CHILD NEUROPSYCHOLOGY

Transcription

1 CHILD NEUROPSYCHOLOGY

2 CHILD NEUROPSYCHOLOGY Assessment and Interventions for Neurodevelopmental Disorders PHYLLIS ANNE TEETER ELLISON University of Wisconsin Milwaukee MARGARET SEMRUD-CLIKEMAN Michigan State University Springer

3 Phyllis Anne Teeter Ellison Margaret Semrud-Clikeman Department of Educational Psychology Department of Psychology University of Wisconsin Michigan State University 2400 East Hartford Avenue 3123 South Cambridge Road Milwaukee, WI Lansing, MI Library of Congress Control Number: ISBN-13: eisbn-13: ISBN-10: Printed on acid-free paper. This book was previously published by Pearson Education, Inc by Allyn & Bacon 2007 Springer Science + Business Media, LLC All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights spnnger.com

4 This book is dedicated to my mother, Mae Ellison, who taught me the love of words and reading, and to my brother, Stan Chemacki, who taught me how to walk, talk, and read. RAT. This is for all the children from whom I learned so much. M. S.-C

5 CONTENTS List of Figures List of Tables xi xiii Foreword George W. Hynd xv Preface xix Acknowledgments xxi PART I ANATOMY AND PHYSIOLOGY 1 Introduction to Child Clinical Neuropsychology 1 Theoretical Orientation: An Integrated Paradigm 1 Emergence of Child Clinical Neuropsychology 1 Perspectives for the Study of Childhood Disorders 2 Neuropsychological Perspectives on Assessment and Intervention 8 Professional Training 11 Overview of Book Chapters 13 2 Functional Neuroanatomy 15 Structure and Function of the Neuron 15 Neuronal Development 19 Structure and Function of the Human Brain 22 Structure and Function of the Brain Stem 23 Role and Function of the Meninges 28 Development of the Central Nervous System 28 Structure and Function of the Forebrain 29 Cerebral Hemispheres 31 Structure and Function of the Cortex 34 The Development of Higher Cortical Regions 39 Genetic Factors Affecting Brain Development 44 The Interaction of Biological and Environmental Factors on Brain Development 46 vii

6 viii PART II CLINICAL ASSESSMENT CONTENTS 3 Electrophysiology and Neuroimaging Techniques in Neuropsychology 51 Electrophysiological Techniques 51 Neuroimaging Techniques 57 Neuroradiological Techniques 62 4 Integrating Neurological, Neuroradiological, and Psychological Examinations in Neuropsychological Assessment 65 The Neurological Examination 65 When to Refer for a Neurological Evaluation 66 Neuroradiological Evaluation 68 Neuropsychological Assessment 69 Integration of Neurological, Neuroradiological, and Neuropsychological Data 69 Psychological Assessment of Children with Neurodevelopmental, Neuropsychiatric, and Other CNS Disorders 70 Impact of Psychological Functioning on Neuropsychological Results 76 5 Neuropsychological Assessment Approaches and Diagnostic Procedures 78 Approaches to Child Clinical Neuropsychological Assessment 78 Luria-Nebraska Assessment Procedures for Children 87 Luria-Nebraska Neuropsychological Battery-Children's Revision 92 Neuropsychological Protocol: Austin Neurological Clinic 97 Boston Process Approach 97 A Transactional Approach to Neuropsychological Assessment 103 PART III CHILDHOOD AND ADOLESCENT DISORDERS 6 Severe Neuropsychiatric and Externalized Disorders of Adolescence and Childhood 107 Biochemical and Neuropsychological Models of Psychiatric Disorders ofchildhood 107 Tourette Syndrome 112 Autism/Pervasive Developmental Disorders 114 Asperger' s Syndrome 119 Attention Deficit Hyperactivity Disorder 120 Conduct Disorder 129

