Handbook of Clinical Child Neuropsychologypractice of clinical child neuropsychology and to inte-grate these advances wherever possible into the updates of their chapters as well as

Handbook of Clinical ChildNeuropsychology

Third Edition

Handbook of Clinical ChildNeuropsychology

Third Edition

Edited by

Cecil R. ReynoldsTexas A&M UniversityCollege Station, TX, USA

and

Elaine Fletcher-JanzenPrivate PracticeCleveland, Ohio

1 3

Editors

Cecil R ReynoldsDepartment of Educational PsychologyTexas A&M UniversityCollege Station, TX, [email protected]

Elaine Fletcher-JanzenPrivate PracticeCleveland, [email protected]

ISBN: 978-0-387-70708-2 e-ISBN: 978-0-387-78867-8DOI 10.1007/978-0-387-78867-8

Library of Congress Control Number: 2008934608

# Springer Science+Business Media, LLC 2009All rights reserved. This work may not be translated or copied in whole or in part without the written permission of thepublisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerptsin connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval,electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed isforbidden.The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such,is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.While the advice and information in this book are believed to be true and accurate at the date of going to press, neither theauthors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. Thepublisher makes no warranty, express or implied, with respect to the material contained herein.

Printed on acid-free paper

springer.com

Contributors

Priscilla A. Bade-White � College of Educa-

tion, University of Arizona, Tucson, Arizona

85721, e-mail: [email protected]

Russell M. Bauer � Department of Clinical

HealthPsychology,UniversityofFlorida,Gainesville,

Florida 32610-0165

Thomas L. Bennett � Department of Psychol-

ogy, Colorado State University, Ft. Collins,

Colorado 80523

Richard A. Berg � Private Practice, Wilmington

Health Associates, Wilmington, North Carolina,

28401, e-mail: [email protected]

T. Carter Bethea � Department of Psychia-

try, University of North Carolina School of

Medicine, Chapel Hill, North Carolina 27599

David Breiger � Department of Psychiatry

and Behavioral Sciences, Children’s Hospital

and Regional Medical Center, University of

Washington School of Medicine, Seattle,

Washington 9810–2499

Ronald T. Brown � College of Health Profes-

sions, Temple University Health Sciences Cen-

ter, Philadelphia, Pennsylvania 19140, e-mail:

[email protected]

Melissa R. Bunner � Austin Neurological

Clinic, Austin, Texas 78705

Margo A. Candelaria � Department of Pedia-

trics, University of Maryland School of Medi-

cine, Baltimore, Maryland 21201

Manuel L. Cepeda � Department of Psychia-

try, College of Medicine, University of South

Alabama, Mobile, Alabama 36617-2293, e-mail:

[email protected]

Cara Conway � Department of School Psychology,

George Mason University, Fairfax, Virginia

22030

Rik Carl D’Amato � Department of Psychol-

ogy, Faculty of Social Sciences and Humanities,

Av. Padre Tomas Pereira, Taipa, Macau SAR,

China

Brian P. Daly � College of Health Profes-

sions, Temple University Health Sciences Cen-

ter, Philadelphia, Pennsylvania 19140

Jill M. Dorflinger � Alexian Brothers Beha-

vioral Health System, Hoffman Estates, Illinois

60169

Laura Eckert � Department of Educational

Psychology, University of Wisconsin–Milwaukee,

Milwaukee, Wisconsin 53201

Tywanda Ellison � Department of Psychia-

try, University of North Carolina School of

Medicine, Chapel Hill, North Carolina 27599

v

Bryan D. Fantie � Department of Psychology,American University, Washington, District ofColumbia 20016-8062

Eileen B. Fennell � Department of ClinicalHealth Psychology, University of Florida,Gainesville, Florida 32610-0165, e-mail:[email protected]

Elaine Fletcher-Janzen � San Angelo, Texas76901

Charles J. Golden � Center for PsychologicalServices, Nova Southeastern University, FortLauderdale, Florida 33314, e-mail:[email protected]

Sam Goldstein � Department of School Psy-chology, George Mason University, Fairfax,Virginia 22030, e-mail: [email protected]

Thalıa Harmony � Instituto de Neurobio-logıa, Universidad Nacional, Autonoma deMexico, Campus Juriquilla, 76230, Queretaro,Qro, Mexico, e-mail: [email protected]

Lawrence C. Hartlage � Augusta Neuropsy-chology Center, Evans, Georgia 30809

Maile R. Ho � Department of Psychology,Colorado State University, Ft. Collins, Color-ado 80523

Stephen R. Hooper � Department of Psychia-try, University of North Carolina School ofMedicine, Chapel Hill, North Carolina 27599

Julie E. Horwitz � Department of Psychol-ogy, University at Albany, State University ofNew York, Albany, New York 12222

George W. Hynd � College of Education,Purdue University, West Lafayette, Indiana47907, e-mail: [email protected]

H. Dennis Kade � Tidewater Child Develop-ment Services, Norfolk Department of Public

Health, Norfolk, and Department of Psychol-

ogy, Old Dominion University, Norfolk, Virgi-

nia, e-mail: [email protected]

Randy W. Kamphaus � Department of Edu-

cational Psychology, University of Georgia,

Athens, Georgia 30602 and Department of

Counseling and Psychological Services, Georgia

State University, Atlanta, Georgia 30302

Kordell Kennemer � Oregon State Hospital,

Portland, Oregon 97232

Marcel Kinsbourne � New School for Social

Research, New York, New York 10011, e-mail:

[email protected]

Bryan Kolb � Department of Psychology,

University of Lethbridge, Lethbridge, Alberta

T1K3M4, Canada, e-mail: [email protected]

John C. Linton � Department of Behavioral

Medicine, West Virginia University School of

Medicine, Charleston, West Virginia 25326

Antolin M. Llorente � Department of Pedia-

trics, University of Maryland School of Medi-

cine, Baltimore, Maryland 21209, e-mail:

[email protected]

Charles J. Long � Psychology Department.

The University of Memphis, Memphis, Tennes-

see 38152.

Christine LoPresti � Department of Psychia-

try and Biobehavioral Sciences, University of

California School of Medicine, Los Angeles,

and Neuropsychiatric Institute and Hospital,

Los Angeles, California 90024

Julie K. Lynch � Albany Neuropsychological

Associates, Guilderland, New York 12084-1522

Robert J. McCaffrey � Department of Psy-

chology, University at Albany, State University

vi CONTRIBUTORS

of New York, Albany, New York 12222 andAlbany Neurological Associates, Guilderland,New York 12084-1522, e-mail: [email protected]

Frank McDonald � Our Children’s House atBaylor, Dallas, Texas 75204

Arthur MacNeill Horton, Jr. � Psych Associ-ates, Towson, Maryland 20814, e-mail:[email protected]

Arthur MacNeill Horton, III � Eastern Virgi-nia Medical School, Norfolk, VA

Lawrence V. Majovski � Department of Psy-chiatry, University of Washington School ofMedicine and Department of Psychiatry, Chil-drens Hospital, Seattle, Washington 98104,e-mail: [email protected]

Benjamin A. Mason � Department of Educa-tional Psychology, Texas A&MUniversity, Col-lege Station, Texas 77843

Kristen L. Mays � Department of Educa-tional Psychology, University of Georgia,Athens, Georgia 30602

Joan W. Mayfield � Our Children’s House atBaylor, Dallas, Texas 75204, e-mail:[email protected]

Allison E.Morgan � Purdue University, WestLafayette, Indiana 47907

Jack A. Naglieri � Center for CognitiveDevelopment, George Mason University, Fair-fax, Virginia 22030, [email protected]

Amy Nelson � Department of EducationalPsychology, University of Wisconsin–Milwaukee,Milwaukee, Wisconsin 53201

Nancy L. Nussbaum � Austin NeurologicalClinic, Austin, Texas 78705, e-mail:[email protected]

John E. Obrzut � College of Education, Uni-versity of Arizona, Tucson, Arizona 85721

Linda Pedersen � Lewisville Independent

School District, Lewisville, Texas

Peter Platten � Department of Educational

Psychology, University of Wisconsin–Milwaukee,

Milwaukee, Wisconsin 53201

Philip P. Randall � College of Education,

University of Arizona, Tucson, Arizona 85721

Cecil R. Reynolds � DepartmentofEducational

Psychology, Texas A&M University, College Sta-

tion, Texas 77843, e-mail: [email protected]

Robert L. Rhodes � Special Education/

Communication Disorders Department, New

Mexico State University, Las Cruces, New

Mexico 88003-8001

Barbara A. Rothlisberg � Department of

Educational Psychology, Ball State University,

Muncie, Indiana 47306

Paul Satz � Department of Psychiatry and Bio-

behavioral Sciences, University of California School

ofMedicine,LosAngeles, andNeuropsychiatric Insti-

tute and Hospital, Los Angeles, California 90024

Adam Schwebach � Neurology, Learning and

Behavior Center, University of Utah, Salt Lake

City, Utah 84112-9057

Margaret Semrud-Clikeman � Department of

Psychology, Michigan State University, East

Lansing, Michigan 48824

Lisa D. Stanford � Department of Psychia-

try and Neurology, University of Illinois Medi-

cal Center, Chicago, Illinois 60612, e-mail:

LStanford @psych.uic.edu

Phyllis Anne Teeter Ellison � Department of

Educational Psychology, University of Wiscon-

sin–Milwaukee, Milwaukee, Wisconsin 53201,

e-mail: [email protected]

Michael G. Tramontana � Vanderbilt Psychia-

tric Hospital and Departments of Psychiatry and

CONTRIBUTORS vii

Neurology, Vanderbilt University, Nashville, Ten-

nessee 37212-3133, e-mail: Michael.tramontana@

vanderbilt.edu

Melanie Vaughn � Arizona State University,

Tempe, Arizona, 85287

Judith K. Voress � Donald D. Hammill Insti-

tute on Disabilities, Austin, Texas 78757, e-mail:

[email protected]

Marie L. Walker � Austin, Texas

Tiffany Watts-English � Department of Psy-

chiatry and Behavioral Sciences, Duke Univer-

sity, Raleigh, North Carolina 27708

Timothy B. Whelan � Department of Psy-

chiatry, Baystate Medical Center, Springfield,

Massachusetts 01199, e-mail: timothy.

