02/16/2024
10:15 am - 11:40 am
Room: West Side Ballroom - Salon 1
Symposia 9
Moving Beyond Secondary Status: Accounting for Social Determinants of Health Across Biopsychosocial Spheres of Influence on Pediatric Neuropsychological Outcomes
Chair:
Rachel Peterson
Kennedy Krieger Institute, Baltimore, Maryland, United States
Discussant:
Richard Boada
Kennedy Krieger Institute, Baltimore, Maryland, United States
Category: Cross Cultural Neuropsychology/ Clinical Cultural Neuroscience
Within the field of neuropsychology, clinical care and research has typically focused on understanding differential outcomes by investigating brain-behavior relationships at different levels of analysis. In medical and neurodevelopmental populations, the emphasis has primarily been on identifying genetic etiologies, pathophysiology, brain mechanisms of injury, or effects of medical interventions, and relating them to immediate and long-term neuropsychological functioning. While we often acknowledge individual sociodemographic factors (e.g., parental education, linguistic/cultural differences, community characteristics) in clinical reports, these are often considered secondary factors that may or may not qualify primary relationships. In past research, these factors have often been treated as confounders to be controlled statistically, if participants from diverse backgrounds were included at all (e.g., bilingual populations, participants from impoverished or rural communities, etc.). In more recent years, non-medical factors have garnered increasing attention in neuropsychological research, with increasing evidence that they often play as central a role in predicting long-term outcomes as genetic and brain-based variables.
According to the World Health Organization, Social Determinants of Health (SDOH) are non-medical factors that influence health outcomes. In this symposium, we propose that SDOH are multi-factorial and should be considered within Bronfenbrenner’s ecological systems theory view of child development. Thai theory divides a person’s environment into five different systems, from the microsystem to the chronosystem, and spans the individual’s immediate (home) environment to the larger social/cultural context, respectively. We highlight how interactions between these individual and social contexts contribute to neuropsychological functioning in children with complex or chronic medical conditions.
For this symposium, we include five presentations that highlight ways of measuring SDOH, their contribution in access to diagnosis and intervention, as well as their impact on neuropsychological outcomes in pediatric medical populations. In alignment with Broffenbrenner’s ecological systems theory, the presentations are organized in the order of sphere of influence, from the microsystem to the macrosystem. The first presentation will discuss how parental factors, including parental mental health and parenting practices, affect externalizing problems in children with early neurological conditions (preterm birth and perinatal stroke). The second presentation highlights the relationship between individual sociodemographic factors, including race and insurance type, and time-to-diagnosis and access to interventions and services. The third presentation addresses how monolingual or bilingual home environment informs cognitive and language recovery in children with a history of arterial ischemic stroke. The fourth presentation will discuss means of examining relevant household and neighborhood resources in a large clinically referred sample of children so that they can be incorporated into models of outcome. The final presentation will highlight how community resources and conversely neighborhood deprivation affects cognitive and academic functioning in children with a history of a brain tumor. With these five studies, the symposium will 1) emphasize the need to consider SDOH as being equally important in predicting differential neuropsychological outcomes, 2) highlight unique methods to measure them, and 3) make the case for their inclusion as primary variables in future research, as they may be some of the more modifiable factors in determining patients’ long-term outcome.
Rivky Green, The Hospital for Sick Children, Toronto, Canada Janaksha Linga-Easwaran, The Hospital for Sick Children, Toronto, Canada Carly Goodman, The Hospital for Sick Children, Toronto, Canada Giulia Fabiano, The Hospital for Sick Children, Toronto, Canada Tricia Williams, The Hospital for Sick Children, Toronto, Canada
Kai Leung, The Hospital for Sick Children, Toronto, Canada Nomazulu Dlamini, The Hospital for Sick Children, Toronto, Canada Robyn Westmacott, The Hospital for Sick Children, Toronto, Canada Elizabeth Rochon, The Hospital for Sick Children, Toronto, Canada Monika Molan, The Hospital for Sick Children, Toronto, Canada
Rachel Peterson, Kennedy Krieger Institute, Baltimore, United States Lisa Jacobson, Kennedy Krieger Institute, Baltimore, United States Tricia King, Georgia State University, Atlanta, United States