7 CONTENTS ix 7 Neuropsychological Correlates of Childhood and Adolescent Psychiatric Disorders: Internalized Disorders 135 Internalizing Disorders Language-Related and Learning Disorders 147 Neurodevelopmental Disorders of Childhood 147 Learning Disabilities 151 Written Language Disorders 162 Nonverbal Learning Disabilities 165 Summary Metabolic, Biogenetic, Seizure, and Neuromotor Disorders of Childhood 169 Metabolic Disorders 169 Chromosomal Syndromes 172 Neurocutaneous Syndromes/Disorders 176 Seizure Disorders 180 Cerebral Palsy 187 Conclusions Acquired Neurological Disorders and Diseases of Childhood 193 Traumatic Brain Injury 193 Fetal Alcohol Syndrome 201 Cocaine-Exposed Infants 204 Childhood Cancer 209 CNS Infectious Diseases: Meningitis and Encephalitis 213 Summary and Conclusions 215 PART IV AN INTEGRATED INTERVENTION PARADIGM 11 Neuropsychological Intervention and Treatment Approaches for Childhood and Adolescent Disorders 217 Multistage Neuropsychological Model: Linking Assessment to Intervention 217 Developmental Neuropsychological Remediation/Rehabilitation Model for Children and Adolescents 221 The Reitan Evaluation of Hemispheric Abilities and Brain Improvement Training (REHABIT) 222 Neuropsychological Framework for Remediation 222 Specific Strategies for Cognitive-Academic, Psychosocial, and Attentional Disorders 223 Classroom and Behavior Management 228

8 X CONTENTS Pharmacological Interventions 231 Home School Physician Partnerships 236 Summary and Conclusions 239 PART V CLINICAL CASE STUDIES 12 Clinical Case Studies 241 Intractable Seizure Disorder 241 Severe Developmental Dyslexia 244 Traumatic Brain Injury 247 Severe Expressive Aphasia and Motor Apraxia with Pervasive Developmental Delay 249 Developmental Progress 252 Specific Recommendations 253 Glossary 254 References 257 Name Index 313 Subject Index 325

9 LIST OF FIGURES Figure 1.1 Transactional Neuropsychological Model for Understanding Childhood and Adolescent Disorders 7 Figure 2.1 Anatomy of the Neuron 17 Figure 2.2 Anatomy Showing Connections between Neuron A and B with Synaptic Cleft 18 Figure 2.3 Sagittal Section of the Brain Showing Brain Stem, Midbrain, and Forebrain Structure 25 Figure 2.4 MRI Sagittal Section of CNS Analogous to Brain Areas Depicted in Figure Figure 2.5 Coronal Section Showing Structures of the Right and Left Hemisphere with Ventricular Systems 26 Figure 2.6 Surface of the Left Hemisphere Showing Sulci, Fissures, and Major Subdivisions of the Cortex 31 Figure 2.7 Major Structures and Functions of the Cortex 35 Figure 2.8 Visual Fields and Cortical Visual Pathways 38 Figure 3.1 Electrode Placement 52 Figure 3.2 Common BAER 54 Figure 3.3 Normal CT Scan 58 Figure 3.4 Normal Coronal MRI Scan 59 Figure 5.1 The Rey-Osterreith Complex Figure 101 xi

10 LIST OF TABLES Table 1.1 Guidelines for Doctoral Training in Neuropsychology 11 Table 2.1 Cranial Nerves 23 Table 2.2 Major Divisions of the Nervous System 24 Table 2.3 Developmental Milestones for Functional Asymmetry and Cerebral Lateralization 33 Table 2.4 Myelination and Cognitive Development 40 Table 2.5 Neurodevelopmental Abnormalities Associated with Neurogenesis or Abnormal Neural Migration 45 Table 4.1 Common Anomalies Revealed during Examination of the Cranial Nerves 67 Table 5.1 Subtests of the Halstead-Reitan Neuropsychological Test Batteries 79 Table 5.2 Abilities Assessed by the HRNB and HDLNB in Children and Adolescents 80 Table 5.3 Right-Left Sensory and Motor Signs on the Halstead-Reitan Neuropsychological Test Battery 84 Table 5.4 Selected Research with the Halstead-Reitan Neuropsychological Test Batteries 86 Table 5.5 Major Systems and Behavioral Correlates of Luria's Functional Units 89 Table 5.6 Developmental Sequences of Luria's Functional Units 91 Table 5.7 Selected Research Findings with the LNNB-CR 96 Table 5.8 Factorsfromthe LNNB-CR Determined by Karras and Colleagues (1987) 97 Table 5.9 Austin Neurological Clinic: A Paradigm of Anterior/Posterior Measures 98 Table 5.10 Neuropsychological Test Procedures: Modified Boston Battery 99 Table 5.11 Domains for Neuropsychological Assessment and Suggested Measures 106 xiii

