Developmental neuropsychology E.V.L van den Hoek (u500677)
Summary of books and articles developmental neuropsychology
WEEK 1 – PREGNANCY AND BIRTH: PRETERM BIRTH AND CEREBRAL PALSY
Chapter 1
Child neuropsychology/paediatric neuropsychology: developmental, cognitive and social psychology and science
has been crucial for mapping changes in brain of a child
- Knowledge of typical development is important, because it provides a template for measuring deviations
Historical perspectives
Plasticity, vulnerability and critical periods
Kennard Principle: if you get brain damage, get it early. One of the first theoretical contributions to child
neuropsychology is a description of plasticity and recovery of function after brain damage -> the Kennard Principle is
one description
Theory of recovery of function: brain of a young child is less differentiated than that of adults -> brain is more
capable to transfer functions from damaged tissues to healthy tissue
Critical period: timeframe in which external influences have a significant effect. If a cerebral area is damaged within
a critical period of cognitive development -> this cognitive ability can be irreversible damaged. Early brain damage
can have different consequences in different periods of development
There can be functional plasticity early in life -> this timeframe can, however, be limited and is not necessarily related
to age in a linear manner
No theoretical framework succeeded in integrating biological, psychological and environment dimensions in a clinical
meaningful way. There are two models who had a big influence on this field: non-verbal learning disability &
multidimensional age at insult approach
Non-verbal learning disability (NVLD)
The NVLD model incorporates knowledge of the changing brain with the development of a specific cognitive profile.
The model also postulates that the timing of damage is particularly important. One of the biggest contributions:
linking cognitive characteristics to an underlying neurological explanation: white matter hypothesis. Normal
development of white matter is essential for healthy development -> NVLD occurs when white matter development is
disrupted during critical periods of childhood. It can be disrupted due to: traumatic brain injury, hydrocephalus,
premature and cranial irradiation
Developmental stage at insult and cognitive outcome
Dennis theory focuses on age/developmental stage at the time of brain injury and progression in cognitive skills after
the time of insult. Her heuristic describes the impact of brain damage on language development. In Dennis theory
skill development has been separated in different levels: emerging: this is where a skill is in the early phase of
acquisition > not yet functional. Developing: skill is partially acquired, but not fully functional and lastly established:
skills are fully functional/matured.
- In Dennis theory three factors influence abovementioned levels of skill development. Age at insult: this
determines the nature of cognitive dysfunction. Time since insult: refers to different patterns of performance
identified at different phases of recovery > progress in some skills, but failing at developing others. So, it can
appear that children have little trouble after the insult, but later in the development they ‘grow into’ the
impairments and they bump into problems And lastly, age at testing: this is important, because even healthy
children vary in their ability to perform cognitive tasks at different developmental stages
- The full impact of brain damage will only be known after the brain is matured
,Developmental neuropsychology E.V.L van den Hoek (u500677)
Current multi-dimensional theoretical approaches
Cognitive reserve model: this model is built around the concept of individual differences in reserve capacity of a
child -> both in brain reserve capacity (BRC) and cognitive reserve capacity (CRC). BRC can be directly measured
by quantifying variables like severity of insult, brain volume or structural connectivity .When BRC is below the
threshold functional deficits occur. CRC refers to factors both intrinsic (cognition and behaviour before insult) and
extrinsic (SES and functioning family) to the child.
- Moderating factors: age and time variables are important for understanding outcomes after early brain
damage > early brain damage reduces the reserves more than later brain damage. Location of insult and
involvement of functional networks is important for functional outcomes in a lot of brain conditions
o Important: the influence of the moderating factors is not constant over time
Recovery continuum model: both early plasticity as early vulnerability cannot explain the outcomes after brain
damage on their own. Recovery can be best explained by a continuum -> potential risks and resilience factors interact
to determine long term outcomes.
- Injury: severity, nature (global or specific) and complications
- Cognitive skill: simple or complex
- Developmental phase of child: age at insult and assessment
- Environment: distal, proximal factors
- Characteristics of child before insult
o Impact of these factors is not linear
Biopsychosocial model
Brain: the ‘bio’ dimension
Development of brain in prenatal period is about structural formation > disruptions in brain development result in
structural abnormalities (dysplasia, neural tube defects, agenesis of the corpus callosum). Development of brain
postnatally is about expanding the brain > establishing connectivity. Consists of dendritisation, synaptogenesis and
myelination
Generally assumed that the brain develops hierarchically > anterior areas mature last. There is evidence for a step-by-
step model of brain development > instead of linear progression. Growth spurt as baby, around 7 – 10 years and
latest spurt in early adolescence
Early disruption of CNS can have irreversible consequences -> more severe and diffuse disruptions lead to worse
outcomes. More severe cerebral pathology leads to greater physical and cognitive deficits
In children brain damage is often more diffuse and influences the brain as a whole. In adulthood more often localised
damage
Theories of plasticity can be too optimistic -> children with early insults can grow into their problems when more is
expected from them. The idea of transfer of function has also been disputed -> prenatal brain damage does not result
in functional transfer, but in skills being ineffectively maintained by damaged tissue -> this slows development.
