Summary Reading Guide Developmental Neuropsychology

Reading guide: Book Developmental Neuropsychology. A clinical approach
(2019). second edition. Vicky Anderson, Elisabeth Northam, and Jacquie
Wrennall.
General:

 The first part of each chapter starts with a summary and the chapter is closed with the main
conclusions. This will help you to find the high lights.
 In the exam neuro-anatomical concepts will be used. We expect that you are familiar with
the concepts. Only concepts discussed in the lectures are referred to in the exam.


Chapter 1 Child neuropsychology: theory and practice

 What is child neuropsychology?
o The study of brain-behaviour relationships within the context of an immature but
rapidly developing brain and the implementation of the knowledge gained into
clinical practice.
o Informs our understanding of typical child development by providing a framework
within which to explore and map parallels between brain maturation and cognitive
and socio-emotional development.
o Primary focus: the generation of a developmentally informed knowledge base that
facilitates optimal understanding of the impact of early brain injury, insult or
disruption on subsequent brain development and child function
 Guiding the design of evidence-based interventions to minimise disability.
o Takes its foundations from adult neuropsychological models
 But, adult neuropsychology relates to a more ‘static’, tightly organised
system, which is unable to easily accommodate the dynamic impact of brain
pathology resulting from brain insult/environmental disadvantage in early
childhood.
o Knowledge of typical development is especially important: provides a template for
measuring deviations relating to early damage and subsequent interruption to
normal growth processes across a range of functional domains (neurologic, cognitive,
socio-emotional) at the time of insult and in the longer term.
o Challenge: grapple with the interactions between biologic, cognitive, social and
developmental factors to reach an understanding of how these factors affect the
child and lead to observed outcomes.
o To fully understand the long-term consequences of brain dysfunction during
childhood, it is essential to address the ‘totality’ of the child: medical, cognitive and
psychosocial experiences that interact to influence recovery and development.
 What does plasticity, vulnerability, ’growing into deficits’, and critical periods mean?
o Plasticity: a theory of recovery of function where the young child’s brain is seen to be
less differentiated than that of the mature adult and more capable of transferring
functions from damaged cerebral tissue to healthy issue
 Acknowledge the unique processes that me be acting in the developing brain
following cerebral insult.
o Vulnerability: the developing brain is uniquely susceptibility, with brain insult leading
to incomplete recovery and poor outcome

, o ‘Growing into deficits’: cognitive deficits or problems can elicit later in life, as
demands increase through late childhood into adolescence.
o Critical periods: the time window during which external influences have a significant
effect
 Some aspects of cognitive development are critically dependent on the
integrity of particular cerebral structures at certain stages of development
 Early brain insult will have different consequences at different times
throughout development.



Influencing factors:
- Injury




(severity/nature/complications)
- Cognitive skill (simple, complex)
- Development (age at injury, age at assessment)
- Environment (distal, proximal factors)

 Describe the biopsychosocial model in this chapter. What are the dimensions?




o Threats to healthy development are numerous and span multiple domains from
health and environment to cognitive development, mental health and quality of
life.
o Now: tools that can more comprehensively explore the interacting influences of
biology and environment
 Challenge: integrate this knowledge with evidence from the fields of
child development, education and mental health.

,  Combined knowledge can be translated into ‘best’ practice in the field to
enhance optimal outcomes for individual children and for the benefit of
the community.
o Brain: the bio dimension
 In the prenatal period, development is largely concerned with structural
formation (establishing the ‘hard-ware’ of the brain).
 Interruptions result in structural abnormalities.
 Postnatal development is directed towards elaboration of the brain,
establishing the connectivity vital for the system to function effectively.
 Development occurs in a hierarchical manner: anterior regions the last to
reach maturity (in late puberty).
 Step-wise model, not gradual/linear
 Influences: brain injury/insult, infection, environmental factors
(malnutririon, trauma, toxins)
 Early disruption to CNS development  irreversible consequences.
 Childhood brain disorders are diffuse, impacting on the brain as a whole
 Focal disorders (tumour and stroke) are rare.
 So, specific impairments, such as modality-specific memory
disorders, are less common in children, while generalised
disturbances of information processing, executive function and
social cognition are more frequently observed.
 Adults more localised cerebral pathologies
 Also discrepancies between adult and child insults for recovery
 Acute recovery is similar, irrespective of age
 Long-term recovery patterns differ in favour of the more mature
brain
o Discussions: plasticity
 Prognosis is more difficult to predict following childhood injury
 Following early brain insult, age at insult (as a proxy for developmental
stage) and nature of insult appear to have a complex relationship
 Earlier insults and more diffuse/complicated insults leading to
slow recovery and poor outcomes.
 Advances in structural and functional neuroimaging have provided
valuable insights into developmental processes within the brain.
o Environment: the social dimension
 The child’s cognitive and socio-emotional skills is dependent on the
quality of the home environment and the role models provided by
parents
 In infancy, social interactions are supported and structured within the
family
 When the child goes to school: need to develop independence &
capacity to function in extrafamilial contexts
 Adolescence: independence is paramount, need to develop an identity,
via peer groups and broader social contexts, becomes important.
 The child adapts to the features and demands of the environment
 Environment is modified by the characteristics of the child.
 In child neuropsychology, only recent attention to proximal
environmental factors, first only distal factors.

,  Environment, neglect, trauma and abuse
 Consequences: reduced intellectual ability, attention, working
memory and self-regulatory deficits, lower academic
achievement, self-confidence, and mental health problems
 Evidence for changes in structure and function in the developing
brain.
 Reduced brain volume, deficits in structural connectivity and
atypical brain activations
 Environment, chronic illness and brain insult
 Children from previously dysfunctional/low SES families show
more problems
 Parents are depressed or distressed  cognitive and social
development of the child is reported to be poorer.
 Better outcomes when there is family cohesion and supportive
social networks
 Double-hazard hypothesis: brain insults may have greater
consequences in children from socially disadvantaged
backgrounds
 The relationship between proximal environmental influences
and child outcomes is bidirectional
 The identification of key environment predictors for outcome
after early child insult signifies a potential ‘modifiable risk factor’.
 A focus on parenting and parent mental health interventions can
result in improved child outcomes, particularly in the domains of
social and behavioural function.
o Child cognitive and socio-emotional function: the psych dimension
 Cognitive development
 Quality and level of thinking are key characteristics to change
and progress
 Stages of Piaget: every stage characterised by increasing
symbolic thought and the ability to deal with increasingly
complex and abstract information
 Timing of growth spurt in myelination, and metabolic and
electrical activity, are roughly consistent with cognitive
progressions.
 Cognitive-developmental theories are not specific to isolated
cognitive domains, but argue for a generalised progression of
cognitive abilities through childhood: domain-general
developmental model
 There may also be different rates and progressions within
specific cognitive domains
o Domain-specific development occurs in cooperation with
similar maturation occurring within other brain systems.
 The pattern of hierarchical functioning and interaction across
skill areas is consistent with our knowledge of maturational
processes within the CNS.
 Relevance of developmental theories to neuropsychology: