Applying Luria's diagnostic principles in the neuropsychological assessment of children

The Necessity of a Reduced Version of the Psychomotor Battery to Screen for Learning Difficulties in Preschool Children

Psychomotor development is important for effective learning. Therefore, psychomotor observation is essential beginning in preschool education; however, observational instruments require practice, experience and time-consuming procedures. Psychomotor Battery (PBM) is useful to observe children’s psychomotor profile but needs 30 to 40 min per child to be applied. Therefore, the main objective of this study was to justify the need of a reduced version of the PBM to enable more frequent psychomotor observations at this level of education. A total of 70 preschool students with typical development were observed over 4 months in a school context, among which 31 were males and 39 were females (4- and 5-year-old). PBM is composed by seven psychomotor factors (PMF) distributed across three neuropsychological functional units. The total average of points for psychomotor observations was obtained using multiple linear regression (MLR) with a Stepwise method. For associations, Pearson’s correlation coefficient (r) was used. The results of this study showed that it is possible to reduce the average time of psychomotor observation by 43.7% (13 min and 31 s), maintaining a very strong association with the total average of points obtained. This reduction in observation time may contribute to the increase in psychomotor observations of preschool children using PMB.

Difference in Executive Functions Development Level between Two Groups: Preschool Children Who Took Extra Music Classes in Art Schools and Children Who Took Only General Music and Dance Classes Offered by Preschools

Previous studies have shown that there is a positive correlation between attending music classes regularly and the development of executive functions. This paper discusses the results of a pilot study dedicated to determining the difference in the level of development of the components of executive functions (inhibitory control, cognitive flexibility, and working memory), between 5–6-year-old children taking extra music classes, and children who participated only in general music and dance education in kindergarten. A total of 94 senior preschoolers from Moscow kindergartens took part in the study. Children were selected into an “extra music lessons” group and a “general preschool music and dance lessons” group based on the results of a questionnaire on supplementary education, which was filled in by parents prior to the research starting. The respondents from the “extra music and dance lessons” group attended music classes in art schools at least two times a week, both in individual and group formats. The current study revealed that children attending regular extra music classes had a higher level of inhibitory control, audio–verbal working memory, cognitive flexibility, and general coordination of the development of all executive functions. The obtained results support the value of regular extra music classes at preschool age. Moreover, this pilot study allows us to articulate the recommendations for further research in this direction.

Going beyond the mean: Intraindividual variability of cognitive performance in prodromal and early neurodegenerative disorders

OBJECTIVE

Intraindividual variability (IIV), generally defined as short-term variations in behavior, has been proposed as a sign of subtle early impairment in neurodegenerative disorders, presumably associated with the disintegration of neuronal network connectivity. We aim to provide a review of IIV as a sensitive cognitive marker in prodromal neurodegenerative disorders.

METHOD

A narrative review focusing not only on theoretical and methodological definitions, including an overview on the neural correlates of IIV, but mainly on results from population-based and clinical-based studies on the role of IIV as a reliable predictor of mild cognitive impairment (MCI) and conversion to dementia in neurodegenerative disorders, mostly Alzheimer's and Parkinson's disease.

RESULTS

Most studies focus on MCI and Alzheimer's disease and demonstrate that IIV is a reliable cognitive marker. IIV is partly more sensitive than mean performance in the prediction of cognitive impairment or progressive deterioration and is independent of socio-demographic variables and disease mediators (e.g., genetic susceptibility). Neuroimaging data, mostly from healthy subjects, suggest a relationship between IIV and dysfunction of the default mode network, presumably mediated by white matter disintegration in frontal and parietal areas.

CONCLUSIONS

IIV measures may provide valuable information about diagnosis and progression in prodromal stages of neurodegenerative disorders. Thus, further conceptual and methodological clarifications are needed to justify the inclusion of IIV as a sensible cognitive marker in routine clinical neuropsychological assessment.

