Case 2 Neuropsychological assessment in children and development of specific
neuropsychological functions
1. Define the different steps of neuropsychological examination? What different sources
of information are considered?
- three key assumptions in neuropsychology:
o If one is to evaluate and treat childhood difficulties effectively, then one must
consider brain functioning (because the two are inexorably linked).
o If one is to understand any concept or phenomenon, then one must be able tv
measure it systematically, reliably, and validly.
o If a neuropsychological assessment is to be clinically relevant, then the
emphasis must rest not on the methods of data gathering, but rather on the
interpretation and integration of all available data and the extent to which they
enhance the appreciation of the various factors impinging on the child's
behavior.
- The assessment process: there are multiple assessment models:
o Fixed batteries: standardized administration of a pre-established set of
assessment procedures.
o Eclectic batteries: "idiosyncratic" batteries chosen by clinicians based upon
their theoretical stances, and employing a variety of tasks selected to answer a
particular question.
o Qualitative batteries: focused upon describing patterns of cognitive
performance.
o Process approaches: emphasis is placed on microanalysis of how the individual
earned a particular score, rather than focusing on the scores themselves.
o Functional evaluations: takes into account poor ecological validity of test
results and attempts to examine "real-life" skills
- 5 step template: 1. Clarification 2. History and assessment 3, Formulation 4.
Communication 5. Monitoring and reassessment
- There are no golden standards for assessment. clinicians should aim to design and
produce evaluations that are useful—and "usefulness" must always remain a context-
dependent concept. Clinical neuropsychological assessments can be construed as n = 1
research projects because specific hypotheses can be explored, the data collected and
summarized systematically, and the results interpreted in the context of the extant
literature. Assessments are "good" if they can answer, as far as possible, the questions
that prompted them. We would argue that in most clinical situations, a goal-oriented,
individually tailored assessment that has been carefully planned according to the
specific referral question(s), developmental level and stamina of the child, and
informed by our knowledge regarding important neuropsychological correlates of the
presenting difficulties, represents the best value for time and money.
Step 1 Clarification: What, Why, Why Now?:
- What is the child doing (or not doing) that is worrying? Who else shares these
worries? If it wasn't for these worries, would anyone be seeking help from
professionals for any other reasons? (This is often useful to uncover other, additional
or comorbid problems.) Does this child have a neurological or medical condition that
is known to impact upon brain functioning? If so, is their current presentation (across
1
, domains) consistent with what (if anything) is expected based on the research
literature? Are there any settings in which the difficulties are relatively less apparent?
(This is useful to establish extent of pervasiveness; it also identifies situations where
either (a) minimal demands are being placed upon the child's weaknesses or (b) the
setting is sufficiently supportive to minimize the impact of these weaknesses.) Why
are you seeking assistance for these difficulties right now? (This helps to identify any
possible triggers that might have exacerbated an underlying weakness.) What do you
(parent/child/school/referrer) hope to gain from this assessment? (This identifies any
inappropriate expectations, and helps to identify key areas to include in formulation.)
- The most common reasons for referral included: Establish a baseline level of
functioning before a change in treatment (commencement of medication, surgery).
Document changes following an acquired brain injury. Track deterioration in
conditions associated with loss of capacities. Identify profile of neurocognitive
strengths and weaknesses to inform educational remediation or as precursor to
rehabilitation planning. Evaluate the efficacy of intervention.
Step 2 history and assessment
- Developmental history: Taking a thorough developmental history is time-consuming,
but time well spent. This is true irrespective of whether the issue at hand involves
damage in the context of normal development (where information on premorbid
functioning is particularly important) or developmental difficulties (in which
consideration of how the difficulties have impacted upon the processes of change are
key). Establishing the child's developmental trajectories across the different functional
domains (motor, language, social, behavioral, emotional) allows one to begin to
generate hypotheses for specific investigation. Parents give this information.
- Integrating the medical condition: At this early stage in the evaluation process, if the
child already has a diagnosable neurological or neurodevelopmental disorder, one can
bring in the medical data (e.g., EEG or MRI results) particular to that child and the
research literature pertinent to the problem area. At this stage, reviewing the literature
to establish what is known in general about the impact on CNS functioning of any
medical conditions or treatments is a good starting point. The neuropsychological
phenotypes of certain disorders that affect the CNS are well documented, and
determining the extent to which the difficulties experienced by the individual at the
focus of your particular assessment do or do not fit the "usual" pattern seen with that
disorder can be a useful starting-point for the formulation.
- Unpicking the present concerns: helps to elucidate potential targets for formal
psychometric assessment. Ideally, this should involve developing a list from the
parents and/or school of the exact types of functional impairments on the observable
level. This should encompass functioning in five key domains: (a) behavioral, (b)
social, (c) emotional, (d) cognitive/learning, and (e) adaptive. This list can sometimes
be divided into two: One is a list that reflects a lack of progress or absence of skills the
other a record of behavior excesses.
- Establishing rapport and gaining consent: We tend to limit our assessment sessions to
two hours, with breaks as necessary. One argument for having longer assessment
sessions is that it stresses the child's brain which will expose any subtle difficulties and
also that it replicates what happens in a school environment.
- Conducting the assessment: administration of psychometric tests of various
neuropsychological constructs and cognitive capacities. We believe that assessments
should encompass five key areas of functioning: (a) behavioral, (b) cognitive/learning,
2
neuropsychological functions
1. Define the different steps of neuropsychological examination? What different sources
of information are considered?
