Comprehensive Psychoeducational and Neuropsychological Assessments for Children

1. Psychoeducational Testing, Learning Disabilities, and School Consultation Courtenay Rourke Ainsworth, Ph.D. Pediatric Neuropsychologist Licensed Clinical Psychologist courtenayainsworth@gmail.com

2. Pediatric Evaluations • School Case Study- team approach including assessment of vision, hearing, social & emotional status, intelligence, academic skills, communication skills, motor abilities • Psychoeducational- IQ, achievement, parent & teacher behavioral checklists, observation • Neuropsychological- cognitive profile in the context of brain/behavior relationship • Neurodevelopmental- assessment of milestone acquisition & trajectories; not predictive of later IQ

3. Conditions & Issues Commonly Referred for Neurodevelopmental/Neuropsychological Assessment • Neurological conditions such as stroke, epilepsy, brain tumors, disorders of movement (e.g., cerebral palsy) • Head trauma • Attention-Deficit/Hyperactivity Disorder • Behavioral problems • Learning disorders • Developmental delay • Socialization difficulties

4. Other Conditions/Issues (continued) • Chromosomal/Genetic disorders • Toxic exposure (in utero & environmental) • Medical conditions such as metabolic disorders, HIV infection, liver disease, renal disease, sickle cell anemia • Perinatal trauma

5. Uses of Neuropsychological Assessment • Differential diagnosis • School-based psychoeducational evaluation will not provide diagnosis • Baseline status secondary to neurological disease, injury, or abnormality affecting cerebral function • Progression of disease/recovery of function over time; measurement of treatment response • Determining cognitive strengths & weaknesses for educational placement • Clarify significance of pathology on “real life” functioning (e.g., academics, social)

6. Uses of Neuropsychological Assessment • Provide information relevant to management, rehabilitation, and treatment planning (e.g., strategies to help compensate for deficits; need for modified school program) • Capacity for functional independence such as driving, decision-making, & independent living • Legal/forensic issues- Litigation around a patient’s cognitive status

7. Neurodevelopmental Testing • Used to assess infants and young children in order to examine early development to see if it is on track

8. NEPSY-II

9. Pediatric Neuropsychological Evaluation • Intellectual Functioning • Academic Achievement • Attention and Concentration • Verbal and Visual Memory • Problem Solving Skills • Receptive and Expressive Language • Visual-Perceptual Abilities • Sensorimotor Skills • Personality and Emotional Status • Behavioral Functioning

10. The Neuropsychological Evaluation • Portable: 4-7 hours • Individually tailored; hypothesis testing • Objectively scored • Standardized, valid, and reliable • Can be modified • Quantitative and qualitative interpretation • Task performance is analyzed to determine component processes

11. Intelligence Testing • Wechsler Intelligence Scale for Children-IV • Verbal Comprehension Index • Perceptual Reasoning Index • Working Memory Index • Processing Speed Index 120+ Superior 110-119 High Average 90-109 Average 80-89 Low Average 70-79 Borderline 69 - Mental Retardation

12. WISC-IV Verbal Questions • Vocabulary • What is a clock? • What does garrulous mean? • Similarities • In what way are an apple and a banana alike? • In what way are reality and a dream alike? • Information • At what temperature does water boil? • What is the capital of France? • Comprehension • Why do people wear seatbelts? • Why do we put stamps on letters?

13. WISC-IV Matrix Reasoning

14. WISC-IV Matrix Reasoning

15. WISC-IV Coding

16. Academic Achievement • Reading- word identification, comprehension, non-word decoding • Math- calculation & application • Spelling words to dictation • Written expression • Academic fluency- timed reading, math, & writing

17. WJ – Reading Fluency

18. 0 3 4 2 WJ – Math Fluency

19. Memory Functions • Immediate verbal/auditory retention span • Learning over trials • Efficacy of retrieval- spont. & cued • Long-term memory • Remote memory *Not assessed in a psychoeducational evaluation

20. Memory Evaluation • Children’s Memory Scale • California Verbal Learning Test/CVLT-C • Rey-Osterreith Complex Figure Test Encoding Storage Retrieval

21. Verbal Memory Tests • Associated with left temporal-limbic function • Narrative Memory(Children’s Memory Scale) • Structure and semantic context • Immediate & Delayed Memory • Recognition • Serial Learning Tests (California Verbal Learning Test) • Attention • Learning- benefit from repeated trials • Chunking/clustering • Immediate, Cued, Delayed Memory • Recognition

23. “Frontal” Errors on Memory Testing • Impoverished learning strategies • Intrusions and perseverations • Poor retrieval strategies • Difficulty with temporal tagging (proactive & retroactive interference) California Verbal Learning Test particularly helpful

24. Visual Memory Tasks • Associated with right temporal-limbic function • Brief Visuospatial Memory Test • Learning trials • Delayed Memory (30 minutes) • Recognition • Rey Complex Figure • Copy • Immediate (3 minutes) • Delayed (30 minutes) • Recognition

29. Rey Complex Figure

32. Evaluation of Attention/Concentration • Test of Everyday Attention for Children • Conner’s Continuous Performance Test • Trail Making Test *Not assessed in a psychoeducational evaluation

33. Trail Making Test- A

34. Trail Making Test (Part B)

35. Trail Making Test: B

36. Executive Functioning *Associated with frontal-subcortical circuitry • Goal formulation • Initiate, maintain, switch, & inhibit • Mental flexibility • Planning & organization • Decision making • Self-monitor, self-correct, & persist • Nonverbal problem-solving *Not assessed in a psychoeducational evaluation

37. Executive Function • Tests of Executive Function • Wisconsin Card Sorting Test • Similarities, Interpretation of Proverbs • Children’s Category Test • Tower of London • Critical for adaptive, independent living

38. Wisconsin Card Sorting Test (WCST)

40. Language Functions • Auditory & verbal comprehension • Vocabulary • Verbal fluency, volume, rate • Articulation • Naming • Pragmatic skills, prosody, gestures

41. Evaluation of Language Function • Verbal/Semantic Fluency • Peabody Picture Vocabulary Test • Expressive One Word Picture Vocabulary Test • Boston Naming Test • Sentence Repetition • Clinical Observation

43. Visual Perceptual Skills • Visuoconstruction • Patterns/sequences • Location in space • Facial recognition/Facial expressions • Visual abstract reasoning • Personal space • Integration/organization • Attention to visual details

44. Visual-Spatial Tasks • Judgment of Line Orientation • Visual Motor Integration • Test of Visual Perceptual Skills-Revised • Test of Facial Recognition

45. Judgment of Line Orientation

47. Visual Motor Integration

48. Visual Motor Integration