Lecture 3

Question 1

What is the aim of neuropsychological assessment in children?

Answer 1

To examine brain-behavior relations in children

This includes integrating medical data, daily life, test scores, and observations to evaluate cognitive functions.

Question 2

What are the settings where pediatric neuropsychologists work?

Answer 2

• Hospitals
• Rehabilitation units
• Schools
• Forensic settings
• Private practice

Pediatric neuropsychologists often work as part of a multidisciplinary team.

Question 3

What are the key components integrated during neuropsychological assessment?

Answer 3

• Medical data
• Daily life observations
• Test scores
• Observations

This integration helps in evaluating cognitive functions.

Question 4

True or False: Similar brain lesions always lead to the same behavior.

Answer 4

False

Similar brain lesions can lead to a variety of behaviors.

Question 5

Neuropsychological assessment

Answer 5

→ Early detection and prevention of long-term negative effects (of medical conditions)
→ Characterize cognitive strengths and weaknesses
→ Guide children towards appropriate rehabilitation, intervention or support resources
→ Monitoring outcomes (recovery or deterioration) and treatment effects

Question 6

What cognitive functions are assessed in neuropsychological evaluations?

Answer 6

• Intelligence
• Language
• Perception
• Memory
• Attention
• Executive functions
• Motor skills
• Emotion and social cognition

Each of these functions plays a crucial role in understanding a child’s cognitive profile.

Question 7

What is the significance of considering age and development in neuropsychological assessments?

Answer 7

Age and development influence functioning and interpretation of deficits

Damage to a developing brain may not show immediate deficits but can become evident later.

Question 8

Fill in the blank: The ICF-Model combines all factors related to a child’s _______.

Answer 8

[health condition]

The ICF-Model includes aspects like body functions, activities, environmental factors, and personal factors.

Question 9

Consideration 1: Age and Development

Answer 9

1. Not always information on ‘before’ functioning
2. Not always imaging data
3. More variety between ages

Question 10

There is no such thing as a child – Winnicot, 1965

Answer 10

• Children function in relationship to their primary caregivers
• Parents can be the causes and cures of psychological problems in children
• Focus on the relationship between child and caregivers
• Children form different relationships with different caregivers.
• Children may exhibit symptoms in their relationship with one caregiver but not in their
  relationship with another caregiver.

Question 11

Consideration 2: Child in Context

Answer 11

Environment on body functions →Child with CP and Fine Motor functioning With or without resources
Environment on Activities →Child with Dyslexia and Reading skills
With and without individual learning support
Environment on Participation →Child with ASD and Social Inclusion
With and without socially supportive environment

Question 12

What is the role of parents in the neuropsychological assessment process?

Answer 12

• Providing information about daily problems
• Observing during rehabilitation
• Listening to medical caregivers

Parents are seen as experts of their own child and integral to rehabilitation outcomes.

Question 13

What are the steps in the diagnostic cycle for neuropsychological assessment?

Answer 13

• Referral
• Intake
• Screening
• Hypothesis
• Assessment
• Analysis
• Report

Each step is crucial for thorough evaluation and understanding of the child’s needs.

Question 14

Intake

Answer 14

• Medical history
  – Complications during pregnancy or birth
  – Other medical complications, genetic diseases
• Developmental history
  – Acquired: pre-insult development
  – Developmental: problems during development
• Activities and participation
  – Limitations and restrictions that were observed
• Environmental factors
  – Family structure, family coping
  – Perception of child & problems
  – School/class structure, behaviour in school
• Personal factors
  – Character, interests

Question 15

When you do a screening?

Answer 15

• When the referral question is too broad
• To get a first picture/look at the patient
• To evaluate the overall cognitive profile (also strengths)

Question 16

What are the tests/methods for screening?

Answer 16

• Observations at home or at school
• Neuropsychological Screening
• Intelligence / developmental tests
  – Wechsler Intelligence Scale for Children (WISC): age6–16y
  – Wechsler Preschool and Primary Scale of Intelligence (WPPSI): age 2 – 6 y – Bayley Scales of Infant and toddler Development (BSID): age 0.6 – 2 y

Question 17

What is the age range for the Wechsler Intelligence Scale for Children (WISC)?

Answer 17

6 – 16 years

This assessment can be conducted using pen-paper or iPads.

Question 18

List the five indexes measured by the WISC-V Intelligence Test.

Answer 18

• Total IQ
• Verbal Comprehension Index (VCI)
• Visual Spatial Index (VSI)
• Fluid Reasoning Index (FRI)
• Working Memory Index (WMI)
• Processing Speed Index (PSI)

Each index provides insights into different aspects of cognitive functioning.

