Child Neuropsychology

123

Assessment and Interventions

for Neurodevelopmental Disorders

Second Edition

Child

Neuropsychology

Margaret Semrud-Clikeman

Phyllis Anne Teeter Ellison

Child Neuropsychology

Second Edition

Margaret Semrud-Clikeman l

Phyllis Anne Teeter Ellison

Child Neuropsychology

Assessment and Interventions

for Neurodevelopmental Disorders

Second Edition

1 3

Margaret Semrud-Clikeman

Michigan State University

3123 S. Cambridge Road

Lansing MI 48911

USA

[email protected]

Phyllis Anne Teeter Ellison

Department of Educational Psychology

University of Wisconsin

793 Enderis Hall

2400 East Hartford Avenue

Milwaukee WI 53211

USA

[email protected]

ISBN 978-0-387-88962-7 e-ISBN 978-0-387-88963-4

DOI 10.1007/978-0-387-88963-4

Library of Congress Control Number: 2008942517

# Springer ScienceþBusiness Media, LLC 2009, First softcover printing 2007

All rights reserved. This work may not be translated or copied in whole or in part without the written

permission of the publisher (Springer ScienceþBusiness Media, LLC, 233 Spring Street, New York,

NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in

connection with any form of information storage and retrieval, electronic adaptation, computer

software, or by similar or dissimilar methodology now known or hereafter developed is forbidden.

The use in this publication of trade names, trademarks, service marks, and similar terms, even if they

are not identified as such, is not to be taken as an expression of opinion as to whether or not they are

subject to proprietary rights.

Printed on acid-free paper

springer.com

Foreword

The human brain represents the product of an ongoing, six-billion-year con￾struction project. In its physical form and function, the human brain represents

millions upon millions of trial-and-error adaptive adjustments. Comprised of

an estimated 100 billion neurons and many more glial cells it is organized into

thousands of regions. The human brain, in a seamlessly integrated manner,

governs body functions and movement but more importantly, regulates cogni￾tion. Not surprisingly, although the brains of different animals may not look

exactly alike, they all work according to the same principles and mechanisms.

These neurons and glial cells communicate using a nearly infinite number of

synaptic connections, yet the entire organ in humans weighs only about three

pounds. As authors Sandra Aamodt and Sam Wang eloquently describe in their

book, Welcome to your brain (2007), billions of years of evolution have resulted in

a very complex human brain, yet one that is a jumbled, far from efficient,

crowded organ. They describe the neuronal pathways of the human brain as

the equivalent of the New York City subway system or the streets of London with

layers upon layers of routes each constructed at a different time in a different

way. Yet this stunning system, for the most part, develops and works fine for

most children.

The adult human brain at between 1300 and 1400 cm is by far not the largest

brain among mammals. Consider that a sperm whale’s brain is approximately

7800 cm and an elephant’s brain is 4700 cm. Thus, bigger brains alone do not

necessarily mean smarter or more developed organisms. Although larger brains

are associated with higher intelligence to some extent, smaller brains can be

advantageous from an evolutionary point of view, particularly if they are equal

in intelligence to larger brains. But many additional factors beyond brain size

impact intelligence. Brain size in vertebrates such as humans may relate more to

social rather than mechanical skills. Lower ratios of brain to body mass may

increase the amount of brain mass available for more complex cognitive tasks.

For reptiles it is about 1:1500; for birds, 1:220; for most mammals, 1:180 and for

humans, 1:50. MRI studies of humans have demonstrated that to some extent

brain size has modest correlation with intelligence. Among our ancestors, homo

erectus had a brain size of about 980 cm; homo habilis a brain of about 750 cm;

homo floresiensis a brain size of about 380 cm; and neanderthals a brain size

v

slightly larger than our current brains. Consider also that an infant is born with a

brain of 300–400 cm tripling in size by the adult years. Yet, between birth and the

conclusion of the first two decades of life, a nearly infinite acquisition of knowl￾edge and behaviors characterizes human development. Gram for gram the

human brain delivers an almost dazzling array of motoric, behavioral, cognitive

and emotional capacities nearly impossible to fathom in light of its’ size. The

brain is a metabolically high cost organ consuming about 20% of the body’s

metabolic energy providing further evidence of its’ complex operations. Further

most energy use is devoted to being ready to think and respond rather than

thinking per se.

