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 2

March 2014

As promised in the February Newsletter, this March newsletter continues to answer questions about research and clinical neuropsychological evaluations. In subsequent months, the discussion will continue about how neuropsychological tests are interpreted and what the results mean for the child, family and school personnel. Past issues are posted at www.isbaron.com.

My child had a psychological evaluation and neuropsychological tests were included. Was this a neuropsychological evaluation?

Although other professionals can learn how to administer and score neuropsychological tests a neuropsychologist’s education, training, and experience are required to make determinations about brain disorder or dysfunction. Reporting scores for one or more neuropsychological tests without an integration of results regarding brain efficiency is not a neuropsychological evaluation.
At a minimum, a well-trained neuropsychologist evaluates whether a child’s behavior is due to clear evidence of brain dysfunction, what the impact is on real-life circumstances, and what interventions are most appropriate.

The best indication of competence in neuropsychology is Board Certification by the American Board of Clinical Neuropsychology, a member Specialty Board of the American Board of Professional Psychology

Why is a test a neuropsychological test?

Neuropsychological tests for children are brief (sometimes minutes long), game-like, often colorful, table-top, or computer interactive instruments that have been researched and shown to be valid for making conclusions about brain integrity. IQ tests, academic achievement tests, and parental behavioral questionnaires do not allow for such specific conclusions about the brain.

How does a neuropsychologist choose which tests to administer?

Pediatric neuropsychologists select tests for children aged 2 years and older that can show how a specific brain region, or the brain in general, is functioning. Each test is individually selected for the child being evaluated based on the reason for referral, initial interview with the parents, and observations made during the testing session. It is not advisable to administer the exact same tests to every child no matter the reason for referral.

Why are so many tests given?

No single test is definitive when a judgment has to be made about brain function. A “poor” test score does not prove brain damage and a “good” score may indicate relative dysfunction in context with the child’s medical, personal, and family histories, third party source information, and behavioral observations. It is the overall pattern of functioning across tests together with the supplemental information that leads to the most accurate evaluation. Areas of the brain that function well indicate the child’s cognitive strengths and can be used to improve weaker functions. Strengths should be documented along with weaknesses.

What practical use does neuropsychological testing have?

Unlike other psychological tests that compare a child to a group of same aged children, neuropsychological tests go further in several ways. These tests allow for:

  • comparison of the child’s left and right brain functions
  • determination of brain surface and deeper region functioning
  • detection of patterns of brain dysfunction which, if found, should be communicated to the referring physician, family and school personnel to guide specific recommendations.

Interventions and resource help are first discussed with parents before the final written report is completed so that parents understand the information they are releasing and can best advocate for their child.

Do PETIT Study Research Participant families have to pay for the comprehensive neuropsychological evaluation?

No. All participants are tested without charge and at no expense to the insurance carriers. A report of the results is provided free of charge, and is often taken to the school to obtain needed resource services or to support an Individualized Educational Plan.

FNA’s March Publication

The following PETIT Study publication was accepted for publication by a peer-reviewed journal this month:

Baron, I. S., Weiss, B. A., Litman, F. R, Ahronovich, M. D., and Baker, R. (online soon) Latent mean differences in executive function in at-risk preterm children: The delay-deficit dilemma. Neuropsychology.

We, and others, have previously shown that some children born extremely preterm and late preterm (34-36 weeks) have lower IQ and poorer cognitive functioning than children born at term. In this study we examined executive functioning in over 1,000 children across three groups (extremely preterm, late preterm, and term) and found that although there was a statistically significant difference at age 3 between extremely preterm and late preterm children compared with term children, this difference was no longer statistically significantly different at age 6 for those born late preterm; the significant difference between extremely preterm and term groups remained. These data suggested that while there may be a lasting deficit in executive functioning following extremely preterm birth, the early age deficit associated with late preterm birth may indicate a developmental lag, with catch-up to children born at term possible by early school age.