Capute & Accardo's Neurodevelopmental Disabilities in Infancy and Childhood: The Spectrum of Neurodevelopmental Disabilities (2) - Hardcover

Pasquale J. Accardo, M.D., is Professor of Pediatrics at Virginia Commonwealth University in Richmond. He received his medical degree from Downstate Medical Center, Brooklyn, New York; completed his pediatric residency at James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, and obtained his developmental pediatrics training at the John F. Kennedy Institute for Handicapped Children (now called the Kennedy Krieger Institute), an affiliate of Johns Hopkins University School of Medicine, Baltimore, Maryland. He is subcertified in neurodevelopmental disabilities in pediatrics by the American Board of Pediatrics. Dr. Accardo is the author and editor of several books including Attention Deficit Hyperactivity Disorder: The Clinical Spectrum (York Press, 2001); Austim: Clinical and Research Issues (York Press, 2000), and Developmental Disabilities in Infancy and Childhood, Second Edition, Volumes I and II (Paul H. Brookes Publishing Co., 1996).

Nathan J. Blum, M.D., Co-director, Behavioral Pediatrics Clinic, Medical Director, Center for Complex Medical Management, and Attending Physician, The Children's Seashore House of The Children's Hospital of Philadelphia; Assistant Professor, Pediatrics, Division of Child Development, University of Pennsylvania School of Medicine. Dr. Blum received his medical degree from The Johns Hopkins University School of Medicine and completed a residency in pediatrics at The Children's Hospital of Philadelphia. He completed a postdoctoral fellowship in developmental-behavioral pediatrics at The Children's Seashore House of The Children's Hospital of Philadelphia. He is Co-director of the Behavioral Pediatrics Clinic for management of common behavior problems in children at Children's Hospital. In addition to publishing in peer-reviewed journals, Dr. Blum is a co-editor of a textbook of pediatric primary care and is one of the authors of the Ask the Experts feature in Contemporary Pediatrics. His academic interests encompass common behavior problems in children, self-injurious behavior in children with developmental disabilities, and the coordinated management of behavioral, medical, and psychological problems in children with chronic illnesses.

Excerpted from Chapter 16 of Capute & Accardo's Neurodevelopmental Disabilities in Infancy and Childhood, Third Edition: Volume II. The Spectrum of Neurodevelopmental Disabilities, edited by Pasquale J. Accardo, M.D.

Copyright © 2008 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Neurodevelopmental disabilities are characterized by a spectrum of abilities and deficits, with associated behavioral and cognitive dysfunction ranging from subtle and focal to profound and pervasive. Psychological assessment is often an essential part of the diagnosis and management of children with neurodevelopmental disabilities because it can facilitate a more thorough understanding of the child's functioning, document developmental progress for future follow-up, help to predict future needs, and serve as a guide for intervention. Psychological assessment involves the dynamic integration of information from the child's history, observation in multiple settings, and the use of standardized psychometric tests. Performance on psychometric tests and standardized observations of behavior is compared with available normative data for age and gender. The tests used in psychological assessment of children with neurodevelopmental disabilities frequently include measures of intelligence, academic achievement, behavior, adaptive skills, language competence, attention, memory, and perceptual and motor skills (Mahone, 2005).

PURPOSES OF PSYCHOLOGICAL ASSESSMENT

Psychological assessment has five general purposes when used in children with neurodevelopmental disabilities. First, it is used to diagnose or classify. In children, this classification may have direct implications not only for medical and behavioral intervention but also for determining eligibility for special education services in the educational setting and ultimately for determining public policy. Second, it is used for prediction. Psychologists use assessment procedures to help document current skills and behavior and to help predict future patterns of skills and behaviors. In children with neurodevelopmental disabilities, an initial baseline assessment is often obtained early in the child's life, with planned follow-up assessments provided throughout the course of childhood in order to monitor progress and revise predictions and prognosis. Third, the psychological assessment can be used to qualitatively and quantitatively describe needs for intervention. Such interventions can be medical (e.g., use of stimulant medication), behavioral (e.g., behavior therapy), educational (e.g., specialized reading instruction), or physical (e.g., occupational therapy for fine motor needs). Fourth, psychological assessment is used to provide objective data in order to monitor responses to these types of intervention (e.g., introduction of stimulant medication, remedial reading). Finally, psychological assessment is used in research, often as a means to more carefully characterize the attributes of a specific population or to monitor treatment effects.