Despite rapid and fascinating advances in our understanding of brain struc￾ture, function and complex human behavior, it still remains the case that there

is much more that we don’t know about how the brain grows, functions and

ages. Though neuroimaging techniques have allowed scientists to appreciate

the relationship between the anatomy and physiology of the brain and motor

functions for example, the basic cognitive operations of the brain remain

elusive.

Beyond anatomical structure and physiology, the brain unlike any other

organ in the body creates an alter ego, the conscious mind. In his fictional

short story They’re made out of meat, author Terry Bison describes aliens with

electronic brains referring to humans as ‘‘thinking meat’’! The idea that the

brain can create consciousness seems like a science fiction phenomena. For

thousands of years philosophers and scientists have debated and waxed poetic

about the nature of the human mind. The mind appears to be composed of a

set of processes driven by language, organized by memory and individualized

by each person’s unique perception and interpretation of their lives. And yet,

the human brain does not appear to possess a localized center of conscious

control. Though highly dependent upon the frontal lobes, consciousness is

also dependent upon sensory, processing and interpretative abilities distribu￾ted throughout the brain. A description of the biological basis of human

consciousness continues to elude the best efforts of current researchers. We

understand how people lose a sense of consciousness. We also understand how

certain conditions are created by alterations in the brain and conscious experi￾ence. Yet as we come to appreciate and understand the relationship between

certain conscious activities and structures within the brain, it still remains the

case that our consciousness extends well beyond the structures and physiology

of our brain.

In her extremely cogent and interesting book, Brain dance (2004), Dean

Falk, a professor of anthropology at Florida State University, describes the

conditions and circumstances that allowed a group of ape-like individuals to

evolve over a period of at least 5 million years into homo sapiens. During this

process, the brain became increasingly more specialized evolving a broad range

of abilities as well as right-brain/left-brain and male/female differences. As

Falk notes, in less than 2 million years, brain size doubled in the homo species,

from around 650 to 1350 cm. Only a small portion of this newly evolved, larger

brain was tied to increasing body size. As Falk points out, this process was

unprecedented in the evolutionary histories of other mammals. As brain size

increased, neurons enlarged and became more widely spaced and the cerebral

cortex became more convoluted. As Falk notes, no new structures were found

vi Foreword

in these larger human brains. However these larger brains set the foundation for

an accelerated evolutionary process never before witnessed in any earthbound,

mammalian species. In this process, the pre-frontal cortex and the posterior

areas of the brain associated with sensory processing in particular became

especially convoluted. As Falk points out, the shift in neurochemicals, anatomy

of neurons and brain function provided the underlying mechanics of our rapid

evolutionary progression, a pattern that was most certainly driven by natural

selection.

It is also the case that for hundreds of thousands if not millions of years our

ancestors have developed a finely tuned capacity to respond emotionally to

events in the environment leading neuronal pathways between emotive centers

of the brain stem and cerebral motor control areas to be shorter than those

connecting complex, cognitive areas in the frontal lobes. Though as human

beings we still process the world first and foremost emotionally, we have devel￾oped an impressive capacity to think before acting on emotion alone. Yet it is still

the case that stressful experiences may quickly override our capacity for ratio￾nale, reflective responding.

Finally, out of this amazing progression forward, we developed language. As

Clive Bromhill writes in his book, The eternal child (2003), long after we devel￾oped the ability to walk on two legs and our brains became larger than those of

any other species on the planet, we were still limited in our capacity for complex

thinking. For a long period of time, our ancestors’ brains grew larger but we

appeared to reap few intellectual benefits. However, within the past 50,000 years

something happened in the human brain that transformed the already large

brains of our ancestors into what they are today. At some point, brain circuitry

changed. Our human ancestors through the harnessing of language developed

the ability to think. As Bromhall notes, the brain became partitioned, permitting

the capacity for subjective experience. In other words, we can simultaneously

experience internal thoughts and the external world, a key ingredient in

consciousness.

As the center of our consciousness and being, it is fitting that we devote an

increasing scientific literature to understanding and facilitating the operation of

the developing brain; in particular an appreciation of the developmental disor￾ders and conditions that adversely affect children’s transition into adulthood.

Children’s brains represent an incredible capacity to learn. In the span of 18

months between 1 1/2 and 3 years of age for example, children move from not

speaking to telling us how to live our lives! In bilingual homes they master two

languages simultaneously.