11 Xiv LIST OF TABLES Table 6.1 Neurotransmitter Circuits, Brain Regions, and Functional Activity 108 Table 6.2 Neurotransmitter Levels, Psychiatric Disorders, and Behavioral Effects 109 Table 6.3 Medication Effects on Neurotransmitters 111 Table 6.4 A Summary of Specific Deficits Associated with Attention Deficit Hyperactivity Disorder (ADHD) 124 Table 7.1 Diagnostic Criteria for a Diagnosis of Major Depression Using the DSM-IV 140 Table 7.2 Anxiety Disorders as Defined by the DSM-IV 143 Table 8.1 A Summary of Specific Deficits Associated with Reading Disabilities: Phonological Core Deficits (PRD) 155 Table 8.2 A Summary of Specific Deficits Associated with Nonverbal Learning Disabilities (NLD) 164 Table 10.1 Transactional Features of Traumatic Brain Injury in Children 198 Table 11.1 Models for Neuropsychological Remediation and Rehabilitation: Linking Assessment to Interventions 218 Table 11.2 Common Uses, Benefits, and Side Effects of Medications for Neuropsychiatric Disorders of Childhood 231

12 FOREWORD The boundary between behavior and biology is arbitrary and changing. It has been imposed not by the natural contours of the disciplines, but by lack of knowledge. As our knowledge expands, the biological and behavioral disciplines will merge at certain points, and it is at these points of merger that our understanding of mentation will rest on particularly secure ground... Ultimately, the joining of these two disciplines represents the emerging conviction that a coherent and biologically unified description of mentation and behavior is possible. (Kandel,1985,p.832) This book represents a unique perspective with regard to the practice of clinical neuropsychology with child and adolescent populations. In these brief remarks, I will attempt to place the practice of clinical child neuropsychology in its historically important context and articulate in a broad sense exactly why this important volume represents a unique turning point in the practice of clinical child neuropsychology. As Kandel (1985) has noted, knowledge in the biological and behavioral sciences will merge at certain points, and it can no longer be argued that the study of behavior and its many deviations can be separatedfromour rapidly evolving understanding of the complexities of the biological organism. One needs only to read the newspaper or watch television to appreciate recent research that addresses the genetic or neurobiological basis of some forms of dementia, depression, or other "behavioral" disorders such as Attention Deficit Hyperactivity Disorder (ADHD) or severe reading disability (dyslexia) to appreciate advances in understanding some of the possible genetic, biological, and environmental interactions that must occur in various neurological or psychiatric disorders. It might be proposed that some 90% of our understanding of the interactions between genetic influences, biological ontogeny, and environmental factors has evolved most significantly in the past century and that the public at large expects this research to continue to have an impact on both our understanding of these interactions and our ability to alter the course of potentially negative outcomes. Necessarily, research that addresses these interactions must be multidisciplinary in nature, and this has both blurred professional boundaries and encouraged a deeper understanding of the importance of communication between scientists and applied clinicians. Within the past century a number of important developments have fostered our current appreciations of the neurobiological underpinnings of neuropsychiatric and neurodevelopmental disorders. First, despite the influences of philosophical orientations that argued against understanding behavioral, cognitive, or psychiatric disorders from a neurobiological perspective (e.g., behaviorism), clinicians continued to observe and validate observations made in the 1800s regarding the effects of brain damage on behavior. Reports published in the late 1800s noted the neurological behavioral relationships observed in aphasic patients and in patients with alexia with and without agraphia. Clinicians in this century continued to observe these relationships, and this led to hypotheses about brain dysfunction or damage in xv

