Newsletter: Preschooler Neuropsychological Evaluation
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Preschooler Neuropsychological Evaluation
There appears to be significant misunderstanding among many about whether a neuropsychological evaluation can be reliably conducted with preschoolers (children aged 2 to 5 years). Even some physicians, psychologists and teachers advise parents who have concerns about their child’s development to wait until their child reaches school age (6 years or older), to give them more time to mature. Although most children will mature sufficiently well given additional time, a parent’s early concerns may be an early “red flag” that something is truly wrong, in which case it can be directly addressed in a formal evaluation.
Infant neurodevelopmental tests provide relevant information about a young child’s brain development to a professional experienced in analyzing a child’s responses and comparing the child’s performance to others of the same age. As well, new standardized psychological tests for preschoolers have been published in recent years. These allow for examination of a wide range of early developing/emerging abilities in very young children.
It is the education and training of the neuropsychologist, not the test administered, which determines whether an informed interpretation about a young child’s neuropsychological functioning is made. Informed consideration of how different brain regions and neural circuits are functioning is what makes the evaluation “neuropsychological”.
An Important Baseline Evaluation: A preschool neuropsychological evaluation provides useful baseline data that allow for more informed comparisons at an older age about a suspected developmental delay. For example, baseline test data can be used to assess how much progress has been made by the next evaluation, to see if a child has made one year’s progress when the child is one year older.
Now that reliable and valid evaluation of a preschool child is possible, early age is an ideal time to obtain a baseline neuropsychological evaluation, especially for a child at-risk for neurodevelopmental delay. The following are examples of a few of the medical disorders and treatments with potential to interrupt the normal developmental trajectory, and for which a preschool age neuropsychological evaluation might be particularly useful:
- Preterm birth
- Delayed motor, language, or social developmental milestones.
- Spina bifida and hydrocephalus, or other conditions requiring surgery
- Heart defects and cardiac surgery
- Cancer, with radiation or chemotherapy treatment
- Neurogenetic disorders
Waiting two or three years for before evaluating a child who is at-risk or suspected to be developing poorly means that this young child will not benefit from early age intervention when it is likely to be most effective.
Preschool Evaluation Fees: Practical considerations include that a preschool neuropsychological evaluation costs much less than an evaluation at an older age, as the professional time expended is also much less. A good baseline evaluation might also have the added benefit of reducing the cost of the future older age evaluation since the preschool assessment contains information that can more tightly focus the future examination.
Question from a reader: How does a neuropsychological evaluation differ from a developmental assessment by a non-neuropsychologist?
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The education, training, and expertise of clinical neuropsychologists differ greatly from that of non-psychologists who provide developmental testing. The education of a neuropsychologist who wishes to become eligible for board certification in clinical neuropsychology includes the following:
- On average, psychologists complete 5-6 years of education while working toward a doctoral degree that focuses on foundational psychological principles and brain-behavior relationships
- There is a requirement for one year of supervised internship
- This is followed by an additional two years of post-doctoral residency training.
Thus, at least 8 years of education, training, and practice occur before one is eligible for licensure as an independent practitioner.
In contrast with others who offer developmental assessment, the education of a psychologist is distinguished by coursework and supervision in normal and abnormal child development, intervention/rehabilitation, ethical/legal considerations, cultural diversity issues, test construction, measurement theory, and statistical analysis. A neuropsychologist has additional specialized expertise in understanding brain-behavior relationships across all stages of development, making it possible to interpret test data through an informed understanding of how the brain functions and develops over the individual’s lifespan. Neuropsychologists are also able to discuss a child’s future risk, integrating neurological, brain-behavioral, and psychological factors.
Since knowledge of how a test is constructed and normed, and of how to interpret results based on statistical features is essential, non-psychologists might fail to consider important statistical data in reaching a conclusion. Instead, they might summarize a child’s performance by reporting IQ or other summary scores that can be statistically significant (i.e., the point difference between two scores is large) yet not practically meaningful or clinically significant (since a large percentage of the normative sample also obtained a difference that large). Often, a non-psychologist is not sufficiently educated in statistical theory and practice to interpret test results completely and accurately.
Note: State Psychology Boards in DC, MD and VA license psychologists but do not specifically license the specialty area of neuropsychology. Thus, a licensed psychologist can administer neuropsychological tests even if not trained as a neuropsychologist. Medical licenses do not prevent a physician from administering psychological tests.
Lucas, J. A., Mahone, M., Westerveld, M., Bieliauskas, L. & Baron, I.S. (2014) The American Board of Clinical Neuropsychology and American Academy of Clinical Neuropsychology: Updated Milestones From 2005-2014. The Clinical Neuropsychologist.
Dr. Baron, Chair of the Subspecialization Committee of the American Board of Clinical Neuropsychology, was invited to present to the AACN Pediatric Neuropsychology Special Interest Group about Subspecialty Board Certification in Pediatric Neuropsychology at the 12th Annual American Academy of Clinical Neuropsychology Conference in New York, NY.