Pediatric Neuropsychology

Pediatric or child neuropsychology is a field of study involving the relationship of abilities, behaviors and mental skills (cognitive functions) in children. Clinical, pediatric, or child neuropsychology (neuropsych) involves the application of this field to diagnostic assessment and clinical treatment of normal and abnormal child developmental, medical, psychiatric, and neurological conditions or problems. The field shares a knowledge base with other professions. A child or pediatric neuropsychologist may work with other pediatric specialists in behavioral neurology, developmental pediatrics, pediatric neurology, child psychiatry, pediatricians, occupational therapists and speech and language therapists.

Neuropsychologists are licensed as psychologists or in some states neuropsychologists. By definition, in almost all states, these individuals have doctoral degrees from accredited programs by the American Psychological Association usually in clinical psychology or neuropsychology. To be considered a neuropsychologist one must have formal graduate level training and clinically supervised experience in neuropsychology.

Most psychology licensing boards require a year of internship, which may be pre-doctoral as well as one year of supervised residency. Modern definitions of a neuropsychologist now usually require graduate level training and supervision and two years of supervised post-doctoral experience. A psychologist should not hold themselves out as a neuropsychologist with graduate training and supervision in the field. It is generally recognized that taking continuing education courses after licensure is not sufficient.

Neuropsychologists' extensive training and supervised experience usually involves normal and abnormal brain anatomy, study of brain diseases and dysfunction, and extensive training in using psychological tests to assess brain functioning. In most states, calling an assessment a psychological assessment or neuropsychological assessment is limited to licensed psychologists. Sometimes unlicensed providers or individuals who may not be specifically trained as rigorously as neuropsychologists may call their assessment reports by other names.

Pediatric or child neuropsychologists have training and experience in applying neuropsychological assessment or treatment techniques to children. Since children mature, they are faced with varying age-specific challenges in terms of their academic and social development. Far more than a simple downward extension of adult neuropsychology, the pediatric neuropsychology involves an understanding of normal and abnormal child development and learning, developmental motor skills, and language disorders as well as diseases associated with children.

Pediatric or child neuropsychologists commonly assess children for attention problems such as Attention-deficit Hyperactivity Disorder (ADHD), learning disorders such as dyslexia or math difficulties, or disorders of language and/or coordination difficulties. Evaluations are often more detailed than simply involving ability assessment, and assumptions are made about brain-behavior relationships. Evaluations may also involve assessments of Autism Spectrum Disorders which include autism, Asperger's Disorder, and Pervasive Developmental Disorder (PDD). Assessments are also performed to evaluate neurological conditions such as effects of a tumor, anoxia, birth complications, Cerebral Palsy, toxic exposures, head injuries or concussions. They may involve subtle or not so subtle deficits which may be involved with anemia, kidney disease or other metabolic diseases, and the effects of treatments or interventions which may impact on neurological or neuropsychological functions.

Since children’s skills go through periods of rapid change, and they are faced with increasing cognitive and academic demands with each passing year, there is often a need to conduct periodic re-assessments. Some conditions may not impact until later years, such as when facing the multi-tasking demands of middle school, or the increased volume of work and writing demands of high school.
Results of pediatric or child neuropsychology assessments may be used to assist in diagnosis, to assist with educational placement or remediation, clinical treatment planning, rehabilitation, formulating accommodations, disability determinations, determining the effects of medication or surgery, or in rarer cases in matters involving criminal responsibility or criminal competency. Applications of neuropsychological assessment to legal proceedings or determinations is termed forensic neuropsychology.

When choosing a clinic or neuropsychologist to conduct a neuropsychological evaluation on your child, it is wise to ensure the individual providing or supervising the services is a licensed psychologist with training involving both neuropsychological assessment and with children and adolescents. Asking how many child or adolescent evaluations are typically completed in a year or month may help you determine the level of experience with children the neuropsychologist or clinic may have. Asking about the extent of supervised experience in child neuropsychology and where this training was obtained is advised along with obtaining information as to the overall number of years of experience. Asking your pediatrician or family doctor for a recommendation is wise. If a neuropsychologist is or has practiced child neuropsychology or trained in a hospital setting this would generally suggest the individual's credentials have been reviewed and that they likely had training in more serious and rare conditions.

The more assessments a neuropsychologist or clinic conducts, the more likely that the neuropsychologist may use psychometricians or psychology assistants to assist with test administration and scoring.

However, the neuropsychologist is always responsible for the interpretation of the results and producing a report. The neuropsychologist will always maintain an active role in observing, interacting

with, questioning, taking developmental, neuropsychological, and social history, and examining the child.

Parent interviews and questionnaires are usually necessary, and in many cases school and medical records are reviewed. Teacher ratings are also frequently requested.

Children and adolescents often pose special challenges in assessment. While most children are familiar with being tested due to their school experience, sometimes one or more sessions may be necessary to help establish rapport. The examiner usually needs to provide more encouragement and breaks than may be necessary for adult patients.

Assessments may require a day or two, or in some cases a number of half-days. The often considerable expense must be weighed in the context of the professional time involved as well as the importance of ruling out other disorders or complicating factors which may be important in appropriate treatment planning.

Since the results of an assessment may impact medical care, rehabilitation planning, or in some cases placement or eligibility for benefits or services for months or years, it is easy to understand the importance of accurate and thorough assessment.

More information about our range of psychological and neuropsychological assessment and other services is available by clicking on the following link: More about neuropsychological assessment.

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