pediatric neuropsych testing

8/13/2019 Pediatric Neuropsych Testing

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What is it?

Who can benefit?

Reasons for making a referral

Referral Process NP Testingissues with children

Feedback Options

Presented by Richard DiPrima, Psy.D.

Licensed Clinical Neuropsychologist

Senior Instructor

University of Rochester Medical Center

November 23, 2004


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A specialty profession that focuses on brain functioning inchildren.

A pediatric neuropsychologist is a licensed psychologistwith expertise in how learning and behaviorareassociated with brain structures and systems.

Formal testing of abilities such as memory and languageskills assess brain functioning.

The pediatric neuropsychologist conducts the evaluation,interprets the test results, and makes specificrecommendations.

A NPE assists in better understanding a students currentlevel of functioning. (Like a SNAPSHOT)

This information is used to assist a students teachers,therapists, and physicians provide treatments and

interventions that meet his/her unique needs.

What is PediatricNeuropsycholgy?

(American Psychological Association, Division 40 - Clinical Neuropsychology)


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In a NPE, brain function is objectively measured to betterunderstand howthe brain is effectively directing anindividuals behavior and learning.

This involves a specialized assessment of verbal andnonverbal abilities and general intellectual functioning

including:Attention & Concentration

Learning and Memory

Language skills (Expressive & Receptive)

Visuospatial skills

Motor coordinationExecutive function (Organization, Planning, Inhibition, Flexibility)

A pattern of relative strengths and weaknessesis used inimportant decision making to assist schools with providingappropriate educational programs for students.

What is a Pediatric NeuropsychologicalEvaluation ?

(American Psychological Association, Division 40 - Clinical Neuropsychology)


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A NPE is typically extensive and oftentime-consuming and notall students

referred for a NPE will benefit from

this type of assessment.

Therefore, the evaluator will carefullyconsider, through consultation with the

referral source, the appropriatenessof

each referral.

The following information shouldserve as guidelinesfor determining

whether a NPE could be beneficial.

What is a Pediatric NeuropsychologicalEvaluation ? Cont.


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Students are typically referred by a doctor, teacher,

school psychologist, or other professional becauseof one of the following reasons:

Difficulties with learning, attention, behavior,

socialization, or emotional control.

After a brain injuryfrom an accident, birth trauma, stroke or

other physical stress.

When recent or long standing,but poorly understood,

changes in a students cognitive and behavioral

functioning are noted.

When the pattern of difficultiesobserved in the student have

not responded well to previous interventions(i.e., special

education services, medication or classroom interventions).

The student continues to demonstrate difficulties in

academic progress(i.e., failing to acquire reading skills),

despite interventions.

When May a Student Benefit from a NP Referral?


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A student with past or current history of the following:

neurological involvement (e.g., epilepsy, brain tumor, stroke,

muscular dystrophy, cerebral palsy, focal deficits)

genetic disorders (e.g., Turners or Kleinfelters Syndromes)

head trauma, physical abuse and/or substance abuse

neurotoxin exposure (e.g., lead, mercury, carbon monoxide),

nutritional deficiencies or infectious diseases

childhood cancer survivors

students that have difficulties with memory, attention or

learningin the presumed absence of any other significant

cognitive difficulty

significant discrepancy between verbal and nonverbal skills

Students that May Benefit from a NPReferral? (Page 2)


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Students with profound and pervasive cognitive deficits that have beenformally screened and found to have Moderate to Severe Mental Retardation or

a known developmental disorder such as Autism or Down Syndrome. Students whose behavior is so problematic that assessment is either invalid or

grossly unreliable such as students with severe oppositional and/or conductdisorders or who are floridly psychotic.

Students who are over medicated should not be evaluated until their medicationis within normal limits.

Students who have been adequately evaluated in the past, are alreadyreceiving appropriate remedial services and treatment, and have shownimprovement in their functioning.

NOTE: It is important to recognize that each case has its ownunique circumstances and concerns. Therefore, there can beexceptions and the above conditions may not necessarily apply.These should serve as guidelinesfor determining whether a NPEcould be beneficial.Although a NPE often coincides with thetriennial evaluation, it is not part of the triennial assessment, butinstead is supplemental and completely voluntary.

Who May NOT Benefit from a NPE?


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School assessmentsare usually

performed to determine whether a

student qualifies for special

education programs or therapies toenhance school performance with

focus onachievementand skills

needed for academic success.

Generally, they do not diagnoselearning and behavior disorders

caused by altered brain function or

development.


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Most referrals are made through the patients PCP and/orneurologist for purposes of payment reimbursement byinsurance companies.