[email protected]

viii CONTRIBUTORS

Preface to the Third Edition

In the more than 20 years since we conceptualized and

outlined the first edition of the Handbook of Clinical

Child Neuropsychology, much has changed in our

field yet much has remained the same. There have

been great strides in understanding both normal and

pathognomic development of neural structures that

have led us to greater depths of understanding the

brain–behavior relationships in children. It seems

that advances in neurobiology and related neuros-

ciences continue to add impetus to the need for

emphasizing the role of the brain in many forms of

psychopathology that were once considered solely the

domain of psychodynamics and behaviorism. We

have implored the authors of this third edition to

take careful note of the science that underlies the

practice of clinical child neuropsychology and to inte-

grate these advances wherever possible into the

updates of their chapters as well as considering them

in the chapters that are new to this volume. At the

same time that our depth of understanding of brain–

behavior relationships has improved, many of the

methodological and statistical problems that have pla-

gued research in the field remain. We continue to

provide chapters on these issues in an attempt to

improve research and research outcomes in the disci-

pline in addition to providing chapters that give gui-

dance to current best practices for the workhorse

practitioner.

Unfortunately, one of the things that has not

changed in our field is the presence of a dearth of

qualified pediatric and child clinical neuropsycholo-

gists. While there are more qualified child practi-

tioners now than ever before, children remain

underserved. Every year, without fail, since the

National Institute of Mental Health began issuing a

list of underserved populations within the United

States, children have appeared in the top 10 of all

underserved populations. Our hope is that by continu-

ing to provide information on current practice,

science, and thought about the practice of clinical

child neuropsychology in a common location, we

will continue to foster the development of the field

and perhaps attract additional practitioners to obtain

expertise with children.

In this third edition, updates of chapters from

the second edition appear along with a variety of new

chapters that present information on topics that have

become more salient over the several decades we have

toiled over this handbook. Those familiar with prior

editions will note new works by Sam Goldstein and

Adam Schwebach on the Neuropsychological Basis of

Learning Disabilities; Antolin Llorente on the Neu-

ropsychological Assessment of Spanish-Speaking

Children and Youth; Arthur MacNeill Horton, Jr.

and Arthur MacNeill Horton, III on the Child Clini-

cal Neuropsychology of Drug Abuse; Sam Goldstein

and Kordell Kennemer on Neuropsychological

Aspects of ADHD; Robert McCaffrey, Julie Horwitz

and Julie Lynch on Child Forensic Neuropsycho-

logy; Priscilla Bade-White, John Obrzut, and Philip

Randall on Neuropsychological Aspects of Pervasive

Developmental and Autism Spectrum Disorders;

and Jack Naglieri, Cara Conway, and SamGoldstein

on Using the PASS Theory in Neuropsychological

Assessment. We consider these to be central/main

stream efforts that are central to understanding the

field of clinical child neuropsychology and the broad-

ening role of child practitioners in our discipline. As a

strong example of the latter, JoanMayfield’s chapter

on the role of the pediatric neuropsychologists in

coma is a seminal work in the guidance it provides

the child practitioner.As we have noted in prior volumes, there are

many individuals to whomwemust express our appre-

ciation and without whom this work could not have

been completed. As the publishing industry has con-

solidated, this handbook has moved across publish-

ers. We greatly appreciate the efforts of Sharon

ix

Panulla and Janice Stern, of Springer, for continuing

to appreciate the need for this volume as well as their

guidance and ultimately bringing it to fruition at its

new home. We also cannot forget Eliot Werner, our

original editor from Plenum Publishing Company

(now absorbed under the Springer umbrella), who

had sufficient faith in us as well as the development

of child clinical neuropsychology as a discipline to risk

publishing a large, comprehensive handbook origin-

ally in this field. The dedication and efforts of all of

our chapter authors are acknowledged and sincerely

appreciated. Without their hard work and careful

thought, this handbook would be a shallow effort on

our part. Elaine wishes to express her gratitude to her

family, David, Emma, and Leif for their support and

encouragement. Cecil continues to note and appreci-

ate Julia’s contributions to his efforts not only

through her confidence, emotional support, and com-

panionship, but through her willingness to engage him

in discussions particularly of the applicability of our

science to the day-to-day problems of the clinical

practitioner, of which she remains a superb example.

College Station, Texas Cecil R. Reynolds

Cleveland, Ohio Elaine Fletcher-Janzen

x PREFACE TO THE THIRD EDITION

Contents

I. Foundations and Current Issues

1 Development of Neuropsychology as a Professional Psychological Specialty: History,Training, and Credentialing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

LAWRENCE C. HARTLAGE AND CHARLES J. LONG

2 Development of the Child’s Brain and Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

BRYAN KOLB AND BRYAN D. FANTIE

3 Development of Cerebral Lateralization in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

MARCEL KINSBOURNE

4 Development of Higher Brain Functions: Birth Through Adolescence . . . . . . . . . . . . . . 67

LAWRENCE V. MAJOVSKI AND DAVID BREIGER

5 Neuropsychology of Child Psychopathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

MICHAEL G. TRAMONTANA, STEPHEN R. HOOPER, TIFFANY WATTS-ENGLISH,TYWANDA ELLISON, AND T. CARTER BETHEA

6 Neurodevelopmental Malformations: Etiology and Clinical Manifestations . . . . . . . . . 147

GEORGE W. HYND, ALLISON E. MORGAN, AND MELANIE VAUGHN

7 Pediatric Brain Injury: Mechanisms and Amelioration . . . . . . . . . . . . . . . . . . . . . . . . . . 169

LISA D. STANFORD AND JILL M. DORFLINGER

8 Neuropsychological Basis of Learning Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

SAM GOLDSTEIN AND ADAM SCHWEBACH

9 Measurement and Statistical Problems in NeuropsychologicalAssessment of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

CECIL R. REYNOLDS AND BENJAMIN A. MASON

10 Models of Inference in Evaluating Brain–Behavior Relationships in Children . . . . . . . 231

EILEEN B. FENNELL AND RUSSELL M. BAUER

xi

II. Neuropsychological Diagnosis

11 Halstead–Reitan Neuropsychological Test Batteries for Children . . . . . . . . . . . . . . . . . 247

NANCY L. NUSSBAUM AND MELISSA R. BUNNER

12 The Nebraska Neuropsychological Children’s Battery . . . . . . . . . . . . . . . . . . . . . . . . . . 267

CHARLES J. GOLDEN

13 Applications of the Kaufman Assessment Battery for Children, 2nd Edition inNeuropsychological Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281

KRISTEN L. MAYS, RANDY W. KAMPHAUS, AND CECIL R. REYNOLDS

14 Clinical Neuropsychological Assessment with the Test of Memoryand Learning, Second Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297

CECIL R. REYNOLDS AND JUDITH K. VORESS

15 Utilizing a Neuropsychological Paradigm for UnderstandingCommon Educational and Psychological Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321

ROBERT L. RHODES, RIK CARL D’AMATO, AND BARBARA A. ROTHLISBERG

16 Assessment of Behavior and Personality in the Neuropsychological Diagnosis ofChildren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349

PHYLLIS ANNE TEETER, LAURA ECKERT, AMY NELSON,PETER PLATTEN, MARGARET SEMRUD-CLIKEMAN, AND RANDY W. KAMPHAUS

17 Psychophysiological Evaluation of NeuropsychologicalDisorders in Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383

THALIA HARMONY

18 The Assessment of the Hispanic Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401

MARGO A. CANDELARIA AND ANTOLIN M. LLORENTE

III. Techniques of Intervention

19 Neurocognitive Interventions for Childhood and Adolescent Disorders:A Transactional Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427

PHYLLIS ANNE TEETER

20 Brain Injury Rehabilitation of Children and Youth:Neurodevelopmental Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459

H. DENNIS KADE AND ELAINE FLETCHER-JANZEN

xii CONTENTS

21 The Neuropsychology of Pediatric Epilepsy and Antiepileptic Drugs . . . . . . . . . . . . . . 505

THOMAS L. BENNETT AND MAILE R. HO

22 Neuropsychological Effects of Stimulant Medication on Children’s Learning andBehavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529

RONALD T. BROWN AND BRIAN P. DALY

23 Nonstimulant Psychotropic Medication: Desired and Adverse Cognitive Events . . . . . 581

MANUEL L. CEPEDA

IV. Special Topics in Clinical Child Neuropsychology

24 Child Clinical Neuropsychology of Drug Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 599

ARTHUR MACNEILL HORTON, JR. AND ARTHUR MACNEILL HORTON, III

25 Neuropsychological Aspects of Attention-Deficit Hyperactivity Disorder . . . . . . . . . . . 617

SAM GOLDSTEIN AND KORDELL KENNEMER

26 Neurobehavioral and Neurodevelopmental SequelaeAssociated with Pediatric HIV Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 635