An Early Years Toolbox for Assessing Early Executive Function, Language, Self-Regulation, and Social Development: Validity, Reliability, and Preliminary Norms

Several methods of assessing executive function (EF), self-regulation, language development, and social development in young children have been developed over previous decades. Yet new technologies make available methods of assessment not previously considered. In resolving conceptual and pragmatic limitations of existing tools, the Early Years Toolbox (EYT) offers substantial advantages for early assessment of language, EF, self-regulation, and social development. In the current study, results of our large-scale administration of this toolbox to 1,764 preschool and early primary school students indicated very good reliability, convergent validity with existing measures, and developmental sensitivity. Results were also suggestive of better capture of children's emerging abilities relative to comparison measures. Preliminary norms are presented, showing a clear developmental trajectory across half-year age groups. The accessibility of the EYT, as well as its advantages over existing measures, offers considerably enhanced opportunities for objective measurement of young children's abilities to enable research and educational applications.

Examination of the Underlying Structure of the Nepsy: A Developmental Neuropsychological Assessment

The internal structure of the NEPSY, a developmental neuropsychological instrument, was investigated with exploratory principal axis factor analyses using the correlation matrix for the 5- to 12-year-old children of the standardization sample. Additionally, a review of the psychometric properties of the NEPSY was conducted. The concurrence of multiple criteria indicated that a one-factor solution best describes the NEPSY (5-12) core domain structure. The five core domains specified in the test manual may significantly overdefine the NEPSY structure. Estimates of the unique variance accounted for by NEPSY subtests were also calculated. Most of the subtests have adequate or moderate specificity. Three subtests met the criteria for ample or excellent specificity. The subtest data should not be interpreted as if they reflect unique neuropsychological processing skills. Practitioners should be cautious in interpreting the core domain and subtest profiles of children's performance on the NEPSY. Further research of the utility of the NEPSY is needed.

Executive function of Spanish-speaking language-minority preschoolers: Structure and relations with early literacy skills and behavioral outcomes

Young children's executive function (EF) is increasingly recognized as an important construct associated with development in cognitive and socioemotional domains. To date, however, few studies have examined EF in populations of language-minority children. In this study, 241 Spanish-speaking language-minority preschoolers who ranged in age from 38 to 69 months (M=54.23 months, SD=6.17) completed three tasks designed to measure inhibitory control (IC) and four tasks designed to measure working memory (WM). Children completed assessments of their vocabulary skills, early literacy skills, and behavioral self-regulation in both English and Spanish, and their classroom teachers completed three behavior rating measures. Children were classified as more proficient in English or Spanish based on their scores on the vocabulary measures, and all IC and WM measures were administered in the children's more proficient language. Results of confirmatory factor analyses supported a two-factor model of EF for both groups of children as well as strong measurement and structural invariance across groups. Children's EF was substantially related to the language, early literacy, and behavioral self-regulation measures as well as teacher ratings of inattention and hyperactivity/impulsivity. For children with more proficient English, EF was associated with skills in both English and Spanish; however, for children with more proficient Spanish, EF was associated primarily with skills in Spanish. These results provide evidence of strong correspondence for EF measured in Spanish-speaking language-minority preschoolers and monolingual preschoolers, and they identify a potential key factor that can enhance understanding of development in this population of children.

Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and meta-analysis

OBJECTIVE

To provide an up-to-date systematic review and critical appraisal of prospectively performed studies evaluating neurocognitive function in children treated with adenotonsillectomy.

DATA SOURCES

PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library.

REVIEW METHODS

Searches were performed from inception through September 2, 2015.

