Neuropsychological assessment for children and adolescents
In conjunction with evidence from clinical interviews and other testing, neuropsychological assessment can be used to aid diagnostic decisions and refine treatment in developmental disorders such as ADHD, Learning Disorders and Conduct Disorder. It can also be used to identify children and adolescents with giftedness.
Importance of neuropsychological assessment
Neuropsychological assessment is very important to determine the precise cognitive
deficits (the brain mechanics) that underlie learning disorders and ADHD. Such
deficits early in life can contribute to a maladaptive behavioural style that
can adversely affect personality development and social maturity across the life
span (Clark et al., 2002). Gifted children with behavioural and educational problems
also need to be correctly identified to avoid misdiagnosis.
Traditional testing of ADHD
The popular neuropsychological
method for identifying ADHD has involved use of continuous performance
tests (CPTs) such as the Test of Variable Attention (TOVA) or Conners
CPT (Corkum & Siegel, 1993; Riccio et
al., 2001; Seifert et al., 2003). The results from CPTs are encouraging
but at a clinical cut off of > 2 SD, the sensitivity of the test
falls down to approximately 60 % (Forbes, 1998). This means that a
lot of ADHD children are not identified or if a more conservative cut-off
of > -1.5 SD is used then the is a high number of normal children that
are identified as having ADHD (Greenhill et al., 2002; Grodzinsky & Barkley,
The results indicate that no single
instrument can be used to identify the comprehensive range of cognitive
abnormalities that can occur in ADHD (Doyle et al., 2000; Frazier et
al., 2004 The use of neuropsychological test batteries which combine
multiple cognitive tests tapping into different domains of cognitive
function are considered better and have provided much more encouraging
results (Doyle et al., 2000; Frazier et al., 2004; Muir-Broaddus et
al., 2002; Perugini et al., 2000; Pineda et al., 1999). Authors have
also considered that a comprehensive neuropsychological battery is
needed to advance ADHD research (Sergeant et al., 2003).
An example of the utility of the
test battery approach has been illustrated by Pineda et al. (Pineda
et al., 1999) who found that they could correctly classify 85.5% of
a sample of 62 ADHD and 62 control subjects using 10 neuropsychological
variables. Further sensitivity is obtained by using brain function
and neuropsychological measures (Hermens et al., 2006) and the brain
function measures are the only way to identify the cause of the neuropsychological
deficit (Rowe & Hermens, 2006). It is this information that is
important for determining the most optimal treatment approach.
Traditional assessment and learning disability
Traditional assessments of achievement that rely solely on IQ (intelligence)
tests and simple processes such as subtraction and comprehension, often fail
to detect children and adolescents with learning difficulties. This is particularly
the case for those who are high functioning (Fletcher et al., 1992; Francis et
al., 1996; Morgan et al., 2000).
Traditional IQ and aptitude assessments are not designed to measure the cognitive
functions that underlie such learning difficulties. This can lead to a failure
accurately identify comorbid learning or motor-related problems.
More accurate assessment can be made using neuropsychological measures that provide a more sensitive measure of cognitive strengths and weaknesses (Clark et al., 2002; Lovejoy et al., 1999).
Neuropsychology versus aptitude tests
Neuropsychological assessment overcomes the problems of aptitude assessment by evaluating a broad range of cognitive functions including sensorimotor coordination, language, time estimation, verbal and nonverbal memory, decoding and organization of information, speed of information processing, attention, working memory, learning and the self-monitoring.
Assessment and refinement of treatment
Neuropsychological assessment can be used to provide cognitive profiles that
are useful for assessing and predicting current and future academic performance,
and designing focused education strategies for children with learning difficulties
(Alloway et al., 2004; Biederman et al., 2004; Gathercole & Pickering, 2000;
Kennard et al., 2000; Rabiner & Coi,
Alloway, TP, Gathercole, SE, Willis, C, and Adams, AM (2004).
A structural analysis of working memory and related cognitive skills
in young children. Journal of Experimental Child Psychology , 87 (2),
Biederman, J, Monuteaux, MC, Doyle, AE, Seidman, LJ, Wilens,
TE, Ferrero, F, Morgan, CL, and Faraone, SV (2004). Impact of Executive
Function Deficits and Attention-Deficit/Hyperactivity Disorder (ADHD)
on Academic Outcomes in Children. Journal of Consulting & Clinical
Psychology , 72 (5), 757-766.
Clark, C, Prior, M, and Kinsella, G (2002). The relationship
between executive function abilities, adaptive behaviour, and academic
achievement in children with externalising behaviour problems. Journal
of Child Psychology and Psychiatry , 43 (6), 785-796.
Corkum, PV and Siegel, LS (1993). Is the Continuous Performance
Task a valuable research tool for use with children with Attention-Deficit-Hyperactivity
Disorder? Journal of Child Psychology & Psychiatry & Allied
Disciplines , 34 (7), 1217-1239.
