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, 1999).

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, 2000).

next Read and find out more about our treatment options.
next Read some of our case examples.
next Look at some of our scientific publications on ADHD.
next Read about our metacognitive and internal language program for ADHD.

References

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), 85-106.

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), 477-488.

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), 555-561.

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), 461-476.

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 2), 177-194.

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 Suppl), 26S-49S.

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), 12-21.

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), 222-233.

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), 159-173.

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), 859-867.

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.

 


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