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Wednesday, February 25, 2015

Does Your Child Need a Neuropsychological Evaluation?

From Beyond BookSmart's
Executive Functioning Strategies Blog

By Dr. Anya Dashevsky
February 20, 2015

At every age, a child is working on mastering a particular set of skills or developmental tasks. Thus, every age and every stage of development brings with it its own set of challenges. Difficulties in mastering age-appropriate developmental tasks will likely manifest as behavioral problems, academic struggles, or challenges in interacting with family members or peers.

Parents can see that their child is struggling, but are not always sure what is going on and how to help. In order to understand the nature of a child's difficulties and to chart the most appropriate course of action for addressing the problem, parents might choose to bring their child in for a neuropsychological evaluation.

Neuropsychological Evaluation of Preschool Children

When a child is between one and three years of age, a huge developmental task to master is learning to use language in order to communicate with others. Being able to express themselves through language enables children to interact with family members and peers, better tolerate their frustration by labeling their emotions, think symbolically and engage in pretend play. If a child has difficulty learning to communicate effectively, parents become concerned.

A big worry at this age is that the delay in language acquisition is due to the presence of Autism Spectrum Disorder. Parents might bring in their child for an evaluation in order to determine if the child's difficulties are due to the presence of an Autism Spectrum Disorder, or due to other factors, such as developmental delays or a language disorder.

By four or five years of age, the “terrible twos” and the “terrific threes” are supposed to be over, and children are expected to learn to manage their frustration by ways other than temper tantrums or physical aggression. When parents bring their 4- or 5-year-old in for an evaluation, they typically have concerns about their child's behavior at home or in preschool. “When something doesn't go according to plan, my son becomes so upset, he starts pushing other kids or knocking over chairs!” a parent will tell me.

A number of factors might be involved in a preschooler's difficult behavior – from anxiety to attentional difficulties to language delays. The goal of an evaluation is to find out what is causing the child to act impulsively and to determine best ways to help him.

Neuropsychological Evaluation of Elementary School Children

In early elementary-school years, children are expected to learn to read, write, and master basic math concepts. Sometimes children who have not had any difficulties prior to starting school will struggle in the classroom. “I know my daughter is really smart, but she just can't seem to learn how to read,” a parent will tell me. “Could she have dyslexia?”

Some children try to take attention away from their learning difficulties by acting out in school. Parents of 6, 7, and 8-year-olds bring their children in for a variety of concerns related to learning and school performance. These difficulties could be caused by a variety of factors, including learning disabilities or ADHD.

In later elementary-school years, academic expectations increase to include completing larger assignments and grasping more complex concepts. Some children who have done reasonably well until 3rd, 4th, or 5th grade, might struggle with increased expectations for independence and for managing larger, more complicated tasks. A neuropsychological assessment might reveal executive functioning difficulties, attentional challenges, or a learning disorder, as the root cause of a child's struggles in school.

Neuropsychological Evaluation of Adolescents

The emotional up-and-downs of early teen-age years, coupled with the challenges of navigating a complex social world of middle school, make it difficult for many children to make it through this stage without bumps along the way. Low self-esteem, anxiety about school performance or friendships, strained relationships with parents, are some of the typical concerns that I hear from parents of middle school children.

High school years bring with them increased expectations for structuring time, navigating peer and romantic relationships, and outlining plans for the future. Because of increased academic demands, a child with an undiagnosed learning disability, executive functioning difficulties, or performance anxiety might find it difficult to remain successful. Even if they have been able to “compensate” for their difficulties up until high school (often through high intelligence, hard work and determination), the students realize that in order to remain successful in high school, they will first need to address their difficulties.

Transition to college is a major developmental task of later adolescent years. Adjusting to living away from home, making new friendships, choosing a career path, and managing the academic workload are only some of the challenges that college students face. If there are learning or emotional issues that have not been addressed prior to this time, these issues will likely come to the surface during the college years. Again, a comprehensive evaluation can help figure out what is standing in the way of success, and how to help the student clear the road blocks.

At every age, a child is working on mastering age-appropriate developmental tasks. If parents see their child struggle in the process, they may choose to bring their child in for neuropsychological testing. A comprehensive evaluation is often the best way to identify each child's unique pattern of strengths and challenges and to develop a plan for using the child's strengths in order to address areas of challenge.

About the Author

Dr. Dashevsky holds a doctoral degree in Clinical Psychology from the MA School of Professional Psychology and a Master's degree in Child Development from Tufts University.

She was director of the Neurodevelopmental Assessment Service for Young Children, a program at the Brenner Assessment Center that she envisioned and co­founded.

Her background includes working with young children in need of Early Intervention services, providing therapy to children, adolescents, and families, and facilitating parent groups. 

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