Pediatric-onset multiple sclerosis (POMS) currently accounts for approximately 2 to 5% of all individuals with MS. In recent years, neuropsychological screening questionnaires have been increasingly utilized for pediatric populations who are regularly in the care of multiple medical specialties. These questionnaires serve as a useful tool for guiding neuropsychological consultations and referral decisions, which can be extremely helpful in the setting of hospitals with limited access to neuropsychological services. Given this, we examined the clinical utility of two screening measures for indicating the need for follow-up neuropsychological evaluation in patients with POMS.

Retrospective data was gathered from electronic medical records at a single children’s hospital. Participants included children and adolescents diagnosed with POMS who underwent a targeted neuropsychological evaluation that included the screening measures as part of their clinic visit. Exclusion criteria included patients with MS diagnosis other than relapsing and remitting. Data from relevant neuropsychological measures in addition to caregiver ratings on the Pediatric Perceived Cognitive Functioning Questionnaire (PedsPCF), which yields a T-score, and the Colorado Learning Difficulties Questionnaire (CLDQ), which yields z-scores for Reading, Math, and Spatial indices, were obtained. Spearman rank-order correlations were obtained between screening measures and neuropsychological testing scores; alpha for exploratory correlations was set at a more conservative level of p 1 standard deviation below the mean). Nonparametric ROC curve analysis was performed, and alpha level of p < .05 was used for these targeted follow-up analyses.

49 participants were included (69% female; 43% Hispanic/Latinx; mean age = 16.14 years, range = 9.90-20.63 years). Correlation analyses demonstrated strong interrelatedness between ratings on screening measures and testing performance, such that more reported challenges were related to lower test performance. Effect sizes were medium in size across comparisons (CLDQ: Spearman’s rho = -.321 to -.563; PedsPCF: Spearman’s rho = .308 to .444). ROC curve analysis showed that the PedsPCF T-score predicted impaired performance on processing speed (visuomotor) and math fluency (AUC = 0.748 to 0.796; all ps<.05). The CLDQ Reading z-score predicted vocabulary, working memory, processing speed (oral), visual motor integration, timed word reading, and math fluency test performance (AUC = 0.699 - 0.847; all ps<.05). The CLDQ Math z-score predicted vocabulary, and math fluency (AUC = 0.779 to 0.825; all ps<.05). The CLDQ Spatial Organization z-score did not predict any neuropsychological testing scores.

This is an exploratory study that examines the potential utility of the PedsPCF and the CLDQ for clinical use in a multidisciplinary setting for individuals with POMS. Our findings suggest that the measures demonstrate clinical utility, with the CLDQ Reading Scale being the most helpful, for identifying areas of academic and cognitive difficulty for individuals with POMS that warrant further assessment. This study illustrates how pediatric neuropsychologists can leverage screening tools to focus consultative interviews and effectively triage referrals for testing within an academic medical setting.