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MARGARET SEMRUD-CLIKEMAN, PHD

Margaret Semrud-Clikeman, Ph.D., received her doctorate from the University of

Georgia in 1990.  She completed and internship and postdoctoral fellowship at
the Massachusetts General Hospital/Harvard Medical school (MGH) and received
a post-doctoral neuroscience fellowship at MGH from NIH to study
neuropsychological and brain morphology in children with ADHD.  Her
dissertation was awarded the Outstanding Dissertation of the Year Award from
the Orton Dyslexia Society.  She continues her research interests in the areas of
ADHD and educational neuroscience.  She is currently working on research in
ADHD, 18q- syndrome, and autistic spectrum disorders.  With Dr. Plizska at
UTHSCSA, Margaret was awarded a NIH grant to study the effects of stimulant
medication on neuropsychological functioning.  Dr. Semrud-Clikeman and her
students have developed a social competence intervention that has been
successfully piloted.  Dr. Semrud-Clikeman was awarded the 1999 Early Career
Contributions award from the National Academy of Neuropsychology and was
elected a fellow in that organization in 2009.  She has also been awarded support
for her work studying NVLD and Asperger Disorder from a private foundation. 
Moreover, Dr. Semrud-Clikeman was recently awarded intramural funding for
her study of executive function and attentional problems in children who
survive cerebral malaria in Malawi.  She has published more than 70 articles, 75
chapters and 6 books as well as making over 200 presentations at national and
international conferences. Dr. Semrud-Clikeman is currently a professor of
Pediatrics and Division Head of Pediatric Behavioral Neuroscience at the
University of Minnesota Medical School.  She also has board certification from
the American Academy of Child Neuropsychologists

OVERVIEW
Neuropsychological assessment is designed to provide insight into how a child:

• solves problems,
• can remember information both in the short and long-term, 
• uses and understands language,
 • processes information both visually and orally, and
• is able to use cognitive ability in a flexible manner.

It is designed to provide parents, educators, and medical personnel not only with
what the child knows, but how the child thinks and arrives at solutions.   It
encompasses cognitive ability as well as emotional and behavioral regulation
assessment.  Children can have difficulty for many different reasons and a
neuropsychological evaluation provides a window into understanding what is
problematic, what is a strength, and also treatment recommendations.  In
addition, discussions about typical development, prognosis, and possible
referrals (i.e. neurology, genetics, metabolism) are also appropriate as part of the
assessment.

DESCRIPTION
What is a neuropsychological assessment?

A pediatric neuropsychologist is a professional with a doctorate in psychology.

He/she has additional specialized training in working with children and
adolescents who have difficulties.  The neuropsychologist is a licensed
psychologist who has done advanced study in how learning and behavior are
related to the developing brain and neural networks.  Children and adolescents
are different from adults in that their brain is still developing.  For example, one
would not expect the same type of skills and learning of a 6 year old as a 16 year
old.  The reason for this difference is that the brain changes throughout
childhood and adolescence. Basic brain areas that mature early are  ‘hard-
wired.’  This means that they are genetically programmed.  These areas include
visual acuity, auditory processing, and motor control. Other brain areas continue
to develop throughout childhood and involve the ability to learn, remember, pay
attention, and manage behavior.  Some parts of the brain (the frontal lobes) do
not fully mature until the person is in his/her mid-twenties.  The frontal lobes
are important for controlling impulses, learning from past mistakes and having
insight into one’s own behavior and its effect on others (Semrud-Clikeman &
Ellison, 2009).

Most pediatric neuropsychologists see children of all ages up through late

adolescence/early adulthood.  Infants as young as a few days old can be
evaluated to determine their level of progress.  The evaluation of these children
is fairly short and focuses on where the child is developmentally, particularly in
the areas of motor and alertness.  For example,

• the evaluation of preschoolers focuses on language and cognitive

development
• school-age children are evaluated for academic progress, emotional control,
social functioning, and attention
• adolescents are also evaluated for academic progress, emotional and
behavioral control, and social functioning

Assessments of infants and preschoolers are around 2 hours of time while those
with adolescents can take longer.

For some children, the pediatric neuropsychologist may see them over time to
determine progress.  Most frequently these repeated evaluations are for children
who have concussions, who have genetic and neurological disorders, or whose
emotional and behavioral control issues are such that the neuropsychologist
wants to make sure they are being provided sufficient support.

