INS NYC 2024 Program

Symposium	Symposia 9 Program Schedule 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 Simposium #5 Community-Based Social Determinants of Health Predict Neuropsychological Outcomes in Pediatric Brain Tumors Rachel Peterson, Kennedy Krieger Institute, Baltimore, United States Lisa Jacobson, Kennedy Krieger Institute, Baltimore, United States Tricia King, Georgia State University, Atlanta, United States Category: Cross Cultural Neuropsychology/ Clinical Cultural Neuroscience Keyword 1: neuro-oncology Keyword 2: cross-cultural issues Keyword 3: pediatric neuropsychology Objective: Pediatric brain tumors and their treatment have been shown to disrupt intellectual functioning (FSIQ), academic achievement, and adaptive functioning. While the impact of treatment exposures and neurological complications on IQ, academics, and adaptive functioning are well documented, fewer studies have examined the additional role of social determinants of health on cognitive performance in pediatric brain tumors. To date, many studies have narrowly focused on family income or parental education as predictors of cognition in pediatric brain tumors. To our knowledge, studies have not yet considered neighborhood deprivation or resources and its contribution to neuropsychological outcomes in this population. The Child Opportunity Index (COI) is a composite index score using census tract level data to capture neighborhood resources and conditions. It is comprised of three indices: Education, Health and Environment, and Social and Economic domains. We hypothesized that access to greater community resources would be associated with better neuropsychological functioning over and above treatment exposures and complications in pediatric brain tumor survivors. Participants and Methods: Participants included pediatric brain tumor patients (N=181) seen for a clinical neuropsychological evaluation [8.71(5.09) years at diagnosis, 13.76(4.57) years at evaluation]. Data were extracted retrospectively from medical records; cognition (IQ) was obtained from age-appropriate intelligence measures (WISC >6 years or DAS-II<6 years). Untimed word reading and math calculation skills were examined via WIAT, KTEA, or WJ subtests. Adaptive functioning was examined with the ABAS General Adaptive Composite. Neurological Predictor Scale (NPS) provided an estimate of cumulative treatment exposure and complications. Multiple regressions examined variance in FSIQ, GAC, and academic achievement accounted for by each of the three COI indices, when controlling for NPS. Results: On average, patients demonstrated lower FSIQ (M=94.12; SD=15.81; p<.001) with 12.9% performing in the impaired range (<-1.5SD). After controlling for NPS, COI indices accounted for 12.5% of variance [F(4,172)=6.01, p<.001]. The COI Education domain was the only significant predictor of IQ when all indices were included in the model [β=.375, t(176)=2.21; p=.03). When COI indices were entered into separate models, Education (R2=.12, p<.001), Health and Environment (R2=.095, p<.001), and Social-Economic (R2=.087, p<.01) domains each significantly predicted FSIQ. The Education domain predicted word reading [β =.443, t(125)=2.38, p=.02], accounting for 16.7% of the variance. Both Education [β =.578, t(125)=2.94, p<.01) and Social-Economic [β =-.338, t(125)=-2.12, p=.04) indices predicted math calculation skills, accounting for 15.9% of the variance. Interestingly, COI indices did not predict global adaptive functioning (p>.05). Conclusions: The importance of different early social determinants of health to commonly employed broad measures of neuropsychological outcome that included FSIQ, academic achievement, and adaptive function was identified using the COI among almost 200 pediatric brain tumor survivors. These findings identified Education, Health and Environment, and Social-Economic as factors that warrant further examination when studying pediatric neuropsychology outcomes. Nuances of the data will be discussed as they relate to clinical care and research.

Symposium

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

Simposium #5

Community-Based Social Determinants of Health Predict Neuropsychological Outcomes in Pediatric Brain Tumors

Rachel Peterson, Kennedy Krieger Institute, Baltimore, United States
Lisa Jacobson, Kennedy Krieger Institute, Baltimore, United States
Tricia King, Georgia State University, Atlanta, United States

Category: Cross Cultural Neuropsychology/ Clinical Cultural Neuroscience

Keyword 1: neuro-oncology
Keyword 2: cross-cultural issues
Keyword 3: pediatric neuropsychology

Objective:

Pediatric brain tumors and their treatment have been shown to disrupt intellectual functioning (FSIQ), academic achievement, and adaptive functioning. While the impact of treatment exposures and neurological complications on IQ, academics, and adaptive functioning are well documented, fewer studies have examined the additional role of social determinants of health on cognitive performance in pediatric brain tumors. To date, many studies have narrowly focused on family income or parental education as predictors of cognition in pediatric brain tumors. To our knowledge, studies have not yet considered neighborhood deprivation or resources and its contribution to neuropsychological outcomes in this population. The Child Opportunity Index (COI) is a composite index score using census tract level data to capture neighborhood resources and conditions. It is comprised of three indices: Education, Health and Environment, and Social and Economic domains. We hypothesized that access to greater community resources would be associated with better neuropsychological functioning over and above treatment exposures and complications in pediatric brain tumor survivors.

Participants and Methods:

Participants included pediatric brain tumor patients (N=181) seen for a clinical neuropsychological evaluation [8.71(5.09) years at diagnosis, 13.76(4.57) years at evaluation]. Data were extracted retrospectively from medical records; cognition (IQ) was obtained from age-appropriate intelligence measures (WISC >6 years or DAS-II<6 years). Untimed word reading and math calculation skills were examined via WIAT, KTEA, or WJ subtests. Adaptive functioning was examined with the ABAS General Adaptive Composite. Neurological Predictor Scale (NPS) provided an estimate of cumulative treatment exposure and complications. Multiple regressions examined variance in FSIQ, GAC, and academic achievement accounted for by each of the three COI indices, when controlling for NPS.

Results:

On average, patients demonstrated lower FSIQ (M=94.12; SD=15.81; p<.001) with 12.9% performing in the impaired range (<-1.5SD). After controlling for NPS, COI indices accounted for 12.5% of variance [F(4,172)=6.01, p<.001]. The COI Education domain was the only significant predictor of IQ when all indices were included in the model [β=.375, t(176)=2.21; p=.03). When COI indices were entered into separate models, Education (R2=.12, p<.001), Health and Environment (R2=.095, p<.001), and Social-Economic (R2=.087, p<.01) domains each significantly predicted FSIQ. The Education domain predicted word reading [β =.443, t(125)=2.38, p=.02], accounting for 16.7% of the variance. Both Education [β =.578, t(125)=2.94, p<.01) and Social-Economic [β =-.338, t(125)=-2.12, p=.04) indices predicted math calculation skills, accounting for 15.9% of the variance. Interestingly, COI indices did not predict global adaptive functioning (p>.05).

Conclusions:

The importance of different early social determinants of health to commonly employed broad measures of neuropsychological outcome that included FSIQ, academic achievement, and adaptive function was identified using the COI among almost 200 pediatric brain tumor survivors. These findings identified Education, Health and Environment, and Social-Economic as factors that warrant further examination when studying pediatric neuropsychology outcomes. Nuances of the data will be discussed as they relate to clinical care and research.