13 xvi FOREWORD children and adolescents with speech and language disorders, specific learning disability such as dyslexia, mental retardation, and behavioral disturbance. Second, in the postwar recovery period after World War II, economic influences caused resources to be allocated so that millions of individuals, including veterans, were afforded an opportunity to pursue higher education. Not only did this influence the general educational level in the United States, but it was accompanied by legislation passed in the late 1950s that funded scientific research at a much higher level, in large part in response to the Soviet Union launching Sputnik into space and accelerating the "space race." What this accomplished was that we now had a vastly improved appreciation of the importance of scientific investigation and its potential to answer basic questions about our existence and those genetic, biological, and environmental influences that had an impact on our health and behavior. Finally, advances in medical, social, and behavioral research in the past three decades have strongly encouraged the belief that basic and applied research could provide hope in improving our health and general welfare. As an example, one can well appreciate the impact that the eradication of smallpox, the prevention of polio, the development of new and more effective medicines for the treatment of epilepsy and infections, and the ability to visualize our internal organs through imaging techniques has had on the public. This may help us to understand why the public at large now expects basic research to lead to positive outcomes in treating conditions that are either life-threatening (e.g., AIDS) or have a negative impact on achieving what are now perceived to be normal health, educational, social, or even financial expectations in life (e.g., ADHD, dyslexia) Previously published volumes in either child or pediatric neuropsychology, including mine, have focused primarily on providing a basic understanding of the neurobiological bases of child and adolescent cognitive or behavioral disorders due to overt disruptions of neurological integrity, as in cases of brain damage, or due to deviations in neurological development. Until the publication of this book, little attention has been directed at integrating this basic understanding with clinical treatment or intervention practices of proven value, although relevance was generally acknowledged or presumed, but not demonstrated. This is exactly why this book is such an important contribution! While this book advances our basic understanding of brain behavior relations in child and adolescent clinical populations, it also provides upto-date information for the clinician on how to treat neuropsychological^ based childhood and adolescent disorders. The integrated transactional intervention paradigm so articulately presented in this volume mandates that all clinicians who work with children and adolescents with neurodevelopmental or neuropsychiatrically based disorders have this volume as a ready resource in providing the most current and effective treatments available. Further, and perhaps most important, the authors clearly understand and address the many different medical, behavioral, and educational treatment approaches summarized and advocated in this book. These authors recognize so well that children and adolescents with neurodevelopmental and neuropsychiatric disorders can be fully understood only in a transactional context that incorporates neurobiological, medical, familial, social, and educational perspectives. In support of their transactional model, they provide richly described clinical case studies of children and adolescents with learning disabilities, ADHD, seizure disorder, and traumatic brain injury. Clearly, this volume advances the potential impact of clinicians who provide neuropsychological services to children and adolescents in helping their clients to lead more productive and meaningful lives. This volume sets a new standard for those who practice clinical child neuropsychology and thus provides parents, teachers, medical professionals, and other health care providers with an increased level of expectation for the quality and impact of services provided. In this sense, then, this book marks a turning point for the practice of clinical child neuropsychology. No longer will the neuropsychologist be viewed as a professional who only provides a comprehensive neuropsychological evaluation. It raises the expectation that the clinical child neuropsychologist should indeed

14 FOREWORD XVII provide both a comprehensive and treatment-specific evaluation and should have the knowledge and professional expertise to provide the treatment themselves, whether dealing with a child or adolescent with a neurobehavioral or neuropsychiatrically related disorder. This volume will be a highly regarded resource for all psychologists who provide neuropsychological services to school-aged children and adolescents. It is current, accurately and comprehensively presents our state of knowledge, and is a wonderful resource for the provision of comprehensive neuropsychologically based strategies of clinical intervention. In this sense, this volume itself serves to illustrate that the boundaries between the neurobiological and behavioral sciences is indeed merging and the resulting perspectives can favorably impact on our ability to understand and effectively treat neurodevelopmental and neuropsychiatry disorders in children and adolescents. George W. Hynd Center for Clinical and Developmental Neuropsychology The University of Georgia REFERENCE Kandel, E. R. (1985). Cellular mechanisms of learning and the biological basis of individuality. In. R. Kandel & J. H. Schwartz (Eds.), Principles of neural science (2nded.),pp

