Response to: Bryce and Allott – Cognitive screening: A significant unmet need in youth mental health. 30 minutes is too long!

To the Editor

In a recent letter to the editor, Bryce and Allott (2019) make an argument that there is an unmet need for a brief cognitive screening tool specifically designed for youth mental health services. There is considerable evidence of cognitive heterogeneity across youth mental health populations with typically three clusters of performance recognised: intact, moderate impairments and significant impairments. Identifying those with impairments (moderate and severe) as early as possible would certainly be a useful endeavour.

There are, however, multiple brief assessment tools that were not considered by the authors. Both the Brief Assessment of Cognition in Schizophrenia (BACS; Keefe et al, 2004) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Gold et al., 1999) have been used to establish comprehensive cognitive profiles across multiple different mental health conditions and can be administered by different health professionals. At 30 and 25 minutes administration time, respectively, these fit within the authors’ recommendation that the tool needs to be administered in <30 minutes. It is acknowledged that neither of these measures have norms for <20 years and establishing such norms would be endorsed under this initiative.

Bryce and Allott put forward four recommendations for the ideal brief screening tool. This author would agree with three of the four. Practically, a 30-minute administration time is unrealistic in busy clinical settings and <10 minutes is suggested as more feasible, akin to the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). The Brief Cognitive Assessment Tool for Schizophrenia (B-CATS) is completed in 10 minutes and could be considered. The individual tasks within this battery, trail making test B, category fluency and digit symbol, show sensitivity to clinical heterogeneity. Again, norms would need to be established for <20 years.