Pediatric Neuropsychological Assessment

A PEDIATRIC NEUROPSYCHOLOGICAL ASSESSMENT is a broad-based and in-depth evaluation of a child’s brain functioning that is highly specialized. It includes all the components of a thorough adult neuropsychological assessment but it also integrates specific knowledge of brain development, specific vulnerabilities during crucial stages of fetal growth, as well as understanding of normal childhood behavior and development. Because neurodevelopmental disorders have early onset, the “event” may affect multiple brain and neurobehavioral systems that will require a framework that includes consideration of brain-behavior relationships, how a child’s nervous system interacts with his/her environment, and how these interactions manifest and change over time.

Early insults can stimulate alternative neural pathways that can assume the function of the affected area. However, the development of these alternative pathways can affect not only the target function but also the “compensating” structures since they have to take on more “responsibilities” that may subsequently result in “crowding” in the neural pathway, thus affecting overall efficiency.

A Pediatric Neuropsychological Assessment provides clear and specific information regarding a child’s functioning compared to his/her average age mates, and may be particularly valuable when problem-areas have been identified in the past but the child has failed to respond to the recommended interventions. In addition, children with neurodevelopmental disorders or conditions that involve early insults or abnormality in the developing central nervous system including premature birth or toxic exposure, often require a thorough pediatric neuropsychological assessment at various points in their lives, so as to better determine their changing needs and abilities over time. When a child has difficulty with thinking and performing tasks that are age appropriate, has problems with learning or memory, displays uncontrollable emotions or unusual behaviors, a neuropsychological assessment may be valuable in bringing the reasons for the problematic presentation to the forefront.

Neurological diagnoses can be associated with genetic (Fragile X, Turner syndrome, neurofibromatosis, Down syndrome, Klinefeler syndrome, phenylketonuria, juvenile Huntington’s, Sickle cell disease, etc), environmental (Fetal Alcohol Syndrome, traumas, infections, toxic exposure and teratogens), medical (seizures, metabolic or endocrine problems, premature birth, brain tumor), multiple factors (Tourette’s Syndrome, Cerebral palsy, Spina Bifida), fetal infections (toxoplasmosis, varicella zoster, parvovirus, rubella, cytomegalovirus). For many of the above mentioned factors the frequency and duration of exposure and timing in relation to fetal growth or critical periods of rapid brain development play a crucial role in the severity of the presentation. Oftentimes, a condition that may present with mild symptoms in the mother can have serious repercussions to the developing fetus. Other times, an insult that was apparently benign, can have a more significant impact at a later stage, as the nervous system grows and the “loss” of function assumes greater consequences in a person’s life.

Young children whose brain has been compromised are often “developmentally off track” and more vulnerable to difficulties with regulation of behavior, attention and stamina. The information derived from a Pediatric Neuropsychological Assessment will provide caregivers (parents, teachers, guardians) with a better understanding of their child’s developmental pattern, strengths and limitations that will result in the adults being more empowered and confident as to what to do to help and set appropriate expectations. When warranted and with parental consent, I will participate in an IEP meeting so as to advocate for the affected child’s educational needs and put in place the appropriate interventions to be implemented at the school setting.