Pediatric neuropsychological conceptualizations routinely take into account individual (i.e., age, sex) and medical factors such as age of onset, length and severity of illness or disease, and etiology. However, there is growing interest in examining the variance in neuropsychological performance accounted for by socio-demographic variables such as social determinants of health (SDOH). Several dimensional indices of socio-demographic status have become increasingly available to pediatric neuropsychologists (i.e., Area Deprivation Index [ADI] and the Childhood Opportunity Index [COI]) which may provide concise and robust means of accounting for SDOH in research and clinical care. This study aimed to compare the ADI and COI to more traditionally used measures of SDOH to determine the extent of shared and unique variance between these measures.

This retrospective study included 10,762 patients seen in outpatient medical clinics at a children’s hospital specializing in neurodevelopmental conditions. Patients were screened using the Hunger Vital Sign, a 2-question screening tool to identify children in households at risk of food insecurity. Socio-demographic variables of interest included race, primary language spoken in the home, need for an interpreter during the appointment, insurance type, and food insecurity screening result. For each patient, national ADI and COI rankings were also calculated. ADI is a 1-100 ranking scale reflective of neighborhood deprivation (higher scores suggest more deprivation) which includes education, income/employment, housing, and household characteristics at the census block level. The COI is a 1-100 ranking scale of access to community resources (lower scores indicate less access) including education, health and environment, and social and economic resources at the census tract level. Factors were simultaneously introduced in a multiple linear regression (MLR) to examine the degree of association/relationship between traditionally used sociodemographic variables and ADI or COI rankings.

Patients in our sample had a mean ADI score of 32.54 (SD = 22.81) and a mean COI score of 64.12 (SD = 29.62). There was a strong, negative correlation between ADI and COI (r = -.824, p < .001), with higher ADI associated with lower COI. In the regression model, all 5 socio-demographic variables of interest independently and significantly accounted for variance in the ADI score (R2 = 0.23, F(5, 10756) = 640.10, p = < .001) and all variables except for interpreter use independently and significantly accounted for variance in the COI (R2 = 0.25, F(5, 10756) = 719.13, p = < .001).

National ADI and COI ranking were highly correlated and may be acceptable dimensional indicators of socio-demographic status when examining cognitive functioning. Both ADI and COI shared significant variance with traditionally used proxies of SDOH. However, additional variance unique to ADI and COI may reflect other socio-demographic differences and the impact of intersectionality on SDOH. Further exploration of ADI and COI is needed to better understand the sociodemographic perspective that ADI and COI can offer pediatric neuropsychology.

Cross Cultural Neuropsychology/ Clinical Cultural Neuroscience

diversity

bilingualism/multilingualism

pediatric neuropsychology