CSCN Samenvatting
H1 Introduction to Child Clinical Neuropsychology
The contribution of Neuroscience
Diffusion Tensor Imaging (DTI) = Allows to view white matter tracts of the brain, and can
evaluate how efficiently the messages are able to travel.
Professional Training Standards
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Multicultural Issues in Neuropsychology
Many of the measures utilized for testing in neuropsychological practice have not been
standardized on ethnicities beyond middle-class Caucasians.
Handedness, specialization of the cerebral hemispheres for tasks, and selfreports of
behavioral functioning may be related to cultural issues + brain development.
Educational level appears to be strongest variable associated with poor neuropsychological
performance rather than ethnicity
One common practice is to translate an English test into Spanish. However, since the norms
are unlikely to be appropriate, this can be problematic.
Children of different ethnicities may benefit from differing learning strategies with varying
range of quality and quantity
Professional Training Issues and Ethics
Practitioners who have not had the recommended training for neuropsychological practice
should not ‘‘diagnose’’ brain difficulties, but should be familiar enough with brain anomalies
to know when to refer.
Educational and clinical professionals are often the individuals who first observe behavioral,
psychological, and cognitive problems exhibited by children with brain-related disorders. In
this position, knowledge about when to refer for further neuropsychological,
neurodiagnostic, or medical evaluations is crucial for the proper diagnosis and treatment of
some disorders (e.g., seizures, brain tumors, or neurodegenerative diseases).
Early interventions are particularly important for low birth weight babies, infants with
intrauterine exposure to prenatal drugs and alcohol, infants with AIDS, and children with
significant cognitive, speech, language, and/or motor delays.
Important Laws for Delivery of Neuropsychological Services
IDEA
Individuals with Diasabilities Education Act (IDEA).
Prior to this law, children with severe disabilities were not in school.
,EACHA = Law that established that children with disabilities were entitled to special
education and associated services. (1990).
The six aspects defining IDEA include
1. zero reject; all children are served regardless of disability
2. non-discriminatory evaluation; any services the child requires to benefit from his
education are provided at no additional charge.
3. a free and appropriate education (FAPE)
4. least restrictive environment; mandates that the child be educated in regular
education for as much of the day as appropriate.
5. due process; allows parents or the school to contest the placement, assessment,
identification, or provision of FAPE
6. parent/child education.
Available for children with o.a. deaf, blind, autism, handicapped
Individual Educational Plan (IEP) = Designed for each child depending on his needs. Specific
goals and objectives, and who is responsible for helping with what
Section 504
Section 504 (1973) prohibits a child with a disability to be denied access to participation in
activities within the educational environment.
Includes disorders that might not affect learning directly such as asthma, diabetes.
Section 504 is an anti-discrimination statute designed to ensure that the needs of students
with disabilities are met at a level that is commensurate with that provided to children
without disabilities.
Health Insurance Portability and Accountability Act (HIPAA)
HIPAA (1996); protect privacy and security of patient information.
Emergence of Child Clinical Neuropsychology
A neurodevelopmental perspective clarifies childhood disorders for several reasons:
1. The influence of developing brain structures on mental development is sequential
and predictable. How the brain changes with development, what structures vary
depending on age, gender, and experience, and what interventions may alter brain
activity.
2. Effects of brain injury in children have been documented. Attention to the scope and
sequence of development of cortical structures and related behaviors that emerge
during childhood is important to assess the impact of the environment (i.e.,
enrichment, instructional opportunities, and intervention strategies) on this process.
3. Nature and persistence of learning problems is dependent on an interaction between
dysfunctional and intact neurological systems. Ability to evaluate brain activity
changes following interventions
, 4. The developing brain is highly vulnerable to numerous genetic and/or environmental
conditions that can result in severe childhood disorders
A Transactional Approach
Due to the complexity of the brain, particularly the developing brain, a transactional
approach to the study and treatment of childhood and adolescent disorders is most
appropriate. Many fields of study involved; clinical, developmental, etc.
A transactional approach can illustrate the following:
- how abnormalities or complications in brain development interact with
environmental factors in various childhood disorders
- how disorders develop over time depending on the nature and severity of
neuropsychological impairment
- how neurodevelopmental, neuropsychiatric, and acquired disorders (i.e., traumatic
injury) need to be assessed and treated within an integrated clinical protocol
addressing neuropsychological, cognitive, psychosocial, and environmental factors
A transactional approach stresses consultation and collaboration with the caregivers of the
child as well as assisting the child in adjusting to his/her areas of challenge.
Perspectives for the Study of Childhood Disorders
To conduct a comprehensive child study, clinicians need to incorporate various paradigms.
Neuropsychological Paradigm
Neuropsychology is the study of brain-behavior relationships and assumes a causal
relationship between the two variables.
The exact nature of brain functioning and behavior is complex and incomplete.
Neuropsychologists utilize techniques that consider the interaction of psychosocial,
environmental, neurocognitive, biogenetic, and neurochemical aspects of behaviors to
understand the relationship more between physiological and psychological systems, and
frequently incorporate them in behavioral techniques.
Behavioural Paradigm
Analysis of the antecedents and consequences of behaviors is an essential feature of
behavioral approaches with attention to the impact of the environment on the
understanding and remediation of learning and behavioral difficulties in children.
Within this perspective, behaviors are targeted for analysis, and subsequent treatment plans
are developed to address areas of concern.
A functional analysis of behavior is now a required piece of an evaluation for determining
appropriateness of a special education placement for behavioral difficulties.
Involving behavioural aspects is important for ecological validity.
, Combining neuropsychological as well as behavioral evaluations assists in developing the
most appropriate interventions.
This can also be useful in evaluating the impact of environmental demands of the child when
making predictions about recovery from brain impairment.
Psychosocial and Cognitive Paradigms
The fact that various neurodevelopmental, psychiatric, and behavioral disorders have
associated psychosocial and cognitive deficits increases the importance of investigating
these features in child clinical neuropsychological assessment and of addressing these
deficits in treatment programs.
The relationship among cognitive functioning, psychosocial characteristics, and
neuropsychological deficits for various childhood disorders is multidirectional or
transactional in nature.
In some instances neuropsychological functioning may help to explain many of the
behavioral, cognitive, and psychosocial deficits found in childhood disorders such as ADHD
and dyslexia
The extent to which social outcomes are related to impulsivity, distractibility, and
disinhibition, which have been found to have a neurobiological basis, needs to be explored
within an integrated paradigm
Basic neurochemical and neuropsychological abnormalities (inattention, overactivity, poor
impulse control) interact with social, psychological, and behavioral factors to create
significant adjustment problems
There are several distinct neurophysiological and neuroanatomical findings that may be
related to the associated psychosocial and cognitive problems found in children and
adolescents with ADHD,
1. Underactivation of the reticular activating system (RAS), a subcortical region that
activates the cortex
2. Subtle anatomical differences in the right caudate nucleus (near the lateral
ventricles) and the frontal lobes
3. Smaller genu and/or splenium in the corpus callosum
Frontal lobe arousal occurs when Ritalin (methylphenidate) is administered. Once activated,
the frontal lobes exert a regulatory influence over sub-cortical and cortical regions of the
brain that
ultimately monitors motor activity and distractibility.
Response inhibition and poor self-regulation in ADHD are the result of impairment in
executive functions mediated by the frontal cortex.
Treatment can alter brain structure and also assist inmodifying behavior or at least providing
an opportunity for the child to ‘‘learn’’ a different method for solving problems.