Clinical child neuropsychologists today and in the future must be scien￾tist practitioners. To do so effectively requires a special type of literature at

our fingertips. The first edition of Clinical Child Neuropsychology provided

such an essential resource. As research scientists the joint and individual

work of Drs. Ann Teeter and Margaret Semrud-Clikeman over the past

thirty years has greatly expanded the boundaries of brain neuroscience. I

have had the exceptional opportunity to work professionally with both of

them. In the second edition of this seminal work, Drs. Ann Teeter and

Margaret Semrud-Clikeman have authored a number of new chapters,

included case studies in all chapters and completely re-written and updated

existing chapters. This volume seamlessly blends current knowledge in

Foreword vii

pediatric neuroscience with practical, reasoned and reasonable strategies to

understand, evaluate and treat the myriad of neurodevelopmental problems

children experience as they grow into adulthood. With great pleasure and

admiration I will place this volume next to the first edition of this text on

my bookshelf.

References

Aamodt, S. A., & Wang, S. (2007) Welcome to your brain. New York: Bloomsbury Press.

Bromhill, C. (2003) The eternal child. London: Ebury Press.

Falk, D. (2004). Brain dance (Revised and Expanded Edition). Gainesville, FL: University

Press.

viii Foreword

Contents

Part I Anatomy and Physiology

1 Introduction to Child Clinical Neuropsychology.................. 3

The Contribution of Neuroscience . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Professional Training Standards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Multicultural Issues in Neuropsychology . . . . . . . . . . . . . . . . . . . . . . . 5

Professional Training Issues and Ethics . . . . . . . . . . . . . . . . . . . . . . . . 6

Important Laws for Delivery of Neuropsychological Services. . . . . . . 8

IDEA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Section 504 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Health Insurance Portability and Accountability Act (HIPAA) . . 9

Emergence of Child Clinical Neuropsychology . . . . . . . . . . . . . . . . . . 11

A Transactional Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Perspectives for the Study of Childhood Disorders . . . . . . . . . . . . . . . 12

Neuropsychological Paradigm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Behavioral Paradigm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Psychosocial and Cognitive Paradigms. . . . . . . . . . . . . . . . . . . . . . . . . 13

Transactional Paradigm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Neuropsychological Perspectives on Assessment and Intervention . . . 17

Neurodevelopmental Framework for Child Neuropsychology . . . . . . 18

Rationale for an Integrated Neuropsychological Model . . . . . . . . . . . 18

Overview of Book Chapters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

2 Functional Neuroanatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Structure and Function of the Neuron . . . . . . . . . . . . . . . . . . . . . . . . . 26

Anatomy of the Neuron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Types of Neurons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Types of Neuroglia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Spinal Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Structure and Function of the Brain. . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Role and Function of the Meninges . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Ventricles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Structure and Function of the Brain Stem . . . . . . . . . . . . . . . . . . . . . . 32

ix

Medulla Oblongata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Pons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Midbrain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Diencephalon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Cerebellum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Structure and Function of the Forebrain . . . . . . . . . . . . . . . . . . . . . . . 35

Neocortex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Cerebral Hemispheres . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Interhemispheric Connections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

lntrahemispheric Connections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Structure and Function of the Cortex. . . . . . . . . . . . . . . . . . . . . . . . . . 38

Frontal Lobes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Parietal Lobes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Occipital Lobes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Temporal Lobes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Olfactory Bulb. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Limbic System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

3 Development in the CNS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Prenatal Course. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Proliferation and Cell Migration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Axon and Synaptic Formations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Postnatal Course . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

The Development of Higher Cognitive Abilities . . . . . . . . . . . . . . . . . 50

Frontal Lobe Maturation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Expressive Speech Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Executive Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Emotional Functions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Parietal Lobe Maturation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Occipital Lobe Maturation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Temporal Lobe Maturation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

How Genetic Factors Influence Development . . . . . . . . . . . . . . . . . . . 55

Biological and Environmental Factors . . . . . . . . . . . . . . . . . . . . . . . . . 58

Prenatal Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Maternal Stress, Nutrition, and Health Factors. . . . . . . . . . . . . . . 58

Maternal Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Postnatal Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

4 Electrophysiological and Neuroimaging Techniques

in Neuropsychology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Electrophysiological Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Electroencephalography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Evoked Potentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Neuroimaging Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

x Contents

Gestation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Computed Tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Magnetic Resonance Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

Research with MRI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Dyslexia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Functional Neuroimaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

ADHD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Structural MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Functional MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Autism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Neuroradiological Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

PET and SPECT Scans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Part II Clinical Assessment

5 Integrating Neurological, Neuroradiological, and Psychological

Examinations in Neuropsychological Assessment. . . . . . . . . . . . . . . . . 89

