Lecture 3 Flashcards
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What is the aim of neuropsychological assessment in children?
To examine brain-behavior relations in children
This includes integrating medical data, daily life, test scores, and observations to evaluate cognitive functions.
What are the settings where pediatric neuropsychologists work?
- Hospitals
- Rehabilitation units
- Schools
- Forensic settings
- Private practice
Pediatric neuropsychologists often work as part of a multidisciplinary team.
What are the key components integrated during neuropsychological assessment?
- Medical data
- Daily life observations
- Test scores
- Observations
This integration helps in evaluating cognitive functions.
True or False: Similar brain lesions always lead to the same behavior.
False
Similar brain lesions can lead to a variety of behaviors.
Neuropsychological assessment
→ Early detection and prevention of long-term negative effects (of medical conditions)
→ Characterize cognitive strengths and weaknesses
→ Guide children towards appropriate rehabilitation, intervention or support resources
→ Monitoring outcomes (recovery or deterioration) and treatment effects
What cognitive functions are assessed in neuropsychological evaluations?
- Intelligence
- Language
- Perception
- Memory
- Attention
- Executive functions
- Motor skills
- Emotion and social cognition
Each of these functions plays a crucial role in understanding a child’s cognitive profile.
What is the significance of considering age and development in neuropsychological assessments?
Age and development influence functioning and interpretation of deficits
Damage to a developing brain may not show immediate deficits but can become evident later.
Fill in the blank: The ICF-Model combines all factors related to a child’s _______.
[health condition]
The ICF-Model includes aspects like body functions, activities, environmental factors, and personal factors.
Consideration 1: Age and Development
- Not always information on ‘before’ functioning
- Not always imaging data
- More variety between ages
There is no such thing as a child – Winnicot, 1965
- Children function in relationship to their primary caregivers
- Parents can be the causes and cures of psychological problems in children
- Focus on the relationship between child and caregivers
- Children form different relationships with different caregivers.
- Children may exhibit symptoms in their relationship with one caregiver but not in their
relationship with another caregiver.
Consideration 2: Child in Context
Environment on body functions →Child with CP and Fine Motor functioning With or without resources
Environment on Activities →Child with Dyslexia and Reading skills
With and without individual learning support
Environment on Participation →Child with ASD and Social Inclusion
With and without socially supportive environment
What is the role of parents in the neuropsychological assessment process?
- Providing information about daily problems
- Observing during rehabilitation
- Listening to medical caregivers
Parents are seen as experts of their own child and integral to rehabilitation outcomes.
What are the steps in the diagnostic cycle for neuropsychological assessment?
- Referral
- Intake
- Screening
- Hypothesis
- Assessment
- Analysis
- Report
Each step is crucial for thorough evaluation and understanding of the child’s needs.
Intake
- Medical history
– Complications during pregnancy or birth
– Other medical complications, genetic diseases - Developmental history
– Acquired: pre-insult development
– Developmental: problems during development - Activities and participation
– Limitations and restrictions that were observed - Environmental factors
– Family structure, family coping
– Perception of child & problems
– School/class structure, behaviour in school - Personal factors
– Character, interests
When you do a screening?
- When the referral question is too broad
- To get a first picture/look at the patient
- To evaluate the overall cognitive profile (also strengths)
What are the tests/methods for screening?
- Observations at home or at school
- Neuropsychological Screening
- Intelligence / developmental tests
– Wechsler Intelligence Scale for Children (WISC): age6–16y
– Wechsler Preschool and Primary Scale of Intelligence (WPPSI): age 2 – 6 y – Bayley Scales of Infant and toddler Development (BSID): age 0.6 – 2 y
What is the age range for the Wechsler Intelligence Scale for Children (WISC)?
6 – 16 years
This assessment can be conducted using pen-paper or iPads.
List the five indexes measured by the WISC-V Intelligence Test.
- Total IQ
- Verbal Comprehension Index (VCI)
- Visual Spatial Index (VSI)
- Fluid Reasoning Index (FRI)
- Working Memory Index (WMI)
- Processing Speed Index (PSI)
Each index provides insights into different aspects of cognitive functioning.
