Journal Identification = NRP Article Identification = 0628 Date: June 16, 2021 Time: 3:50 pm
doi:10.1684/nrp.2021.0628
REVUE DE NEUROPSYCHOLOGIE
NEUROSCIENCES COGNITIVES ET CLINIQUES
34
Point of view
Rev Neuropsychol
2020 ; 12 (S1) : 34-6
The contribution of teleconsultation
to the neuropsychological assessment of children *
Apport de la téléconsultation au bilan neuropsychologique de l’enfant
Sylvie Chokron1,2
1Institut de Neuropsychologie, Neurovision et Neurocognition, Fondation
ophtalmologique A. de Rothschild, Paris
2Integrative Neuroscience and Cognition Center (CNRS – UMR 8002) & Université de Paris
<sylvie.chokron@gmail.com>
To cite this article: Chokron S. The contribution of teleconsultation to the neuropsychological assessment of children.
Rev Neuropsychol 2020;12(S1):34-6 doi:10.1684/nrp.2021.0628
Introduction
The neuropsychological evaluation of children with learning disabilities and more generally with neurodevel- opmental disorders is part of an integrative approach that takes into account the interaction between the neurobiolog- ical, cognitive, psychosocial and cultural factors involved in learning. Regardless of the neurodevelopmental disor- der addressed, this integrated approach is not limited to the study of behaviour alone, but combines the cogni- tive and behavioural approach, the neurobiological and genetic dimension as well as neuroimaging when possible.
In practice, the neuropsychological evaluation of children with neurodevelopmental disorders usually consists of three steps: an extremely detailed history in order to establish the potential causes of the child’s difficulties, a complete neuropsychological evaluation and subsequently the imple- mentation of parental guidance advice given to school and paramedical staff in order to restore the deficient cognitive processes and facilitate learning. This neuropsychological assessment can often be combined with a neuro-paediatric assessment and neuroimaging tests in order to estab- lish the exact nature and precise aetiology of the disorders.
During lockdown, some units such as ours have cho- sen to continue clinical neuropsychological activity with children at a distance through teleconsultation.
∗This article is an English language translation of the following article: Chokron S. Apport de la téléconsultation au bilan neu- ropsychologique de l’enfant.Rev Neuropsychol2020; 12(2): 152-4 doi:10.1684/nrp.2020.0556
Correspondence:
S. Chokron
The different stages of the neuropsychological assess- ment, as well as the child psychiatric and neuropaediatric consultations, were thus carried out by telephone, as pre- sented below.
Telemedicine and neuropsychology
Telemedicine has developed considerably in the field of neuropsychology in France and around the world, with the main goals of offering tests to a large number of patients, sometimes unable to travel to an institution for a check-up, and of using more ecological assessments. Indeed, as dis- cussed by Jollivetet al,[1](2018), Neuropsychology 1.0,i.e.
the practice based on the face-to-face use of questionnaires and conventional paper-and-pencil tests, has a number of limitations. This practice is not very ecological and does not always allow to account for the difficulties that the patient encounters at home or in society. Moreover, and above all, the realization of a face-to-face assessment can prove difficult or even impossible when there is no possibil- ity for the patient to meet a neuropsychologist face-to-face.
Distance due to geographical distance or the presence of medical problems (treatment or heavy medical devices, bed rest...), severe motor or behavioral problems that make any travel extremely complicated. Neuropsychology 2.0, i.e.
assessment using numerical tools, has not yet been com- pletely proven in France in terms of ecological validity and transfer of knowledge into everyday life for revalida- tion tools, as discussed by Jollivet and colleagues[1]. These authors hope that neuropsychology 3.0, using in particular virtual reality, will be more able to help patients espe- cially from the point of view of restoring failing abilities.
In fact, thanks to this technology, certain processes can be trained in a specific way, in a situation very close to
Journal Identification = NRP Article Identification = 0628 Date: June 16, 2021 Time: 3:50 pm
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reality, with the possibility of repeating the exercise easily in conditions safe for the patient and thus allowing a trans- fer of the acquired knowledge to real situations of daily life.
From neuropsychology in the patient’s bed to telephone consultation
Regarding hospital practice, neuropsychologist is accus- tomed to moving to the patient’s bed, hospitalized in the acute phase of a stroke or head injury, or seeing patients in his or her office, however, he or she is less accustomed to performing assessments remotely. Nevertheless, although teleconsultation has been developing in recent years for very specific assessments (such as cerebral visual impair- ments assessments), it can only be offered at a distance to foreign or distant patients who would not be able to benefit from such care around them. Lockdown, because of its sud- den nature, has not allowed us to develop and communicate to families, upstream, advanced technological tools for the neuropsychological assessment of young children. Despite everything, this exceptional health situation allowed us to return to the essentials, to the communication with the par- ents, especially during the first consultation, corresponding to the anamnesis interview thanks to the simple use of the telephone or smartphone. It is difficult to know whether from a technological point of view this refers to 0.5 or 1.5 neuropsychology!