ANTOLIN M. LLORENTE, CHRISTINE LOPRESTI, AND PAUL SATZ

27 Neuropsychological Sequelae of Chronic Medical Disordersin Children and Youth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 671

RICHARD A. BERG AND JOHN C. LINTON

28 Coping and Adjustment of Children with Neurological Disorder . . . . . . . . . . . . . . . . . 703

TIMOTHY B. WHELAN AND MARIE L. WALKER

29 Child Forensic Neuropsychology: A Scientific Approach. . . . . . . . . . . . . . . . . . . . . . . . 729

ROBERT J. MCCAFFREY, JULIE E. HORWITZ, AND JULIE K. LYNCH

30 Neuropsychology and Coma Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 745

JOAN W. MAYFIELD, LINDA PEDERSEN, AND FRANK MCDONALD

31 Neuropsychological Aspects of Pervasive Developmental andAutism Spectrum Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 765

PRISCILLA A. BADE-WHITE, JOHN E. OBRZUT, AND PHILIP P. RANDALL

32 Using the Planning, Attention, Simultaneous, Successive (PASS)Theory Within a Neuropsychological Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783

JACK A. NAGLIERI, CARA CONWAY, AND SAM GOLDSTEIN

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 801

CONTENTS xiii

I

Foundations and Current Issues

1

Development of Neuropsychology as a

Professional Psychological Specialty:

History, Training, and Credentialing

LAWRENCE C. HARTLAGE AND CHARLES J. LONG

Background

Neuropsychology can be depicted as having along history and a short past. As early as 400BC, Hippocrates conjectured a correlation ofbehavioral observations with possible anatomiclocalizations, and later Galen related the ana-tomic localizations to the brain. Although therewere occasional detours and distractions, Gall’searly-19th-century chronological hypothesesserved as the focus of exploration for a time.By the late 19th century more sophisticatedexperimental methodology laid the groundworkfor the underpinnings of current scientific neu-ropsychology. The data from electrical stimula-tion of discrete cortical areas in animals byFritsch andHitzig around 1790, the clinical loca-lization of expressive speech by Broca, and thelocalization of receptive language byWernicke acentury later laid the foundation for majorbreakthroughs in the 20th century. Indeed, dur-ing the 20th century, two major approaches tothe study of brain–behavior relationshipsevolved. In Russia, a qualitative clinical evalua-tion evolved, characterized by the work of Luria

(Luria, 1970; Luria & Majovski, 1977) andBeehtereva (1978). This focused on the observa-tion of cognitive functions such as content, repli-cation, and flexibility of thinking (Puente, 1989).

In the United States, a number of differentfactors influenced early-20th-century approachesto the study of brain–behavior relationships. Theinfluence of British scientists including HenryHead and Hughlings Jackson, unlike their Rus-sian counterparts, supported use of psychometrictests and, unlike Luria’s focus on localization,attended to behavioral/psychological features.In the first half of the 20th century—perhapsreflecting interest following two world wars andthe differentiation of ‘‘functional’’ from ‘‘organic’’sequelae of brain injuries resultant from bothopen and closed head injuries—there was atrend away from localization, instead addressingclassification of behavioral deficits as a unitaryphenomenon, i.e., was the problem ‘‘functional’’or ‘‘organic’’ (Hartlage, 1966). This conceptualapproach is reflected in the work of a number ofwell-recognized names from this era: Wechslerand others attempted configural organizationof subscales to identify organic profiles; Benderdeveloped a constructional praxis measureaddressed to identification of brain injury(Bender, 1938); and Benton developed a com-bined constructional praxis/short-term memorytest for identification of brain injury (Benton,1955).

LAWRENCEC. HARTLAGE � Augusta Neuropsychol-

ogy Center, Evans Georgia 30809. CHARLES J.

LONG � Psychology Department, The University of

Memphis, Memphis Tennessee 38152.

C.R. Reynolds, E. Fletcher-Janzen (eds.), Handbook of Clinical Child Neuropsychology,

DOI 10.1007/978-0-387-78867-8_1, � Springer ScienceþBusiness Media, LLC 2009

3

During the latter years of the first half of the20th century, an approach for measuring biologi-cal bases of intellective functions was promul-gated by Halstead (1947), but his untimely deathcurtailed his further development of these con-cepts. It was his student, Reitan, at Indiana Uni-versity Medical Center, who was able to refineHalstead’s measures and develop a number of hisown, providing the solid scientific and experimen-tal basis for neuropsychological practice based ona standardized, validated, comprehensive batterysensitive to brain dysfunctions. Reitan’s seminal1955 paper (Reitan, 1955) demonstrated differen-tial (Wechsler) verbal and performance IQ scoresresultant from unilateral brain injuries, and overthe next half century, Reitan reported in a num-ber of studies the ability of this neuropsychologi-cal battery to not only identify but differentiateamong brain dysfunction resulting from a varietyof etiologies. This work was largely based onassessment of adults with verifiable brain injury.

Following progress in the development of ascientific database for applied neuropsychology,there was an emerging recognition of psychologyas a profession with potential applications deal-ing with both medical and societal issues.

During World War II, psychology wasrecognized for its potential in military manpowerutilization, especially in fields such as selectionand training of pilots. At war’s end, focus shiftedtoward utilizing psychological procedures fordetermining whether war related problems inveterans represented difficulties of primarily psy-chological as opposed to neurologic origin, suchas might be resultant from various types of headinjuries.

In the early years of its emergence, a looselyconstituted International NeuropsychologicalSociety represented neuropsychology. This wasan interesting group composed of psychologists,neurologists, and educators with an interest inbrain–behavior relationships. The InternationalNeuropsychological Society held its first pro-gram meeting in 1973, on a medical school cam-pus in New Orleans, with approximately ahundred participants. The growth of interest inthe field of neuropsychology and the need forsome type of education and credentialing guide-lines encouraged a small group of psychologiststo organize the National Academy of Neuropsy-chologists (subsequently renamed the NationalAcademy of Neuropsychology). Its first pro-gram meeting was in 1981, in Orlando, with

approximately 350 participants. One of theearly initiatives of the National Academy ofNeuropsychology was to survey identifiable neu-ropsychologists to assess their perception of theneed for some national credentialing body forneuropsychologist’s practice. Following wide-spread agreement that such a body was indeedneeded, the National Academy assigned an ex-president (L.C.H.) to organize such a board. Inthe early 1980s, a board constituted exclusivelyof individuals with (peer nominated) expertise inneuropsychology who were also credentialed bythe American Board of Professional Psychology(typically board certification in clinical psychol-ogy) was organized to serve as a founding boardto refine credentialing issues and procedures.This organization, as an outgrowth and productof the National Academy of Neuropsychology,was incorporated as the American Board ofProfessional Neuropsychology. Overtures weremade to the American Board of ProfessionalPsychology to offer neuropsychology as a newspecialty. However, the American Board of Pro-fessional Psychology was not at that time willingto recognize a new specialty area. Instead theexecutive director (Margaret Ives) agreed offer-ing neuropsychology as a super specialty (e.g.,comparable with the American Board of Psy-chiatry and Neurology Certification in ChildPsychiatry or Neurology, which was added tobasic qualifications, in psychiatry or neurology,with the designation ‘‘with special competence inchild’’). At this point, a group of psychologistsnot formerly affiliated with any professionalorganization, who did not have ABPP qualifica-tions, felt their qualifications in neuropsychol-ogy would be overlooked by this procedure.Accordingly, they organized a rival board thatwas subsequently incorporated as the AmericanBoard of Clinical Neuropsychology.

Following establishment of both scientificand professional facets of neuropsychology andwith the increasing recognition of neuropsycho-logical substrates of learning and adaptive beha-vior problems in adults with brain injury, theredeveloped a progressive interest in some possiblecentral processing dysfunctions as being etiologicin a wide variety of children’s learning problems(e.g., Chalfant & Scheffelin, 1969). Given impetusand support by the focus of ‘‘The Great Society’’programs on identification, description, andtreatment of childhood learning problems,

4 CHAPTER 1

neuropsychology was increasingly involved withthe assessment of exceptional children.

The growing involvement of neuropsychol-ogy with children’s problems raised a number ofscientific and professional questions and issues.As the body of research relating known braindamage to specific learning and behavior pro-blems had for the most part involved adults, oneobvious scientific question involves the extent towhich this research could be applied to children.Stemming from this scientific question arose aprofessional issue, namely, which tests or diag-nostic approaches are appropriate for use withchildren? If findings from adults could beapplied directly to children, then presumably adownward extension of a battery appropriate foruse with adults might be adequate for this pur-pose. Conversely, if findings from adult neurop-sychology could not be applied to children, itwould be necessary to develop a new databasefor application to child neuropsychology.

Another specific question dealt with whetherfindings from individuals with known braindamage verified on neurological, neurosurgical,or neuroradiological criterion measures could beapplied to children who were presumed to haveneuropsychological impairments on the basis ofneuropsychological assessment, but for whomthere was no definitive evidence of structuralor physiological damage. This scientific questiontranslated into obvious professional issues.Because for many children whose neuropsycho-logical examination findings suggested a clearcentral nervous system dysfunction, there wasno external criterion that could validate such animpression, the misclassification of such childrenas ‘‘brain injured’’ could adversely influence theireducational programming and management.