True or False: Damage to a developed brain is easier to assess than damage to a developing brain.
True
Clear differences in functioning before and after damage can typically be identified in developed brains.
What are the seven core subtests of the WISC-V Intelligence Test?
- Block Design
- Matrix Reasoning
- Digit Span
- Coding
- Visual Puzzles
- Figure Weights
- Symbol Search
These subtests are used for screening and contribute to Total IQ and Index Scores.
What does the Total IQ represent in the WISC-V?
The overall measure of intelligence derived from various index scores
Total IQ is calculated from scores across different cognitive domains.
Define the Verbal Comprehension Index (VCI).
A measure of crystallized intelligence assessing word knowledge and verbal reasoning
Similarities & Vocabulary
The VCI evaluates a child’s ability to access and apply acquired word knowledge.
What does the Visual Spatial Index (VSI) assess?
Ability to evaluate visual details and understand visual spatial relationships
Block design & Visual puzzles
VSI is crucial for constructing geometric designs from models.
What does the Fluid Reasoning Index (FRI) measure?
The ability to detect underlying conceptual relationships and apply reasoning
matrix reasoning & figure weights
It involves inductive and quantitative reasoning.
What is assessed by the Working Memory Index (WMI)?
Registration, maintenance, and manipulation of visual and auditory information
Digit span & picture span
WMI reflects attention, concentration, and mental control.
What does the Processing Speed Index (PSI) evaluate?
Speed and accuracy of visual identification, decision-making, and implementation
coding & symbol search
PSI assesses short-term visual memory and cognitive flexibility.
Fill in the blank: The _______ is a measure of the child’s ability to recall numbers in various orders.
Digit Span
It includes forward, backward, and sequencing tasks.
What is the significance of standard deviation in WISC-V scoring?
It indicates the variability of scores around the mean
Standard deviation helps to interpret individual scores in relation to normative data.
True or False: Low scores on the WISC-V always indicate cognitive impairment.
False
Low scores can occur within the normal population and may depend on various background variables.
What cognitive functions might be impaired if a child has a low score in the Verbal Comprehension Index?
- Information retrieval
- Ability to reason and solve verbal problems
- Communication of knowledge
Low scores in VCI can indicate difficulties in accessing and applying language skills.
What considerations should be taken when developing a test battery?
- Type of Test Battery
- Multiple tests per function
- Order of the tests
- Where to start and stop
Considerations ensure comprehensive assessment tailored to the child’s needs.
Fill in the blank: The _______ assesses the child’s ability to view a scale with missing weights and select options to keep it balanced.
Figure Weights
This task is part of the Fluid Reasoning Index.
What are some potential comorbidities to consider when diagnosing cognitive profiles?
- Attention Deficit Hyperactivity Disorder (ADHD)
- Dyslexia
- Autism Spectrum Disorder (ASD)
- Developmental Coordination Disorder (DCD)
Comorbidities may complicate the interpretation of cognitive assessments.
What does the term ‘Task Impurity Problem’ refer to?
The challenge of designing tasks that assess only one cognitive function
Many tasks inadvertently assess multiple cognitive skills simultaneously.
What is the role of observations in cognitive assessments?
- Appearance
- Behavior
- Motivation
- Alertness
Observations provide context for test performance and help identify potential issues.
What is the purpose of integrating observations and test scores?
To determine if the measured function aligns with the intended assessment goals
Integration aids in identifying cognitive strengths and weaknesses.
What does CVI stand for?
Cerebral Visual Impairment
CVI refers to visual impairment resulting from damage to the brain rather than the eyes.
What are some key impairments associated with developmental disorders?
- Impaired communication
- Impaired executive functioning
- Impaired reading skills
- Impaired motor skills
- Impaired visual perception
- Developmental language disorder
- Autism Spectrum Disorder (ASD)
- Developmental Coordination Disorder (DCD)
These impairments can affect a child’s ability to function in daily life.
