Ida Sue Baron, Ph.D., ABPP
Board Certified in Clinical Neuropsychology
Board Certified Subspecialist in Pediatric Neuropsychology
American Board of Professional Psychology
Clinical Professor of Pediatrics
The University of Virginia School of Medicine, Charlottesville, VA
& The George Washington University School of Medicine, Washington, DC

Newsletter: Neuropsychological Evaluation, Part 1

February 2014

I am often asked how neuropsychological evaluations differ from other psychological evaluations. Over the next few months I will be answering these questions. If you have a question, email me at ida@isbaron.com and I will queue it up for an answer.

On a personal note, I am the recipient of the International Neuropsychological Society’s 2014 Distinguished Career Award. I am so honored to receive such a meaningful professional award.

What is Neuropsychology?

Neuropsychology is an area of specialty in psychology whose practitioners have special expertise in determining whether an individual’s behavior is the result of brain injury or disease, or of developmental delay.

Who is a Neuropsychologist?

Pediatric neuropsychologists are licensed psychologists whose special training includes an Internship and Postdoctoral Fellowship in both clinical psychology and neuropsychology. While anyone can learn to administer a neuropsychological test, it is the neuropsychologist’s special education and training about brain development and function that allows for valid conclusions about a child’s brain disorder. A list of board-certified neuropsychologists can be found at www.theaacn.org.

What happens in a Clinical Neuropsychological Evaluation?

  1. A free screening consultation is conducted to determine if the reason for referral is appropriate.
  2. A comprehensive in-person parental interview is conducted on the testing day and parents complete a clinical neuropsychology questionnaire about pregnancy & birth, early development, child and family medical and psychological histories, & academic performance precedes testing.
  3. Many short duration, age appropriate, game-like tests that examine specific brain functions are individually administered to the child by the neuropsychologist. An evaluation last 2 to 6 hours, depending on the child’s age, reason for referral, and performance observed during the testing time.
  4. Rest breaks are provided to ensure optimal functioning.
  5. Parents complete behavioral questionnaires while waiting for their child to complete the test session.
  6. An interpretive session with parents is scheduled to explain what tests were administered, what neuropsychological profile of functioning resulted, and to discuss appropriate recommendations.
  7. A written report is completed following the interpretive session with the parents, which summarizes the behavioral and test results, and includes appropriate recommendations for interventional strategies and classroom performance.
  1. Parents are first contacted through the mail and asked to agree to being contacted for the study.
  2. An appointment is made and informed consent is obtained before the study begins.
  3. Parents complete a research neuropsychology history questionnaire inquiring about pregnancy/birth, early development, child and family medical and psychological histories, & academic performance, and behavioral questionnaires.
  4. Many short duration, age appropriate, game-like tests that examine specific brain functions are individually administered to the child by a trained research technician, for 3 to 4 hours on average.
  5. Rest breaks are provided to ensure optimal functioning.
  6. A written report summarizing behavioral and test results that is useful to the parents, school personnel, pediatrician, and therapists is mailed to the parents, and to the pediatrician with parental signed permission.

FNA PETIT STUDY Publications

The following PETIT Study papers moved from online to hard-copy in peer-reviewed journals this month:

Baron, I.S., Weiss, B. A., Baker, R., Khoury, A., Remsburg, I., Thermolice, J.W., Litman, F. R. & Ahronovich, M.D. (2014) Subtle Adverse Effects of Late Preterm Birth: A Cautionary Note, Neuropsychology, 28, 11-18. DOI: 10.1037/neu0000018

Results: Children born late preterm (34-36 weeks’ gestation) compared with those born at term age had lower IQ; lower verbal, nonverbal, spatial, visuomotor, and dexterity scores; and poorer adaptability. Gestational age was the most important predictor of these subtle outcomes, not their neonatal medical variables. NICU-admitted and non-admitted late-preterm groups did not significantly differ. Only one week longer gestational age (in these children born 4 to 6 weeks before term age) resulted in a nearly 2-point IQ increase.

Conclusion: Gestation is a developmental continuum best not interrupted during its natural course, if there are no fetal or maternal problems. Our data showing subtle but appreciable effects have important implications for obstetric practice and parental decision-making regarding early elective delivery in the absence of maternal or fetal adverse indications.

McCaan, J., Rider, N. G., Weiss, B. A., Litman, F. R., & Baron, I. S. (online 2013) Latent Mean Comparisons on The BRIEF in Preterm Children: Parent and Teacher Differences. Child Neuropsychology DOI:10.1080/09297049.2013.859663

Results: Examination of the factor structure of the Behavior Rating Inventory of Executive Function (BRIEF)-parent form in 124 ELBW children and of the BRIEF-teacher form in 90 ELBW children showed that children born at extremely low birth weight (ELBW) are at risk of executive dysfunction.

Conclusions: Parents and teachers answer questionnaires asking about executive function with different perspectives, and therefore rate children on executive function subscales differently. Thus, both parental and teacher reports should be obtained to better understand a child’s abilities in each setting.