Assessment Approaches

In response to the demand for neuropsycho-logical services for children, and in attempts toaddress the scientific and professional issues raisedby this demand, two diverse approaches to theprovision of neuropsychological services to chil-dren emerged. One approach involved modifiedversions of traditional neuropsychological bat-teries such as the Halstead–Reitan Neuropsycho-logical Battery (Reitan, 1955; Reitan & Davison,1974; Selz, 1981) and the Luria-Nebraska Neurop-sychological Battery (Golden, 1981; Golden,

Hamineke, & Purisch, 1980; Plaisted, Gustavson,Wilkening,&Golden, 1983), which standardizedthe adult battery items on a child sample. For themost part, this standardization took the form ofdeleting from the adult battery those items thatwere too difficult for children. There is reportedlygood congruence between the adult and childbatteries on classificatory accuracy, and alsobetween the Reitan-Indiana Children’s Batteryand the Luria-Nebraska NeuropsychologicalBattery for Children (Berg et al., 1984; Geary,Schultz, Jennings, & Alper, 1984; Golden et al.,1981). Even among proponents of a standardizedbattery approach, there is disagreement concern-ing which battery is best for which population ofpatients (e.g., Adams, 1980a, 1980b; Spiers,1981). The second emphasis is on interpretationof standard psychometric tests from a neuropsy-chological perspective, augmented by some mea-sures of sensory and motor function, usingrelevant age-appropriate tests for children ofgiven ages, ranging from preschool through ado-lescent ages (Hartlage, 1981, 1984; Hartlage &Telzrow, 1983; Telzrow & Hartlage, 1984). Thisapproach uses standardized behavioral tests andinterprets them according to the individual’sstrengths and weaknesses and in some casesmakes inferences regarding neurological integ-rity. Such an approach is popular with psycholo-gists working in school settings, and in manycases may be adequate for child neuropsycholo-gical assessment. Although there is little evidencethat one approach is clearly superior, ‘‘turfskirmishes’’ often center on the issue of qualifica-tions. Psychologists who have developed exper-tise in the use of a given neuropsychological testbattery tend to support the view that the onlylegitimate neuropsychologists are those with asimilar background and expertise. Psychologistswho espoused diagnostic approaches involvingtraditional psychometric tests counter by ques-tioning the relevance of a standardized batterydeveloped for adults with known brain lesionsfor assessing children who often do not haveevidence of brain lesions. They also question theredundancy involved in adding a standard neu-ropsychological battery to the array of psycho-metric instruments required by most schooldistricts for psychoeducational assessment. Thesecond approach appears to be preferred bymost professionals. A survey of internship train-ing programs suggests that most professionalsprefer the second approach (interpretation of

NEUROPSYCHOLOGY AS A PROFESSIONAL PSYCHOLOGICAL SPECIALTY 5

standard psychometric tests from a neuropsycho-logical perspective) (Goldberg & McNamara,1984). Their survey results revealed that 78%employ nonstandardized assessment strategies,63% the Halstead–Reitan Battery, and 35% theLuria-Nebraska. Even those individuals employ-ing a neuropsychological battery frequently aug-ment the battery with common psychologicaltests.

Recently, there has evolved a small followingof practitioners who attempt to modify subpartsof existing neuropsychological batteries, such as afairly recent publication of a ‘‘revised’’ children’syoung adolescent’s version of the Category Test(Boll, 1993), or modify administration of a stan-dardized test commonly used as part of a neurop-sychological battery (e.g., Kaplan, 1991). Asthere is nothing conceptually new or different insuch modifications of existing text or procedures,such approaches can be classified, according touse, in one of these two schemata.

Professional Context of Child

Neuropsychology

With the advent of the CAT scan, NMR,and other instruments, neuropsychologicalassessment has shifted away from simple yes/no‘‘organic’’ diagnosis as a primary endeavor andhas moved toward comprehensive assessment ofthe functional consequences of neurologicaldamage (i.e., cognitive skills). The focus is oncognitive strengths and weaknesses and theirrelationship to academic performance and/orintervention strategies. Neurological integrity isonly indirectly inferred as a contributing factorand the utility of such inferences is questioned. Itcontinues to be argued that neuropsycho-diagnosis has little or no relevance to educationand/or rehabilitation, although it may be rele-vant to planning for intervention.While the dataat present do not indicate that neuropsychologi-cal assessments are essential, it is often the casethat this is the only assessment whereby a com-prehensive investigation of a broad range ofcognitive skills is evaluated in the context ofemotional and situational factors.

Current interest in neuropsychologicalassessment has begun to focus on the ecologicalvalidity (predictive validity) of neuropsychologi-cal tests. While relating test scores to vocationalperformance and real-world behaviors is difficult

because of the variability across jobs and acrosssocial situations, the academic environmentaffords a much more stable environment. Futureresearch in this area may well hold substantialpromise for the development of a better under-standing of the relationship between neuropsy-chological performance in children in a learningenvironment as well as aid in the development ofeffective treatment strategies.

Levels of Inference

An important issue in training and creden-tialing in child neuropsychology involves the pur-poses for which neuropsychologically relevantdata are to be used. A comparatively low levelof inference involves a conclusion that impairedbrain function may be etiologic or at least con-tributory to a given problem. An example of thislevel of inference might be a conclusion reachedby a school psychologist that a child’s failure toacquire a given academic skill is likely related tobrain damage or dysfunction. At a considerablyhigher level of inference are diagnostic state-ments indicating specific localizing and etiologicphenomena. An example of this level of inferencemight be a statement, reached by a clinical childneuropsychologist working in a neurological set-ting, that a child appears to have an astrocytomaconfined to anterior portions of the nondomi-nant cerebral hemisphere. Perhaps the highestlevel of inference involves statements concerningsome irreversible intervention. An example ofthis type of inference might involve a clinicalchild neuropsychologist working in conjunctionwith a pediatric neurosurgeon who concludesthat removal of a major portion of a child’shippocampus will not impair memory or othermental function. Between these low and highlevels of inference occur many intermediate levelsinvolving such matters as optimal instructionalmode, referral to a neurological specialist, prog-nostic statements based on inferred level of cor-tical integrity, or conclusions concerningwhether(or the extent to which) a child’s impaired cogni-tive performance may be related to an injury forwhich legal action is pending.

It is possible that a well-trained clinicalchild psychologist or school psychologist, withonly moderate training (or credentials) in childneuropsychology, may make appropriate lowerlevel inference concerning brain–behavior

6 CHAPTER 1

relationships. For example, a school psycholo-gist may, by training, experience, and clinicalskill, be quite adequately prepared to developperfectly appropriate academic intervention pro-grams for a child with a chronic or acquiredneurological impairment, and precluding suchindividuals from such practice on the groundsthat they are not sophisticated in brain–behaviorrelationships may serve to deprive a child of avaluable professional resource. Conversely, it isnot reasonable to expect such a professional todetect manifestations of an early stage neurode-velopmental disorder or a neoplasm of someslowly progressive type. On the one hand, it canbe argued that, until the proper diagnosis ismade,it is not possible to determine what level of infer-ence may be required: This might suggest that allquestions concerning possible brain involvementin children require the involvement of a qualifiedchild neuropsychologist. On the other hand, in atypical school population, the base rate of neuro-degenerative or slowly progressive neoplastic dis-orders is sufficiently low that such a requirementmay be considered to be unrealistic.

Interactive with the level of inference is theissue of potential harm to the child. Somechronic neurological conditions, such as mightbe represented by chronic cerebral hemisphericfunctional asymmetry, can conceivably be over-looked without necessarily causing major pro-blems. In cases where appropriate educationaland counseling services are provided, overlook-ing the neurological substrates of uneven levelsof academic performance may be only minimallyhandicapping to the child. Conversely, labelingthe child ‘‘brain damaged’’ may deprive the childof needed educational support. Similarly, themismatch between a child’s neuropsychologi-cally mediated abilities and deficits in anongoing educational program that does nottake these factors into account may cause harmto the child, both in terms of frustration andfailure to achieve academically at ability levels.Obviously, individuals should only make higher-order inferences regarding brain–behavior rela-tionships when their training, experience, andclinical skills qualify them for such inferences.Although guidelines concerning training andcredentialing can and should address theseissues, at the present time they have not beeneffectively addressed. Even if they are addressedin the future, it is not reasonable to hope thatsuch guidelines can resolve them all.

Credentialing of Psychologists

Although the study of developmental brain–behavior relationships is a relatively recent endea-vor in neuropsychology (Dean, 1982), it hasalready been argued that there is a need for sometype of credentialing and certainly for more spe-cialized training if one is to provide appropriateneuropsychological services to children.

Clinical psychologists have traditionallytended to function as generalists—setting fewlimits regarding credentialing and developingno formal method for identifying a particulararea of expertise. They tend not to limit theirpractice to a specific problem area or specificage group (VandenBos, Stapp, & Kilburg,1981). This state of affairs no longer appearsappropriate for the current practice of psychol-ogy because of the dramatic change in theknowledge base. Certainly it is clear that neu-ropsychological assessment requires specificknowledge not generally obtained in traditionalclinical psychology training programs. Further-more, the techniques and issues in child psychol-ogy cannot simply be deduced from knowledgeof adults. Specialty training in school psychol-ogy and specialization in child psychology alsospeak to the changes in training promoted tomeet the needs of the child.

