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Karen Schiltz, Ph.D.: We discussed your thoughts when you noticed something was "not quite right" in December. You mentioned your daughter, Ella, was forgetful and "spaced out" in class since the beginning of preschool. Ella was involved in a car accident when she was eight years old, and had headaches and disorientation after the accident that lasted about four weeks. Your pediatrician and neurologist gave Ella a "clean bill of health" but her problems with attention continued. You told your pediatrician of your continuing concerns and she suggested a neuropsychological examination. She was wondering whether Ella had attention problems before the accident and to what extent her concussion was increasing your daughter's trouble with focusing on her work and chores at home. You also mentioned you were concerned about her memory and relationships with her peers. What happened next?
Lynn: Ella needed constant reminders. She was not turning in her homework several times a week, even when she had completed it. The homework is getting more difficult as we approach the middle of the school year. I can't keep on top of her every step of the way. I'm asking her many questions and checking her assignment binder every night because I'm afraid of what might happen to her grades if I don't. I think Ella should be able to check herself by now. Ella is now 10 years old. Her birthday just occurred. Although Ella seems concerned and even worried at this point, I'm afraid teachers think she is lazy. Tell me about the neuropsychological assessment. Will this help my daughter and me?
Dr. S.: Neuropsychological assessment is one of the testing procedures you may definitely consider. A comprehensive evaluation is critical in order for you to understand the big picture of your child's needs. In the case of a learning disability, a neuropsychological assessment will help you understand which brain functions are working poorly and which are working well. (1)
Why do parents, teachers, physicians, and attorneys for the student with learning challenges request neuropsychological assessment?
• Identify strengths and weaknesses of intellectual, higher thinking skills (language, attention and concentration, motor, visual-perceptual, executive functioning skills such as planning and organizational skills, time management, proofing work)
• Confirm parent's "gut feeling" that something is ‘not quite right'
• Identify what is actually underlying a student's difficulties in learning and in life
• Identify learning, thinking, emotional, and social challenges for those with medical disorders
• Identify educational needs
• Discuss weaknesses versus impairments
• Identify evidence-based (research-driven) accommodations for the classroom and test-taking setting
• Provide empirically (research-driven) blueprint of help (interventions)
• Assess progress over time
• Aid the educational, medical, and behavioral specialists in determining precise goals and objectives as they plan intervention goals and objectives
The neuropsychologist will typically assess many areas of thinking and behavior. These include the following:
• Intellectual skills
• Cognitive skills (Attention and concentration, language, motor skills, verbal and visual reasoning skills, visual processing skills, memory, executive skills, i.e., planning and organization, checking tasks)
• Achievement levels
• Social-emotional levels
• Social communication skills
• Adaptive levels (how the child functions on a day-to-basis at home, school)
The neuropsychological evaluation includes the testing data, input from parents, other caregivers, and teachers and all educational and pertinent medical records. A child with a learning disorder may have had multiple assessments from different professionals. The neuropsychologist will interview the parents at length about their child's history in terms of their presenting concerns as well as educational, medical, and social background. Adults who are involved in a child's life will typically complete surveys so we can understand the child from different perspectives and contexts, i.e., school and home. The neuropsychologist then reviews and integrates all of the test data, the interview information and the records to create a final report. The neuropsychologist, in assessing all aspects of a child's functioning, is able to integrate the information obtained and describe exactly how this child is approaching learning, and where the process is breaking down for him or her. (2)
A comprehensive evaluation of your child's strengths and weaknesses will help you understand what your child really needs in order to succeed in school. It is important to know that a child's strengths and weaknesses are not assumed in this type of evaluation. (2) All conclusions are based on a systematic and organized manner of assessment using a scientific approach.
The lifelong consequences of a learning disability can be quite alarming. Society depends, for the most part, on an individual's ability to read and write, manage their attention and emotions, and get to school/work in time. Early intervention is everything when you suspect your child may have learning, emotional, and attentional challenges. Having a thorough roadmap is critical for your child's success in life; academically and socially.
I will be interviewing speech-language therapist, Robin Burkholz M.A.CCC-SLP, next month about her role when assessing a student with possible difficulties with speech and language skills. These evaluations are also very important when a student has trouble with social skills.
Happy New Year and thank you for following this blog!
Best Always,
Karen L. Schiltz, Ph.D.
Psychologist (CA PSYCH 9508)
Private Neuropsychology Practice of Karen Schiltz Ph.D. and Associates
Associate Clinical Professor (Voluntary)
Medical Psychology Assessment Center
Semel Institute for Neuroscience and Human Behavior
Department of Psychiatry and Biobehavioral Sciences
David Geffen School of Medicine at UCLA
REFERENCES:
1. Silver, et al., (2008). Learning disabilities: The need for neuropsychological evaluation. Archives of Clinical Neuropsychology, 23, 217-219.
2. Schiltz, K.L., Humphrey, L.A., & Pappas, K.B. (2000). Neuropsychological applications to remediation planning in children. The Educational Therapist, 21, 12-18.
