[W1] - CH1 Flashcards
Low Birth Weight, Prematurity and School Neuropsychology
Prematurity and LBW should be considered as neurodevelopmental risk factors and should be noted in developmental histories, and neurocognitive functions should be monitored in the preschool and elementary years.
The deficits faced by these groups are becoming increasingly relevant due to the rising survival rates. While new technology can help such infants survive when they may not have in the past, several months hooked up to ventilators and monitors in early life may have negative consequences on one’s academic and behavioural development.
Low birthweight infants are at risk for neurosensory, cognitive/neuropsychological, behavioural, and school/academic difficulties. Prematurely born infants also exhibit neurodevelopment impairment, with great variation in the severity (of babies born at 26 weeks, around 80% are likely to display some level of developmental delay or disability - with 22% experiencing severe disabilities)
The Impact of Medical Advances on School Neuropsychology
Modern medical advances have influenced the survival rates for cancer, AIDS, demyelinating diseases, TBI, chronic conditions (asthma, diabetes, heart disease), etc.,
These conditions can cause secondary academic and behavioral problems, and have been linked to neuropsychological deficits - which can lead to later specific learning disability diagnoses (SLDs).
TBI and School Neuropsychology
Traumatic brain injuries present a unique challenge for teachers
Children nowadays often forego cognitive rehabilitation post-TBI, and return to school whenever they are medically stabilized
However, care for children with TBIs in health and educational systems is not well coordinated or integrated, resulting in increased risk of poorer outcomes. School personnel are often not equipped to educate children with/recovering from TBI or severe chronic illness.
Children with TBI require uniquely specialized treatment and monitoring, due to the uneven spontaneous recovery of brain function and continued developmental changes - which sees the clinical manifestation of TBI constantly change for the individual. Unlike some disabilities that only require three-year re-evaluations, children with TBI need frequent re-evaluation for changes in academic, behavioral, adaptive, and social-emotional functioning.
School Psychologists can play a major role in being the liaisons between the school and medical community, developing transitional/re-entry plans for school-aged children returning to school after injury or insult, assisting with IEP (Individual Education Plan) development and monitoring, and general case management.
Medication and school-aged children; why do we turn to polypharmacy?
Polypharmacy amongst children (the simultaneous use of more than one psychiatric medication for ongoing treatment) is also a concern of note for modern school neuropsychologists - given the dramatic increase in the use of prescription medication(s) in the regulation of emotional and behavioural difficulties amongst children.
Why does this happen? The decision may be made to utilize polypharmacy when the child:
(a) has multiple distinct disorders for which there are different and appropriate multiple medications
(b) the symptoms of the disorder are only partially treated with one medication
(c) an additional medication is needed to reduce side effects of the other medications
(d) in complex cases decisions to prescribe medications are complicated by diagnostic uncertainty.
SNPs need to be cognizant of the impact these medications can have in the assessment process, as well as their contributions to learning/behaviors that may be mistaken for various diagnostic disorders – and communicate that information to parents and educational staff.
The question as to what the long-term consequences of polypharmacy may be, and the neuropsychological effects of certain medications, remains open.
Neurological Impairment and Misdiagnoses
Another major concern in educational practice is inaccurate diagnoses of children with known or suspected neurological impairments.
Neurologically impaired children are often mislabeled as seriously emotionally disturbed or specific learning disabled. These diagnoses and subsequent educational and behavioral interventions do NOT address the underlying neuropsychological dysfunction; and are therefore ineffective for both the practitioner and the child.
The most recent SLD definition ( “a disorder in one or more of the basic psychological processes involved in understanding or using language/mathematics”) requires the ruling out of certain exclusions such as intellectual disability or perceptual limitations as the causal factors for SLD; and therefore encourages the assessment specialist to determine the reasons WHY there is a learning delay.
Identifying an individual’s neurocognitive strengths and weaknesses following an SLD diagnosis can increase the likelihood of academic improvement for that child; through enabling the use of interventions that are more TARGETED, and evidence based. School psychologists trained in how to integrate neuropsychological principles into their professional practice are uniquely qualified to assess PSW (patterns of strengths and weaknesses) in children with SLD.
Why do we need neuropsychological assessment in schools?