Although the American Psychological Asso-ciation initially recognized only four specialtyareas, a review in credentialing activities bySales (1985) identified 31 specialty-credentialingboards; and at the time of this writing the Amer-ican Board of Professional Psychology has addedseveral more boards and is negotiating withothers for inclusion under its umbrella approachto credentialing. The overall credentialing processcontinues to undergo review. In February 1994the APA Council of Representatives voted toestablish an APA College of Professional Psy-chology that will function as a credentialingbody (APA Practice Directorate, 1994). Also in1994, APA formed the Joint Interim Committeefor the Recognition and Identification of Special-ties and Proficiencies. These activities point outAPA’s awareness of organizing and clarifying thecredentialing process. Even though psychologistsare identifying areas of specialization and devis-ing procedures for membership inclusion, clinicalpsychologists seem reluctant to limit their prac-tice by establishing formal specialties within


clinical psychology and such activities are notlikely to be readily endorsed. Indeed, clinical psy-chologists have been able to push legislation toenact state licensing and to specifically definediagnoses of brain damage, and the practice ofneuropsychology, as within the specific purviewof clinical psychology.

In the absence of credentialing, control isleft to licensing activities, done at the state levels,resulting in a wide variety of requirements forpractice in a specified area such as neuropsychol-ogy and a tendency to rely on the individualpractitioner with respect to not making profes-sional judgments at levels of inference for whichthe practitioner is not qualified. As has justbeen noted, however, in cases involving someneuropsychological problems, an otherwisewell-trained clinician may not recognize the neu-ropsychological nature of the problem and at thesame time feel justified by avoiding any inferen-tial statements concerning CNS involvement.Although it could be argued that making noinferential statement concerning CNS deficit insuch a case may in fact be inferring somethingabout CNS integrity, such activities are extre-mely difficult to control within limitations ofgeneric state licensing laws. Few states attemptto designate specialty training within psychologyalthough recently Louisiana has identified a sub-specialty in neuropsychology with inclusion con-tingent on satisfying the requirements of eitherthe American Board of Professional Neuropsy-chology or the American Board of ClinicalNeuropsychology.

A national credentialing board, not limitedby legislators who enact and amend licensinglaws at the state level, is an accepted approachtoward ensuring some level or degree of compe-tence among practitioners who have met therequirements of that board. With credentialingrequirements set by professionals, this obviouslyrepresents an approach with considerable poten-tial for helping ensure such competence. Asparticipation in the activities required for cre-dentialing is entirely voluntary (and can entail afair amount of energy, frustration, and money),there is no assurance that the only qualified neu-ropsychology practitioners are those who areboard certified. As with generic state licensure,board certification in neuropsychology does notnecessarily guarantee expertise in all areas ofneuropsychology. Unlike the American Boardof Neurology and Psychiatry, which adds ‘‘with

special competence in child neurology’’ (or psy-chiatry) for practitioners who satisfy therequired training and experience for this endor-sement, neuropsychology issues only genericendorsement.

At the present time there are two boards inneuropsychology: the American Board of Pro-fessional Neuropsychology and the AmericanBoard of Clinical Neuropsychology. Althoughboth boards are attempting to comprehensivelyevaluate professionals and award the diplomatestatus to those who are judged to be qualified,the number of individuals who can be evaluatedby this comprehensive process is limited. Eventhough both credentialing boards have been invarying states of activity since 1984, it is esti-mated that only about 800 individuals have suc-cessfully completed the oral examination andhave been awarded the diplomate in neuropsy-chology. Furthermore, both boards can onlycomprehensively evaluate 40–50 per year. Theresult is that it will be quite some time beforethe majority of qualified neuropsychologists canbe identified. An even greater problem relates tothe fact that both boards evaluate neuropsychol-ogists as a broad category. While the individualoutlines specific areas of competency within neu-ropsychology such as interest in children, there isno formal designation as to those who are speci-fically qualified in child neuropsychology.

The awareness of a lack of understanding ofthe specialty practices by third-party payers ledthe National Academy of Neuropsychology andthe APA’s Division of Clinical Neuropsychol-ogy to form a Joint Task Force in 1991. Afternumerous discussions several guidelines wereproposed. This included the formation of newneuropsychological assessment codes and a defi-nition of a neuropsychologist.

Definition of a Clinical Neuropsychologist

A. Level I Certification by examination byeither the American Board of Clinical Neu-ropsychology or the American Board ofProfessional Neuropsychology

B. Level II

1. Education—Doctorate degree in psy-chology from a regionally accreditedinstitution with a program in psychology

8 CHAPTER 1

2. Experience—Three years (minimum of500 hours per year) of clinical neuropsy-chological experience at either predoc-toral or postdoctoral levels

3. Supervision—Two years supervision inclinical neuropsychology satisfied byone or more of the following:

a. Two years postdoctoral supervisionb. One year predoctoral and one year

postdoctoral supervisionc. Successful completion of a postdoc-

toral fellowship

4. LicenseState or province licensure at the level ofindependent practice

5. Definition

Clinical neuropsychology is defined as the studyof brain–behavior relationships based on a com-bination of knowledge from basic neurosciences,functional neuroanatomy, neuropathology,clinical neurology, psychological assessment,psychopathology, and psychological inter-ventions.

This was followed by a letter of October1994 from Carl B. Dodrill, Ph.D., Division 40president, in which he indicated that the abovedefinition was in error and that the only defini-tion of a clinical neuropsychologist approved byDivision 40was published in The Clinical Neu-ropsychologist, 1989, volume 3, p. 22 [see Appen-dix for guidelines for doctoral training in clinicalneuropsychology], which is as follows:

A Clinical Neuropsychologist is a profes-sional psychologist who applies principles ofassessment and intervention based upon thescientific study of human behavior as it relatesto normal and abnormal functioning of the cen-tral nervous system. The Clinical Neuropsychol-ogist is a doctoral level psychology provider ofdiagnostic and intervention services who hasdemonstrated competence in the application ofsuch principles for human welfare following:

A. Successful completion of systematic didacticand experiential training in neuropsychol-ogy and neuroscience at a regionally accre-dited university;

B. Two or more years of appropriate super-vised training applying neuropsychologicalservices in a clinical setting;

C. Licensing and certification to provide psy-chological services to the public by the laws

of the state or province in which he or shepractices;

D. Review by one’s peers as a test of thesecompetencies.

Attainment of the ABCN/ABPP Diploma inClinical Neuropsychology is the clearest evi-dence of competence as a Clinical Neuropsy-chologist, assuring that all these criteria havebeen met.

As can be seen from the confusion in defini-tions, the issues are far from resolved regardingclinical neuropsychology in general, and theissue of specialization in child neuropsychologyhas not been addressed.

Further complicating the issue of boardcertification, usually designated as ‘‘diplomate’’status, is the pervasive level of inference issue.Because only the best neuropsychological clin-icians—for instance, those qualified to makethe highest levels of neuropsychological infer-ence—are likely to receive ‘‘diplomate’’ status,who is to do the lower level of inference work?As has been mentioned, whereas it might beconsidered optimal practice to have all childrenwith any problem seen by a skilled child neurop-sychologist, to ensure that problems of a neuro-logical nature are not overlooked, this isobviously not realistic.

These problems raise the question of the useof technicians in neuropsychology. The Division40 Task Force on Education, Accreditation, andCredentialing concluded that ‘‘the use of . . . tech-nicians is a common and accepted practice whenthe supervising psychologist maintains and moni-tors high standards of quality assurance’’ (APATask Force, 1989, p. 25). Surveys of practicingneuropsychologists indicate that 53% use techni-cians. It would appear that neuropsychologistscan make effective use of technicians to providemore cost-effective services. Such use would notpreclude the neuropsychologist spending timewith the patient in obtaining the history, reevalu-ating questionable areas of weakness by the use ofadditional tests, or clarifying test findings duringthe debriefing with the patient.

It appears that specialty credentialing isunlikely to be accepted in the near future by thevast majority of clinical psychologists. There-fore, training must be designed and offered tobest prepare these individuals for their desig-nated area of clinical service. Universities offer-ing specialty training in school psychology, child


psychology, and/or neuropsychology are meet-ing such needs.

General Issues in Child Clinical Training

With respect to educational context, clinicalchild neuropsychology can be viewed as a sub-area of clinical child psychology, and it is rele-vant to preface a review of issues in clinical childneuropsychology training with an overview oftraining issues in clinical child psychology. Pre-sently, although there are seven formal predoc-toral training programs in neuropsychology(Lubin & Sokoloff, 1983), few are specificallydesigned for child neuropsychology. In someprograms, students are required to satisfy therequirements of the child clinical and neuropsy-chology training programs to be designated astrained in child neuropsychology. Without sucharrangements, much of the specialty training inclinical child neuropsychology currently is pro-vided by postdoctoral positions.

The report of the task force from Division40 recommends that in the absence of formalaccredited educational programs:

(1) The entry level credentials for the practice of

clinical neuropsychology shall be predicated on

the license to practice at the independent profes-

sional level in the state or province in which the

practitioner resides; (2) In addition, 1600 hours of

clinical neuropsychological experience, supervised

by a clinical neuropsychologist at the pre- or post-

doctoral level, shall be required; (3) Persons

receiving a doctoral degree in psychology before

1981 may substitute 4800 hours of post-doctoral

experience in a neuropsychology setting involving

a minimum of 2400 hours of direct clinical service.

