SCHOOL NEUROPSYCHOLOGY: MIND, BRAIN & EDUCATION
TABLE OF CONTENTS
WEEK 1 ESSENTIALS OF NEUROPSYCHOLOGICAL ASSESSMENT.........................................................2
CHAPTER 1 THE SPECIALIZATION OF SCHOOL NEUROPSYCHOLOGY..................................................2
CHAPTER 4 WHEN TO INCORPORATE NEUROPSYCHOLOGICAL PRINCIPLES INTO A COMPREHENSIVE
INDIVIDUAL ASSESSMENT...................................................................................................................8
CHAPTER 5 SCHOOL NEUROPSYCHOLOGY ASSESSMENT MODELS...................................................17
CHAPTER 7 MAJOR SCHOOL NEUROPSYCHOLOGICAL TEST BATTERIES FOR CHILDREN...................24
WEEK 2 MIND, BRAIN & EDUCATION/EXERCISE AS SCHOOL INTERVENTION...................................30
CHAPTER 13 EXECUTIVE FUNCTIONS................................................................................................30
CHAPTER 14 ATTENTION AND WORKING MEMORY FACILITATORS/INHIBITORS..............................38
WEEK 3 DEVELOPMENTAL COORDINATION DISORDER (DCD)..........................................................44
CHAPTER 10 SENSORIMOTOR FUNCTIONS.......................................................................................44
CHAPTER 11 VISUOSPATIAL AND AUDITORY COGNITIVE PROCESSES...............................................50
CHAPTER 12 LEARNING AND MEMORY COGNITIVE PROCESSES.......................................................54
WEEK 4 DYSLEXIA............................................................................................................................61
CHAPTER 15 SPEED, FLUENCY, AND EFFICIENCY OF PROCESSING FACILITATORS/INHIBITORS.........61
CHAPTER 16 ACQUIRED KNOWLEDGE: ACCULTURATION KNOWLEDGE AND LANGUAGE ABILITIES 65
CHAPTER 17 ACQUIRED KNOWLEDGE: ACADEMIC ACHIEVEMENT..................................................68
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,WEEK 1 ESSENTIALS OF NEUROPSYCHOLOGICAL
ASSESSMENT
CHAPTER 1 THE SPECIALIZATION OF SCHOOL
NEUROPSYCHOLOGY
Miller introduced the Integrated School Neuropsychology (SNP)/CHC model, which integrated school
neuropsychological assessment measures with Cattell-Horn-Carroll (CHC) theory.
Schneider and McGrew (2018) cite several factor-analytic studies which included both traditional
CHC tests and neuropsychological measures. These studies have provided evidence of CHC construct
validity for many of the neuropsychological measures currently in use.
The specialization of school neuropsychology has continued to rapidly evolve since this book was first
published in 2007 and later revised in 2013. Several new major tests have been published since the
second edition of this book.
As a result of this continued integration of traditional CHC measures of cognitive abilities and
academic achievement with neuropsychological measures, graduate training programs are struggling
to find time in packed curricula to train future school psychologists and clinical psychologists in these
broader-based assessment skills. Practitioners need to keep updating their skills, to match the new
developed test.
The number of children with neurodevelopmental risk factors has increased since 2007 and the need
for more comprehensive neuropsychological assessments to guide evidence-based interventions has
become more important than ever.
REASONS WHY THERE IS A GROWING INTEREST IN SCHOOL NEUROPSYCHOLOGY
Recognition of the Neurobiological Bases of Childhood Learning and Behavioral disorders
DON’T FORGET: Many parents and educators are looking to school psychologists for answers as to
why a student is not achieving at grade level or behaving in socially inappropriate manner rather
than merely receiving a special education diagnosis.
Some major theorists in our shared past, such as B. F. Skinner and John B. Watson, were strict
behaviorists. They believed that observable behavior was the only essential element that needed to
be considered in human behavior. The curriculum-based measurement/assessment approach touted
by many practitioners today has its theoretical roots in behaviorism.
In the late 1950s, researchers came to realize that the behaviorist approaches could not “explain
complex mental functions such as language and other perceptual functions”, and this holds true
today. At the opposite end of the theoretical spectrum were the cognitive psychologists such as
George Miller, Noam Chomsky, and Michael Posner, who believed that brain function needed to be
considered in understanding human behaviors. Starting in the 1970s through today, cognitive
psychologists have been aided tremendously by the development of neuroimaging techniques.
