The objective of the proposed study is to evaluate psychometric properties of neuropsychological instruments in which standardized procedures have been modified to bypass oral speech and motoric response demands. Commonly used tests of cognition including neuropsychological and psychoeducational instruments are not accessible to children with significant motoric or communicative impairments, despite the high risk for mental retardation and need for special education support in this population. One consequence is that relatively little is known about the specific neuropsychological profiles and educational needs of children with conditions such as cerebral palsy (CP), the leading cause of childhood disability. The relatively small number of neuropsychological studies of children with CP typically exclude participants with significant motoric and communicative impairments. The lack of information about the academic potential of many of these children is a burden to families and a source of conflict between families and schools. Technological advances in augmentative communication and rehabilitation engineering can be used to adapt presentation and response formats of assessment instruments, thus providing targeted diagnostic testing and more refined educational planning for these children.
Specific aims of this research are: 1. To examine psychometric properties including reliability and concurrent validity of newly developed adapted neuropsychological tests 2. To examine the predictive validity of adapted instruments by examining the associations between phonemic awareness and reading level; 3. To compare the neuropsychological profiles within and between groups using the standardized and adapted versions of instruments. To accomplish these aims, 60 children with CP and 60 typically developing children will be administered standardized and/or adapted versions of common neuropsychologjcal instruments. Children diagnosed with CP will be in one of two subgroups representing different levels of impairment: 1. Oral communicators with functional activity levels of GMFCS l-lll; 2. Nonverbal limited communicators (able to provide a reliable yes/no non-verbal response) and classified as GMFCS Levels IV and V. Cognitive measures will be administered using adaptive techniques such as computerized presentations of stimuli, forced choice response options, and other modifications. All children, with the exception of those classified as Level IV or V, will complete both standardized and adapted measures. Children classified as GMFCS IV-V will complete adapted versions only as standardized instruments require spoken or discrete fine motor responses. We will use multiple analysis of variance to describe differences in neuropsychological profiles not only between CP and TD groups, but also between CP subgroups. Bivariate correlations will be used to measure validity and reliability of adaptive measures. Logistic regression analyses will be used to identify cognitive factors most predictive of reading skills in children with CP. The results are expected to provide preliminary data for a larger, multi-site study of neuropsychological risks and needs associated with CP and provide data to inform not only an understanding of how children diagnosed with CP develop reading skills, but also specific interventions to maximize academic potential. ? ? ?
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