A pediatric neuropsychological evaluation differs from a school psychological

assessment in emphasis.  Most school psychologists evaluate a child’s need for
special education as well as to determine what is the most appropriate
educationally.  The focus is on education achievement and the skills to succeed
in school.

A pediatric neuropsychological evaluation differs from a general psychological

assessment.  A psychological assessment looks at how the child is functioning
intellectually, academically, socially, and emotionally.  This type of assessment

compares the child to other children the same age and looks for differences that
will assist with psychological interventions such as psychotherapy and/or parent
training.  At times children have completed a psychological assessment prior to
being referred for a neuropsychological assessment.  Many of the same
measures are used, but interpreted differentially based on the
neuropsychologist’s view of the developing brain.

Why is a child/adolescent referred for a neuropsychological assessment?

Children are often referred for an evaluation to determine why they are
experiencing difficulties.  These difficulties can be problems with learning, with
behavior, or with emotional control.  They are also referred because a medical
issue has been newly diagnosed.  These issues may be genetic in origin, can
include concussions or brain injury, be the result of cancer or brain tumor
treatment, or be related to diagnoses such as epilepsy, neurofibromatosis, or
movement disorders such as Tourette syndrome.  In addition, children may be
referred for evaluation if they have been exposed to alcohol during the
pregnancy or ingested or breathed in lead.  Neuropsychologists also see children
who have significant problems with controlling their behavior and emotions. 
Diagnoses such as autism, attention deficit hyperactivity disorder (ADHD), and
dyslexia are also reasons for a child to be evaluated.

Children are most often referred for a neuropsychological assessment by their

pediatrician, teacher, school psychologist, or by their parent.  The most common
reasons are:

1) learning problems, behavior, difficulty, social difficulty, emotional control

problems;

2) a disease or a genetic problem that affects the brain; or

3) a brain injury (this may be from birth, an accident, or fetal alcohol/lead

exposure).

Areas such as memory, attention, processing of visual and auditory information,

motor coordination, language, and emotional functioning are evaluated.  These
assessments are designed to provide useful interventions and treatments for the
child.  In addition, neuropsychological assessments can also help the parent,
teacher, and other professionals to understand the child and his/her behavior
better and to provide needed support.

DIAGNOSTIC STANDARDS
What types of measures are used in this assessment?

A good neuropsychological assessment tailors the evaluation to the child’s needs

as well as being comprehensive.  Thus, not all children will be administered the
same measures.  A detailed developmental and medical history is gathered as
well as information from the main people in the child’s life (parent, teacher). 
This data provides a beginning point from which the neuropsychologist can
determine possible areas of difficulty for the child, what measures are most
appropriate, and what possible diagnoses need to be explored.  In addition, the
neuropsychologist will observe the child’s behavior toward the examiner as well
as toward the measures utilized.  Areas that are evaluated include the child’s
motivation, how he/she manages frustration, level of cooperation, social
interaction, and behavior.

The main areas that are evaluated in a neuropsychological assessment include

the following:

• a measure of general cognitive functioning

• attention
• executive functions

• planning, organization,
• cognitive flexibility,
• working memory (ability to keep information in mind while solving a
problem)

• learning and memory
 • language
• visual-spatial skills
• adaptive behavior (how a child performs independently in everyday life)
• behavior and emotional abilities
• social skills
• sometimes academic ability

TYPES OF SCORES

In the next paragraphs each of these areas will be described.  It is important to

understand the scores meaning that may be included in the neuropsychological
report.  There is one of four types of scores reported on the test report:

1. scaled scores
2. standard scores
3. T-Scores
4. Z-scores

In some cases you may see age and grade scores. These are estimates of how the
child would perform and should not be used to compare over time as they are
unreliable.

The scores reported on a neuropsychological assessment are  scaled for the

child’s age and in some cases gender (i.e. the child is compared with others
his/her age). For example, a child aged 6 is compared to one also at age 6.  Fewer
items are expected for the same score at younger ages than at older ages.

Standard scores are used for overall indices of ability as well as adaptive
behavior.  Average scores range between 85 and 115 and are standardized for
the child’s age.  Scores from 70 to 84 are considered low average to below
average and those below 70 are considered to be impaired.  On the other end of
the scale, scores from 116-129 are above average and those above 129 are
considered superior.