Question 19

True or False: Damage to a developed brain is easier to assess than damage to a developing brain.

Answer 19

True

Clear differences in functioning before and after damage can typically be identified in developed brains.

Question 20

What are the seven core subtests of the WISC-V Intelligence Test?

Answer 20

• Block Design
• Matrix Reasoning
• Digit Span
• Coding
• Visual Puzzles
• Figure Weights
• Symbol Search

These subtests are used for screening and contribute to Total IQ and Index Scores.

Question 21

What does the Total IQ represent in the WISC-V?

Answer 21

The overall measure of intelligence derived from various index scores

Total IQ is calculated from scores across different cognitive domains.

Question 22

Define the Verbal Comprehension Index (VCI).

Answer 22

A measure of crystallized intelligence assessing word knowledge and verbal reasoning

Similarities & Vocabulary

The VCI evaluates a child’s ability to access and apply acquired word knowledge.

Question 23

What does the Visual Spatial Index (VSI) assess?

Answer 23

Ability to evaluate visual details and understand visual spatial relationships

Block design & Visual puzzles

VSI is crucial for constructing geometric designs from models.

Question 24

What does the Fluid Reasoning Index (FRI) measure?

Answer 24

The ability to detect underlying conceptual relationships and apply reasoning

matrix reasoning & figure weights

It involves inductive and quantitative reasoning.

Question 25

What is assessed by the Working Memory Index (WMI)?

Answer 25

Registration, maintenance, and manipulation of visual and auditory information Digit span & picture span ## Footnote WMI reflects attention, concentration, and mental control.

Question 26

What does the Processing Speed Index (PSI) evaluate?

Answer 26

Speed and accuracy of visual identification, decision-making, and implementation coding & symbol search ## Footnote PSI assesses short-term visual memory and cognitive flexibility.

Question 27

Fill in the blank: The _______ is a measure of the child’s ability to recall numbers in various orders.

Answer 27

Digit Span ## Footnote It includes forward, backward, and sequencing tasks.

Question 28

What is the significance of standard deviation in WISC-V scoring?

Answer 28

It indicates the variability of scores around the mean ## Footnote Standard deviation helps to interpret individual scores in relation to normative data.

Question 29

True or False: Low scores on the WISC-V always indicate cognitive impairment.

Answer 29

False ## Footnote Low scores can occur within the normal population and may depend on various background variables.

Question 30

What cognitive functions might be impaired if a child has a low score in the Verbal Comprehension Index?

Answer 30

* Information retrieval * Ability to reason and solve verbal problems * Communication of knowledge ## Footnote Low scores in VCI can indicate difficulties in accessing and applying language skills.

Question 31

What considerations should be taken when developing a test battery?

Answer 31

* Type of Test Battery * Multiple tests per function * Order of the tests * Where to start and stop ## Footnote Considerations ensure comprehensive assessment tailored to the child's needs.

Question 32

Fill in the blank: The _______ assesses the child’s ability to view a scale with missing weights and select options to keep it balanced.

Answer 32

Figure Weights ## Footnote This task is part of the Fluid Reasoning Index.

Question 33

What are some potential comorbidities to consider when diagnosing cognitive profiles?

Answer 33

* Attention Deficit Hyperactivity Disorder (ADHD) * Dyslexia * Autism Spectrum Disorder (ASD) * Developmental Coordination Disorder (DCD) ## Footnote Comorbidities may complicate the interpretation of cognitive assessments.

Question 34

What does the term 'Task Impurity Problem' refer to?

Answer 34

The challenge of designing tasks that assess only one cognitive function ## Footnote Many tasks inadvertently assess multiple cognitive skills simultaneously.

Question 35

What is the role of observations in cognitive assessments?

Answer 35

* Appearance * Behavior * Motivation * Alertness ## Footnote Observations provide context for test performance and help identify potential issues.

Question 36

What is the purpose of integrating observations and test scores?

Answer 36

To determine if the measured function aligns with the intended assessment goals ## Footnote Integration aids in identifying cognitive strengths and weaknesses.

Question 37

What does CVI stand for?

Answer 37

Cerebral Visual Impairment ## Footnote CVI refers to visual impairment resulting from damage to the brain rather than the eyes.

Question 38

What are some key impairments associated with developmental disorders?