(Newsletter 40, 1984)

In the absence of formal training programsin child neuropsychology, specialization in childneuropsychology must either combine two exist-ing areas or seek further postdoctoral training.

Because of the changing nature of the ner-vous system in the child and the impact of non-neurological factors on the child’s behavior, thechild neuropsychologist needs to be trained inbasic psychological, developmental, and neu-ropsychological issues. In addition, the role ofpsychological assessment in clinical child neu-ropsychology needs to be well understood.

The reliance on standardized tests increaseswith decreasing experience of professionals in

any discipline. Of primary importance is theissue to be addressed or the question to beanswered. If the primary question relates towhether there is cerebral dysfunction, thenregardless of the test employed, the evaluators’effectiveness depends on their training in brain–behavior relationships and their understanding ofthe nervous system and its contributions to beha-vior. Without such training, effective interpreta-tion of behavior leading to decisions regardingbrain dysfunction cannot be reached. If learningdisability is of primary interest, then the evaluatorneeds to understand the relationship between testbehavior and learning disability. The same argu-ment holds for developmental delays, emotionaldisorders, retardation, and so on.

New graduates, individuals shifting theirarea of basic training, or researchers tend todepend on a fixed battery or evaluation strategyand rigorously defend it against all others. Theythus exhibit a strong tendency to become methodoriented, rather than problem oriented. Withfurther education on the part of the professionaland understanding of the relationship betweenareas of primary importance, less reliance ismade on a specific test battery and a broadrange of assessment devices may be employed inorder to effectively assay the behaviors in ques-tion and outline an effective treatment plan.

Clinical neuropsychology as a specialtywithin psychology is a fairly new area that is con-tinuing to undergo change and self-analysis inorder to outline clinical courses most appropriateto the practice of neuropsychology. The databaseon neuropsychology has also served to shift psy-chologists into a designated specialty area as theknowledge base required to pursue neuropsycho-logical assessment is sufficiently broad to make itdifficult for traditionally trained psychologists topursue effectively such clinical activities withoutextensive training or experience.

In 1977 it was recognized that a conferencedealing with training in clinical child psycho-logy was needed, and a preliminary workingconference was held in 1983 with the principalconference held in May 1985. In general, therecommendations included three features in-volving general clinical psychology training,involving requirements for training in normaldevelopment; experience with normal children;and minimal competencies in assessment, psy-chopathology, and intervention with children(Johnson & Tuma, 1986; Tuma, 1986). Specific

10 CHAPTER 1

to clinical child psychology graduate trainingwere seven recommendations, the first of whichendorsed the Boulder Model for clinical childpsychology. Another recommendation endorsedthe APA Division 27 Task Force-documentedGuidelines for Training Psychologists to Workwith Children, Youth and Families (Roberts,Erickson, & Tuma, 1985). In general, the otherrecommendations specific to clinical child psy-chology training dealt with such issues as recog-nizing cultural diversity and the multiple contextsin which psychologists working with children,youth, and families must function. Internshiptraining was recommended as involving at leasttwo-thirds of the training experience in child clin-ical activity, with research incorporated into theinternship program. Postdoctoral and continuingeducation training in clinical child psychologywas recommended, although specific guidelinesconcerning required background prerequisites orcontext areas were not proposed.

With respect to recognition of proficienciesand specialty areas in psychology, the APABoard of Professional Affairs (BPA) appointeda Committee on Specialty Practice from 1970 to1980 to explore such issues. Specialty guidelinesfor clinical, counseling, industrial/organiza-tional, and school psychology were approvedby the APA Council in 1980, making APA’sfirst detailed public statement concerning serviceprovisions in specialty areas. The BPA appointeda Subcommittee on Specialization in 1980 toaddress the issues involved in criteria for specialtyareas not covered by these four major areas, andin 1983 a second draft manual for the identifica-tion and continued recognition of proficienciesand new specialty areas in psychology was pub-lished (Sales, Bricklin, & Hall, 1983). Differentia-tion was made between proficiencies andspecialties, on the basis of several major criteria.A specialty was recommended as involving abody of knowledge with (1) unique client popula-tions, (2) specific techniques and technologies, (3)problems addressed, and (4) settings wherein theknowledge applied. Proficiency, on the otherhand, would involve a body of knowledge andskills that provide the basis for services in one ofthese four parameters.

The requirements for the identification of aspecialty area involved (1) a formal organiza-tion, recognized in the field that is responsiblefor managing the development of a specialty;(2) a definition of the specialty, including

knowledge and skills required; and (3) an educa-tional sequence of training and experience.Requirements for the identification of the profi-ciency involved (1) a formal organization, (2) adefinition, (3) evidence of need and parametersof practice, (4) demonstrated efficiency, and (5)uniqueness. In this context, neuropsychologycould be viewed as representing either a specialtyor an area of proficiency, with clinical child neu-ropsychology a subarea of either a specialty or aproficiency.

In a related and somewhat parallel area, theAPA Task Force on Education and Credential-ing (1985) published a recommendation con-cerned with educational content required fordesignation as a psychology program. Althoughrelated in only a tangential way to clinical childneuropsychology, the designation system tendsto discourage the graduate education of clinicalchild neuropsychologists in academic settingswithout a clear identification as part of a psy-chology program (e.g., freestanding clinicalchild neuropsychology programs in medicalschools or professional schools would have dif-ficulty meeting the designation criteria).

Focus on Training in Clinical Child

Neuropsychology

Where does training in clinical child neu-ropsychology fit into this broader context?Training in clinical child neuropsychology isgenerally provided in one of three ways: gradu-ate coursework, internship/practicum training,and postdoctoral training fellowships.

There has been a dramatic increase in train-ing programs over the past decade, increasingfrom approximately 7 to approximately 40 pro-grams offering a terminal degree in neuropsychol-ogy (Division 40 of the American PsychologicalAssociation, 2005). While graduate course offer-ings show considerable variability, many offertraining as a subspecialty of clinical psychology;many more clinical programs offer some course-work in neuropsychology; and some clinical pro-grams offer lectures on neuropsychology but noformal coursework (Golden & Kuperman, 1980).Thus, among the 60 or more APA-approved clin-ical programs that indicate they provide offeringsin neuropsychology, these offerings may rangefrom formal coursework to practica or even pos-sible work placements.


Division 40 of the APA (Neuropsychol-ogy), aware of the need for establishing guide-lines for neuropsychology training, has formed atask force to develop such guidelines (see Appen-dix). A preliminary report of their efforts waspublished in Newsletter 40 (1984). According tothose guidelines the major function of the clin-ical neuropsychologist is to assess current beha-vioral disturbances associated with neurologicalimpairment. The report suggested that neurop-sychological assessment should include mea-sures of (1) abstract reasoning and categoricalthinking, (2) cognitive flexibility and planning,(3) language communication, (4) learning andmemory, (5) sensation and perception, (6) fineand gross motor functions, (7) initiation andattention, (8) affect and mood, and (9) psycho-social adaptation.

In order to effectively pursue these assess-ment goals, the diagnostician needs training in(1) functional neuroanatomy, (2) clinical dis-eases, (3) child development, (4) changes inbehavior as a function of aging, (5) behavioralpsychopharmacology, (6) psychophysiologicalprinciples underlying pathologies, (7) sociocul-tural factors, (8) personality assessment andinterviewing skills, (9) principles of test construc-tion and validation, and (10) test administrationand interpretation. Properly trained neuropsy-chologists should be able to outline treatmentplans and consult with family members, educa-tors, employers, and so on, in order to assist inimproving the behavioral adjustment of the indi-vidual in specific situations. Remediation by aclinical neuropsychologist focuses primarily ondisability associated with cerebral dysfunctionand secondarily on emotional or other maladap-tive behaviors that are a consequence of theindividual’s primary disability.

The Newsletter outlined the needs of thechild neuropsychology training to include muchof the above with adjustment in training sug-gested to incorporate bodies of knowledge aswell as techniques and resources specific to clin-ical child neuropsychology. Major issues such aschild development, CNS plasticity, and the nat-ure of the referral questions are seen as primaryadditional areas of competence. One of the pri-mary distinctions between child and adult neu-ropsychology is the emphasis on description ofprocesses in children, because the focus on pro-cess helps delineate specific treatment plans.More so than with adults, a multidisciplinary

team often evaluates children; thus, child neurop-sychologists must have knowledge of related pro-fessions so that they may effectively interfacetheir findings in developing the final treatmentplan.

Among practicum offerings that includechild neuropsychology as an area of training,these offerings in many cases exist as ancillaryoptions, such as being available on a limitedbasis within a child therapy practicum. Even inpracticum or internship settings wherein neurop-sychology is mentioned as an area of trainingemphasis, there is considerable variability. Thisvariability appears to reflect both the differingconcepts of neuropsychology as a specialty areawithin clinical neuropsychology and the uniquebackgrounds of the faculty who provide suchtraining. In one grouping of 28 graduate settingsthat offered neuropsychology training, Goldenand Kuperman (1980) found that the tests usedmost frequently were the Wechsler and BenderGestalt.

