Neuropsychological Assessment Of Children Research Articles

Gender differences in cognitive development.

The potential effect of gender on intellectual abilities remains controversial. The purpose of this research was to analyze gender differences in cognitive test performance among children from continuous age groups. For this purpose, the normative data from 7 domains of the newly developed neuropsychological test battery, the Evaluación Neuropsicológica Infantil [Child Neuropsychological Assessment] (Matute, Rosselli, Ardila, & Ostrosky-Solis, 2007), were analyzed. The sample included 788 monolingual children (350 boys, 438 girls) ages 5 to 16 years from Mexico and Colombia. Gender differences were observed in oral language (language expression and language comprehension), spatial abilities (recognition of pictures seen from different angles), and visual (Object Integration Test) and tactile perceptual tasks, with boys outperforming girls in most cases, except for the tactile tasks. Gender accounted for only a very small percentage of the variance (1%-3%). Gender x Age interactions were observed for the tactile tasks only. It was concluded that gender differences during cognitive development are minimal, appear in only a small number of tests, and account for only a low percentage of the score variance.

Developmental Profile and Trajectory of Neuropsychological Skills in A Child With Kabuki Syndrome: Implications for Assessment of Syndromes Associated with Intellectual Disability

Kabuki syndrome (KS) is a rare genetic syndrome involving dysmorphic facial features, and reports of intellectual disability (ID). We examined the developmental trajectory of neuropsychological skills in a child with KS (seen at ages 4, 6, 7, 9, and 11). Examination of raw and age-corrected standard scores suggests that language-based skills developed appropriately, but visually based skills slowed and reached a plateau. Executive dysfunction and mood symptoms were also observed. While ID is described as a core feature of KS, some patients may not meet diagnostic criteria for ID, and may be better described as having specific deficits in nonverbal skills. Longitudinal neuropsychological assessment of children with KS and other syndromes associated with ID is warranted to understand the true prevalence of ID versus isolated cognitive impairments.

Development of aptitude at altitude

Millions of people currently live at altitudes in excess of 2500 metres, where oxygen supply is limited, but very little is known about the development of brain and behavioural function under such hypoxic conditions. We describe the physiological, cognitive and behavioural profile of a large cohort of infants (6-12 months), children (6-10 years) and adolescents (13-16 years) who were born and are living at three altitude locations in Bolivia ( approximately 500 m, approximately 2500 m and approximately 3700 m). Level of haemoglobin oxygen saturation and end-tidal carbon dioxide were significantly lower in all age groups living above 2500 metres, confirming the presence of hypoxia and hypocapnia, but without any detectable detriment to health. Infant measures of neurodevelopment and behaviour yielded comparable results across altitude groups. Neuropsychological assessment in children and adolescent groups indicated a minor reduction in psychomotor speed with increasing altitude, with no effect of age. This may result from slowing of underlying brain activity in parallel with reduced cerebral metabolism and blood flow, evidenced here by reduced cerebral blood flow velocity, particularly in the basilar artery, in children and adolescents. The proportion of European, Native American and African genetic admixture was comparable across altitude groups, suggesting that adaptation to high altitude in these children occurred in response to chronic hypoxic exposure irrespective of ethnic origin. Thus, psychomotor slowing is proposed to be an adaptive rather than a deficient trait, perhaps enabling accuracy of mental activity in hypoxic conditions.

The brief neuropsychological battery for children: a screening tool for cognitive impairment in childhood and juvenile multiple sclerosis

Background A critical problem with neuropsychological assessment in children and adolescents with multiple sclerosis (MS) is the absence of a standardized, well-validated neuropsychological battery specifically tailored for detecting disease-related cognitive problems in this age range. Objective To develop a Brief Neuropsychological Battery for Children (BNBC) with MS. Methods We assessed cognitive functions in 61 patients with childhood and juvenile MS and 58 demographically matched healthy controls through an extensive neuropsychological battery. Results In MS patients, we found a proportion of cognitive impairment of 41%. In the BNBC, we included the tests with higher discriminating ability (the Selective Reminding Test, the Symbol Digit Modalities Test, the Trail Making Test, and the Vocabulary test from the Wechsler Intelligence Scale for children). The BNBC yielded a sensitivity of 96% and a specificity of 76%. Conclusion Our findings provide preliminary evidence of the usefulness of the BNBC as a screening tool for detecting cognitive impairment in childhood and juvenile MS cases.