Answer 38

* Impaired communication * Impaired executive functioning * Impaired reading skills * Impaired motor skills * Impaired visual perception * Developmental language disorder * Autism Spectrum Disorder (ASD) * Developmental Coordination Disorder (DCD) ## Footnote These impairments can affect a child's ability to function in daily life.

Question 39

What is the first intervention focus for a child with visual impairment?

Answer 39

Identify the main problem or disorder ## Footnote Addressing the primary issue helps in creating an effective intervention plan.

Question 40

What is included in a written report for assessment?

Answer 40

* Background * Intake * Test results * Observations * Summary * Conclusions * Recommendations ## Footnote A comprehensive report aids in understanding the child's condition and planning further actions.

Question 41

What is the importance of conversation with the patient or their guardians during the assessment?

Answer 41

Gathering 'good news' and addressing their questions ## Footnote This conversation helps in understanding the family's perspective and concerns.

Question 42

What factors influence the assessment and rehabilitation plan?

Answer 42

* Medical condition * Functions * Limitations * Personal factors (age) * Environment (context) ## Footnote These factors are essential for tailoring interventions to the individual child's needs.

Question 43

True or False: Age and context do not influence functions, activities, and participation.

Answer 43

False ## Footnote Age and context are significant factors in shaping a child's abilities and experiences.

Question 44

Why is a first screening important?

Answer 44

To have an overview and give direction ## Footnote Early screening helps in identifying key areas of concern and planning further assessments.

Question 45

What is the role of clinical observations during tests?

Answer 45

Essential for interpreting the scores ## Footnote Observations provide context for understanding a child's performance beyond numerical scores.

Question 46

What should always be kept in mind during neuropsychological assessments?

Answer 46

Differential Diagnosis: The process of distinguishing between two or more conditions that share similar symptoms, to accurately identify the cause of the issue. Growing into Deficit: When a developmental disorder or brain injury is not immediately apparent, but its effects become more noticeable as the child grows and more complex skills are required. ## Footnote These considerations help ensure accurate diagnosis and effective intervention strategies.

Question 47

Fill in the blank: Child neuropsychology is a complex _______.

Answer 47

[puzzle] ## Footnote The complexity arises from the interplay of various cognitive, emotional, and developmental factors.

Question 48

Consideration 3: Task Impurity Problem

Answer 48

It is impossible to design a task which assesses only one function – Because of the design of the task: – Because of the (behaviour/needs of the) specific child * Overall observations: – Appearance – Behaviour – Motivation – Alertness: tired? * Task/Function specific observations – Motor: Handedness, pen grip, walking the stairs – Language:speech,comprehensionofinstructions – Perception: viewing distance, squinting eyes, tripping, missing information – Memory:Rememberinginstructions,secondassessment – ExecutiveFunctions:Planning,checkinganswers,impulsivity,processingspeed – Attention: distracted by internal or external cues?

Question 49

Analysis and interpretation

Answer 49

1. Scoring - converting to norm scores – classification - interpretation 2. Is a low score always an indication of an impairment? – Lowscorescanbefrequentlyfoundwithinthenormalpopulation – Thechanceoffindinglowscoresincreaseswiththenumberoftestsbeingconducted – Low scores may depend on background variables of the child (SES, ethnicity, age, gender) 3. Integration of observations and test scores: did you measure the function you aimed for? 4. Analysis on item, (between/within) subtest, (between/within) function level 5. Interpretation of test results in light of daily functioning/problems 6. Does the cognitive profile fit with a neurodevelopmental disorder?

Question 50

Consideration 4: Differential diagnosis

Answer 50

* Comorbidity or causal relationship between functions? Dyslexia * How to deal with differential diagnoses? * Make clear hypothesis: What cognitive profile do you expect per disorder? * Use a multi-method assessment design (structured interview, tests, observations) * Do literature research on frequent comorbidities * After your assessment, ask yourself (or the parents): Attention Deficit Hyperactivity Disorder (ADHD) cation Cerebral Visual Impairment (CVI) Impaired communi Impaired Impaired Executive Functioning Reading skills Autism Spectrum Disorder (ASD) Developme ntal Coordinatio n Disorder (DCD) Developm ental Language Disorder Impaired Visual Perception * What function/disorder is the main problem for this child? * What should our first intervention focus on? * What other functions are important contributing factors?

Question 51

Conclusions

Answer 51

Child neuropsychology is a complex puzzle * Age and context influence functions, activities and participation But also give direction to the assessment and rehabilitation plan * A first screening is important to have overview and give direction * Clinical observations during tests are essential to interpret the scores * Always keep all factors in mind, including Differential Diagnosis and Growing into deficit