It is important to acknowledge that the integration of neuropsychological principles into educational
practice got off to a rough start. Doman and Delcato’s perceptual-motor training for children with
“minimal brain dysfunction” or tests such as the Illinois Test of Psycholinguistic Abilities, these
approaches may have a good face validity, but they did not accurately show treatment efficacy for
either perceptual-motor deficits or language deficits. These early missteps in integrating
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,neuropsychological principles into educational practice only reinforced the rising role of behaviorism
in school psychology.
he past 30 years have yielded substantial evidence for the biological bases of behavior. There is
strong neurobiological evidence for attention deficit/hyperactivity disorders (ADHDs), reading
disorders, written language disorders, genetic and neurodevelopmental disorders, and autism
spectrum disorders.
Increased Number of Children with Medical Conditions that Affect School Performance
An increasing number of children in the schools are affected with known or suspected neurological
conditions. Unfortunately, many of these children rarely have their educational needs addressed.
Accurate developmental histories may not be available to reflect early developmental concerns,
medical conditions, or genetic predispositions.
When a school neuropsychologist reviews the cumulative record of a child referred for special
education services, it is not uncommon to find a positive history of birth trauma or neonatal risk
factors. While there has been no noticeable decrease in the number of low birth weight (LBW)
infants born each year, advancement in quality neonatal intensive care has resulted in an increased
survival rate.
Past reviews of the literature reveal that LBW infants are at risk for neurosensory,
cognitive/neuropsychological, behavioral, and school/academic difficulties. Babies born prematurely
exhibit neurodevelopment impairment, the severity of which can vary significantly. The percentage
of infants who have survived without neurodevelopmental impairment increased 16% between 2000
and 2011.
The advances in medical treatment and care have led to better neurodevelopmental outcomes for
infants born prematurely and with LBW. Younge et al. suggested that early neurodevelopmental
assessment is important for the timely identification of children at risk for long-term neurologic
impairment or developmental delay; however, early neurodevelopmental assessment does not
always reliably predict later functioning in childhood. Many children will catch up to their peers by
school age, whereas other children will have persistent neurodevelopmental impairments.
Conversely, some children without signs of neurodevelopmental impairment in early childhood will
have impairments that manifest at school age. Prematurity and LWB 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.
Modern medical advances have also had an
impact on the lives of children with other
medical conditions such as cancer, AIDS,
demyelinating diseases, traumatic brain
injury (TBI), and more rare medical diseases
and conditions. The percentage of children
with chronic health conditions is on the rise.
These health problems and their treatments
can cause secondary academic and
behavioral problems that could also lead to
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,classification under other IDEA categories (e.g., specific learning disabilities, serious emotional
disturbance, etc.).
Care for children with TBI in health care and educational systems is still not well coordinated or
integrated, resulting in increased risk for poor outcomes. Potential solutions include identifying at-
risk children following TBI, evaluating their need for rehabilitation and transitional services, and
improving utilization of educational services that support children across the lifespan.
Despite the fact that TBI and other health impairments (OHI) have been disability classifications for
decades, school personnel are often not prepared to educate children with, or recovering from,
severe and chronic illnesses, including TBI. Children and adolescents with TBI require specialized
treatment and monitoring, different from other special education classifications. Due to uneven
spontaneous recovery of brain function and continued developmental changes, the clinical
manifestation of TBI is constantly changing and requires frequent monitoring. School
neuropsychologists can play a major role in being the liaisons between the school and the medical
community, developing transitional/re-entry plans for school-aged children returning to school after
injury or insult, assisting with IEP (Individual Education Plan/Program) development and monitoring,
and general case management.
Increased Use of Medications with School-Aged Children
The use of prescription medication for emotional and behavioral regulation in children has increased
dramatically in the last 20 years. Research on the use of medication with children has not kept pace,
and many kinds of medications are used off label with children. “Off label” means the medication has
not been approved for use (by the Food and Drug Administration) for that particular age or group or
for that particular disorder.
Polypharmacy is the simultaneous use of more than one psychiatric medication for ongoing
treatment, which is both a common and an increasingly used treatment strategy for youth.
Polypharmacy in the treatment of childhood mental disorders may be appropriate for four reasons:
(a) the child may have 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,
and (d) in complex cases decisions to prescribe medications are complicated by diagnostic
uncertainty.