In school settings, the referral source (e.g., teacher,parent) talks with the school principal to ascertain

approval for payment by the district.

The referral source completes the Request andConsentForms for NPE signed by parent/legal guardian.

Once the forms are sent to the Mental Health DepartmentProgram Coordinator and approved, they are forwarded tothe evaluator.

The evaluator then begins the process, throughconsultation with the referral source, of determining theappropriateness of each NP referral and whether thestudent would benefit from this service.


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What does a Pediatric NPE involve?

A multifaceted and thorough evaluation may involve the following: Ascertaining possession of signed consentsfrom a parent/legal guardian or

student over 18 years of age before any direct contact with a referred student.

Discussing with the referral source specific concernsabout the student being

referred. Clarifying the specific referral questionwill guide the entire NPE

from the choice of testing materials to the provision of recommendations andfeedback.

EX: Current level of cognitive and behavioral functioning, diagnostic clarification,

need for academic programming, behavioral management, etc.

In children, this often involves making various collateral contactswith

individuals and professionals that know the child best with signed consent. Gathering further information by having parents and/or teachers complete

specific forms and/or questionnaires. Talking with parents/teachers to assess

functioning in the home and school.


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What does a PED NPE involve?(Page 2)

A multifaceted and thorough evaluation may involve the following: Clinical interview with the student and parent.

Obtaining a thorough developmental historyand get an understanding ofspecific medical, social, behavioral, and academic concerns.

Discussing the familys expectations for the evaluation and clarify any

misconceptions. Observinghow the student interacts in the classroom (if possible), during the

clinical interview, and throughout the evaluation period.

Review available school records, medical records and any academic or previouspsychological testing.

Evaluation of students current levelof neuropsychological and behavioralfunctioning, including general intellectual capacities, attention, concentration,learning, memory, language skills, visuospatial skills, motor coordination,achievement and executive function skills of organization, planning, inhibition,and mental flexibility. NOTE: Some of these measures may have been recently assessed by other psycho-educational

professionals and it will be important for results of these components to be made available for

review. There should be a minimum of 6 months before re-administering a specific instrumentto minimize the adverse implication of practice effects.


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What does a PED NPE involve?(Page 3)

Other special issues involved in assessing children (Ryan et al): Building rapport and introducing the evaluation in an age-appropriate language.

EX: Explain that while the child is having fun with the examiner, the parent will be

doing homework in the waiting area.

Establishing ground rules to structure the testing session.

EX: Discuss the use of short breaks in a way that makes the child feel in charge.

Maintaining appropriate effort and motivation. This is challenging, but essential

to obtain valid test results. Importance of using a core battery that the examiner

is highly familiar with to maintain a good testing rhythm and on-task behavior.

EX: Snapshot

EX: Explain level of difficulty akin to videogames

Give ongoing praise for effort.

Interpreting results in view of behavioral observations


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By comparing the referred students test scores to scores of individuals of similarages, a profile of the students strengths and weaknessesis found and used toassist those involved in the students care in the following ways:

NPT results provide a better understandingof the students behavior andlearning in school, at home, and in the community.

NPT results may explain whya student is having school problems.

EX: A student may have difficulty reading because of an attention problem,a language disorder, or a reading disability. Specific interventions may berecommended to draw upon the students objectively found strengths and

remediate relative weaknesses based on the students learning style.

NPT results can help detect the effects of developmental, neurological, andmedical problems, such as epilepsy, attention deficit hyperactivity disorder,dyslexia, etc.. NPT may be done to obtain a baselineagainst which tomeasure the outcome of treatment or the students development over time.

Different disorders result in specific patterns of strengths and weaknesses.

These profiles can help identify a students disorderand the brain areasthat are involved.

EX: NPT results can help differentiate between an attention deficit anddepression or determine whether a language delay is due to a problem in

producing speech, understanding or expressing language, social shyness, orcognitive delay.

What will NPT Results Tell Me?


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Feedback can be tailoredbased on the individual needs ofeach patient, student, teacher, parent, etc.. It is important to

provide feedback in a language that is understandable to allparties involved so that the recommendations aresuccessfully implemented. Typical feedback options includethe following:

All NP reports are given directly to the parent/legal

guardian either through the mail with a number includedfor contacting examiner with any questions or during aface-to-face feedback session.

A referral source may obtain a copy of the NP reportwith a Consent to Release and Obtain Informationformthat is signedby a parent/legal guardian or student18 years of age or older and witness.

Teachers, parents, and other service providers may alsowish to have a more formal feedback meeting that

includes representatives from the students educationaland/or medical team.

Feedback Options


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Thank

You !!

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