15 PREFACE This book presents to psychologists the most current information about the influences of brain function on the cognitive-perceptual, academic-learning, behavioral, and psychosocial adjustment of children and adolescents. An integrated, transactional framework is explored across various neuropsychiatric and neurodevelopmental disorders, acquired injuries and diseases, biogenetic disorders, and other brain-related disorders of childhood. Thisframeworkwas developed to show that theory, research, and clinical findings across paradigms that are often discussed in dichotomous or mutually exclusive ways (e.g., neuropsychological versus behavioral, neurocognitive versus psychosocial approaches) can be integrated in meaningful ways. It is essential to view childhood and adolescent disordersfroman integrated perspective so that we may better understand the dynamic interplay of biological, neurodevelopmental, and environmental factors on children's learning, psychological, emotional, and social development. Such an approach enables clinicians and researchers alike to address these disorders more comprehensively. This book is written for psychologists and graduate students from various applied disciplines in psychology (child, clinical, counseling, pediatric, neuropsychological, and school). Other medical, mental health, and educational professionals who work with children and adolescents with learning, behavioral, and psychosocial adjustment problems may also find this book of interest because implications for assessment and treatment are emphasized. The orientation of the book is transactional, so that professionals and students with varying theoretical backgrounds can develop a broader perspective on childhood disorders. A transactionalframework is important for a number of reasons. First, biogenetic factors influence and set the stage for early brain development long before the impact of the environment comes into play. The manner in which the developing brain affects the child's ability to profit from and respond to the environment is of interest to psychologists. Furthermore, disturbances in early cell proliferation, migration, and myelination underlie a number of childhood disorders (e.g., learning disabilities, autism, seizure disorders), which in turn ultimately affect cognitive, neuropsychological, academic, and psychosocial development. Second, in many instances brain function and psychosocial-behavioral manifestations are so closely linked that it is difficult to make distinctions among contributing factors (e.g., biogenetic and neuropsychological) and their psychological outcomes. Third, numerous neurodevelopmental and acquired disorders can be altered with appropriate environmental stimulation and systematic intervention (i.e., educational or remedial strategies). Thus, biogenetic and/ or neuropsychological factors can be modified such that negative learning and psychosocial outcomes (e.g., reading disabilities, attentional deficits, and psychological disorders) can be minimized with interventions that address the underlying neuropsychological substrates of the disorders (e.g., phonological awareness deficits, disinhibition of executive control functions). Further, interventions for neurodevelopmental and biogenetic disorders often require medical or pharmacological as well as behavioral, academic, and psychosocial strategies, so an integrated, transactional assessment intervention paradigm is crucial. This book includes five major sections. Chapters 1 and 3 provide an introduction to child neuropsychology. This includes a discussion of the various components of the transactional model (i.e., behav- XIX