Although school neuropsychologists are not physicians, they can, and should, provide information to
parents and educational professionals about how psychotropic medication used to treat common
problems such as depression, anxiety, and attentional processing disorders can affect learning and
behavior. School psychologists/neuropsychologists also need to be cognizant of the impact these
medications can have in the assessment process, as well as their contributions to behaviors that may
be symptomatic of, or mistaken for, various diagnostic disorders.
Increase in the Number of Challenging Educational and Behavioral Issues in the Schools
School psychologists note that there appear to be more children today, than 10–20 years ago, who
are exhibiting severe behavioral, social-emotional, and academic problems.
Many of the serious emotional disturbances experienced by children, such as depression, anxiety-
related disorders, and ADHD, all have known or suspected neurological etiology. Nevertheless, many
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,children with known or suspected neurological impairments who exhibit symptoms of mental health
problems are not identified or are identified but not receiving services.
Another major concern in educational practice is inaccurate diagnoses and placements of children
and adolescents with known or suspected neurological impairments.
Too often, educators treat only the symptoms and not the underlying problems.
Increased Emphasis on the Identification of Processing Disorders in Children Diagnosed with SLD
In the most recent version of the Individuals with Disabilities Act of 2004 (United States Department
of Education, 2004), the definition of a specific learning disability includes language which states:
“a disorder in one or more of the basic psychological processes involved in the understanding or in
using language, spoken or written, that may manifest itself in an imperfect ability to listen, think,
speak, read, write, spell, or do mathematical calculations, including conditions such as perceptual
disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia” but does
not include “learning problems that are primarily the result of visual, hearing, or motor disabilities, or
intellectual disability, or emotional disturbance, or of environmental, cultural, or economic
disadvantage”.
By requiring an assessment specialist to rule out exclusions such as intellectual disability or
perceptual limitations as the causal factors for SLD, the SLD definition encourages the assessment
specialist to determine the reasons why there is a learning delay.
One of the approved approaches for SLD identification is the assessment of patterns of strengths and
weaknesses (PSW) to determine the underlying causes for an SLD. School psychologists trained in
how to integrate neuropsychological principles into their professional practice are uniquely qualified
to assess PSW in children with SLD.
THE NEED FOR NEUROPSYCHOLOGICAL ASSESSMENT IN THE SCHOOLS
Access to Neuropsychological Services in Schools
Access to neuropsychological services both inside and outside of the schools is often limited. Ideally,
each school district should have access to a pediatric neuropsychologist who would write reports
that were both informative and educationally relevant and who would consult regularly with
educators and parents.
Limited Usefulness of Some Neuropsychological Reports
DON’T FORGET: The delivery of neuropsychological services in the schools is more than completing
comprehensive assessments. Overseeing the planning and implementation of the evidenced-based
interventions is crucial.
“pin the tail on a lesion” type of report: neuropsychological reports from outside consultants are
often filled with diagnostic conclusions and much test data, but lack prescriptive recommendations
that would be useful interventions in educational settings.
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,School neuropsychologists have the advantage of working with children with whom they have a long
educational history and multiple opportunities for assessment and intervention progress monitoring.
Comparatively, pediatric neuropsychologists typically only see children outside of the school setting
for a brief period of time (e.g., during a hospital stay) and are not able to observe the child in the
natural school setting, or to follow-up on the effectiveness of their recommended interventions.
Also, clinical neuropsychologists may not understand that a clinical report with a Diagnostic Statistical
Manual (DSM)-5 or ICD-10 (International Statistical Classification of Diseases and Related Health
Problems—10th Revision) diagnosis does not always equate to a child’s need for special education
services.
The advantage of having a school psychologist trained in integrating neuropsychological principles
into practice is that the end product of all services delivered by the school psychologist will be
generally more pragmatic for the school and the child. However, as Miller (2013) noted, although a
school neuropsychologist writes an insightful report and makes practical, evidence-based
recommendations, there is no guarantee that the recommendations will be implemented.
The Unique Contribution of School Neuropsychological Assessments
What make school neuropsychological assessments unique is the inclusion of more in-depth
assessment of individual neurocognitive constructs such as sensory-motor functions, attentional
processing, learning and memory, executive functions, and so on.
School neuropsychological assessments are useful for:
1. Identifying processing deficits in a child that could adversely affect educational attainment
and the development of remediation and/or compensatory strategies to maximize the child’s
learning potential.