Postdoctoral training programs in clinicalchild psychology are relatively rare. However, anumber of postdoctoral programs in clinicalneuropsychology offer some exposure to childneuropsychology, and a few provide some seg-ment of the program devoted to work for chil-dren. Informal surveys of postdoctoral traineeswho have had at least some postdoctoral train-ing in clinical neuropsychology reveal a ratherwide range of backgrounds. Some ‘‘retread’’postdoctoral fellows, whose doctoral training isin nonclinical areas such as physiological psy-chology, have very little background in eitherchild development or the special skills neededto evaluate children. Others with backgroundsin areas like school psychology may have excel-lent skills in child assessment and good knowl-edge of developmental phenomena, but littleexpertise in functional neuroanatomy or basicbrain–behavior relationships. Yet others enterpostdoctoral child neuropsychology trainingprograms with good assessment skills involvingboth children and adults, with coursework inneuroanatomy and physiology, and prior expo-sure to neurologically impaired children frompracticum or work experiences. Thus, the con-tent of the ‘‘ideal’’ postdoctoral experience inclinical child neuropsychology may relate to theunique backgrounds that such postdoctoral fel-lows bring to the program.

12 CHAPTER 1

Professional Context of Clinical Child

Neuropsychology

Neuropsychologists assume that under-standing brain–behavior relationships is neces-sary for both diagnosis and treatment planning.Such knowledge is not, however, sufficient, andtherefore few neuropsychologists focus on thebrain as the only contributing variable. Childneuropsychological assessment must includemeasures of personality/emotional well-beingand identification of environmental influences.Given such a broad ‘‘systems’’ analysis, the childneuropsychologist can provide information ofbenefit to a number of other disciplines. Forexample, the interpretation of neurological dys-function in the context of situational, learning,emotional, and other important dimensions pro-vides the neurosurgeon with a more comprehen-sive picture of the role that a lesion or area ofdamage might exert on a child’s behavior. Thiscan assist teachers in the classroom and parentsat home by identifying strengths and weaknessesand identifying those factors that appear to bemost amenable to modification. The assumptionis that one needs to identify factors that contri-bute to aberrant behaviors and prioritize themregarding those that would appear to requireprimary assistance as well as those that aremost likely to change with remediation.

Unlike the adult brain, which is assumed tobe developmentally static with fixed effects asso-ciated with injury, the child’s brain is character-ized by growth and differentiation that extendsfrom conception up to young adulthood (Renis &Goldman, 1980; Rourke, Bakker, Fisk, & Strang,1983). The effects of neurological damage areinfluenced by age, the locus of the injury, thenature of the damage, the sex and socioeconomicstatus of the individual, as well as the emotionaladjustment, coping, and adaptive skills of theindividual (Bolter & Long, 1985). Thus, evenour limited understanding of chronogeneric loca-lization can improve the assessment and remedia-tion of neurologically impaired children.Neurological damage during the developmentalyearsmay produce permanent deficits, temporarydeficits, and/or delayed-onset deficits (Teuber &Rudel, 1962). Understanding the neurologicalcontribution to the overall behavioral complexis necessary to effectively identify barriers andplan for remediation.

Professional Relationships

Although all psychologists view behaviorfrom a systems perspective, problems are viewedsomewhat differently depending on the speciali-zation. School psychologists focus primarily onacademic problems and secondarily on how non-academic factors influence school performance(e.g., emotional, situational, neurological,genetic, developmental). Child psychologistsfocus primarily on emotional/behavioral pro-blems with secondary focus on other areas. Thechild neuropsycho-logist focuses primarily onbrain–behavior relationships with other factorsbeing viewed ‘‘as’’ secondary.

Professionals in other specialties have chal-lenged the approach of child neuropsycholo-gists. School psychologists have argued thatunderstanding neurological systems is notimportant for effective treatment (Senf, 1979).It is further argued that neurological labelingconnotes irreversibility and mitigates responsi-bility for remediation (Sandoval & Haapanen,1981). In fact, Hynd (1982) suggested that theneuropsychological evaluation might provideinformation that reduces the need for referralfor expensive and nonproductive neurologicalevaluations.

There remain many unresolved issuesregarding training and practice of clinical childneuropsychology. As outlined in this chapter,the clinical child neuropsychologist must possessa knowledge base that cuts across many existingareas of specialization. Perhaps for this reason,individuals from a number of specialty areasmay function in the assessment and treatmentof children with neurological dysfunction in thefuture. Hopefully, with improved awareness andeducation, effectiveness of communication willbe enhanced across these specialties. This maylead us to recognize the requisite combination ofbroad skills in general child clinical areas andspecific skills in child neuropsychology as con-stituting clinical child neuropsychology, both aspecialty and an area of proficiency.

Appendix

Source: The Clinical Neuropsychologist1987. Vol. 1, No. 1, pp. 29–34, Swets & Zeitlin-ger, Reports of the INS-Division 40 Task Forceon Education, Accreditation, and Credentialing


Guidelines for Doctoral Training Programs

in Clinical Neuropsychology

Doctoral training in clinical neuropsychol-ogy should ordinarily result in the awarding of aPh.D. degree from a regionally accredited uni-versity. It may be accomplished through a Ph.D.program in clinical neuropsychology offered bya psychology department or medical faculty orthrough the completion of a Ph.D. program in arelated specialty area (e.g., clinical psychology)which offers sufficient specialization in clinicalneuropsychology.

Training programs in clinical neuropsy-chology prepare students for health service deliv-ery, basic clinical research, teaching, andconsultation. As such they must contain (a) ageneric psychology core, (b) a generic clinicalcore, (c) specialized training in the neurosciencesand basic human and animal neuropsychology,(d) specific training in clinical neuropsychology.This should include an 1800-hour internshipwhich should be preceded by appropriate prac-ticum experience.

(A) Generic psychology core

1. Statistics and methodology2. Learning, cognition, and perception3. Social psychology and personality4. Physiological psychology5. Life-span developmental6. History

(B) Generic clinical core

1. Psychopathology2. Psychometric theory3. Interview and assessment techniques

i. Interviewingii. Intelligence assessmentiii. Personality assessment

4. Intervention techniques

i. Counseling and psychotherapyii. Behavior therapy/modificationiii. Consultation

5. Professional ethics

(C) Neurosciences and basic human and ani-mal neuropsychology

1. Basic neurosciences2. Advanced physiological psychology

and pharmacology

3. Neuropsychology of perceptual, cogni-tive, and executive processes

4. Research design and research practi-cum in neuropsychology

(D) Specific clinical neuropsychological training

1. Clinical neurology and neuropathology2. Specialized neuropsychological assess-

ment techniques3. Specialized neuropsychological inter-

vention techniques4. Assessment practicum (children and/or

adults) in university-supervised assess-ment facility

5. Intervention practicum in university-supervised intervention facility

6. Clinical neuropsychological internshipof 1800 hours preferably in noncaptivefacility. (As per INS-Div. 40TaskForceguidelines). Ordinarily this internshipwill be completed in a single year, butin exceptional circumstance may becompleted in a 2-year period.

(E) Doctoral dissertationIt is recognized that the completion of a

Ph.D. in clinical neuropsychology prepares theperson to begin work as a clinical neuropsychol-ogist. In most jurisdictions, an additional year ofsupervised clinical practice will be required inorder to qualify for licensure. Furthermore,training at the postdoctoral level to increaseboth general and subspecialty competencies isviewed as desirable.

Guidelines for Neuropsychology Internships

in Clinical Neuropsychology

The following report summarizes the recom-mendations of the subcommittee on internshipsof the INS-Division 40 Task Force. The reportwas prepared by Linus Bieliauskas and ThomasBoll.

At the outset, it is recognized that theinternship program is designed primarily for stu-dents with degrees in clinical psychology. Suchinternship programs are those accredited by theAmerican Psychological Association and orthose listed in the Directory of the Associationof Psychology Internship Centers.

Entry into a psychology internship programis aminimum qualification in a neuropsychologyinternship. Such entry must be based on

14 CHAPTER 1

completion of at least 2 years in a recognizedpsychology Ph.D. graduate training program inan area of health services delivery (e.g., clinical,clinical neuropsychology, counseling, or schoolpsy-chology). Alternately, entry into a psychol-ogy internship program must be based on com-pletion of a ‘‘retreading’’ program designed tomeet equivalent criteria as a health services deliv-ery program per se. Within the training pro-grams described above, the student must alsohave completed a designated track, specializa-tion, or concentration in neuropsychology.

There are generally two models for psychol-ogy internship training: (1) generic clinical psychol-ogy, and (2) specialty in clinical neuropsychology.The former does not concern us here since suchtraining is not geared toward producing specializedexperience or qualification. The latter type ofinternship program, when designed to provide spe-cialized training in neuropsychology, is what con-stitutes a clinical neuropsychology internship.

A clinical neuropsychology Internship mustdevote at least 50% of a 1-year full-time trainingexperience to neuropsychology. In addition, atleast 20% of the training experience must bedevoted to general clinical training to assure acompetent background in clinical psychology.Such an internship should be associated with ahospital setting which has neurological and/orneurosurgical services to offer to the trainingbackground. Such an internship should not beassociated only with a strictly psychiatric setting.

Experiences to Be Provided

The experiences to be provided to the internin clinical neuropsychology should conform tothe descriptions of professional activities in theReport of the Task Force on Education, Accred-itation, and Credentialing of the InternationalNeuropsychological Society and the AmericanPsychological Association (1981). Necessarytraining should be provided in both a didacticand experiential format. Supervisors in such aninternship should be board-certified clinicalneuropsychologists.

