Neuropsychological Services at CARD

Transcription

1 Neuropsychological Services at CARD

2 Objectives Who are we? What do we do? Why do providers refer to us? Case Example

3 Who We Are Neuropsychologists: Rebecca Vaurio, Ph.D.; Renee Folsom, Ph.D., Garland Jones, Ph.D.; & Ericka Wodka, Ph.D., ABPP Clinical Psychologists: Tiffany Washington, Ph.D.; Ali Mostow, Ph.D.; Kelly Sheperd, Ph.D. Trainees

4 Neuropsychological Assessment Brain Differences Behavior Differences

5 Neuropsychological Assessment Structured and standardized observations Brain-behavior relationship examination is unique and particularly important in understanding children with autism: Used to think was just behavior disorder Now overlapping neurological conditions recognized Additional disorders impact neurological development

6 Neurodevelopmental Disorders Atypical brain development Neurological correlates of behaviorally defined conditions have been uncovered For autism, while groups of children show differences in brain development, there is no biological/neurological marker used clinically Diagnosis based on observed behavior

7 /class/bio201/brain/brainmodel Map.htm Children with autism have increased whole brain volumes, cerebral hemispheres, and cerebellum, and decreased corpus callosum. Stanfield et al., 2008.

8 Brain-Behavior Relationship Different relationship in brain structure and performance observed in typical children and autism. Specific to basic motor skills (Mostofsky, Burgess, & Gidley Larson 2007) Typical Children: More brain volume = Better Performance Autism: More Brain Volume = Worse Performance

9 Challenges to Behavioral Diagnosis Differences in clinical judgment/impressions Biases of parent/caregiver/teacher reports Fluctuations in child s behavior Day to day Across settings Standardized means of observing and quantifying a child s behavior reduces some of these challenges

10 Standardized scores # Items 100 Correct Age

11 Neuropsychological Assessment Not required to make diagnosis Instead, provides useful information and Helps prevent misunderstanding of abilities based on observation/perceptions alone Risk is apparent for high and low functioning children

12 Components of a Neuropsychological Assessment Parent and child (play) interview Standardized assessment of cognitive and emotional-behavioral functioning. Behavior observation Task-approach observation all scores are not equal

13 Types of Neuropsychological Assessment Baseline Assessment Planned Follow-up Problem-Focused Assessment Screening Team and Independent Assessments Mahone & Slomine, 2008

14 Referral to neuropsychological assessment for? Diagnostic clarification, clarify functioning, and provide recommendations If child is not correctly described, they cannot be effectively treated

15 What is Autism A quantity and severity of deficits in core areas: Social Communication Social Reciprocity Restricted or Hyper-focused interest Repetitive Behavior Sensory Processing

16 How is neuropsychological assessment useful in Autism? Assist with diagnostic clarification Clarify child s functioning (strengths and weaknesses) Provide recommendations for anticipated future difficulties

17 Frequent parent questions Where is my child relative to other children? Where is my child relative to past educational achievement? Where is my child relative to where we might expect them to be? What are my child s prospects for independent functioning as an adult?

18 Impressions Thorough evaluation integrates seemingly unrelated phenomenon Identify Changes Consider Current and Previous Intervention Consideration of Interfering behaviors Mahone & Slomine, 2008

19 Recommendations Developmental understanding allows for predictive recommendations Recommendations based on current situation as well as anticipated needs in order to plan for the future Mahone & Slomine, 2008

20 Recommendations Developmental understanding allows for predictive recommendations Recommendations based on current situation as well as anticipated needs in order to plan for the future Address home, school, community, leisure, and medical intervention Plans for the child s entire life cannot be made based on one evaluation

21 What Other Childhood Disorders can Look Like Autism (Rule-outs) Receptive/Expressive Language Disorder Attention Deficit/Hyperactivity Disorder Anxiety Specific Phobia Social Phobia Intellectual Disability Learning Disability Tourette Syndrome Giftedness Many more

22 Social Reciprocity Autism Lack of nonverbal socialization Failure to develop peer relationships Lack of spontaneous seeking to share enjoyment Lack of social reciprocity ADHD Interrupts and intrudes on others Talks excessively Difficulty playing quietly Does not listen when spoken to directly Difficulty sustaining attention to tasks or play

23 Case Example: Stevie s History Referral Question: Diagnostic clarification Previously diagnosed with PDD-NOS Developmental history: Language milestones WNL, appropriate gestures. Currently only poor articulation. Trouble maintaining friendships. Plays interactively and imaginatively. Poor pragmatics (e.g., boundaries) Very interested in video games and television. Often paces

24 Case Example: Stevie s Presentation 6 years old Appropriate eye contact, shook examiner s hand, quickly fell to the floor and then hid Inquisitive, reciprocal, and conversational Active, out of his seat, under the table Impulsive and impersistent

25 Case Example: Stevie s Performance Age appropriate for most measures Weakness in processing speed, basic auditory attention, and motor persistence Formal parent- and teacher-report noted clinically significant levels of inattention, hyperactivity, social problems, and emotional control

26 Case Example: Stevie, Impression Developmental history could be considered consistent with ASD: Language milestones WNL, appropriate gestures. Currently only poor articulation. Trouble maintaining friendships. Plays interactively and imaginatively. Poor pragmatics (e.g., boundaries) Very interested in video games and television. Often paces However, these are likely better accounted for by a rather severe case of ADHD

27 Case Example: Stevie, Recommendations Pediatrician prescribed psychotropic medication Treatment with behavioral psychologist initiated Patient responded incredibly well to the combine therapies, and both parent and teacher reported notable changes in his behavior at home and in school

28 Questions