- three key assumptions in neuropsychology:
o If one is to evaluate and treat childhood difficulties effectively, then one must
consider brain functioning (because the two are inexorably linked).
o If one is to understand any concept or phenomenon, then one must be able tv
measure it systematically, reliably, and validly.
o If a neuropsychological assessment is to be clinically relevant, then the
emphasis must rest not on the methods of data gathering, but rather on the
interpretation and integration of all available data and the extent to which they
enhance the appreciation of the various factors impinging on the child's
behavior.
- The assessment process: there are multiple assessment models:
o Fixed batteries: standardized administration of a pre-established set of
assessment procedures.
o Eclectic batteries: "idiosyncratic" batteries chosen by clinicians based upon
their theoretical stances, and employing a variety of tasks selected to answer a
particular question.
o Qualitative batteries: focused upon describing patterns of cognitive
performance.
o Process approaches: emphasis is placed on microanalysis of how the individual
earned a particular score, rather than focusing on the scores themselves.
o Functional evaluations: takes into account poor ecological validity of test
results and attempts to examine "real-life" skills
- 5 step template: 1. Clarification 2. History and assessment 3, Formulation 4.
Communication 5. Monitoring and reassessment
- There are no golden standards for assessment. clinicians should aim to design and
produce evaluations that are useful—and "usefulness" must always remain a context-
dependent concept. Clinical neuropsychological assessments can be construed as n = 1
research projects because specific hypotheses can be explored, the data collected and
summarized systematically, and the results interpreted in the context of the extant
literature. Assessments are "good" if they can answer, as far as possible, the questions
that prompted them. We would argue that in most clinical situations, a goal-oriented,
individually tailored assessment that has been carefully planned according to the
specific referral question(s), developmental level and stamina of the child, and
informed by our knowledge regarding important neuropsychological correlates of the
presenting difficulties, represents the best value for time and money.
Step 1 Clarification: What, Why, Why Now?:
- What is the child doing (or not doing) that is worrying? Who else shares these
worries? If it wasn't for these worries, would anyone be seeking help from
professionals for any other reasons? (This is often useful to uncover other, additional
or comorbid problems.) Does this child have a neurological or medical condition that
is known to impact upon brain functioning? If so, is their current presentation (across
1
, domains) consistent with what (if anything) is expected based on the research
literature? Are there any settings in which the difficulties are relatively less apparent?
(This is useful to establish extent of pervasiveness; it also identifies situations where
either (a) minimal demands are being placed upon the child's weaknesses or (b) the
setting is sufficiently supportive to minimize the impact of these weaknesses.) Why
are you seeking assistance for these difficulties right now? (This helps to identify any
possible triggers that might have exacerbated an underlying weakness.) What do you
(parent/child/school/referrer) hope to gain from this assessment? (This identifies any
inappropriate expectations, and helps to identify key areas to include in formulation.)
- The most common reasons for referral included: Establish a baseline level of
functioning before a change in treatment (commencement of medication, surgery).
Document changes following an acquired brain injury. Track deterioration in
conditions associated with loss of capacities. Identify profile of neurocognitive
strengths and weaknesses to inform educational remediation or as precursor to
rehabilitation planning. Evaluate the efficacy of intervention.
Step 2 history and assessment
- Developmental history: Taking a thorough developmental history is time-consuming,
but time well spent. This is true irrespective of whether the issue at hand involves
damage in the context of normal development (where information on premorbid
functioning is particularly important) or developmental difficulties (in which
consideration of how the difficulties have impacted upon the processes of change are
key). Establishing the child's developmental trajectories across the different functional
domains (motor, language, social, behavioral, emotional) allows one to begin to
generate hypotheses for specific investigation. Parents give this information.
- Integrating the medical condition: At this early stage in the evaluation process, if the
child already has a diagnosable neurological or neurodevelopmental disorder, one can
bring in the medical data (e.g., EEG or MRI results) particular to that child and the
research literature pertinent to the problem area. At this stage, reviewing the literature
to establish what is known in general about the impact on CNS functioning of any
medical conditions or treatments is a good starting point. The neuropsychological
phenotypes of certain disorders that affect the CNS are well documented, and
determining the extent to which the difficulties experienced by the individual at the
focus of your particular assessment do or do not fit the "usual" pattern seen with that
disorder can be a useful starting-point for the formulation.
- Unpicking the present concerns: helps to elucidate potential targets for formal
psychometric assessment. Ideally, this should involve developing a list from the
parents and/or school of the exact types of functional impairments on the observable
level. This should encompass functioning in five key domains: (a) behavioral, (b)
social, (c) emotional, (d) cognitive/learning, and (e) adaptive. This list can sometimes
be divided into two: One is a list that reflects a lack of progress or absence of skills the
other a record of behavior excesses.
- Establishing rapport and gaining consent: We tend to limit our assessment sessions to
two hours, with breaks as necessary. One argument for having longer assessment
sessions is that it stresses the child's brain which will expose any subtle difficulties and
also that it replicates what happens in a school environment.
- Conducting the assessment: administration of psychometric tests of various
neuropsychological constructs and cognitive capacities. We believe that assessments
should encompass five key areas of functioning: (a) behavioral, (b) cognitive/learning,
2