Psychological assessment is more than administration of psychometric tests (Matarazzo, 1990). A comprehensive approach to psychological assessment draws information from three primary sources—history, observations, and formal testing—while taking into account the unique life circumstances and the chronicity of illness seen in children with neurodevelopmental disabilities (Bernstein & Waber, 1990). Psychological assessment has welldocumented application in medical and educational settings. A recent meta-analysis on the use of psychological assessment procedures based on more than 800 samples concluded that the validity of psychological tests is strong and comparable with medical test validity (Meyer et al., 2001). The authors concluded that clinicians who rely solely on interview in their assessments are prone to incomplete understanding of patient functioning.

Psychological assessment of children with neurodevelopmental disabilities should be carried out by a psychologist who is experienced in working with children with disabilities. Psychologists are typically doctoral-level professionals who specialize in the scientific study of behavior, emotions, motives, and cognition. In recent years, however, psychologists have also begun to study the biological and physiological bases of behavior as a result of the emerging evidence of the interdependence of mind and body—and especially the relationship between brain development and behavior. Psychologists who specialize in working with children with neurodevelopmental disabilities have often obtained an additional 1-3 years of specialized training.

Although there are several branches of applied psychology (e.g., clinical psychology, counseling psychology, school psychology, neuropsychology), the core training in these professional areas is similar. The Health Care Financing Administration published a regulation defining the general term for purposes of participation in the Medicare program. A clinical psychologist is defined as an individual who 1) holds a doctoral degree in psychology and 2) is licensed or certified on the basis of that degree, by the state in which he or she practices, at the independent practice level of psychology to furnish diagnostic, assessment, preventive, and therapeutic services directly to individuals. Specific guidelines and legal requirements typically surround the administration and interpretation of psychological tests, and the user is encouraged to review the specific guidelines outlined by the American Psychological Association (APA) (2000).

NEUROPSYCHOLOGICAL ASSESSMENT

Because children with neurodevelopmental disabilities often have early disruption to brain development, they are frequently referred for neuropsychological assessment. Neuropsychological examinations are performed by psychologists who have undergone intensive training in the clinical neurosciences, including interrelationships among behavioral functions and neuroanatomy, neurology, and neurophysiology. Pediatric neuropsychologists have additional training and experience in the application of developmental and neuropsychological principles to children with neurological disorders. They typically work closely with consulting pediatric physicians and surgeons in the assessment of a child's neurological development and cerebral status. Pediatric neuropsychological assessment differs from school assessments. School psychological assessments are typically performed to determine whether a child qualifies for special education programs or therapies to enhance school performance and hence focus on academic achievement and skills needed for school success. In contrast, neuropsychological examinations diagnose learning or behavioral disorders caused by altered brain function or development (APA, 2001). Neuropsychological examinations are often clinically indicated for children with known congenital or acquired neurological disabilities and for those suspected of these conditions. The neuropsychological examination should be considered a valuable addition to the overall neurodiagnostic assessment that includes other techniques such as the neurological examination and appropriate laboratory tests.

CHALLENGES TO PSYCHOLOGICAL ASSESSMENT

Terminology

Because neurodevelopmental disabilities are conditions that involve early insult to or abnormality in the developing nervous system, the normal development of the nervous system in these children has often been altered, resulting in reorganization and competition for function. Functional impairments in some children are observed immediately, whereas in others, the full range of functional deficits may not manifest until later in life, even though the...