State of Multicultural Neuropsychological Assessment in Children: Current Research Issues

Scientific attention to cultural considerations in child neuropsychological assessment has not developed parallel to the focus these issues have received in adult and elderly neuropsychological assessment. There are limited data on the presence, magnitude, etiology, and implications of culture-related differences in cognitive test performance among children. This preliminary report reviews the available empirical literature on the current state of multicultural neuropsychological assessment in children. The review identified articles by searching PubMed and PsycINFO databases, and the tables of contents of Developmental Neuropsychology and Child Neuropsychology from 2003-2008. Of the 1,834 abstracts reviewed, ten papers met inclusion criteria for the review. Five studies were completed in America; four of these compared performance between ethnic groups while the fifth examined neighborhood level poverty indicators exclusively within African-American children. Of the five international studies, all established local normative data and/or were exploratory investigations of neuropsychological functions in specific cultural groups, including Taiwanese infants, South African youth, and bilingual British children. Taken together, the results yield important clinical and research data that begin to inform many of the complex and fascinating mechanisms by which ethnic identity and culture impact cognitive development and the neuropsychological assessment of children. A critique of the existing literature and directions for future research are provided.

Learning Disabilities Spectrum and Sexual Dimorphic Abilities in Girls with Congenital Adrenal Hyperplasia

Congenital adrenal hyperplasia could provide a promising model for the study of the effects of hormones on cognition. The aim of this study was to assess sexual dimorphic abilities related to oral language, spatial abilities, and verbal fluency and to determine the existence of learning disabilities in 11 congenital girls with adrenal hyperplasia compared with 11 healthy girls. Both groups underwent a neuropsychological evaluation using the Child Neuropsychological Assessment battery for Spanish-speaking children. Results showed that the congenital adrenal hyperplasia group had a significantly lower performance than the control group in the repetition and expression domains, right-left comprehension task, and verbal semantic fluency task. A higher incidence of learning disabilities (predominantly reading related) in the patient group compared with their controls was also evident. Thus, the presence of weak verbal areas along with a high incidence of learning disabilities related primarily, though not exclusively, to reading was documented in these girls.

Taking a Systemic Perspective on Cognitive Assessments and Reports: Reflections of a Paediatric and Adolescent Psychology Service

This article discusses current approaches in the neuropsychological assessment of children and young people. An audit of assessments found that nearly a quarter of referrals for neuropsychological assessments could have been resolved more effectively without completing a cognitive assessment. The audit also found that families and young people often found the report difficult to understand or unhelpful. We highlight the difficulties we have had with specific aspects of this process in a paediatric and adolescent medicine psychology service, and discuss the approaches we have taken in the light of feedback from children, young people and parents. The article describes how a systemic framework has been used in processing and responding to referrals. It also gives case examples illustrating how systemic theory and principles have been incorporated into the written reports. Families have responded very favourably to the use of creative and child friendly language in the feedback.

Non-Verbal Learning Disabilities in Children with Infantile Hydrocephalus, Aged 4 - 7 Years: A Population-Based, Controlled Study

The aim of this population-based, controlled study was to investigate non-verbal learning disabilities (NLD) in children with infantile hydrocephalus (IH). For this purpose, the results from subtests measuring either assets or deficits within Rourke's model of NLD were analyzed. Children with myelomeningocele (MMC), intracranial tumors, or IQ < 70 were excluded. Of the 52 IH children included in the study, 46 were shunt-treated, whereas 6 were not shunted. The 44 controls were matched according to age, gender, and geographic variables. The Neuropsychological Assessment of Children (NEPSY) was administered to 52 children (age 4-7) with IH; (F = 17, M = 35), and to 44 controls (F = 17, M = 27). The tests used were classified along each of the dimensions "assets" or "deficits", according to Rourke's model of the elements and the dynamics of the NLD syndrome. Differences between sum scores for the subtests classified as "assets", versus "deficits" were significantly higher in the IH group as compared with the controls (p < 0.005). These findings are compatible with a higher frequency of NLD in the IH group, in which neurological confounding factors have been excluded. In addition, the model of the elements and the dynamics of the NLD syndrome may be useful when analyzing neuropsychological test results obtained with traditional and comprehensive test batteries.

