Neurodevelopmental Evaluations
A standard psycho-educational evaluation does not provide enough specific information about how effective a child processes information to allow for the identification of possible underlying causes of learning difficulties. This is the purpose of a Neurodevelopmental Evaluation. This kind of evaluation demands a far more thorough and detailed investigation of the child’s developmental history, including his or her medical, social, psychological history and the history of his or her specific developmental conditions. The extent of the diagnostic process depends on whether or not the child has recently undergone any other specific evaluation procedures such as a psycho-educational, occupational therapy or speech therapy evaluation. If this is the case, the data from these evaluations is integrated into the developmental history and summarized in the report. The planning of the diagnostic session or sessions takes all available and useful information into account. The motto that guides the decision about which tests to administer and how many to administer is “as few as possible but as many as are necessary”.
The following areas of the child’s functioning may be examined in the process of a neurodevelopmental evaluation: Cognitive profile, non-verbal intelligence, profile of basic academic skills, visual processing, auditory processing, working memory, long-term memory, learning memory, visu-constructive skills, spatial reasoning, hand-eye dominance, laterality of hand-eye coordination, eye dominance, ocular muscle control, speech and language development, gross- and fine motor development, status of neuro-muscular development. If any of these areas have recently been evaluation, they are not re-evaluated but rather complemented by tests that allow diagnostic information to be gathered about areas that were not examined in previous evaluations.
Various types of neuropsychological tests and diagnostic instruments may be administered. Some of these are standardized tests, others are informed but informal clinical observations and yet others rely on the spontanious or systematic observations of the child’s parents and teachers of his or her typical patterns of coping behaviour in stressfull learning or social situations. The observations of parents and teachers are reported in the form of rating scales or questionnaires. These allow for the efficient and systematic collection of data that can be compared discussed between the observing parties: I.e. about their different perceptions of the child’s difficulties. This can lead to an awareness that the child behaves differently in different situations, depending on the demands that are made on him or her in these situations.
The underlying causes of learning difficulties may be subtle or pronounced. They may be simple single causes that can easily be “fixed” (providing the child with glasses) or multiple and complex causes (language development delay caused by exposure to inconsistent, confusing phonological environments). They may be deviances or deficits in the way a child perceives and processes verbal, visual and/or auditory information; immature development of executive skills, such as the inability to plan ahead; to break down larger goals into smaller achievable goals; to resist impulses; to resist distractions; to organize thinking and/or work processes etc., are all symptoms that are associated with ADHD, but also with other forms of learning difficulties; or language processing difficulties due to phonetic or grammatic confusion or limited vocabularies; or gross and fine motor coordination difficulties or deviant or delayed neuromuscular development (i.e. primitive reflexes that persist into late childhood, adolescents and adulthood), symptoms related to Autism Spectrum Disorder and/or more subtle psychological or environmental difficulties or abnormalities. Some or all of these underlying deviances, deficits or difficulties with processing information are collectively called a Non-Verbal Learning Disorder.
The choice of specific neuropsychological tests to be administered to the child are decided on during the biographical interview with the parents and depend on the hypothesis developed by myself regarding the “probable” cause of the child’s difficulties. This is based on the biographical information available and the presenting symptoms.
A Neurodevelopmental Evaluation may be requested by concerned parents as a follow-up to a psycho-educational evaluation (teachers usually do not refer for such an evaluation). A psycho-educational evaluation only establishes if a child is suffering from a Specific or Generalized Learning Disorder. If such a diagnosis is made, the child is usually entitled to receive learning support services provided by the school and perhaps special classroom and test accommodations to alleviate the negative impact of the LD on the child’s learning efforts. A neurodevelopmental evaluation seeks to uncover the underlying cause of the child’s difficulties with processing important information effectively. Remedial treatment must usually be organized outside of the school premises and school hours. They usually require clinical interventions. Recommendations about specialists to be visited or clinical intervention programmes that need to be implemented will be given whenever possible and appropriate.
The same remarks made under the heading Psycho-Educational Evaluations about the specific qualification requirements needed to perform such a service, the professional experience and rountine requirements, the total time commitment needed to complete a Neurodevelopmental Evaluation and the fees charged according the time commitment necessary. applies here too.