Didactic Training.

A. Training in neurological diagnosis.B. Training in consultation to neurological

and neurosurgical services.

C. Training in direct consultation to psychia-tric, pediatric, or general medical services.

D. Exposure to methods and practices of neu-rological and neurosurgical consultation(grand rounds, bed rounds, seminars, etc.).

E. Training in neuropsychological techni-ques, examination, interpretation of testsresults, report writing.

F. Training in consultation to patients andreferral sources.

G. Training in methods of intervention speci-fic to clinical neuropsychology.

Experiential Training.

A. Neuropsychological examination and eva-luation of patients with actual and sus-pected neurological diseases and disorders.

B. Neuropsychological examination and eva-luation of patients with psychiatric disor-ders and/or pediatric or general medicalpatients with neurobehavioral disorders.

C. Participation in clinical activities with neu-rologists and neurosurgeons (bed rounds,grand rounds, etc.).

D. Direct consultation to patients involvingneuropsychological issues.

E. Consultation to referral and treating pro-fessions.

Exit Criteria

At the end of the internship year, the internin clinical neuropsychology should be able toundertake consultation to patients and profes-sionals on an independent basis and meetminimal qualifications for competent practiceof clinical neuropsychology as defined inSection B, Neuropsychological roles and func-tions of the Report of the Task Force (1981).

Guidelines for Postdoctoral Training in Clinical

Neuropsychology

Postdoctoral training, as described herein, isdesigned to provide clinical training to producean advanced level of competence in the specialtyof clinical neuropsychology. It is recognized thatclinical neuropsychology is a scientifically basedand evolving discipline and that such trainingshould also provide a significant research compo-nent. Thus, this report is concerned with postdoc-toral training in clinical neuropsychology that is


specifically geared toward producing indepen-dent practitioner level competence whichincludes both necessary clinical and researchskills. This report does not address training inneuropsychology which is focused solely onresearch.

Entry Criteria

Entry into a clinical neuropsychology post-doctoral training program ordinarily should bebased on completion of a regionally accreditedPh.D. graduate training program in one of thehealth service delivery areas of psychology or aPh.D. in psychology with additional completionof a ‘‘respecialization’’ program designed tomeetequivalent criteria as a health services deliveryprogram in psychology. In all cases, candidacyfor postdoctoral training in clinical neuropsy-chology must be based on demonstration oftraining and research methodology designed tomeet equivalent criteria as a health services deliv-ery professional in the scientist-practitionermodel. Ordinarily, a clinical internship, listedby the Association of Psychology InternshipCenters, must also have been completed.

General Considerations

A postdoctoral training program in clinicalneuropsychology should be directed by a board-certified clinical neuropsychologist. In most cases,the program should extend over at least a 2-yearperiod. The only exception would be for individualswho have completed a specific clinical neuropsychol-ogy specialization in their graduate programs and/or a clinical neuropsychology internship (Sub-committee Report of the Task Force, 1984) pro-vided the exit criteria are met (see below). As ageneral guideline, the postdoctoral training pro-gram should provide at least 50% time in clinicalservice and at least 25% time in clinical research.Variance within these guidelines should be tai-lored to the needs of the individual. Specifictraining in neuropsychology must be provided,including any areas where the individual isdeemed to be deficient (testing, consultation,intervention, neurosciences, neurology, etc.).

Specific Considerations

Such a postdoctoral training programshould be associated with hospital settings

which have neurological and/or neurosurgicalservices to offer to the training background.Necessary training should be provided in botha didactic and experiential format and shouldinclude the following:

Didactic Training.

A. Training in neurological and psychiatricdiagnosis.

B. Training in consultation to neurologicaland neurosurgical services.

C. Training in direct consultation to psychia-tric, pediatric, or general medical services.

D. Exposure to methods and practices of neu-rological and neurosurgical consultation(grand rounds, bed rounds, seminars, etc.).

E. Observation of neurosurgical proceduresand biomedical tests (revascularizationprocedures, cerebral blood flow, Wadatesting, etc.).

F. Participation in seminars offered to neurol-ogy and neurosurgery residents (neuro-pharmacology, EEG, brain cutting, etc.).

G. Training in neuropsychological techniques,examination, interpretation of test results,report writing.

H. Training in consultation to patients andreferral sources.

I. Training in methods of intervention speci-fic to clinical neuropsychology.

J. Seminars, readings, etc., in neuropsychol-ogy (case conferences, journal discussion,topic-specific seminars).

K. Didactic training in neuroanatomy, neuro-pathology, and related neurosciences.

Experiential Training.

A. Neuropsychological examination and eva-luation of patients with actual and sus-pected neurological diseases and disorders.

B. Neuropsychological examination and eva-luation of patients with psychiatric disor-ders and/or pediatric or general medicalpatients with neurobehavioral disorders.

C. Participation in clinical activities with neu-rologists and neurosurgeons (bed rounds,grand rounds, etc.).

D. Experience at a specialty clinic, such as adementia clinic or epilepsy clinic, whichemphasizes multidisciplinary approachesto diagnosis and treatment.

16 CHAPTER 1

E. Direct consultation to patients involvingneuropsychological assessment.

F. Direct intervention with patients, specific toneuropsychological issues, and to includepsychotherapy and/or family therapy whereindicated.

G. Research in neuropsychology, i.e., collabora-tion on a research project or other scholarlyacademic activity, initiation of an indepen-dent research project or other scholarly aca-demic activity andpresentation or publicationof research data where appropriate.

Exit Criteria

At the conclusion of the postdoctoral train-ing program, the individual should be able toundertake consultation to patients and profes-sionals on an independent basis. Accomplish-ment in research should also be demonstrated.The program is designed to produce a competentpractitioner in the areas designated in Section Bof the Task Force Report (1981) and to provideeligibility for external credentialing and licen-sure as designated in Section D of the TaskForce Report (1981). The latter also includestraining eligibility for certification in clinicalneuropsychology by the American Board of Pro-fessional Psychology.

Additional Sources

Meyer, M. J. (1981). Report of the taskforce on education, accreditation, and creden-tialing of the international neuropsychologicalsociety. The INS Bulletin, September, pp. 5–10.Report of the Task Force on Education. Accred-itation, and Credentialing. The INS Bulletin,pp. 5–10. Newsletter 40, 1984, 2, 3–8.

Report of the Subcommittee on PsychologyInternships. Newsletter 40, 1984. 2, 7. The INSBulletin. 1984. p. 33. APIC Newsletter. 1983, 9,27–28.

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18 CHAPTER 1

2

Development of the Child’s Brain

and Behavior

BRYAN KOLB AND BRYAN D. FANTIE

Introduction

Perhaps the central issue in neuropsychologyover the past 100 years has been the question ofhow psychological functions are represented inthe brain. At the turn of the century, the debatewas largely whether or not functions were actu-ally localized in the cortex. Although today thisis no longer a subject of major discussion, thegeneral problem of determining what is localizedin the cortex remains. One way to examine thisissue is to look at the way function and structureemerge in the developing child.

As we look historically at the considerationof structure–function relationships in develop-ment, we are struck by the reluctance ofresearchers to engage in such analyses. Indeed,although Freud and Piaget were trained in biol-ogy, both carefully avoided inclusion of braindevelopment in their theories of psychologicaldevelopment. It is likely that one major impedi-ment to such theorists was an absence of biolo-gical data about developmental neuroscience(Segalowitz & Rose-Krasnor, 1992).

The development of structure–functionrelationships can be examined in three basicways. First, we can look at the structural

development of the nervous system and correlateit with the emergence of specific behaviors. Initi-ally this approach seems ideal, as the develop-ment of both the nervous system and behavior isorderly and consistent across individuals.Unfortunately, it is not as simple as it appears.

The nervous system matures in a relativelyunremitting way, unfolding to the dictates oftime. Behavioral change, on the other hand, isoften more highly dependent on environmentalfactors. Thus, the degree of damage caused bysensory deprivation is largely determined bywhen it occurs during an animal’s life (Hubel &Wiesel, 1970). In contrast, whether or not some-one can ice-skate will be more easily predictedwhen one knows if the person was raised inCanada or Brazil. In addition, age-related neuralchanges are seldom immediately observable invivo so it is extraordinarily difficult to correlatestructural and functional variables directly.Furthermore, hypotheses regarding braindevel pment are hard to verify, especiallybecause the human nervous system cannot bemanipulated during development. Nevertheless,despite these impediments, this approach is stillpossible.

The second way to examine morphologicaland psychological development is to scrutinizebehavior and then make inferences about neuralmaturation. For example, we might study theemergence of distinct cognitive stages carefully,as Piaget (1952) and his followers have done,and then predict what alterations must haveoccurred in the nervous system to account for

BRYAN KOLB � Department of Psychology, University

of Lethbridge, Lethbridge, Alberta T1K3M4,

Canada. BRYAN D. FANTIE � Department of

Psychology, American University, Washington, DC

20016-8062, .

C.R. Reynolds, E. Fletcher-Janzen (eds.), Handbook of Clinical Child Neuropsychology,

DOI 10.1007/978-0-387-78867-8_2, � Springer ScienceþBusiness Media, LLC 2009

19

Documents

Handbook of Clinical Child Neuropsychologypractice of clinical child neuropsychology and to inte-grate these advances wherever possible into the updates of their chapters as well as