Week 3 Flashcards
What is paediatric neuropsychology
From birth to 18 years (or more definitively when a child leaves school)
They need to know about brain development because they’re looking at the impairment in the brain, and the timing it is acquired.
Brain development
Abnormalities that happen prenatally will impact on brain structure.
Neuronal proliferation - defect
Generation of lots of different neurons (peaking from 5-17 weeks)
Defect:
microcephaly (too few neurons - down syndrome)
macrocephaly (too many neurons - autism)
Migration
8-15 weeks
Once the cells develop, they move to specific structures in the brain in sheets (laminae) with similar cells.
By 5 months gestation, most cell layers are visible.
Defect:
- lissencephaly (smooth brain)
- corticol dysphasia (sheets of cells move to the wrong place - grey and white matter could be mixed up)
- polymicrogyra (thin and highly folded cortex, too many folds)
Myelination
axons are surrounded by myelin sheath which helps in conduction and velocity (important in processing speed) - starting 28 weeks and continuing postnatally.
Defect - prenatal disruption could be through the mother having traumatic brain innjuries
Prenatal development
Most of the development is structure based
Postnatal development
The most rapid development is connectivity (formulation of dendrites) and natural cell death (dying of those branches if they are not adaptive, so that the brain can become more efficient)
Synaptic density:
peaks at 6 years old, and then pruning occurs to make the brain more efficient
autism often involves not enough pruning of the brain
Survival centre of the brain:
Fight, flight, freeze
Fully functioning at birth and handles all basic instincts and functions - regulates autonomic functions (breathing, digestion, heart rate, sleep, hunger, instinctual behaviours and behaviours that sustain life)
Emotional centre of the brain
Develops between 0-5 years (limbic system)
- processes emotions
- memory
-response to stress
- nurturing
- separation anxiety
- fear, rage
- social bonding
- hormone control
Executive centre
The prefrontal cortex
- Developmental shifts around ages 5-6, 11 and 15
Handles logic, empathy, compassion, creativity, self-regulation, self-awareness, predicting, planning, problem solving, attention
What’s the paediatric neuropsychologist’s role?
- Assessment of cognitive, adaptive, behavioural, emotional, academic and social abilities in young people
- interpretation of test results within the context of background history and child’s condition
- feedback of results, functional implications and recommendations
- contributing to diagnosis and management (referrals, monitoring, educational placement)
- develop implement and evaluate intervention
Difference between developmental disorders and acquired disorders
Developmental: an injury/impairment sustained in the uterus (e.g. epilepsy, ASD, down syndrome, exposure to toxins)
Acquired: an injury/impairment sustained after birth (stroke, brain tumours, traumatic brain injuries)
What are the similarities between adult and child neuropsychology?
- Localisation of function
- Similar causes of brain impairment
- Similar range of functional impairments
- Dose-response relationships (the more extensive the brain damage, the more difficulties the child will have) remains
- Early intervention and rehabilitation
How does paediatric neuropsychology differ from adult neuropscyhology?
Dynamic vs relatively static
- kids are rapidly developing (dynamic)
- different parts of the brain interact, different parts of development interact, as such you can get much more generalized impairment in children
Immature vs mature cognitive functions
Brain damage in children may disrupt normal ongoing development
Dealing with dependents (therefore the entire family unit and teachers, etc)
In children, impairment may be less immediate, or it may change or emerge over time (i.e. the gap may widen). The impact of brain impairment is typically more generalized.
Process of information gathering:
Interviews (age appropriate interviews w children, their teachers, health professionals)
Direct observation
Information from multiple sources
Standardized assessment (tailored to be attractive to children)
What do paediatric neuropsychologists assess?
Comprehensive assessments tailored to the referral question - but will cover a broad range of functions. Also look at behaviour and emotional mental health (high comorbidity).
Intellectual function
Adaptive skills
attention
info processing
memory
language
visuospatial
exec function
academic function
social skills
behaviour
mental/emotional
Neuro CBT model
Work out how those brain impairments are impacting upon the child’s thinking (attention, concentration, memory) behaviour (impulsivity, withdrawn, dysregulation) and emotions (anxious, depressed).
Indirect effects on thinking, behaviour, emotion
- such as biological contributions (ADHD is highly heritable) or social / environmental issues (teachers, education, abusive parents)
What is intellectual functioning?
