Lectures developmental neuropsychology
Lecture 1: Course introduction and principles of child
neuropsychological assessment
Child neuropsychology= paediatric neuropsychology
- Study of brain-behavior relationships in the context of an immature but rapidly developing
brain
- Developmental neuropsychology= lifespan perspective on child neuropsychology
Child brain: dynamic, maturing, undifferentiated networks
Adult brain; static, tightly organized networks
Child neuropsychological assessment: psychological assessment + interpretation in terms of brain
structure and function = child neuropsychological assessment.
- Essential ingredient; theoretical knowledge of typical and atypical brain structure and
associated cognitive skills
Categories of patients;
- Neonatal and acquired brain insults
- Congenital (=structurally inborn) disorders
- Neuropsychiatric disorders
- Medical disorders
- Genetic and metabolic disorders
Biopsychosocial model;
- Leading model in the field
- 3 dimensions of developing child
1. Bio/neuro= neurodevelopment of the brain
2. Psycho= cognitive and socio-emotional development
3. Social environmental influences= familial and extrafamilial
Cortex develops posterior to anterior
Cortex develops lateral to medial
Hierarchical brain development;
- Development follows a sequence
- Brain maturation is non-linear
- Characterized by growth-spurts
- In line with developmental stages (Piaget)
3 contemporary views on brain development;
- Brain maturation; genetically determined development of neuroanatomical regions
(prenatally – lecture 2)
- Interactive specialization; emergence of new skill reflects refinement of connectivity
between regions (postnatally – current lecture)
, - Skill learning; brain activation changes during skill acquisition, increasing focal brain
activation with age (postnatally – lecture 3)
Interactive specialization explained;
- Specific brain areas are involved in complex functions
- Brain areas that fire together, wire together
- Specialized networks are evolving
- Environmental stimulation is crucial for shaping
networks
- Many (overlapping) networks:
Social information processing (face network)
Language (left hemisphere specialization)
Reading
Executive functions
Consequences of injury compared to adults;
- Early disruption can have irreversible consequences
- More diffuse pathology affecting the whole brain
- Generalized disturbance in information processing,
executive function, social cognition
- Normal acute recovery, but worse long-term recovery
- Prognosis is more difficult to predict
Growing into deficits;
- Impairment becomes visible when damaged areas are
starting to mature
- Progressively emerging cognitive deficits after early brain injury (congenital/traumatic)
- Fail to acquire age-expected skills; slowing of cognitive development
- Not; deterioration or progressive neurologic condition
Summary bio/neuro;
- Hierarchical brain development
- Three views on brain development; early maturation, interactive specialization, skill learning
- Brain-wise, children are not little adults
Irreversible consequences
More diffuse and generalized disturbances
Growing into deficit
Cognitive development (Piagetian stages);
- Children need to pass through pre-set developmental stages
- Hierarchical – each stage must be passed
- Children will go through stages when they are ready
- You cannot force them through
Cognitive stages;
- Sensorimotor (0-2); object permanence
, - Preoperational (2-7); magical thinking, egocentrism, assimilation
- Concrete operations (7-11); logical thinking, accommodation, conservation task
- Formal operation (12); abstract reasoning
Summary psycho;
- Stage-like development
- In line with hierarchical brain development
- Psychological development is an iterative process
Neural maturation
Cognitive skills
Interaction with environment
Social dimension;
- Family unit: language, cognitive skills, social behavior, rules
- Extrafamilial contexts; academic skills (school), motoric skills
(sports, games), identity development (peers)
Healthy brain development requires adequate nurturing relationships
- Regulation of physiology; hunger, sickness, sleep, body temperature, physical contact
- Self-regulation/cognition; adequate exposure to language, interactive play, emotional
feedback
- Caregiving quality feeds emotional health and intelligence
Adequate nurturing can be deprived;
- Chronic illness and/or hospitalization
- Parental mental illness (depressed/distressed)
- Combination of factors
Low SES
Multiple family stresses
Low levels of maternal education
Previous psychological disturbances
Goals of (child) NP assessment;
1. Do cognitive assessment to determine integrity of the brain
2. Detect/diagnose symptoms, syndromes and disorders
3. Characterize strengths and weaknesses in cognition and function
4. Guide towards appropriate rehabilitation, intervention or support based on NP profile
5. Monitor outcomes and evaluate interventions/treatments
Depends on setting; acute medical setting versus secondary care (school, outpatient clinic,
rehabilitation unit)
Assessment includes;
- History taking; medical, developmental, psychosocial
- Behavioral approaches; observations (behavior, motivation, emotions), rating scales
(parent/teacher)
- Cognitive tests; intelligence (step 1), specific cognitive skills (step 2)
, 4 principles;
1. Longitudinal follow-up is crucial
2. IQ-testing is the foundation (but simplistic)
3. Age-appropriate testing (and norms)
4. Testing lower levels of function first
Normal developmental trajectory;
1. Early intercept= developmental starting point
2. Mature intercept= developmental end point
3. Developmental slope= speed of development
Early onset disorders; lower starting and end point
- Genetic syndromes (Down, Ullrich-Turner, Klinefelter
syndrome)
- Neural tube errors (spina bifida meningomyelocele)
- Hormone biosynthesis (congenital adrenal hyperplasia)
- Prenatal environment (fetal alcohol spectrum syndrome)
- Developmental and learning disorders (autism, ADHD,
dyslexia)
Later-onset injury; changed slope (dip and speed)
- TBI
- Epilepsy
- Brain tumor
- Stroke
Longitudinal perspective;
- Age at time of lesion
Greater impact with younger age
Sensitive periods (language development)
- Age at testing
Recovery versus development
- Time since insult
Greater functional impairment with time
IQ-testing;
- Starting point
- Global cognitive abilities (simplistic)
- Sensitive to early brain damage
- Framework for further hypothesis testing
Wechsler;
- Set of subtests that are combined into G-factor/total IQ
(TIQ)/full scale IQ (FSIQ)
- Mostly used model= Cattell-Horn-Carroll (CHC)-model
Measurement errors;