What is the first intervention focus for a child with visual impairment?
Identify the main problem or disorder
Addressing the primary issue helps in creating an effective intervention plan.
What is included in a written report for assessment?
- Background
- Intake
- Test results
- Observations
- Summary
- Conclusions
- Recommendations
A comprehensive report aids in understanding the child’s condition and planning further actions.
What is the importance of conversation with the patient or their guardians during the assessment?
Gathering ‘good news’ and addressing their questions
This conversation helps in understanding the family’s perspective and concerns.
What factors influence the assessment and rehabilitation plan?
- Medical condition
- Functions
- Limitations
- Personal factors (age)
- Environment (context)
These factors are essential for tailoring interventions to the individual child’s needs.
True or False: Age and context do not influence functions, activities, and participation.
False
Age and context are significant factors in shaping a child’s abilities and experiences.
Why is a first screening important?
To have an overview and give direction
Early screening helps in identifying key areas of concern and planning further assessments.
What is the role of clinical observations during tests?
Essential for interpreting the scores
Observations provide context for understanding a child’s performance beyond numerical scores.
What should always be kept in mind during neuropsychological assessments?
Differential Diagnosis: The process of distinguishing between two or more conditions that share similar symptoms, to accurately identify the cause of the issue.
Growing into Deficit: When a developmental disorder or brain injury is not immediately apparent, but its effects become more noticeable as the child grows and more complex skills are required.
These considerations help ensure accurate diagnosis and effective intervention strategies.
Fill in the blank: Child neuropsychology is a complex _______.
[puzzle]
The complexity arises from the interplay of various cognitive, emotional, and developmental factors.
Consideration 3: Task Impurity Problem
It is impossible to design a task which assesses only one function
– Because of the design of the task:
– Because of the (behaviour/needs of the) specific child
* Overall observations: – Appearance
– Behaviour
– Motivation
– Alertness: tired?
* Task/Function specific observations
– Motor: Handedness, pen grip, walking the stairs
– Language:speech,comprehensionofinstructions
– Perception: viewing distance, squinting eyes, tripping, missing information
– Memory:Rememberinginstructions,secondassessment
– ExecutiveFunctions:Planning,checkinganswers,impulsivity,processingspeed – Attention: distracted by internal or external cues?
Analysis and interpretation
- Scoring - converting to norm scores – classification - interpretation
- Is a low score always an indication of an impairment?
– Lowscorescanbefrequentlyfoundwithinthenormalpopulation
– Thechanceoffindinglowscoresincreaseswiththenumberoftestsbeingconducted
– Low scores may depend on background variables of the child (SES, ethnicity, age, gender) - Integration of observations and test scores: did you measure the function you aimed for?
- Analysis on item, (between/within) subtest, (between/within) function level
- Interpretation of test results in light of daily functioning/problems
- Does the cognitive profile fit with a neurodevelopmental disorder?
Consideration 4: Differential diagnosis
- Comorbidity or causal relationship between functions?
Dyslexia- How to deal with differential diagnoses?
- Make clear hypothesis:
What cognitive profile do you expect per disorder? - Use a multi-method assessment design
(structured interview, tests, observations) - Do literature research on frequent comorbidities
- After your assessment, ask yourself (or the parents):
Attention Deficit Hyperactivity Disorder (ADHD)
cation
Cerebral Visual Impairment (CVI)
Impaired communi
Impaired Impaired Executive Functioning Reading skills
Autism Spectrum Disorder (ASD)
Developme ntal Coordinatio n Disorder (DCD)
Developm ental Language Disorder
Impaired Visual Perception- What function/disorder is the main problem for this child?
- What should our first intervention focus on?
- What other functions are important contributing factors?
Conclusions
Child neuropsychology is a complex puzzle
* Age and context influence functions, activities and participation But also give direction to the assessment and rehabilitation plan
* A first screening is important to have overview and give direction
* Clinical observations during tests are essential to interpret the scores
* Always keep all factors in mind, including Differential Diagnosis and Growing into deficit