The Neurological Examination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

When to Refer for a Neurological Evaluation . . . . . . . . . . . . . . . . 90

Neuroradiological Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

When to Refer for Neuroradiolgical Evaluation . . . . . . . . . . . . . . 92

Neuropsychological Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

When to Refer for Neuropsychological Evaluation . . . . . . . . . . . . 92

The Integration of Neurological, Neuroradiological, and

Neuropsychological Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Psychological Assessment of Children with Neurodevelopmental,

Neuropsychiatric, and Other CNS Disorders. . . . . . . . . . . . . . . . . . . . 94

Impact of Psychological Functioning on Neuropsychological Results 94

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Hospital: Developmental/Behavioral Program. . . . . . . . . . . . . . . . . . . 96

Reason for Referral. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Behavioral Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Tests Administered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Test Interpretations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Summary and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Strategies for Improved Memory Skills . . . . . . . . . . . . . . . . . . . . . . . . 100

Psychometric Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Differential Abilities Scale-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

6 Neuropsychological Domains of Functioning . . . . . . . . . . . . . . . . . . . . 105

Cognitive Ability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

Woodcock-Johnson Tests of Cognitive Ability-III. . . . . . . . . . . . . 105

Wechsler Intelligence Scale for Children-IV . . . . . . . . . . . . . . . . . . 105

Differential Ability Scal-2 (DAS-2). . . . . . . . . . . . . . . . . . . . . . . . . 106

Kaufman Assessment Battery for Children (KABC II) . . . . . . . . . 106

Academic Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Woodcock-Johnson Tests of Achievement-III . . . . . . . . . . . . . . . . 107

Contents xi

Wechsler Individual Achievement Test-II (WIAT-II) . . . . . . . . . . 108

Executive Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Attention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

Memory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Language. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

Motor Abilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

Visual-Spatial and Visual-Motor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

Psychosocial Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Child Behavior Checklist (CBL) . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Behavior Assessment System for Children . . . . . . . . . . . . . . . . . . . 122

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

7 The Neuropsychological Assessment Process . . . . . . . . . . . . . . . . . . . . 127

The Intake Interview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Insert Developmental History Form About Here . . . . . . . . . . . . . . . . 128

Preparing the Child for the Assessment . . . . . . . . . . . . . . . . . . . . . 128

The Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

Feedback Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Neuropsychological Reports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132

Reason for Referral. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132

Background and Developmental History . . . . . . . . . . . . . . . . . . . . 132

Behavior Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

Tests Administered and Results . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

Summary and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . 133

Neuropsychological Report Example . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Test Interpretations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

Strategies for Improved Memory Skills . . . . . . . . . . . . . . . . . . . . . . . . 137

Techniques to Help Students with Attentional Problems in the

Classroom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Physical Arrangement of Room . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Lesson Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Worksheets and Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Psychometric Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

8 Neuropsychological Assessment Approaches and Diagnostic Procedures 151

Approaches to Child Clinical Neuropsychological Assessment . . . . . . 151

Halstead-Reitan-Indiana Assessment Procedures . . . . . . . . . . . . . 151

Conceptual Model for the Halstead-Reitan Methods . . . . . . . . . . 151

Halstead-Reitan Neuropsychological Batteries for Children . . . . . 151

Multiple Levels of Inference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152

Neuropsychological Deficit Scale Approach . . . . . . . . . . . . . . . . . 157

Normative Analysis of the Halstead-Reitan Neuropsychological

Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

Biobehavioral Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

Pragmatic Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

Research Findings with CHRNB and HINB . . . . . . . . . . . . . . . . . 158

Luria Theory of Neuropsychological Assessment for Children . . . . . . 159

xii Contents

Luria’s Conceptual Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

Functional Unit I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

Functional Unit II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

Functional Unit III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

Developmental Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

NEPSY: A Developmental Neuropsychological Assessment. . . . . . . . 166

Attention and Executive Functioning. . . . . . . . . . . . . . . . . . . . . . . 166

Language. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

Memory and Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

Sensorimotor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

Social Perception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

Visuospatial. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

Research Findings with NEPSY . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

CAS: Cognitive Assessment System . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Attention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Simultaneous. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Successive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Research Findings with CAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Neuropsychological Protocol: Austin Neurological Clinic. . . . . . . . . . 168

Boston Process Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168

Tests of Reasoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

Tests of Verbal Language and Memory . . . . . . . . . . . . . . . . . . . . . 170

