What are the guidelines for using MOCA-Peds (Montreal Cognitive Assessment for Pediatrics) in pediatric patients?

Guidelines for Using MOCA-Peds in Pediatric Patients

The MOCA-Peds (Maintenance of Certification Assessment for Pediatrics) is designed as an online, continuous assessment tool for pediatricians to demonstrate medical knowledge and promote learning, rather than as a cognitive assessment tool for pediatric patients.

What is MOCA-Peds?

MOCA-Peds was developed by the American Board of Pediatrics (ABP) as an alternative to the traditional proctored Maintenance of Certification (MOC) examination 1. It is specifically designed for pediatricians to maintain their board certification, not as a clinical assessment tool for pediatric patients.

Key features of MOCA-Peds include:

• Online, summative (pass/fail) continuous assessment of pediatrician knowledge
• Multiple-choice questions delivered quarterly
• Immediate feedback on questions with rationales and references
• Can be taken at any time within the quarter on any device with internet connectivity
• Launched for General Pediatrics, Pediatric Gastroenterology, Child Abuse, and Pediatric Infectious Diseases in 2019, with other subspecialties following between 2020-2022 1

Effectiveness and Acceptance of MOCA-Peds

Research has shown high acceptance of MOCA-Peds among pediatricians:

• 97.6% of participating pediatricians reported learning, refreshing, or enhancing their medical knowledge through MOCA-Peds 2
• 62.0% reported making practice changes related to participation 2
• Over 90% of participants indicated they would choose MOCA-Peds over the traditional proctored examination 3

Important Distinction: MOCA-Peds vs. MoCA

It is critical to understand that MOCA-Peds should not be confused with the Montreal Cognitive Assessment (MoCA), which is a cognitive screening tool used to detect mild cognitive impairment in adults.

MoCA (Montreal Cognitive Assessment)

The MoCA is a validated cognitive screening tool for adults that:

• Assesses multiple cognitive domains including memory, language, executive function, attention, and orientation 4
• Uses a cutoff score of 23/30 to indicate mild cognitive impairment 4
• Has alternate versions to decrease learning effects with repeated testing 5
• Is recommended for cognitive assessment in adults, not pediatric patients 6

Cognitive Assessment Tools for Pediatric Patients

For cognitive assessment in pediatric patients, particularly those with mild traumatic brain injury (mTBI) or other conditions affecting cognition, the following evidence-based approaches are recommended:

1. For mild traumatic brain injury assessment:

   • Use standardized tools for assessment rather than biomarkers 6
   • Note common modifiers that may delay recovery and use clinical risk scores to predict risk of prolonged symptoms 6
   • Consider comprehensive neuropsychological evaluation when there are complicating factors 6

2. For attention-deficit/hyperactivity disorder (ADHD) evaluation:

   • Initiate evaluation for any child or adolescent aged 4-18 years who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity 6
   • Use standardized tools to obtain informant reports on changes in cognition, function, and behavior 6

Conclusion

MOCA-Peds is a professional certification assessment tool for pediatricians and should not be used as a cognitive assessment tool for pediatric patients. For pediatric cognitive assessment, clinicians should use age-appropriate, validated assessment tools specific to the condition being evaluated, such as those recommended in guidelines for mTBI, ADHD, or other pediatric conditions affecting cognition.

When cognitive assessment is needed for pediatric patients, consultation with pediatric neuropsychology or developmental specialists is recommended to select the most appropriate assessment tools based on the child's age, developmental level, and specific clinical concerns.