Access to clinical and paediatric neuropsychologists is often very difficult, if not impossible. If an evaluation is arranged, it will be costly and there may be a long wait time associated (plus those that do specialise in paediatrics usually work in hospitals and generally would not have time for school-based assessments).
If neuropsychological insights ARE obtained, the question becomes; how are they utilised and what effects do they have? Neuropsychological reports are often filled with diagnostic conclusions and test data, but lack prescriptive recommendations that would be useful interventions in educational settings. They are difficult to understand and are often filed away as educationally irrelevant when presented to a school.
The neuropsychologists lack relevant information for these cases; that being, information about educational laws like IDEA or Every Student Succeeds (ESSA) – or just information about how school is organized or operated.
School neuropsychologists are therefore better suited to such a role. They have the child’s educational history, and have multiple opportunities for assessment and intervention progress monitoring. Paediatric neuropsychologists see the child briefly, outside of the school, and cannot/do not follow-up on the effectiveness of the interventions they recommended.
Many of the new cognitive abilities tests and tests of memory and learning that are used by school psychologists have strong theoretical foundations in neuropsychological theory. At a minimum, all school psychologists will have to improve their knowledge base about neuropsychological theories if they are going to appropriately interpret these new tests.
It is important also that the recommendations given are implemented; as an excellent neuropsychological evaluation filed away will benefit neither the school nor the child. A neuropsychologist, whether external or an internal school one, should help teachers in the implementation and program evaluation of all recommendations
What are SNP assessments and what are they used for?
School neuropsychological assessments focus on individual neurocognitive constructs such as sensory-motor functions, attentional processing, learning and memory, executive functions etc.,
They are used for:
Identifying processing deficits in children and developing remediation/compensatory strategies to maximise their learning potential
Describing a child’s neurocognitive strengths and weaknesses and relating that to their learning and behaviour in school and home environments
Documenting whether changes in learning or behaviour are associated with neurological disease, psychological conditions, neurodevelopmental disorders, or non‐neurological conditions
Monitoring educational progress of children over time, particularly for those with neuropsychological insults such as TBI
Providing comprehensive assessment data which will increase the likelihood of successful interventions
Define School Neuropsychology
School neuropsychology is the incorporation of neuropsychological and educational principles into the assessment and subsequent interventions of children to facilitate optimal learning and behaviour in school and family systems.
School neuropsychologists are also important in curriculum development, classroom design, and the provision of optimal learning environments through differentiated instruction based on brain-behaviour principles.
The Roles and Functions of an SNP - developed from the writings of George Hynd
Provide neuropsychological assessment and interpretation services to schools
for children with known or suspected neurological conditions.
Assist in the interpretation of neuropsychological findings from outside
consultants or medical records.
Seek to integrate current brain research into educational practice.
Provide educational interventions that have a basis in the neuropsychological or
educational literature.
Act as a liaison between the school and the medical community for transitional
planning for TBI and other health impaired children and adolescents.
Consult with curriculum specialists in designing approaches to instruction that
more adequately reflects what is known about brain-behavior relationships.
Conduct in-service training for educators and parents about the
neuropsychological factors that relate to common childhood disorders.
Engage in evidenced-based research to test for the efficacy of
neuropsychologically-based interventions
Summarizing Chapter 1
The understanding and respect for the biological bases of behavior has been a
part of the field of psychology since its inception.
The increased interest in applying neuropsychological principles into school psychology and educational settings has been a result of:
- The growth in pediatric/child neuropsychological research,
- Advances in neuropsychological theories applied to assessment,
- Advances in functional and structural brain imaging techniques,
- Limitations of clinical applications in school settings,
- Increased use of medications by children and youth and their potential
side effects on cognitive processing,
- Advances in understanding of the neurocognitive effects of TBI, common neurodevelopmental disorders, and chronic illness.
There will be continued interest in school neuropsychology as school psychologists constantly work with neurodevelopmental
disorders. School psychologists and educators need to know the documented neuropsychological correlates to common neurodevelopmental disorders in order to
prescribe and monitor the most effective interventions.
School psychologists have more
assessment tools today that are psychometrically sound and theoretically based
than ever before. The challenge for all of education, school psychology as a discipline, and school neuropsychology as an emerging specialization, is to increase
research that validates the linkage with assessment data to prescriptive interventions that have been shown to be the most effective.
School neuropsychology has its roots firmly planted in the historical foundations of clinical neuropsychology and school psychology.