2. Describing a profile of a child’s neurocognitive strengths and weaknesses and relating that
information to the child’s learning and behavior in the school and home environments.
3. Documenting whether changes in learning or behavior are associated with neurological
disease, psychological conditions, neurodevelopmental disorders, or non-neurological
conditions.
4. Monitoring educational progress over time in children, particularly in children with severe
neuropsychological insults such as TBI.
5. Providing comprehensive assessment data that will increase the likelihood of success with
evidence-based interventions.
Summary of the Need for School Neuropsychological Assessments in the Schools
Clinical neuropsychologists are not in a position to be held accountable for evidence of the success or
failure of interventions. School psychologists, on the other hand, are directly responsible for
outcomes and therefore are close at hand on a daily basis to see the interventions through to
fruition.
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,DEFINITION OF SCHOOL NEUROPSYCHOLOGY
Miller, in collaboration with two colleagues, wrote the following definition of school
neuropsychology:
“School neuropsychology requires the integration of neuropsychological and educational principles to
the assessment and intervention processes with infants, children, and adolescents to facilitate
learning and behavior within the school and family systems. School neuropsychologists also play an
important role in curriculum development, classroom design, and the integration of differentiated
instruction that is based on brain-behavior principles in order to provide an optimal learning
environment for every child.”
“School neuropsychology requires the integration of neuropsychological and educational principles”
The blend between educational and neuropsychological foundations is an essential knowledge base
for school neuropsychologists.
“to the assessment and intervention processes with infants, children, and adolescents” School
neuropsychology is not limited to assessment and diagnosis.
“to facilitate learning and behavior within the school and family systems.” School neuropsychologists
are trained to work with children and adolescents within the context of their school and home
environments. Family involvement is crucial in effecting positive behavioral and academic change in a
child.
“School neuropsychologists also play an important role in curriculum development, classroom design,
and the integration of differentiated instruction that is based on brain-behavior principles in order to
provide an optimal learning environment for every child.” School psychologists and school
neuropsychologists are trained as consultants to the learning environment, linking instructional
design, curriculum development, and differential assessment to research-based interventions. School
neuropsychologists are uniquely trained to apply brain-based research principles to enhance the
educational environment
ROLES AND FUNCTIONS OF A SCHOOL NEUROPSYCHOLOGIST
CHAPTER SUMMARY
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,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
the practice of school psychology and educational settings has been a direct result of many factors
including
- 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, and
- 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 work with
children who have known or suspected neurodevelopmental disorders daily. With the increased
emphasis on implementing and monitoring the effectiveness of evidence-based interventions, school
psychologists are under pressure to provide the best assessment-intervention linkage as quickly as
possible. 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. The past two decades, in particular, have been an exciting time for school
psychologists interested in learning more about neuropsychology and how to apply that knowledge
base to helping children, educators, and their families. 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.
CHAPTER 4 WHEN TO INCORPORATE
NEUROPSYCHOLOGICAL PRINCIPLES INTO A
COMPREHENSIVE INDIVIDUAL ASSESSMENT
COMMON REFERRAL REASONS FOR A SCHOOL NEUROPSYCHOLOGICAL EVALUATION
High Incidence Neurodevelopmental Disorders
When a child is experiencing learning or behavioral difficulties, it is uncommon to start with a
neuropsychological evaluation. Typically, behaviorally defined neurodevelopmental disorders such as
intellectual disabilities, attention deficit/ hyperactivity disorder (ADHD), and autism spectrum
disorders (ASD) are evaluated using psychoeducational assessments.
Intellectual Disabilities
Intellectual disability is defined as a permanent condition originating sometime between birth and
age 18. The child’s general intellectual functioning is significantly below average (roughly an IQ of 70
or below) and the child has concurrent deficits in adaptive behavior. The need for a
neuropsychological assessment is rare when evaluating a child with an intellectual disability. The
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,exceptions would be an intellectually disabled child with an unusual scatter of performance with
splinter skills well above the significantly below average range.
Attention Deficit/Hyperactivity Disorder
The neuropsychological deficits associated with ADHD are inattention, poor response inhibition
and/or impulse control, and executive dysfunctions.