Intellectual functioning is a person’s general learning ability ‘g’
Several domains: verbal abilities, nonverbal abilities, working memory, processing speed
Important to consider context (culture, ESL status, life experience) when assessing.
A score of 69 or lower (threshold for mild intelelctual impairment) you would be diagnosed with intellectual disability - but the 70s are borderline!
Only 2% of the population have intellectual impairment!
What are the causes of intellectual impairment
Acquired: birth difficulties, TBI, tumour and treatment, virus/infection of brain, metabolic disorders.
Developmental: genetic abnormalities, unknown aetiology, extreme use of drugs/alcohol during pregnancy
What factors do we have to exclude if a kid is performing poorly:
- environmental depravation
- low ses
- culture
- english as a second language
- motivation / mood
What are the criteria for an intellectual disability?
- deficits in intellectual function (reasoning, problem solving, planning, judgement, academics)
- deficits in adaptive functioning (activities in daily life) across multiple environments
Define adaptive functions
How effectively an individual copes with common life demands - how well they meet the standard of personal independence and social responsibility in comparison to others of similar age and sociocultural background.
3 domains: conceptual skills (language, writing, maths, skill memory), social/leisure skills (social judgement, empathy, interpersonal), practical skills (personal care, money management, job responsibility)
What is ‘mild intellectual impairment’
Those in the bottom 2% of intellectual ability
Below 70
- Will impact upon their lives
- mental age of 10
- need extra assistance and support
- will be able to learn basic academics
- may be able to work if they have a supported environment
What is a moderate intellectual disability?
- schooling - IQ support classes available from kindergarten
- may require supported accommodation
- may development independence in personal care, with training
- will needs life long support in planning
Standardized Test Intellect
Weschler Preschool and Primary Scale of Intelligence
Differential Ability Scales
WISC (Australian)
Standford Binet V
Standardized test of adaptive functions
Vineland Adaptive Behaviour Scales (questionnaire or survey)
Adaptive behaviour assessment system
What is specific learning disorder
An academic issue - problem with literacy or numeracy - could be very select, or a global disorder.
Can’t diagnoes unless this person has had targeted intervention after 6 months.
Difficulty decoding words, reading comprehension problems, written expression, math calculation
They need to cause significant interference with academic or occupational performance or with daily living activities.
Difficulties being during school age, and not better accounted for by intellectual disabilities, etc
What are learning difficulties?
Reading: rate, accuracy (regular/irregular), comprehension
Spelling (regular, irregular)
Maths (syntax - concepts /reasoning, spatial - computational)
May have widespread learning difficulties or specific learning difficulties
What is the most helpful thing to do?
For kids with specific learning disorders - give the targeted or evidence based interventions.
Standardized tests of academic functions
Weschler Individual Achievement Test (WIAT)
- diagnostic screener (i.e. rules out there’s not something else going on)
- Castles & Coltheart
What is the relationship between IQ and academic functioning?
- can be a disassociation between IQ and academic functioning
- correlation between the 2 is only 30-40 %
What are the components of attention?
Sustained attention = concentrating for a longer period of time -> considerable development in this up until age 11
Divided attention -> being able to multitask
Shifting attention -> being able to shift you rattention from one thing to another
Inhibition
All of these develop at different rates and can be differentially affected (ADHD has deficits in sustained attention and selective attention, sometimes better divided attention)
What are the assessments of attention?
Test of Everyday Attention for Children
NEPSY
Continuous performance test
What are the conditions associated with attention difficulties
ADHD
Autism
Conduct disorder
Prematurity
Hyproxia
- Anxiety disorders
Executive functioning
higher level thinking (planning, mental flexibility, concept formation, self-monitoring of performance)
executive behaviours = social learning, self-control, flexibility, initiation, empathy, impulse control
executive skills are required in novel and complex situations where routine responses do not exist
driven by frontal lobes and their and their networks (making up 1/3 of the cerebral hemispheres in humans)
Childhood conditions associated with executive dysfunciton
- ADHD
- ASD
- metabolic disorders
- prematurity
- epilepsy
- TBI
- brain tumours
- spina bifida and hydrocephalus
- infection
What about TBI?
- 90% of acquired brain injuries are the result of a traumatic injury
- approximately 180/100 000 children sustain brain injuries each year
- frontal lobes are particularly vulnerableG
Go back to case studies!