RESULTS

Nineteen prospective studies (898 adenotonsillectomy patients) met criteria and reported neurocognitive outcomes. The average age of children was 6.6±2.3 years (range 2.5-14 years) and 51.1% were male. Pre- and post-operative data utilizing the Neuropsychological Developmental Assessment score demonstrated an increase from a means±standard deviations of 101.5±14.7 [95% CI 100.0, 103.0] to 108.8±13.4 [95% CI 107.4, 110.2], p-value <0.0001 (375 children, three studies). Pre- and post-operative data utilizing the Stanford-Binet Intelligence Scales (IQ) demonstrated an increase in IQ scores from a means±standard deviations of 97.1±13.8 [95% CI 91.6, 95.4] to 100.7±11.1 [95% CI 100.4, 103.4], p-value <0.0001 (254 children, three studies). The mean pre- and post-adenotonsillectomy apnea-hypopnea index (AHI) decreased from 8.0 to 1.8 (274 children, six studies).

CONCLUSIONS

This meta-analysis found an improvement in neurocognitive function and IQ after pediatric adenotonsillectomy, especially in pre-school aged children. However, this must be interpreted with caution as only three studies were performed in pre-school aged children. The decreased effectiveness in older children suggests possibly a threshold age when neurocognitive deficits become irreversible.

A cross-cultural investigation of inhibitory control, generative fluency, and anxiety symptoms in Romanian and Russian preschoolers

The current study focused on the early development of inhibitory control in 5- to 7-year-old children attending kindergarten in two Eastern-European countries, Romania and Russia. These two countries share many aspects of child-rearing and educational practices, previously documented to influence the development of inhibitory control. Using the Lurian-based developmental approach offered by the Developmental Neuropsychological Assessment battery, the study aimed to contribute to cross-cultural developmental neuropsychology by exploring (a) early interrelationships between subcomponents of inhibitory control (response suppression and attention control) and generative fluency (verbal and figural) in these two cultures, as well as (b) the predictive value of external factors (culture and maternal education) and individual differences (age, gender, nonverbal intelligence, trait anxiety) on inhibitory control and fluency outcomes in children from both countries. First, findings in both culture samples suggest that even at this young age, the construct of inhibitory control cannot be considered a unitary entity. Second, differences in maternal education were not predictive of either inhibitory control or fluency scores. However, children's attention control performance varied as a function of culture, and the direction of these cultural effects differed by whether the target outcome involved performance accuracy versus efficiency as an output. Findings also confirmed the previously documented intensive developmental improvement in preschoolers' inhibitory control during this period, influencing measures of response suppression and particularly attention control. Finally, the results further stress the importance of individual differences effects in trait anxiety on attention control efficiency across cultures.

The neurocognitive assessment of Hispanic English-language learners with reading failure

This study examined the performance of referred Hispanic English-language learners (N = 40) on the English and Spanish versions of the Cognitive Assessment System (CAS; Naglieri & Das, 1997 ). The CAS measures basic neuropsychological processes based on the Planning, Attention, Simultaneous, and Successive (PASS) theory (Naglieri & Das, 1997 ; Naglieri & Otero, 2011c). Full Scale (FS) scores as well as PASS processing scale scores were compared, and no significant differences were found in FS scores or in any of the PASS processes. The CAS FS scores on the English (M = 86.4, SD = 8.73) and Spanish (M = 87.1, SD = 7.94) versions correlated .94 (uncorrected) and .99 (corrected for range restriction). Students earned their lowest scores in Successive processing regardless of the language in which the test was administered. PASS cognitive profiles were similar on English and Spanish versions of the PASS scales. These findings suggest that students scored similarly on both versions of the CAS and that the CAS may be a useful measure of these four abilities for Hispanic children with underdeveloped English-language proficiency.

Preliminary Validation of the Motor Skills Rating Scale

This study examined psychometric properties of the Motor Skills Rating Scale (MSRS), a questionnaire designed for classroom teachers of children in early elementary school. Items were developed with the guidance of two occupational therapists, and factor structure was examined with an exploratory factor analysis (EFA). The resulting model showed good fit with 19 items that loaded on 3 subscales: Shapes and Letters, Classroom Fine Motor, and Body Awareness. In tests of concurrent criterion validity, each scale was correlated in the expected direction with direct assessments of children’s ( N = 242) visuospatial processing, sensorimotor functioning, and executive function (EF) obtained using a direct neuropsychological assessment. Children with higher ratings on the Classroom Fine Motor scale of the MSRS also had higher teacher-rated and directly assessed mathematics achievement. Study findings provided preliminary support for the utility and validity of a brief teacher report of elementary children’s motor skills.

