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Samenvatting Clinical Assessment and Treatment
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Samenvatting CA&TClinical child neuroscience
The study that focuses on the fundamental mechanisms that underlie disorders and diseases of the
brain and the central nervous system (CNS) to understand behaviour and behaviour problems (study
of brain-behaviour pathways). To develop new ways of conceptualizing and diagnosing and develop
novel treatments for the disorders and diseases. The brain and CNS have a direct impact on the
behavioural, cognitive and psychosocial adjustment of individuals.
Neurocognitive functions
Cognitive functions are closely linked to the function of brain areas, neural pathways or cortical
networks in the brain. All cognition is the result of neurological activity. There is a developmental
pathway in the cognitive functions.
Neuropsychological assessment and treatment
Trying to find answers in fundamental brain mechanisms that
underlie the behaviour. One way to look at behaviour is the
brain-behaviour pathway model. Genes and brain
(dys)functions drive neurocognitive (dys)functions and they
drive behaviour or behaviour problems. The interplay with the
environment is really important.
There are three very important things to keep in mind when
doing np assessment with children:
- Development
Children are developing. The brain is also in development. The development is not only drive
by genes, it is developing in interaction with the environment. So the way that a child
develops their brain and neurocognitive functions is in interplay with the environment. With
assessment you also deal with the brain in development and not only with the brain at hand.
This gives certain difficulties, but also opportunities in np assessment.
- Adulthood
Some children already have neurocognitive dysfunctions and they continue to develop. They
have either way to deal with the impaired neurocognitive functions. Some children have a
genetic disorder, which predisposes them to certain np difficulties.
- Definition of normal
Need to know what is defined as normal. We do not know a large part of things about np
functions. You need to set a threshold to the child’s capabilities themselves.
Np assessment is relevant when:
- The question at hand should be answerable and useful.
- The motivation for the question is clear.
For example when there are concerns or complaints of the child or the environment.
- The objective of the question should be clear.
A certain set goals based on the np strength and weakness profile of the child.
- The timing is appropriate
For example stable and assessable. The child should be able to be tested and the situation
should be positive and not stressful.
,
,Indications (reasons) for np assessment in children:
- Developmental disorders
Anything that deals with problems with the development. For example motor difficulties,
disturbance during pregnancy, somatic problems, diseases that affect the CNS, eating
disorders or ADHD.
- Brain damage
For example tumor, epilepsy, traumatic brain injury or lack of conscious.
- Evaluation of treatment
For example after cognitive behaviour therapy or beside chemotherapy.
- Evaluation of development
A way to track the development and be able to take prevented action.
For example children with gene disorders, who will growing into deficits, what will result in a
different development.
- Supporting choice for education, parenting or profession
For example the choice for regular or special education or fitting parenting style to the np
profile of the child
The way structures in the developing brain are related to changes in psychological and cognitive
development is of interest to clinical child neuropsychologists. The diagnostic assessment-treatment
cycle is one way to find out what is going on, how you can help and threat the child or the family.
Assessment is a small part from the assessment-treatment cycle. There are a lot of steps that need to
be taken with regards to np assessment and treatment. Other steps also help to form the
explanatory theory:
- Problem inventory
Listening to all the difficulties/issues that the child, parents, school or other important
caregivers may experience. Ask yourself if you expect these difficulties in normal
development. You have to care at much info as possible and then you will decide if it is a
problem based on your knowledge about typical and np development.
- Developmental history
Check all the things step by step that happened from pregnancy till now. Early development
of the brain has impact on the development throughout life. See how and where things
might have been a marker, whether development problems arose early or whether
something has triggered them.
- Hypotheses on dysfunctions and disorders
Based in the info from the previous to steps, you form hypotheses about which dysfunctions
or disorders may think are going to happen or are present. Hypotheses about how you can
understand the behaviour. You decide which of those functions you go to asses.
- Assessment
Testing to find out what are the strengths and weaknesses in np functioning. Np assessment
is not only the tasks, but also the questionnaires and observations. Both in the situation
itself, but also in school and parenting situations. Questionnaires can with regards to
complaint, np functions or about the self (such as emotional well-being, personality, self-
image). Intelligence, perception, processing speed, language/speech, motor skills, time and
place orientation, attention, memory, EF, social cognition and emotion regulation are all the
np functions that one may or may not assess. Intelligence tests are often include more than
one np function, for example WM and info processing speed.
, - Profile with strengths and weaknesses
Based on the info from the previous steps and the test performance, you form a profile with
the np functions that are developed appropriately and the np functions that are developed
poorly.
- Explanatory theory
Based on the profile, you set up an explanatory theory about the coherence of the strengths
and weaknesses, the developmental problems that are experienced in everyday life, and the
influence of the environmental factors. A theory about what the neuropsychologist
understand about the behaviour. It is a descriptive diagnosis and not a classifying diagnoses.
For example saying that a child has a developmental disorder is a classifying diagnoses and
saying that a child has difficulty with social cognition and that leads to difficulties
understanding one another is an descriptive diagnosis. After the explanatory theory the
assessment cycle is finished.
- Prognosis
The start of the treatment cycle. Make an judgement about what is natural development.
You look at the severity and degree of the dysfunction and if you need to do something. You
estimate the etiology of the disorder. Sometimes you know with a certain amount of
certainty that the etiology of the dysfunction is based on something, but sometime you don’t
know. For example when there are info processing speed difficulties and you know that there
is a genetic disorder that is linked to these impairments or it is a good possibility that the
difficulties are linked to a traumatic brain injury, but it might also be that it is not. It can also
be based on/linked to a certain amount of events. You say what the opportunities are for
recovery or is it a dysfunction for life. Should you bother to try and threat the dysfunctions or
should you try to limit the impact on the behaviour. You will see whether you be able to
stimulate or train the weaker functions, can compensate the weaker functions (strategy
training) or influence the development of the child in a positive way by making adaptions to
the environment. Prognosis can also lead to go back to the problem inventory, when things
are not fully explained yet.
- Treatment plan
A plan about what you will do with the child and the environment.
- Treatment
Treatment is usually individual and most often in a multidisciplinary treatment-setting. You
incorporate the child and the whole environment in the treatment.
- Evaluation
Beforehand, you need to set goals of treatment. Through the goals you know when you will
evaluate the treatment, evaluate it in a properly way and know what you will do when the
goals are not met. Evaluation of treatment by means of tracking symptoms or complaints
with np assessment. It is very important to incorporate info from all part of the system.
The question is: Has the child enough tools to deal with the np dysfunctions and can he/she
continue on with their life? When this is not the case, you can go back to the problem
inventory, prognosis or explanatory theory.
Np interventions from brain level to environment:
- Medication
There are certain types of medication that can be prescribed to enhance certain
neurocognitive functions, such as methylphenidate in ADHD to enhance neurological
communication that enhance info processing in the brain.
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