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School Neuropsychological Evaluation

James B. Gillock, Ed.D. ABSNP Certified School Psychologist

Licensed Psychologist-PA & NJ

What is School Neuropsychology?

!  Integration of neuropsychological & educational principles in assessment and intervention with pre-school to school-aged students, aged 3-21 for the following purposes:

Purposes of School Neuropsychological Evaluation

!  Provides understanding of brain-behavior principles that play important role in: " Facilitating learning & behavior

" Curriculum development " Classroom design "  Integration of differentiated instruction

" Providing optimal learning environment for every child

American Board of School Neuropsychology

2436 S, I35E, Suite 376-114 Denton, Texas 76205

940-497-2276

New Concept of Intelligence

!  Concept of Learning-encompasses the integration of multiple neurobehavioral factors that rely on critical processes, including sensory-perceptual, attention, executive functions, memory, language and motor output. These neurobehavioral constructs collectively give rise to what has historically been known as “intelligence.”

Outline for School Neuropsychological Evaluation

!  I. Reason for Referral " Clarification of why child is being referred " Statement of questions parents & teachers want

answered

#  School Psychological Evaluations often are canned, routine testing formats that fail to consider the reason for referral or answer important questions. Frequently, just determine if child is eligible for special education.

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II. Background Information

!  Medical/Developmental History !  Family History !  Educational History !  Social History !  Previous Assessment Results "  It is important to interpret current test

results in light of a child’s history to understand progression of symptoms

III. Mental Status Evaluation

!  Observation of Student in Classroom & Testing Environment

!  Interview of Teachers & Parents !  Level of Alertness/Attention & Memory !  Remote Memory

!  Orientation to Time, Place & Person

Language

!  Fluency of Speech !  Articulation !  Length of Utterance

!  Appropriateness of volume, pitch & prosody

!  Use of grammar

!  Use of Neologisms

!  Language Comprehension

!  Naming !  Language Repetition !  Presence of Paraphasic

Errors

Mental Status Evaluation (continued)

!  Right/Left Orientation !  Geographic

Orientation

!  Ideomotor Apraxia-inability to carry out a motor act/gesture on verbal command

!  Ideational Apraxia-inability to recall sequence of motor acts

!  Constructional Dyspraxia-Inability to write due to deficits with visual spatial synthesis of written language production

Sensory-Perceptual Exam

!  Vision Testing !  Hearing Testing !  Testing for Visual Field Neglect !  Testing for Auditory Neglect !  Testing of Somatosensory Strip

" Finger Agnosia

" Stereognosis " Graphesthesia

Mental Status Evaluation (continued)

!  Gross Motor (balance, skipping, heel-to-toe walk, ability to negotiate space)

!  Logic & Abstraction !  Delusions & Halluciations !  Affect

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IV. Assessment of Attention

!  Auditory Attention "  Selective Attention-ability to

monitor & orient oneself to relevant stimuli

"  Sustained Attention-ability to maintain attention during continuous activity

"  Divided Attention "  Shifting Attention "  Inhibition of Attention

!  Visual Attention "  Selective Attention "  Sustained Attention "  Divided Attention-ability to

attend to multiple tasks simultaneously

"  Shifting Attention-Switching from one task to another

"  Inhibition of Attention-ability to inhibit attention to non-target stimuli

V. Assessment of Executive Functions

!  Cognitive EF "  Processing Speed &

Efficiency

"  Initiation & Conceptual Shifting

"  Planning, Organizing & Self Monitoring

"  Retrieval Fluency "  Motor Programming

!  Emotional EF "  Motivation, Goal

Directed Behavior & Drive

"  Impulse Control/ Disinhibition & Internal Emotional States/Empathy

Executive Functions

!  Many sub-domains of EF are empirically derived

!  Labels based on clinical judgment & knowledge of brain-behavior relationships

!  LD/Executive Functions Disorder-Learning Disability subtype not recognized by DSM-IV

VI. Learning & Memory

!  Learning/Intelligence "  Influenced by many other cognitive constructs and

environmental factors such as: Prior learning opportunities; Sensory & Perceptual ability; Attention, EF and Memory

Working Memory

!  Definition-the ability to hold information in memory while manipulating and/or reorganizing the material.

!  Provides a good “snapshot” of the integrity of one’s memory

Memory (Continued)

!  Different networks involved in memory for Auditory-verbal material; Visual-verbal material; Visual-spatial material & Motor Memory

!  Different networks involved in Initial Registration/Consolidation & Retrieval

!  Test differences in how memory is measured: Free Recall or Cued Recognition

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VII. Language

!  Receptive Language "  Phonology

"  Semantics "  Grammar/Syntax

"  Pragmatics "  Listening

Comprehension

!  Expressive Language "  Phonology (Articulation

"  Semantics (Vocabulary) "  Grammar/Syntax

"  Pragmatics (Use of language for social purposes)

"  Discourse (Length of utterance)

Language (Continued)

!  Reading "  Phonology-decoding of

non-sense words "  Pragmatics-oral reading "  Decoding "  Fluency "  Comprehension

!  Written Expression "  Phonology-Sequential

Processing (Spelling) "  Fluency "  Semantics "  Grammar/Syntax "  Comprehension-ability

to convey ideas in writing

"  Organization of Thought & Content

VIII. Motor Skills

!  Fine Motor "  Manual Dexterity,

Coordination & Speed "  Complex Mechanical

Processes #  Writing #  Copying

!  Gross Motor !  Strength

"  Grip Strength

IX. Mathematics

!  Verbal "  Number Knowledge "  Counting "  Computation/Problem Solving "  Reasoning

!  Nonverbal "  Math Notation (knowledge of math signs) "  Computation "  Reasoning in time-space continuum

!  Visual-spatial

X. Social-Emotional

!  Personality Characteristics & Temperament " Parent rating scales " Self rating scales

" Clinical Interview " Projective measures

XI. Diagnostic Impressions

!  Medical/Neurological Implications "  Identify patterns (from historical data, mental status

exam, neuropsychological testing, observations & interviews, rating scales and clinical interview/projective testing) and their brain-behavior relationships

"  DSM-IV Diagnosis !  Educational Implications

"  Implications of findings for school functioning "  Eligibility for Special Education/Related Services "  Most appropriate eligibility category

!  Psycho-Social Implications

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XII. Intervention Strategies

!  Recommendations for Follow Up

!  Special Education Eligibility & Program Recommendations

!  Reading Approach

!  Writing Programs !  Math Programs !  Social-Emotional

!  General Classroom Recommendations "  Attention & Memory "  Executive Functions

"  Study Habits "  Testing