Assessing Visuospatial Neglect in Children with Brain Injury

Abstract

Visuospatial neglect (VSN), the failure to report, respond, or orient to novel or meaningful visual stimuli presented in a specific location, is a frequently occurring outcome following stroke. VSN can negatively impact the functions of daily life and is an important predictor for long term outcomes. The phenomenon is frequently studied in adult populations; however, the nature and incidence of VSN following childhood stroke is virtually unknown. Current research investigating the neuroanatomical correlates of VSN and hypothesized models of dysfunction all assume a fully mature brain and thus lack a developmental perspective. Similarly, current neuropsychological measures used to assess VSN are almost exclusively developed and normed with adult populations. While some individual adult tests have been modified for use with children, no standardized battery to assess VSN in young children currently exists. The present study investigated the reliability and validity of a five-task neuropsychological testing battery, the Pediatric Visuospatial Neglect Battery, developed at the Children’s Hospital of Philadelphia (CHOP) to assess VSN in young children ages 2-6 following stroke.

Although there were some exceptions, the reliability estimates of task scores obtained from the present sample were generally low. With regard to criterion-related validity, sensitivity to detect brain injury was generally poor while specificity was high. Some of the low reliability and validity estimates were due to measurement problems of the calculated variables. These variables can be reexamined and likely improved in future studies. In other instances, modifications to the tasks are recommended. Specific recommendations for improving the five existing tasks are provided as well as suggestions for additional tasks that could potentially be added to the battery in future administrations. Although somewhat disappointing, low initial reliability and validity estimates are part and parcel to test development. This study represents an important first step in developing a standardized battery to detect VSN in children. With refinement and additional testing, the Pediatric Visuospatial Neglect Battery may soon become an excellent instrument for investigating the VSN phenomenon in children.