DEVELOPING A SCREENING TOOL TO ASSESS CONCUSSION IN A PRESCHOOL POPULATION: PHASE 1 – ITEM GENERATION

Abstract

Traumatic brain injury (TBI) is the most common injury in childhood, and it is the leading cause of disability. Early childhood is an area of specific interest because it is a period of rather significant vulnerability to longer-standing problems. Better health and behavior-related outcomes generally improve when diagnosis occurs early enough to inform evidence-based interventions adequately. However, there continues to be relatively weak identification of concussions in early childhood, and misdiagnoses often lead children to receive the incorrect intervention if they receive intervention at all. Clinicians need to identify symptoms of a concussion immediately following injury. To this end, the present study examines the literature to determine domains, and any narrow abilities impacted following a concussion. Assessments items were generated based on a review of published norm references tests and task demands analyses (n = 18). Testing items were cross-referenced using developmental literature to ensure they were appropriate for assessment for children age 3 years. Via the Delphi survey method, a heterogeneous panel of experts (Round 1 n = 17; Round 2 n = 13), including physicians, psychologists, school nurses, speech and language pathologists, and athletic trainers, offered their opinion regarding what areas are impacted following a concussion. The panel provided clarification on the operational definitions and agreed that the testing items, indeed, were developmentally appropriate. The group also decided that a paraprofessional could administer the items with minimal training, which is an essential consideration because children in early childhood are often cared for by professionals untrained in assessment, working in daycare or preschool settings. The present study concludes that, indeed, an evaluation of concussions symptoms that are like traditional sideline assessments is possible. However, the results of this assessment are only preliminary, and there was no evidence for validity based on response processes or relations to other variables; likewise, reliability data are unavailable at this time. Recommendations for future research are included, and ideas to move toward standardization are presented. Recommendations for the training of paraprofessionals in these assessment procedures, too, are outlined.