Transcript No Slide Title

November 23, 2004
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What is it?
Who can benefit?
Reasons for making a referral
Referral Process
NP Testing – issues with children
Feedback Options
Presented by Richard DiPrima, Psy.D.
Licensed Clinical Neuropsychologist
Senior Instructor
University of Rochester Medical Center
What is Pediatric
Neuropsycholgy?
(American Psychological
Association,
Division
40 - Clinical
Neuropsychology)
• A specialty
profession
that focuses
on brain
functioning
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children.
A pediatric neuropsychologist is a licensed psychologist
with expertise in how learning and behavior are
associated with brain structures and systems.
Formal testing of abilities such as memory and language
skills assess brain functioning.
The pediatric neuropsychologist conducts the evaluation,
interprets the test results, and makes specific
recommendations.
A NPE assists in better understanding a student’s current
level of functioning. (Like a SNAPSHOT)
This information is used to assist a student’s teachers,
therapists, and physicians provide treatments and
interventions that meet his/her unique needs.
in
What is a Pediatric Neuropsychological
Evaluation ?
(American Psychological Association, Division 40 - Clinical Neuropsychology)
• In a NPE, brain function is objectively measured to better
understand how the brain is effectively directing an
individual’s behavior and learning.
• This involves a specialized assessment of verbal and
nonverbal abilities and general intellectual functioning
including:
 Attention & Concentration
 Learning and Memory
 Language skills (Expressive & Receptive)
 Visuospatial skills
 Motor coordination
 Executive function (Organization, Planning, Inhibition, Flexibility)
• A pattern of relative strengths and weaknesses is used in
important decision making to assist schools with providing
appropriate educational programs for students.
What is a Pediatric Neuropsychological
Evaluation ? Cont.
• A NPE is typically extensive and often
time-consuming and not all students
referred for a NPE will benefit from
this type of assessment.
• Therefore, the evaluator will carefully
consider, through consultation with the
referral source, the appropriateness of
each referral.
• The following information should
serve as guidelines for determining
whether a NPE could be beneficial.
When May a Student Benefit from a NP Referral?
• Students are typically referred by a doctor, teacher,
school psychologist, or other professional because
of one of the following reasons:
 Difficulties with learning, attention, behavior,
socialization, or emotional control.
 After a brain injury from an accident, birth trauma, stroke or
other physical stress.
 When recent or long standing, but poorly understood,
changes in a student’s cognitive and behavioral
functioning are noted.
 When the pattern of difficulties observed in the student have
not responded well to previous interventions (i.e., special
education services, medication or classroom interventions).
The student continues to demonstrate difficulties in
academic progress (i.e., failing to acquire reading skills),
despite interventions.
Students that May Benefit from a NP
Referral? (Page 2)
• A student with past or current history of the following:
 neurological involvement (e.g., epilepsy, brain tumor, stroke,
muscular dystrophy, cerebral palsy, focal deficits)
 genetic disorders (e.g., Turner’s or Kleinfelter’s Syndromes)
 head trauma, physical abuse and/or substance abuse
 neurotoxin exposure (e.g., lead, mercury, carbon monoxide),
nutritional deficiencies or infectious diseases
 childhood cancer survivors
 students that have difficulties with memory, attention or
learning in the presumed absence of any other significant
cognitive difficulty
 significant discrepancy between verbal and nonverbal skills
Who May NOT Benefit from a NPE?
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Students with profound and pervasive cognitive deficits that have been
formally screened and found to have Moderate to Severe Mental Retardation or
a known developmental disorder such as Autism or Down Syndrome.
Students whose behavior is so problematic that assessment is either invalid or
grossly unreliable such as students with severe oppositional and/or conduct
disorders or who are floridly psychotic.
Students who are over medicated should not be evaluated until their medication
is within normal limits.
Students who have been adequately evaluated in the past, are already
receiving appropriate remedial services and treatment, and have shown
improvement in their functioning.
– NOTE: It is important to recognize that each case has its own
unique circumstances and concerns. Therefore, there can be
exceptions and the above conditions may not necessarily apply.
These should serve as guidelines for determining whether a NPE
could be beneficial. Although a NPE often coincides with the
triennial evaluation, it is not part of the triennial assessment, but
instead is supplemental and completely voluntary.
• School assessments are usually
performed to determine whether a
student qualifies for special
education programs or therapies to
enhance school performance with
focus on achievement and skills
needed for academic success.
• Generally, they do not diagnose
learning and behavior disorders
caused by altered brain function or
development.
• Most referrals are made through the patient’s PCP and/or
neurologist for purposes of payment reimbursement by
insurance companies.
• In school settings, the referral source (e.g., teacher,
parent) talks with the school principal to ascertain
approval for payment by the district.