Postnatally the transfer of function can cause depression of function since there are too many skills at one spot
Recovery is not static -> reflects ongoing disruption to maturation of functional neural networks and has greater
negative impact to long term outcomes
Environment: social dimension
An enriching environment is critical for the optimal development of a child. The development of the cognitive and
socio-emotional skills of a child are dependent on the quality of the home environment and the role models of the
parents. Child and environment influence each other
Abuse, trauma and neglect: cognitive and socio-emotional consequences of abuse and neglect consist of decreases in
intellectual skills, attention, working memory and also self-regulating deficits. It also consists of changes in structure
and function in the developing brain: diminished brain volume (grey and white matter), deficits in structural
,Developmental neuropsychology E.V.L van den Hoek (u500677)
connectivity and atypical brain activity. Specific brain areas are susceptible: MPFC, OPFC, hippocampus, amygdala
and corpus callosum
Children in dysfunctional or low SES families show more problems -> when parents are depressed or stressed the
cognitive and social development of the child is worse. There are better outcomes if there is family cohesion and
supporting social networks
Double-hazard hypothesis: brain damage can have greater consequences in children with social detrimental
backgrounds
Child cognitive and socio-emotional function: the ‘psych’ dimension
There is a hierarchical or steplike process of cognitive development. There is an increase in symbolic thought and
ability to deal with increasingly complex and abstract information.
First phase of cognitive development: mostly simple motoric and sensory activities -> no abstract thinking and
gradually arising if object permanence (working memory). Joint attention arises in this period and is critical for socio-
emotional development (attachment)
Around 2 year: development of symbolic thought, theory of mind and empathy. Limited higher order skills.
Unidimensional approaches for problem-solving and egocentric responses
Around 7 year: operational thinking, increasingly reasoning and problem-solving abilities. Executive abilities
Formal operational stage: executive abilities become matured
Important: the timing of growth spurt in myelination and metabolic and electric activity is fairly consistent with
cognitive progression
Children with early brain damage can have problems with understanding social rules and acquiring social and
emotional skills and knowledge due to intellectual deficits, reduced self-regulation, functional deficits, social stigma
and limited interactions with the environment.
Psychiatric disorders are 5 times more likely in children with brain damage -> presence of epilepsy supplemental
risk factor. Depending on the nature and localisation of cerebral pathology, children can be impulsive, hyperactive,
aggressive, depressive and anxious. They can have reduced empathy, theory of mind and moral reasoning skills
Social brain network: brain areas and functional neural networks involved in socio-emotional processing: the
superior temporal sulcus (STS), fusiform gyrus (FG), temporal pole (TP), medial PFC, frontal pole (FP),
orbitofrontale cortex (OFC), amygdala, insula, TPG and cingulate
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Chapter 2: the developing brain
Connectionist view: functional neural networks support a series of complex skills -> attention, working memory,
executive functioning and social cognition
Originally researchers postulated that the brain of a baby was equipotential: all brain areas take equal responsibility
for every function
- In case of brain damage: healthy brain areas can be acquired to take over normal functions
Innate specialisation model postulates that key abilities like language are localised at birth. So brain areas have a
specific function in the brain and or not equally responsible for every function
Interactive specialisation approach: influences like genes and experience should be taken into account in the
developing organisation of the brain -> this approach identifies 3 separate, but not incompatible, approaches to
understand the progression of cognitive abilities in babies
- Maturation: genetically predetermined developmental sequence of specific neuro-anatomical areas ->
provide the basis for emergences of sensory, motor and cognitive processes
, Developmental neuropsychology E.V.L van den Hoek (u500677)
- Interactive specialisation: occurrence of a new ability reflects finetuning of connectivity between brain
areas, not just activity in one or more areas
- Skill learning: patterns of brain activity change during acquisition of skills
o The unmatured brain needs to acquire more brain areas to complete a task successfully
Developmental progression of brain development
Fastest rate of brain growth occurs prenatally. During birth and adulthood the brain quadruples in size and grows from
400 – 1500 gram.
- Increase in size is due to differentiation, growth and maturation of existing neurons, expansion of dendrites
and synapses and due to myelination
Two phases of brain development:
- Prenatal: structural formation CNS -> genetically determined
- Postnatal: expansion of the brain -> synaptogenesis, myelination and growth dendrites
o Brain damage -> disrupts expansion of CNS and development of interconnections and functional
neural networks
CNS starts developing at 40 days of embryonic life. Cerebral development is not a simple, linear progression -> series
of developmental processes occurring at the same time:
- Hierarchical progression
- Regression and additive processes
- Growth spurt in neurological processes
Hierarchical progression
Brainstem and cerebellar areas develop first. After that posterior areas develop and anterior areas mature the latest.
Synaptogenesis appears simultaneously in different areas -> this suggests a simultaneous development rather than a
hierarchical development
- Not all areas follow hierarchical pattern of development -> corpus callosum
Additive and regressive processes
Additive development: ongoing accumulation of growth processes. For example myelination; it develops in a
steplike manner in the brain during childhood and young adulthood. So with every step there is more.
Regressive development: originally overproduction and after that selective elimination of unnecessary elements.
Synapses that do not form a functional neural network will be pruned.
- Linear decrease in cortical density -> there is an increase in grey matter before adolescence and a decrease
after adolescence
Prenatal period
The prenatal period is characterized by dynamical activity and consists of gross structural formation. Like:
neurulation, proliferation, migration, dendritic development, synaptogenesis, differentiation and apoptosis.
Process of neurulation progresses via rapid generation of cells within the system and consists of two kinds of cells:
neurons and glial cells
- Neurons are responsible for neural transmission in the brain and they have 4 components: cell body (RNA &
DNA), axon (sends impulses), dendrites (receives impulses) and presynaptic terminal (storage NT and
releasing NT)
- Glial cells play a supporting and nursing roll in the CNS. Permits regeneration of damaged neurons and
produces scar tissue at damaged sites