Scaled scores are used for the individual subtests most commonly on the main
cognitive measure as well as on some executive functioning scales.  Average
scaled scores are between 7 and 13 with a mean of 10.  Scores below 5-7 are
below average and those 4 and below are impaired.  Scaled scores 13-15 are
above average and those above 15 are significantly above average.

Another type of score you will see is the T-score.  These are used with overall
ability measures, developmental measures, and behavioral rating scales. 
Average T-scores range between 40 and 60 with scores above 60 indicating above
average ability and those below 40 as impaired.  It is important to acknowledge
here that behavior rating scales use T-Scores but are interpreted differently from
the cognitive measures.  On a behavior rating scale, scores above 60 may
indicate problematic behavior while those below 40 mean exemplary behavior.

Sometimes percentiles are reported.  Percentiles are not as exact as the above
standardized scores and cannot be subtracted or added.  What percentiles do
provide is a rough estimate as to how the child compares to others his/her age. 
So a child performing at the 50th percentile is performing in the average range
for his age.

DOMAINS ASSESSED

The following paragraphs will describe each of the domains assessed as well as
providing information about the most utilized measures.

General Cognitive Ability

Measures of general cognitive ability, also known as IQ tests, evaluate the child’s
ability to:

• solve visual problems,

• understand and use language,
• answer questions, 
• construct block designs,
 • compare visual patterns,
• evaluate how fast a child/adolescent can process visual information, and
• evaluate working memory.

IQ measures provide an overall score of ability.  Most measures also provide

scores as to the child’s verbal skills and visual-spatial ability.  Some provide
additional scores in working memory, processing speed, and learning ability.

IQ can vary over time for children who have experienced a medical difficulty. 
Typically, IQ is stable after the age of 8 in healthy children.  Children who have
had concussions, traumatic brain injuries (TBI), cancer treatment, and
transplants often will show lowering of overall ability.  For this reason, serial
evaluations are important in order to determine the child’s functioning and
continuing intervention needs.

IQ tests are developed for different ages.

The Wechsler tests are developed for 3 different ages:

1. preschool and primary (ages 3-7)

2. school-age (ages 6-16)
3. adult (ages 16-89)

The Differential Abilities Scale-2 (DAS-2) has 2 forms; one for children aged 2
years 6 months to 5 and another for ages 5-17.

The Wechsler and DAS scales also have scales that can be computed that
measure solely nonverbal ability.

The Kaufman Assessment Battery for Children-2 (K-ABC2) is a measure for a

child that is meant to be administered with less emphasis on timing and
language.  The KABC2 also provide a nonverbal scale as well as general ability
scales.  These are the main measures of IQ that are used in general practice.

The Stanford-Binet Intelligence Scale 5 can be used but is weighted on

language for school-age children.

The Comprehensive Test of Nonverbal Intelligence (C-TONI), the Leiter

International Scale of Intelligence, and the Universal Nonverbal Test of
Intelligence (UNIT) are measures that do not rely on language and are used with
children whose first language is not English.

Attention

Attention is an important area for evaluation because if a child has attentional

problems, he/she may struggle on all of the other measures.  Attention is often
evaluated through clinical interviews with parents and teachers as well as the
completion of behavior rating scales. There are many behavior rating scales that
are used.  Some scales ask questions about attention as well as other aspects of
behavior and emotional adjustments (Behavior Assessment System for
Children-2; Child Behavior Checklist).  Others solely ask about attention
(Connors-3; Vanderbilt scales; Brown ADHD scales).  Most of these measures
are available for parent and teacher completion and some have self-report
versions.

In addition to behavior rating scales, there are continuous performance

measures.  These measures require the child to be in front of a computer and
click a switch for a selected target and resist clicking to a nontarget.  Some of
these include:

• Test of Variables of Attention

• Gordon Diagnostic System
• Connors Continuous Performance Test
• Visual and Auditory Continuous Performance Test

All of these provide some information about the child’s ability to pay attention to
a long and boring measure.  Most of these measures have auditory and visual
versions.

These tests, by themselves, cannot diagnose an attention deficit hyperactivity
disorder.  Such a diagnosis requires careful interviewing and observation of the
child in more than one setting.  In addition, behavior rating scales from
caregivers and teachers are an important part in these diagnoses.