• The referral source completes the Request and Consent
Forms for NPE signed by parent/legal guardian.
• Once the forms are sent to the Mental Health Department
Program Coordinator and approved, they are forwarded to
the evaluator.
• The evaluator then begins the process, through
consultation with the referral source, of determining the
appropriateness of each NP referral and whether the
student would benefit from this service.
What does a Pediatric NPE involve?
• A multifaceted and thorough evaluation may involve the following:
 Ascertaining possession of signed consents from a parent/legal guardian or
student over 18 years of age before any direct contact with a referred student.
 Discussing with the referral source specific concerns about the student being
referred. Clarifying the specific referral question will guide the entire NPE
from the choice of testing materials to the provision of recommendations and
feedback.
 EX: Current level of cognitive and behavioral functioning, diagnostic clarification,
need for academic programming, behavioral management, etc.
 In children, this often involves making various collateral contacts with
individuals and professionals that know the child best with signed consent.
 Gathering further information by having parents and/or teachers complete
specific forms and/or questionnaires. Talking with parents/teachers to assess
functioning in the home and school.
What does a PED NPE involve? (Page 2)
• A multifaceted and thorough evaluation may involve the following:
 Clinical interview with the student and parent.
 Obtaining a thorough developmental history and get an understanding of
specific medical, social, behavioral, and academic concerns.
 Discussing the family’s expectations for the evaluation and clarify any
misconceptions.
 Observing how the student interacts in the classroom (if possible), during the
clinical interview, and throughout the evaluation period.
 Review available school records, medical records and any academic or previous
psychological testing.
 Evaluation of student’s current level of neuropsychological and behavioral
functioning, including general intellectual capacities, attention, concentration,
learning, memory, language skills, visuospatial skills, motor coordination,
achievement and executive function skills of organization, planning, inhibition,
and mental flexibility.
 NOTE: Some of these measures may have been recently assessed by other psycho-educational
professionals and it will be important for results of these components to be made available for
review. There should be a minimum of 6 months before re-administering a specific instrument
to minimize the adverse implication of practice effects.
What does a PED NPE involve? (Page 3)
• Other special issues involved in assessing children (Ryan et al):
 Building rapport and introducing the evaluation in an age-appropriate language.
 EX: Explain that while the child is having fun with the examiner, the parent will be
doing homework in the waiting area.
 Establishing “ground rules” to structure the testing session.
 EX: Discuss the use of short breaks in a way that makes the child feel in charge.
 Maintaining appropriate effort and motivation. This is challenging, but essential
to obtain valid test results. Importance of using a core battery that the examiner
is highly familiar with to maintain a good testing rhythm and on-task behavior.
 EX: “Snapshot”
 EX: Explain level of difficulty akin to videogames
 Give ongoing praise for effort.
 Interpreting results in view of behavioral observations
What will NPT Results Tell Me?
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By comparing the referred student’s test scores to scores of individuals of similar
ages, a profile of the student’s strengths and weaknesses is found and used to
assist those involved in the student’s care in the following ways:
 NPT results provide a better understanding of the student’s behavior and
learning in school, at home, and in the community.
 NPT results may explain why a student is having school problems.
 EX: A student may have difficulty reading because of an attention problem, a
language disorder, or a reading disability. Specific interventions may be
recommended to draw upon the student’s objectively found strengths and
remediate relative weaknesses based on the student’s learning style.
 NPT results can help detect the effects of developmental, neurological, and
medical problems, such as epilepsy, attention deficit hyperactivity disorder,
dyslexia, etc.. NPT may be done to obtain a baseline against which to
measure the outcome of treatment or the student’s development over time.
 Different disorders result in specific patterns of strengths and weaknesses.
These profiles can help identify a student’s disorder and the brain areas
that are involved.
 EX: NPT results can help differentiate between an attention deficit and
depression or determine whether a language delay is due to a problem in
producing speech, understanding or expressing language, social shyness, or
cognitive delay.
Feedback Options
• Feedback can be tailored based on the individual needs of
each patient, student, teacher, parent, etc.. It is important to
provide feedback in a language that is understandable to all
parties involved so that the recommendations are
successfully implemented. Typical feedback options include
the following:
 All NP reports are given directly to the parent/legal
guardian either through the mail with a number included
for contacting examiner with any questions or during a
face-to-face feedback session.
 A referral source may obtain a copy of the NP report
with a Consent to Release and Obtain Information
form that is signed by a parent/legal guardian or student
18 years of age or older and witness.
 Teachers, parents, and other service providers may also
wish to have a more formal feedback meeting that
includes representatives from the student’s educational
and/or medical team.
Thank
You !!