Which elements are necessary for child neuropsychological evaluation? - Chapter 11

The aim of this chapter is to discuss the elements that are necessary for child neuropsychological evaluation. These elements, which will be discussed into more detail in the remainder of this chapter, are:

1. Nature of presenting problem.
2. Background history.
3. Qualitative data, including direct observation and parent/teacher observation.
4. Quantitative data, including intellectual evaluation, evaluation of specific skills, and functional skills.
5. Formulation and diagnosis.
6. Feedback and treatment.
7. Evaluation of intervention.

Typically, best practice in child neuropsychological evaluation avoids reliance on any single source of information or data. Instead, information regarding different factors and from various sources is collected and integrated in a meaningful way. Such different sources may include: medical history, developmental history, psychological factors (of both the child and his or her family, e.g., coping style, well-being, recent family disruptions and so forth, behavioural observations, and quantitative methods such as a standardised paper-and-pencil task. Typically, neuropsychological evaluation is comprehensive, comprising various domains, including: cognitive evaluation (intellectual function), assessment of specific cognitive skills (attention, learning and memory , executive function, processing speed, visuo-perceptive / visuo-spatial / visuo-constructive skills, speech and language, motor, perceptual, and sensory skills), assessment of behavioural and adaptive function (social cognition and social competence), and assessment of academic and/or vocational achievement. Finally, collating these various information sources is the final and most important aspect of neuropsychological evaluation. The goal is to achieve a formulation that is reliable, objective, and accurate. One the child's pattern of strengths and weaknesses has been identified and interpreted, the next step is to use this information to devise appropriate rehabilitation and interventions. 

What is child neuropsychological assessment?

Neuropsychological assessment refers to the evaluation of brain - behaviour relationships, which is at the heart of neuropsychological practice. Child neuropsychological assessment may serve various goals:

1. To provide information regarding the integrity of the brain via comprehensive cognitive assessment.
2. To detect and diagnose the presence of symptoms, syndromes, or disorders.
3. To characterise the cognitive strengths and weaknesses of the child.
4. To guide children and their care team towards appropriate treatment and rehabilitation.
5. To monitor outcomes and evaluate the efficacy of treatment and intervention. 

Thus, child neuropsychological assessment aids in the understanding of an individual's deficits and provides an important contribution to treatment and rehabilitation of the individual. The specific goal for a neuropsychological assessment typically depends on the setting. For example, in acute hospital settings, assessments are typically brief, basic, conducted at the bedside, and mainly aimed at determining the child's level of consciousness, alertness, and orientation. More comprehensive evaluations tend to be conducted in secondary care settings, such as outpatient clinics and rehabilitation units, schools or private practice. These assessments involve longer, more targeted assessment in order to, for example, obtain information across a wide range of functional domains to formulate a comprehensive neuropsychological profile. Child neuropsychological assessment is different generic psychological evaluation, not so much by the test measures used, but by the interpretation of the data resulting from those measures. In neuropsychological assessment, assessment data with medical information need to be interpreted in the context of the child's day-to-day life and to provide assistance and direction for managing and treating the deficits of the child. The relationship between brain (structure) and behaviour (function) is key. Over the past years, a paradigm shift has occurred, from localisation of function models to an understanding that cognitive functions are dependent on a diffuse neural network, in which disruption results in a wide range of consequences. 

What are the reasons for referral of neuropsychological evaluation?

Typically, child neuropsychological assessment represents a tertiary intervention, because most children referred already have undergone medical assessment and many have also been assessed for sensory, speech, and educational status. Child neuropsychologists frequently receive referrals for the assessment of various medical and neuropsychological conditions. Most referrals simply require an opinion regarding the nature and severity of the problems of the child. More sophisticated requests which may require fine-grained evaluation of cognitive or learning skills or advice regarding appropriate educational placement, treatment, and management, occur less common. Children seen for neuropsychological evaluation can be divided into a number of categories:

1. Neonatal and acquired brain insult (PT birth, TBI, tumour, epilepsy, cerebral infection).
2. Congenital disorders involving structural brain insult (spina bifida and cerebral palsy).
3. Medical disorders that impact brain function (diabetes, phenylketonuria, cardiac disease).
4. Genetic and metabolic disorders (Klinefelter syndrome, galactasaemia, Wilson's disease).
5. Neuropsychiatric disorders with impaired brain function (autism, ADHD, learning disability).

What are the principles of child neuropsychological assessment?

Three principles have to be taken into account: 

1. Developmental considerations: consider the specific trajectory of cognitive and social development, emphasising the importance of age-appropriate, well-normed assessment tools).
2. Socio-emotional considerations: a child may behave differently in an unfamiliar hospital setting).
3. Environmental considerations: multiple dimensions of environmental influence; social history, access to resources, impact of family factors, such as marital problems, parental depression, and sibling conflict).