Children exposed to valproate in utero—Population based evaluation of risks and confounding factors for long-term neurocognitive development

Purpose: To evaluate neurological and cognitive functioning of school-aged (≥6 years) children exposed to valproate monotherapy in utero in a population based, evaluator-blinded, controlled study. Methods: Studied children ( N = 39, aged 6.6–13.4 years) and their mothers were identified through a population based pregnancy registry. Mothers with carbamazepine monotherapy and mothers with epilepsy but without antiepileptic drug (AED) treatment during pregnancy and their age and gender matched children served as controls. Hospital records were reviewed and neurological examination (Touwens test), intelligent quotients (IQ) of mothers (WAIS), and children (WISC-III) and neuropsychological assessment of children (NEPSY) were performed evaluator-blinded. Results: The prevalence of low intelligence (FIQ < 80) was 19% (4/21) and the prevalence of exceptionally low intelligence (FIQ < 70) 10% (2/21) in valproate (VPA) monotherapy exposed children. Children exposed to carbamazepine (CBZ) and children of women with epilepsy but without AED exposure during pregnancy had all at least low average intelligence. The mothers using valproate scored significantly lower ( p < 0.05) in FIQ, VIQ and PIQ tests and had also significantly lower ( p = 0.035) educational level. Altogether 21% (8/39) of the children had minor neurological dysfunctions. Conclusions: In a population based setting inheritance and cumulating environmental factors may partly explain the increased prevalence of neurocognitive symptoms in children exposed to valproate in utero although concern about the possible long-term effects of intrauterine valproate exposure does exist.

Repeated Assessment of Cognition in Children and the Measurement of Performance Change

There is limited understanding of the problems associated with repeated neuropsychological assessment in children, including the statistics used to guide decisions about cognitive change. This study investigated the utility of a computerized assessment battery that was specifically designed for the repeated assessment of cognitive function in children. Eighty-seven participants aged 8 to 12 years completed the battery four times within a 2-hour testing session. The results support the application of this assessment battery for measuring cognitive change in children. A novel method for calculating measurement error is employed, and its use in the detection of cognitive change in individual children is discussed. An estimate of the measurement error within each of the tests is provided, and recommendations are made regarding the application of this assessment battery for measuring cognitive change in children.

COPY AND RECALL PERFORMANCE OF 6–8-YEAR-OLD CHILDREN AFTER STANDARD VS. STEP-BY-STEP ADMINISTRATION OF THE REY-OSTERRIETH COMPLEX FIGURE

The Rey-Osterrieth Complex Figure (ROCF; Rey 1941; Osterrieth, 1944) is frequently used in the neuropsychological assessment of children and adults. The present study was designed, in part, to examine the impact of providing organizational scaffolding to young children being tested with the ROCF. To this end, 6-, 7-, and 8-year–old children were administered the test either in the standard fashion, or using a format in which the 18 key elements of the figure were introduced sequentially. Participants included 132 children who were randomly assigned to the standard or step-by-step administration groups. Significantly higher accuracy and organization scores for both copy and recall were seen with the step-by-step format than with the standard format, even though children in the step-by-step condition took less time to execute their drawings. Retention of encoded information was not affected by age or testing format. The fact that 6-year-olds in the step-by-step condition performed as well as, or better than, 8-year-olds in the standard condition suggests that the primary problem young children experience with the ROCF lies with organizational strategy formation. Advantages of using the Step-by-step ROCF in clinical practice are discussed. This research was supported by NSERC grant no. 138829-01 to LSJ. The authors would like to thank the children who participated in this research, and their families, for their time and effort.

Avaliação neuropsicológica da criança

OBJETIVO: O objetivo deste trabalho e descrever a metodologia empregada na avaliacao neuropsicologica de criancas e suas contribuicoes, priorizando aqueles aspectos de interesse dos profissionais da area da saude, em especial pediatras, psicologos, psiquiatras, neurologistas. FONTE DOS DADOS: Revisao da literatura sobre o tema proposto nos ultimos anos e incluidas referencias de livros texto e manuais dos testes imprescindiveis para a compreensao do exame neuropsicologico e aporte da experiencia da Unidade de Neuropsicologia do HSL - PUCRS. SINTESE DOS DADOS: A avaliacao neuropsicologica nao se limita a aplicacao de testes psicometricos e neuropsicologicos organizados em baterias, mas objetiva, tambem, avaliar a relacao destes achados com a patologia neurologica e/ou comportamental e em estabelecer a possivel area cerebral envolvida. Adicionalmente, a interpretacao cuidadosa destes resultados deve ser associada a analise da situacao atual do sujeito e do contexto onde vive. CONCLUSAO: O resultado final deve fornecer um perfil neuropsicologico do paciente que, combinado a avaliacao dos aspectos neurologicos/clinicos, psicologicos e sociais, permitira auxiliar no seu diagnostico e/ou orientar sobre o melhor aproveitamento de suas potencialidades.