Doyle, AE, Biederman, J, and Seidman, L (2000). Diagnostic
efficiency of neuropsychological test scores for discriminating boys
with and without attention deficit-hyperactivity disorder. Journal
of Consulting & Clinical Psychology , 68 (3),
Fletcher, JM, Francis, DJ, Rourke, BP, Shaywitz, SE, and
Shaywitz, BA (1992). The validity of discrepancy-based definitions of
reading disabilities. Journal of Learning Disabilities , 25 (9),
Forbes, GB (1998). Clinical utility of the Test of Variables
of Attention (TOVA) in the diagnosis of attention-deficit/hyperactivity
disorder. Journal of Clinical Psychology , 54 (4),
Francis, DJ, Fletcher, JM, Shaywitz, BA, Shaywitz, SE,
and Rourke, BP (1996). Defining learning and language disabilities: Conceptual
and psychometric issues with the use of IQ tests. Language, Speech, & Hearing
Services in Schools , 27 (2), 132-143.
Frazier, TW, Demaree, HA, and Youngstrom, EA (2004). Meta-Analysis
of Intellectual and Neuropsychological Test Performance in Attention-Deficit/Hyperactivity
Disorder. Neuropsychology , 18 (3), 543-555.
Gathercole, SE and Pickering, SJ (2000). Working memory
deficits in children with low achievements in the national curriculum
at 7 years of age. British Journal of Educational Psychology , 70 (Pt
Greenhill, LL, Pliszka, S, Dulcan, MK, Bernet, W, Arnold,
V, Beitchman, J, Benson, RS, Bukstein, O, Kinlan, J, McClellan, J, Rue,
D, Shaw, JA, Stock, S, and American Academy of Child and Adolescent Psychiatry
(2002). Practice parameter for the use of stimulant medications in the
treatment of children, adolescents, and adults. Journal of the American
Academy of Child & Adolescent Psychiatry , 41 (2
Grodzinsky, GM and Barkley, RA (1999). Predictive power
of frontal lobe tests in the diagnosis of attention deficit hyperactivity
disorder. The Clinical Neuropsychologist , 13 (1),
Hermens, DF, Rowe, DL, Gordon, E, and Williams, LM (2006).
Integrative neuroscience approach to predict ADHD stimulant response. Expert
Review of Neurotherapeutics , 6 (5), 753-763.
Kennard, BD, Stewart, SM, Silver, CH, and Emslie, GJ (2000).
Neuropsychological abilities and academic gains in learning disabled
children: A follow-up study over an academic school year. School
Psychology International , 21 (2), 172-176.
Lovejoy, DW, Ball, JD, Keats, M, Stutts, ML, Spain, EH,
Janda, L, and Janusz, J (1999). Neuropsychological performance of adults
with attention deficit hyperactivity disorder (ADHD): diagnostic classification
estimates for measures of frontal lobe/executive functioning. Journal
of the International Neuropsychological Society , 5 (3),
Morgan, AE, Singer-Harris, N, Bernstein, JH, and Waber,
DP (2000). Characteristics of children referred for evaluation of school
difficulties who have adequate academic achievement scores. Journal
of Learning Disabilities , 33 (5), 489-500.
Muir-Broaddus, JE, Rosenstein, LD, Medina, DE, and Soderberg,
C (2002). Neuropsychological test performance of children with ADHD relative
to test norms and parent behavioral ratings. Archives of Clinical
Neuropsychology , 17 (7), 671-689.
Perugini, EM, Harvey, EA, Lovejoy, DW, Sandstrom, K, and
Webb, AH (2000). The predictive power of combined neuropsychological
measures for attention deficit/hyperactivity disorder in children. Child
Neuropsychology , 6 (2), 101-114.
Pineda, D, Ardila, A, and Rosselli, M (1999). Neuropsychological
and behavioral assessment of ADHD in seven- to twelve-year-old children:
A discriminant analysis. Journal of Learning Disabilities , 32 (2),
Rabiner, D and Coi, JDP (2000). Early Attention Problems
and Children's Reading Achievement: A Longitudinal Investigation. Journal
of the American Academy of Child & Adolescent Psychiatry , 39 (7),
Riccio, CA, Waldrop, JJ, Reynolds, CR, and Lowe, P (2001).
Effects of stimulants on the continuous performance test (CPT): implications
for CPT use and interpretation. Journal of Neuropsychiatry & Clinical
Neurosciences , 13 (3), 326-335.
Rowe, DL and Hermens, DF (2006). Attention-deficit/hyperactivity
disorder: neurophysiology, information processing, arousal and drug development. Expert
Review of Neurotherapeutics , 6 (11), 1721-1734.
Seifert, J, Scheuerpflug, P, Zillessen, KE, Fallgatter,
A, and Warnke, A (2003). Electrophysiological investigation of the effectiveness
of methylphenidate in children with and without ADHD. Journal of
Neural Transmission , 110 (7), 821-829.
Sergeant, JA, Geurts, H, Huijbregts, S, Scheres, A, and Oosterlaan, J (2003).
The top and the bottom of ADHD: a neuropsychological perspective. Neuroscience & Biobehavioral
Reviews , 27 (7), 583-592.