Neurosensory Center Comprehensive Examination for Aphasia. . 171

Tests of Perception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172

Test of Facial Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172

Cancellation Tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172

Summary and Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172

Delis-Kaplan Executive Function System (D-KEFS). . . . . . . . . . . 173

A Transactional Approach to Neuropsychological Assessment. . . . . . 173

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

Part III Childhood and Adolescent Disorders

9 Neuropsychological Correlates of Childhood and Adolescent Psychiatric

Disorders: Disruptive Behavior Disorders. . . . . . . . . . . . . . . . . . . . . . . 181

Biochemical and Neuropsychological Models of Psychiatric

Disorders of Childhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

Medication Effects on Neurotransmitters. . . . . . . . . . . . . . . . . . . . 181

Tourette Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184

Genetic Correlates and Brain Mechanisms of TS. . . . . . . . . . . . . . 184

Implications for Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

Implications for Interventions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

Pharmacological Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

Psychosocial and Behavioral Interventions . . . . . . . . . . . . . . . . . . 185

Attention-Deficit Hyperactivity Disorder. . . . . . . . . . . . . . . . . . . . . . . 186

Comorbidity: ADHD with Other Childhood Disorders. . . . . . . . . 187

Neurological Study of ADHD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Primary Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189

Contents xiii

Self-Regulation Theory of ADHD . . . . . . . . . . . . . . . . . . . . . . . . . 191

Transactional Model of ADHD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192

Genetic Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192

Family Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194

Psychosocial Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194

Intellectual, Perceptual, Attention, and Memory Functioning. . . . 195

Academic and School Adjustment . . . . . . . . . . . . . . . . . . . . . . . . . 195

Implications for Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

Implications for Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198

Conduct Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

Incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

Gender. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

Developmental Course . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

Comorbid Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200

Genetic Influences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200

Family Influences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201

Physiological Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201

Neuropsychological Correlates . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202

Intellectual/Academic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202

Implications for Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

Implications for Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204

Reason for Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

Assessment Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206

Adaptive Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206

School Functioning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

Behavioral Observation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

Assessment Results and Interpretation. . . . . . . . . . . . . . . . . . . . . . . . . 208

Language. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208

Intellectual. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208

Learning and Working Memory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208

Executive/Neuropsychological Skills . . . . . . . . . . . . . . . . . . . . . . . . . . 209

Attention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

Motor/Perceptual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

Academic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

Emotional/Personality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210

Diagnostic Impression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211

Recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211

Reason for Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212

Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212

Assessment Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

Adaptive Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

School Functioning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214

Behavioral Observation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214

Assessment Results and Interpretation. . . . . . . . . . . . . . . . . . . . . . . . . 215

Language. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

Intellectual. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

Learning and Working Memory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

xiv Contents

Executive/Neuropsychological Skills . . . . . . . . . . . . . . . . . . . . . . . . . . 216

Attention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216

Motor/Perceptual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216

Academic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216

Emotional/Personality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217

Diagnostic Impression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218

Recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219

10 Neuropsychological Correlates of Childhood and Adolescent

Internalized Disorders: Mood and Anxiety Disorders. . . . . . . . . . . . . . 225

Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

Childhood Depression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

Pediatric Bipolar Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231

Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232

Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236

Depression Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

Learning Characteristics Assessment . . . . . . . . . . . . . . . . . . . . . . . 237

Developmental History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

Birth and Developmental Milestones . . . . . . . . . . . . . . . . . . . . . . . 237

Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

Family Medical and Psychiatric History. . . . . . . . . . . . . . . . . . . . . 238

Academic History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

Early Academic Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

Behavioral Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

Test Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

Intellectual Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

Scholastic Achievement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

Working Memory and Attention . . . . . . . . . . . . . . . . . . . . . . . . . . 240

Executive Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240

Memory Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240

Visual-Motor-Spatial Skills. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241

Emotional Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241

Major Depressive Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241

Generalized Anxiety Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242

Panic Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242

Attention-Deficit Hyperactivity Disorder. . . . . . . . . . . . . . . . . . . . 242

DSM-IV-TR Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243

Summary and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243

Recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244

11 Autistic Spectrum Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249

Incidence and Prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249

Neuropsychological Aspects of ASD . . . . . . . . . . . . . . . . . . . . . . . . . 250

Asperger Disorder and High Functioning Autism . . . . . . . . . . . . . 250

Social Understanding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250

Rett’s Disorder/Childhood Disintegrative Disorder. . . . . . . . . . . . 252

Childhood Disintegrative Disorder. . . . . . . . . . . . . . . . . . . . . . . . . 252

Contents xv