Developments in clinical neuropsychology: implications for school psychological services

BACKGROUND

According to the 2000 Report of the Surgeon General's Conference on Children's Mental Health, a significant percentage of children and adolescents have emotional or behavioral problems serious enough to merit a mental health diagnosis. The No Child Left Behind Act of 2001 and the Individuals With Disabilities Education Improvement Act of 2004 reemphasized the schools' importance in supporting cognitive and behavioral development in students, particularly those identified with learning problems. In this article, we examine the growing specialty of clinical neuropsychology and provide suggestions for integrating this field into school-based psychological services.

METHODS

This article provides a review of the neuropsychological bases for many childhood learning disorders and addresses how school psychologists can work with clinical neuropsychologists to better address the needs of exceptional children through neuropsychological testing.

RESULTS

There is substantial neurological evidence for attention-deficit hyperactivity disorder as well as disorders of reading, language, and mathematics. Close collaborative partnerships between clinical neuropsychologists and school psychologists will help develop assessment protocols that are likely to result in more effective intervention services for students with neuropsychological conditions.

CONCLUSIONS

Schools are being asked to support the physical, cognitive, and emotional development in students, particularly those identified with chronic physical and mental health challenges. Dissatisfaction with minimal screenings, the growing awareness of the neurology of learning disorders, and the passage of the Individuals With Disabilities Education Improvement Act of 2004 obliges all school-based mental health providers to consider how to fully integrate the tools of clinical neuropsychology into school-based psychological services.

Neurological soft signs and their relationships to neurocognitive functions: a re-visit with the structural equation modeling design

Background

Neurological soft signs and neurocognitive impairments have long been considered important features of schizophrenia. Previous correlational studies have suggested that there is a significant relationship between neurological soft signs and neurocognitive functions. The purpose of the current study was to examine the underlying relationships between these two distinct constructs with structural equation modeling (SEM).

Methods

118 patients with schizophrenia and 160 healthy controls were recruited for the current study. The abridged version of the Cambridge Neurological Inventory (CNI) and a set of neurocognitive function tests were administered to all participants. SEM was then conducted independently in these two samples to examine the relationships between neurological soft signs and neurocognitive functions.

Results

Both the measurement and structural models showed that the models fit well to the data in both patients and healthy controls. The structural equations also showed that there were modest to moderate associations among neurological soft signs, executive attention, verbal memory, and visual memory, while the healthy controls showed more limited associations.

Conclusions

The current findings indicate that motor coordination, sensory integration, and disinhibition contribute to the latent construct of neurological soft signs, whereas the subset of neurocognitive function tests contribute to the latent constructs of executive attention, verbal memory, and visual memory in the present sample. Greater evidence of neurological soft signs is associated with more severe impairment of executive attention and memory functions. Clinical and theoretical implications of the model findings are discussed.

The neural basis of motor sequencing: an fMRI study of healthy subjects

The present study used functional MRI to clarify the brain regions activated during a series of motor sequencing tasks in healthy volunteers. Ten subjects were scanned while performing three soft signs tasks ranging from simple (PT: palm tapping), moderate (PS: pronation/supination) to complex movements (FEP: fist-edge-palm). The FEP task induced significant activations within the cortical networks including bilateral sensorimotor, SMA, left parietal, and right cerebellum, but no activation in the prefrontal area. Moreover, the percentage signal changes within the left sensorimotor, left thalamus and right cerebellum showed an increase in activation with task complexity. The present findings challenge the traditional belief that FEP was a task for frontal lobe function but suggest that successful performance of more complex neurological soft sign tasks like FEP requires the participation of more brain areas than simple motor sequencing and coordination task like PS and PT. These also provide the empirical data on the neural basis of neurological soft signs for further study in other clinical group like schizophrenia in the near future.