Neuropsychological assessment in children

Neuropsychological assessment in children

Neuropsychological assessment in children

To describe the methods used for neuropsychological assessment in children, emphasizing aspects of interest to pediatricians, psychologists and neurologists. Review of the published literature concerning neuropsychological assessment, including textbooks and reference manuals. The experience of the Neuropsychology Unit at Hospital São Lucas, Brazil, is described. Neuropsychological assessment should not be limited to the application of psychometric and neuropsychological tests; it should also correlate test findings with the neurological/behavioral disorder and establish which part of the brain is likely to be involved. In addition, the careful interpretation of result must be associated with an evaluation of the individual's current status and of the context in which s/he lives. The final result of neuropsychological assessment should be a neuropsychological profile of the patient, which, in combination with the evaluation of neurological/clinical, psychological and social aspects will contribute to diagnosis and provide elements to guide the patient in terms of maximizing his/her potential.

Utilizações da WISC-III na avaliação neuropsicológica de crianças e adolescentes

Este texto pretende evidenciar os principais contributos da Terceira Edição da Escala de Inteligência de Wechsler (WISC-III) para a avaliação neuropsicológica de crianças e adolescentes. Alguns indicadores são objeto de exploração: Quociente Intelectual da Escala Completa, Quociente Intelectual verbal, Quociente Intelectual de realização, discrepância(s) entre QIv e QIr, Índices Factoriais, análise por subteste,variabilidade inter-testes, formas reduzidas, avaliação do nível de funcionamento cognitivo pré-mórbido, testes neuropsicológicos e funções psicológicas examinadas a partir da WISC-III. Neste contexto, são revistos alguns dos principais estudos com grupos clínicos de crianças com lesão cerebral traumática, cancro, espinha bífida, hidrocefalia, epilepsia. É feita uma referência breve ao futuro próximo da investigação relativa à utilização neuropsicológica da WISC-III.

Neuropsychological assessment in children with cerebral palsy and dual sensory impairment

Neuropsychological assessment in children with cerebral palsy and dual sensory impairment

Neuropsychological assessment in children with cerebral palsy and dual sensory impairment

Neuropsychological assessment in children with cerebral palsy and dual sensory impairment

Applying Luria's diagnostic principles in the neuropsychological assessment of children.

The first part of this article examines the theoretical justification for applying Luria's approach in the assessment of children. It is concluded that Luria's concepts of functional systems and the principle of specifying primary and secondary deficits may be applied to children. However, the selection of functional components to assess should be based on traditions of child neuropsychology rather than on Luria's assessment of adults. In addition, the tendency for comorbid disorders, mechanisms of neural adaptation to damage, and the prevalent types of brain abnormality in children render brain-behavior relationships more complex in children than in adults. The second part of the article describes how Luria's methods were adapted for use with children. An assessment, NEPSY, was developed by integrating Luria's views with contemporary child neuropsychological traditions. The NEPSY includes 27 homogeneous and psychometrically developed subtests, standardized in the United States and Finland for the age range of 3 to 12 years. The rationale of analyzing disorders of cognitive processes through a comprehensive and systematic assessment of their components, characteristic of Luria's approach, was preserved, but more specific principles of diagnosis were modified. Research findings obtained with a previously published, Finnish NEPSY version are presented.

Specific attention and executive function deficits in the long-term outcome of severe closed head injury.

Twenty-eight children (mean age= 10.9 years, SD= 1.9 years) who had experienced a severe closed head injury were assessed for outcome on tests of intelligence, attention and executive function at 1 year post-injury. The children with closed head injury were matched with children from a normative sample for age and intellectual ability. Specific deficits in attention and executive function were found in the closed head injury sample. The importance of including these outcome variables in child neuropsychological assessment is supported.

Parent Perceptions About the Process and Outcomes of Child Neuropsychological Assessment

The purpose of this study was to evaluate the impact of child neuropsychological evaluations from the parent's perspective. Fifty-five parents of children with neurodevelopmental problems completed a 19-item questionnaire, indicating their assessment of the process and outcomes of the evaluation. Respondents reported an increased understanding of the child's impairments and strengths, greater knowledge about treatment strategies and community resources, improved school services, and a high level of overall satisfaction. The strongest predictors of overall satisfaction were (a) perceptions of the professional's concern and technical competence and (b) ratings of the recommendations provided. Child neuropsychological evaluations have the potential to improve child outcomes by influencing multiple systems of care, including family, health care providers, educational programs, and community service agencies.