Autism Spectrum Disorders
The major diagnostic criteria for ASD includes:
- persistent deficits in social communication and social interactions;
- restricted, repetitive patterns of behavior, interests, or activities;
- symptoms must be present in the early developmental period; and
- symptoms cause clinically significant impairment in social, occupational, or other important
areas of current functioning;
- these disturbances are not better explained by intellectual disability (intellectual
developmental disorder) or global developmental delay.
The diagnosis of autism in the schools typically involves a multidisciplinary team and a school
neuropsychologist may or may not be a member. The known neuropsychological processes often
impaired in children with ASD include: executive functions, attention, working memory, sensory-
motor, and language.
A school neuropsychological assessment should be
requested when one of the referral questions
listed in Rapid Reference 4.1 is under
consideration.
Children with a Known or Suspected Neurological
Disorders
A thorough record review and gathering a
developmental history from the caregiver are
important steps in uncovering any past
neurological traumas. However, uncovering
evidence of neurological trauma or risk-factors
may be difficult in families that are reluctant to
share information about past childhood abuse or
neglect, or from families where the child is
adopted or being raised by a relative.
If a child has a positive history for neurological trauma or insult, or the school neuropsychologist,
parents, or educators suspect a positive, but undocumented, history of neuropsychological trauma or
insult, the child is probably a viable candidate for a school neuropsychological evaluation. The only
caveat to consider before referring a child for a school neuropsychological evaluation is that the child
must be experiencing some form of academic or behavioral difficulties. Monitoring children and
youth who have a positive history of neurological insults (e.g., TBI) is important because these
children may be showing adequate annual yearly progress (AYP) currently, but they are at risk for
future learning and behavioral problems.
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, Children with Pas or Recent Head Injuries who are Having Academic or Behavioral Difficulties
According to the National Institute of Neurological Disorders and Stroke website, “Traumatic brain
injury (TBI), also called acquired brain injury or simply head injury, occurs when a sudden trauma
causes damage to the brain”. A closed head injury happens when the skull is not penetrated but the
force of the blow causes damage. An open head injury happens when an object pierces the skull and
enters brain tissue. TBI is classified as mild, moderate,
or severe, dependng upon the extent of the brain
damage.
Like many of the disorders or traumas to the brain,
developmental factors play a major role in the loss of
function, course of recovery, and manifestation of the
TBI symptoms acutely and later on in the life of a child.
When TBI children are experiencing academic and
behavioral difficulties, they are often misclassified or misdiagnosed as having a different disability
other than TBI such as specific learning disability, intellectual disability, or severe emotional
disturbance. The first few years after a TBI hold the most potential for functional change and
remediation. A child with a history of a TBI should be monitored for behavioral or academic
difficulties, and more frequently be re-evaluated.
Children with a History of Acquired or Congenital Brain Damage
Anoxia/Hypoxia Anoxia is an absence of oxygen supply to organ tissues, including the brain. Hypoxia
is a decreased supply of oxygen to organ tissues. Anoxia and hypoxia can be caused by a variety of
factors. Anoxia/hypoxia can cause loss of consciousness, coma, seizures, or even death. If the child
does recover from anoxia/hypoxia, a variety of psychological and neurological symptoms may
appear, last for a while, and may then disappear.
Cerebral Vascular Accidents (CVAs) CVAs are one of the 10 major causes of death in children. There
are three major arteries in the cerebral cortex: the anterior cerebral artery (ACA), the middle
cerebral artery (MCA), and the posterior cerebral artery (PCA).
Ischemia and hemorrhage are two forms of stroke. Ischemia occurs when there is a blockage of the
flow of blood. A hemorrhage occurs when a blood vessel breaks or ruptures. Ischemia is the most
common type of stroke in children, with cardiac disorders or heart disease being the most common
cause.
Meningitis is the inflammation of the lining around the brain and spinal cord that is relatively
common in children and can be life-threatening. Early symptoms of meningitis include: severe
headache, stiff neck, dislike of bright lights, fever/vomiting, drowsiness and less responsive/vacant,
rash anywhere on the body, and possible seizures. Survivors of bacterial meningitis were five times
more likely to have intellectual impairment (IQ<70) than controls.
Encephalitis refers to an inflammation of the brain usually caused by viruses that occur perinatally or
postnatally. Acute symptoms include fever, altered consciousness, seizures, disorientation, and
memory loss.
Seizure Disorders Epilepsy is one of the most prevalent neurological diseases worldwide. Seizure
disorders are typically caused by complex brain disease. There are approximately 30 different seizure
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