In practice, in order to honor the planned consul- tations, all of our activity has been reorganized into teleconsultations. Parents of children with neurodevelop- mental disorders have been extremely sensitive to this approach, knowing that most institutions have been forced to close for obvious health reasons, thus sending children with sometimes severe behavioural disorders back to their homes.
To simplify the procedure, the anamnesis, the pillar of the neuropsychological assessment, was therefore carried out by telephone conversation (without video feedback), in the presence of both parents and the child. In a second stage, the tests of the neuropsychological assessment were carried out either by telephone with video feedback, or by the par- ents who received neuropsychological tests by e-mail, to be proposed to their child, with precise instructions for taking them. The parents then had to return the tests performed by the child, also by e-mail. Afterwards, a second telephone consultation for the results and parental guidance was pro- posed. In addition, copies of the children school notebooks as well as short videos of the child during daily activi- ties (meals, games, trips, etc.) were made by the parents and sent to the neuropsychologist so that he could evalu- ate the degree of difficulty of the child in more ecological contexts.
Towards a generalization of the offer of teleconsultations in neuropsychology?
The experience of the last few weeks, involving sev- eral dozen children and adolescents, aged between 3 and 17 years old, tested in this way (first consultation or follow- up consultation) is very positive. First of all, it reveals a great freedom of speech during the phone interview (without video feedback) which could last up to an hour and a half.
This interview, intended for the first consultations to make a detailed anamnesis or during the follow-up consultations to discuss the progress made or the difficulties encountered since the last consultation, proved to be very detailed and very free. The absence of visual feedback seems to have allowed the parents greater freedom of expression and less control (over appearance, facial emotions, reactions) and the clinicians greater listening skills and concentration than face-to-face. Today, the image of oneself and one’s loved ones via smartphones is widely disseminated through social networks, and commonly used to assert oneself, express oneself, measure one’s popularity rating, etc. . . However, having carried out these teleconsultations without video feedback allowed us to detach ourselves from this play around self-image, thus allowing us to focus during the telephone interviews on the deeper evaluation of cogni- tive processes, behaviour and learning difficulties, subjects at the heart of the neuropsychological assessment. As no visual information disturbed the interview, the speaking time was exclusively devoted to an informative dialogue, with parents and children showing extreme attention and listening skills. The speaking turns were respected, there was no untimely interruption of either one or the other as is sometimes seen in face-to-face consultations. Similarly, the telephone consultation seems to have reduced the presence of visual distractors that sometimes distract the attention of the clinician, the child or the parents during the face-to-face consultation.
The families felt helped and taken into consideration in an individual and adapted way in this complex period of lockdown where they were often left alone due to the cessation of schooling and care. They expressed extreme gratitude that these teleconsultations could be set up during the lockdown and it is interesting to note that all the families followed in this way wish that this would continue after the lockdown.
From an evaluation point of view, it goes without saying that the carrying out of the tests, in their regular adminis- tration, cannot be achieved through teleconsultation. The reopening of the neuropsychology units will make it pos- sible to resume a face-to-face consultation activity with regular administration of calibrated and standardized tests aiming to evaluate cognitive, perceptual, gestual and verbal performances in children.
Nevertheless, the experience of the lockdown has shown us that this type of practice could be particularly adapted to the first consultations of anamnesis as well as
Journal Identification = NRP Article Identification = 0628 Date: June 16, 2021 Time: 3:50 pm
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to the follow-up consultations in order to be able to take stock of the child’s evolution, to adapt the arrangements and the care put in place and to guide parents, teachers and interveners.
Moreover, these teleconsultations could be particularly appropriate for children with motor (cerebral palsy, hemi- plegia) or behavioural disorders, or with severe disabilities, or from far away, for whom face-to-face consultations can represent an extremely high cost and energy. Indeed, fatigue and stress related to travel often affect the child’s cooperation during face-to-face interview which is most dis- appointing for parents whose expectations are high during these appointments and who often deplore the discrepancy between the energy expended (setting aside a day off for the parents, travel, accommodation if necessary) and their child’s difficulty to invest in face-to-face consultations.
In conclusion, if the experience of the lockdown has not given us the possibility of objectively measur- ing, thanks to a rigorous experimental procedure, the contribution of teleconsultations in neuropsychology, the shared experience of different clinicians (psychologists, neuropsychologists, speech therapists, child psychiatrists, neuro-paediatricians) confronted with teleconsultations in children with neurodevelopmental disorders reveals the richness of telephone interviews and raises the ques- tion of the development of this type of practice even in a habitual context that does not require social distancing.
Conflict of interest None.
Reference
1.Jolivet M, Fortier J, Besnard J, Le Gall D, Allain P. Neuropsy- chologie et technologies numériques. Revue de Neuropsychologie 2018 ; 10 : 69-81.