16 XX PREFACE ioral, cognitive, neuropsychological, and psychosocial paradigms), and professional training issues in Chapter 1. An overview of anatomy and physiology, including neurodevelopmental stages, is explored in Chapter 2. Chapters 3, 4, and 5 present techniques for neuropsychological assessment. Neurophysiological and neuroimaging techniques are described in Chapter 3, with guidelines for referring children for neurological, neuroradiological, and neuropsychological evaluations presented in Chapter 4. Descriptions of standard neuropsychological batteries and tests are presented in Chapter 5, and a "process approach" to neuropsychological assessment is described. Chapters 6 through 10 review selected childhood and adolescent disorders within a transactional framework. Neuropsychiatric disorders, including internalized and externalized disorders (Chapters 6 and 7); language and learning disorders (Chapter 8); metabolic, biogenetic, and neuromotor disorders (Chapter 9); and finally acquired disorders and diseases of childhood (Chapter 10) are reviewed. Each chapter presents an overview of the biogenetic and environmental factors that affect the neuropsychological functioning of children with these various disorders. The effects of neuropsychological and/or neurochemical anomalies associated with each disorder are explored, including the effects on the cognitive, perceptual, attentional, and memory functions. Finally, the impact of neuropsychological and environmental factors on the child's academic, behavioral, and psychological development is explored. Implications for assessment and intervention practices are also considered for each major disorder. An integrated intervention paradigm is presented in Chapter 11. Specific methods for addressing neurodevelopmental, acquired, and neuropsychiatric disorders are reviewed. Combined techniques are explored, and the need for collaboration among professionals is highlighted. A number of proven educational techniques for addressing language, learning, and psychosocial problems are presented. The potential benefits and side effects of major classes of medications are also discussed. Finally, case studies are offered in Chapter 12 as examples to illustrate the dynamic neuropsychological environmental transaction, and to show how a comprehensive process-oriented neuropsychological assessment can inform intervention planning. Our intent in writing this book was to review and to integrate childhood disorders within a transactional, neuropsychological paradigm. We hope that by integrating research and clinical findings across different theoretical orientations, we have shown the interaction among neuropsychological and environmental factors in affecting the child's cognitive, behavioral, and psychosocial functioning. We also showed that neurodevelopmental, biogenetic, and acquired brain-related disorders can be altered with appropriate educational, behavioral, pharmacological, and psychosocial interventions. Thus, although biogenetic factors influence neurodevelopment and brain functioning in children and adolescents, this relationship can be influenced in meaningful ways.

17 ACKNOWLEDGMENTS Writing this book was an exhilarating experience in much the same way that finishing a marathon is-in the beginning it seemed like such a good idea, in the middle we forgot what was so great about the halfbrained idea in the first place, and in the end we forgot how long it had taken to reach the finish line. But we never forgot why the goal was worth pursuing. Our interest in children and adolescents, particularly those with neurodevelopmental and neuropsychiatry disorders, was the driving force behind this project. A desire to understand and to articulate this understanding to others was paramount. There were so many children and families who brought the theory and research to life, who made the face of neurologically based disorders so real and poignant. We will always remember your courage and dignity. We learned so much from all of you. My own process of understanding has evolved over the years and has been shaped by a number of people. Many friends and colleagues have influenced my thinking about brain behavior relationships in children. I must acknowledge my co-author, Margaret Semrud-Clikeman. She has been a true collaborator and friend. Her research has been informative and serves as a solid contribution to our knowledge about the neuropsychological foundations of dyslexia and ADHD. I thank her for the many hours she spent on this project and for her sense of humor on those tedious rewrites and hours spent on Medline. There are many others who contributed to my professional development, including Bill Gibson, who taught me so much about neuroanatomy, neurophysiology, and neurodevelopment; John Obrzut, who demonstrated the power and elegance of pursuing a line of research to answer those basic questions about how children learn; and Philip Smith, who provided his research and statistical experience to many projects. George Hynd has been both a mentor and a friend. His research has advanced the field of child neuropsychology in too many ways to mention here. His body of work serves as a model of the excellence to which we all aspire. Finally, my family andfriendshave been forgiving of my "too busy to come" schedule that kept me away from summer visits to Connecticut and longer Christmas breaks. Your love and support was really a godsend. P.A.T. I would like to acknowledge my gratitude to Anne Teeter, my co-author, for introducing me to neuropsychology and encouraging the development of my career. I would also like to acknowledge my debt to George Hynd, Dennis Norman, Pauline Filipek, Ronald Steingard and Joseph Biederman for my research potential and understanding of child neuropsychology. I am most indebted to my husband, John Clikeman, for making the many moves to advance my career, for supporting me through dark days, and for always being my first and foremost cheerleader. M.S.-C. We both owe a debt of gratitude to Dr. Sharon Murphy, Professor of Psychiatry at the University of Chicago, for her helpful comments and suggestions during early drafts of the book. We would like to thank Marilyn Budhl, our graphics artist, for her wonderful and detailed drawings of the brain. Our editor, Mylan Jaixen, also deserves thanks for his patience when we were past our deadlines, and for his encouragement to develop this project in the first place. Mylan passed the baton to Carla Daves, who helped us through the final stages of editing. We thank her for her assistance. Finally, our thanks are extended to Judy Ashkenaz for her meticulous editing and helpful comments. xxi