Effects of age on neurocognitive measures of children ages 5 to 12: a cross-sectional study on 800 children from the United States

The standardization of the NEPSY-A Developmental Neuropsychological Assessment (Korkman, Kirk, & Kemp, 1998) provided an opportunity to study the effects of age across the age range 5 to 12 years. Test scores of 800 children on 20 subtests of NEPSY were analyzed. These measures are based on traditions of neuropsychological assessment and are thought to reflect attention and executive functions, language, sensorimotor functions, visuospatial functions, and memory and learning. The effects of age were very significant on all measures, confirming the developmental sensitivity of the NEPSY. The effects of age were more significant in the 5- to 8-year age range than in the 9- to 12-year range. Only performance on tasks of fluency and memory span for sentences showed significant age effects in the 10- to 12-year age range. This suggests that neurocognitive development is rapid in the 5- to 8-year age range and more moderate in the 9- to 12-year age range.

Neurocognitive development of children with congenital unilateral brain lesion and epilepsy

The aim of this study was to specify the neuropsychological deficits characteristic of children with unilateral non-progressive brain lesion. In order to assess these specific functions, we used a comprehensive model of congenital hemiparesis with partial epilepsy and newly diagnosed partial epilepsy without hemiparesis. The neuropsychological examination was performed using the NEPSY test battery on 44 children aged from 4 to 9 years. The children were divided into three groups: 18 children suffering from congenital hemiparesis with chronic partial epilepsy, 12 children with newly diagnosed partial epilepsy prior to anti-epileptic treatment, and 14 healthy controls matched by sex, age, and socioeconomic status. Children with congenital hemiparesis and epilepsy had a more clearly expressed cognitive dysfunction, especially in language, visuo-perceptual and memory tasks, than children with newly diagnosed partial epilepsy. The profile of cognitive weakness appears to be diffuse and quite similar in both groups, and it did not demonstrate a clear effect of lateralization, according to the side of epileptic electroencephalogram discharges. Children within both groups are likely to have a high risk of developing attention, phonological, visuo-perceptual, and memory deficits in their life. Especially interesting and surprising was the fact that the newly diagnosed epilepsy group demonstrated impairment not only in attention, visuo-perceptual and short-term memory skills, but also in auditory perception, lexical function, and the comprehension of speech. Therefore, it is recommended that children with epilepsy would undergo neuropsychological examination in order to assess their cognitive abilities.

Neuropsychologische Diagnostik im Kindes- und Jugendalter

Zusammenfassung: Bei einer Vielzahl von Fragestellungen und Störungsbildern sollte neuropsychologische Diagnostik einen festen Stellenwert haben, sowohl in der initialen wie auch in der Verlaufsbeurteilung. Mit Blick auf die Anwendung in der Kinder- und Jugendpsychiatrie ist zunächst eine beschreibende Definition dieses Bereichs psychologischer Diagnostik zu versuchen. Dabei bestehen methodisch grundlegend unterschiedliche Zugangswege, die in ihren Auswirkungen auf Psychometrie wie Interpretation zu erörtern sind. Unabhängig davon, dass die gegenwärtige Verfügbarkeit standardisierter neuropsychologischer Diagnostik nur in einigen Bereichen befriedigen kann, wird eine Darstellung der in klinischer Praxis und/oder Forschung anwendbaren Verfahren versucht. Neben einzelnen Testbatterien werden Einzeltestverfahren für die Bereiche visuelle und auditive Gedächtnisfunktionen, Aufmerksamkeitsfunktionen, sprachassoziierte Funktionen und Exekutivfunktionen besprochen. Der aktuelle Stand neuropsychologischer Diagnostik führt zu wesentlichen Aufgaben ihrer Weiterentwicklung. Dies gilt sowohl für kurzfristig erreichbare Ziele wie Adaptation oder Normierung verfügbarer Instrumente als auch für längerfristige Forschungsaufgaben.