all what, I love a good systematic review. How about y’all?

This article provides a comprehensive overview of pediatric tele-neuropsychology. It talks about the importance and its role in assessing and supporting kids with any number of concerns. It outlines the traditional in-person assessment methods and the pressures that led to increased interest in tele-neuropsychology specifically, they mentioned limitations in service capacity and accessibility for marginalized communities.

It also mentions the COVID-19 pandemic, which accelerated this pivot to tele-neuropsychology.[00:10:00] It certainly existed before COVID-19, but I think as we all know, COVID-19 forced us to shine a spotlight on tele-neuropsychology and tele-assessment.

It goes on to discuss the development challenges of tele-neuropsychology, like the need for adaptations to standard neuropsychological assessments, considerations around ethical privacy, and technology issues, which I would imagine a lot of us are familiar with by this point. It highlights that a lot of the research has focused thus far on adult populations with limited data on pediatric assessment which kids present a unique challenge like safeguarding and the need for more caregiver involvement and honestly, just engagement with kids over telehealth. I think that was a concern that a lot of us ran into if you were testing during COVID-19 is how to keep kids engaged during the process.

[00:11:00] So again, being a systematic review, this is a meta-analysis. It went through and found looks like 21 studies that looked at the feasibility, reliability, acceptability, and quality of pediatric tele-neuropsychology. They covered a range of domains and situations and so forth.

What are the findings?

Well, this review found that tele-neuropsychology is “generally” feasible and acceptable. Most of the studies reported high completion rates and positive feedback from participants. Reliability was a little more varied. Some assessments showed strong correlations between in-person and teleneuropsychology scores, especially in domains like IQ, memory, and language. I think this is consistent with what I’ve always [00:12:00] found certainly anecdotally and what I’ve read elsewhere that verbally mediated measures tend to map closer between tele-neuropsychology and in-person.

If there’s anyone out there who wants to disagree with that, I know you’re out there send me an email, but the generalizability of these findings, there’s that word again, is somewhat limited due to, in large part, small sample sizes, lack of diversity. See previous articles on study populations and a lot of, frankly, pilot studies and feasibility studies more than anything else.

I will say as a side note that there is a group out of Texas, I think it is Lana Harder and her group, who has done a lot of research into tele-neuropsychology. I highly recommend that you check them out. I feel like they are [00:13:00] leading the way with some of this research, especially in pediatric tele-neuropsychology.

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All right. Let’s get back to the podcast.

As always, I [00:15:00] feel like all articles end with this kind of thing. It underscores the need for more research, particularly studies with larger and more diverse samples to validate tele-neuropsychology with kids. It also calls for the development of tests specifically designed for remote delivery and talks about the importance of ethical considerations and practical issues in tele-neuropsychology which makes sense. I would love to see more of these measures designed for remote delivery. I think we’re headed in that direction, at least adjacently with measures being developed for digital administration, which is a big step toward remote administration in my mind.

And then it concludes that while tele-neuropsychology presents a promising alternative to traditional in-person assessment, there’s still a lot of work to do to make sure that it’s efficacious and reliable across different settings and populations.

All right. So TLDR, [00:16:00] good stuff, usable, not perfect.

All right. Article 3: A systematic review and meta-analysis of the evidence on learning during the COVID-19 pandemic.

I will say as a footnote before getting started that this topic is going to be such a hot topic over the next years and decades probably as we learn what happened to our kids during COVID-19 and the impact on their learning and education.

This is one of the earliest meta-analyses and certainly one of the most cited meta-analyses on the impact of the COVID-19 pandemic on learning progress in school-age kids. It talks about the widespread disruption to education caused by school closures. I did not know this, but they cited this statistic that it affected approximately 95% of the global student population. That is a very high number. That’s higher [00:17:00] than I would have expected. It talks about the compounding effects of school closures, like reduced face-to-face instruction, shifting to a hybrid teaching model, and negative consequences on kids’ mental and physical health due to lockdowns.

They talk about the concept of a “learning deficit” as a way to describe the delays in expected learning progress and the loss of previously acquired skills and knowledge. You’re emphasizing the potential long-term effects on kids’ education and future labor market opportunities as well as on broader societal outcomes like growth and social cohesion. I think it cut a pretty wide swath here across this topic.

So to assess the extent of COVID-19 learning issues, again, systematic review and over, I mean, they started this two and a [00:18:00] half years into the pandemic and examined peer-reviewed research and all the literature out there to understand as many dimensions of this problem as possible.

What did the findings reveal?

Findings revealed substantial learning deficits, surprise, across various contexts with what they estimated to be a 35% reduction in a school year’s worth of learning progress on average. The deficits emerged pretty early during the pandemic and have persisted without significant improvement.

Importantly, the study underscores the exacerbation of socioeconomic inequalities, which I think we were aware of. People kept saying this over and over during the pandemic. Well, it’s certainly being borne out in research now that, socioeconomic inequalities in education make a big difference. So the disadvantaged or marginalized [00:19:00] communities or kids are experiencing larger setbacks than those who are not disadvantaged or marginalized.

It also talked about the subject-specific differences in learning issues with larger impacts on math compared to reading. The rationale there is that math relies more on formal instruction. Once you learn to read, you presumably know how to read for the rest of your life, whereas math is a compounding skill that builds on itself and relies heavily on formal instruction. There’s no conclusive evidence regarding differences and learning deficits across primary and secondary education levels, but like I said, they did break it out depending on the subject.

Another notable component is that the evidence suggests more pronounced learning [00:20:00] deficits in middle-income countries, which of course raises concerns about the pandemic worsening existing educational issues in those regions. There’s a lack of data from low-income countries and mixed quality of evidence. So again, here it is the call for future research to understand the full scope of the pandemic’s impact on global education.

Now, as far as policy, the article does get into that a bit. It advocates for targeted intervention to address learning deficits, surprise, with a particular focus on supporting kids from low socio-economic backgrounds, asks for future research to explore the pandemic’s effects on gender inequality, and the importance of innovative, low-cost educational intervention to mitigate some of these losses.

Overall, [00:21:00] I think it’s pretty straightforward. It provides an insight into the persistent challenges posed by COVID-19 and the clear impact on kids’ education and learning. And like I said, we’re going to be dealing with this for years and years to come. I’m very curious to see where this goes from here in terms of the research and what we are finding.

I will say this. I’ll put out a call for anyone out there who considers themselves an expert or is willing to speak on this topic in depth. I’d love to interview you on the podcast so that we can dive deeper into the impact of COVID-19 on education and learning.

Okay, folks, that is it. A research review is done. Like I said, all of these articles are linked in the show notes and I encourage you to go check them out. They are free and get a little research fix.

All right. Thanks [00:22:00] for listening as always.

All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes. So make sure to check those out.

If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes, Spotify, or wherever you listen to your podcasts.

If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development, beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign [00:23:00] up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you.

Thanks so much.

The information contained in this podcast and on The Testing Psychologist website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. [00:24:00] If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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