Executive Functions 

Executive functions are those abilities that illustrate how a person solves a
problem rather than just what is solved.  Executive functions include skills such
as:

• planning and organization,

• working memory,
• the ability to inhibit responding,
• flexibility in thinking

Executive functions differ depending on age with younger children showing

fewer executive abilities.  By mid to late adolescence most of the skills should
begin to be evident.  Adolescents who have ADHD will often show difficulty with
executive functioning.  Organization and planning are areas of difficulty for
many adolescents but are particularly present for those with ADHD or who have
experienced a traumatic brain  injury (TBI) or treatment for cancer and/or a
brain tumor.  These areas can also be difficult for children with seizure
disorders.  For that reason it is important to not only evaluate these skills but to
acquire information from parent and teachers.

Direct measures include the Delis-Kaplan Tests of Executive Functioning

(D-KEFS), the Wisconsin Card Sorting Test, and the NEPSY-2.  These measures
consist of several subtests that evaluate inhibition, organization, planning, and
working memory.

A behavior rating scale that can be completed by parents and teachers is the
Behavior Rating Inventory of Executive Functions (BRIEF).  This rating scale
evaluates the same areas that the D-KEFS and NEPSY but from the point of view
of what is observed in the child’s everyday life.  In many cases the child will be
able to complete the tasks on the direct measures because he/she is in a quiet
room with direct feedback being provided.  It is not uncommon for the BRIEF to
illustrate difficulties in application of skills.  It is important to evaluate whether
the child has the skills and can’t apply them or whether he/she doesn’t know
how to complete these types of tasks.  Interventions will differ depending on the
answer to this question.

Learning and Memory

Learning and memory are important aspects of a child’s life.  In this case we are
not referring to academic knowledge but rather how the child learns new
material and then retains it.  Memory tasks are impacted by attention so it is
important to recognize that if something isn’t paid attention to, it will not be
recalled.  The California Verbal Learning Test-Children’s revision, Test of
Memory and Learning-3, and the Wide Range Assessment of Memory and
Learning-2 for children as well as the Wechsler Memory Scale IV and others
are commonly used measures.

Memory tasks are divided into auditory and visual modalities.  For the auditory
tasks a child is often asked to learn a list of words and repeat what they can
recall.  The list is read to the child more than one time so that it can be
determined whether the child profits from repetition.  Most of these types of list
learning also have a break in time of about 20 minutes.  After that time, the child
is again asked to list what words he/she can recall.  In many cases, there is a
recognition component where the child is asked if certain words are on a list or
not.  Other types of auditory memory involve listening to a story and repeated it
back, or learning a pair of words and recalling them over time.

Visual memory tasks show pictures, dot arrays, and designs and ask the child to
point to the pictures previously seen, touch the dots in the same sequence, or
draw designs from memory.  Visual memory tasks are not as reliant on language
but are impacted by attentional problems.  They can also be negatively affected 
by motor difficulties.
Language

Language abilities are often evaluated in a neuropsychological assessment but

are more fully evaluated by a speech and language pathologist, either privately
or through the school.  Neuropsychologists may sample language abilities to
screen whether there are areas of concern prior to referring to the appropriate
specialist.  Language skills are divided into two major areas: receptive language
and expressive language.  Receptive language develops first and is higher than
expressive skills.  Receptive language is the ability of the child to understand
what is being said to him/her.  Expressive language is the ability to tell or express
one’s thoughts.  Within both of these types of language skills are also pragmatic
language abilities.  These are abilities to understand the abstract nature of what
is being said as well as the intent.

Visual-Spatial Skills/Fine Motor

Visual spatial skills often require the child to copy more complex geometric
figures.  In some cases the figures are presented in a grid (Developmental Test
of Visual-Motor Integration) or on cards that the child copies onto a larger
piece of paper (Bender-Gestalt 16est).  One of the difficulties with these
measures is the reliance on motor skills.  In order to determine whether motor is
the difficulty or whether there is a problem with visual-spatial reasoning, it is
important to measure fine motor skills as well as tasks that are relatively motor-
free.

The Purdue Pegboard requires the child to quickly place pegs in a pegboard
first with the dominant hand, then with the non-dominant hand, and then with
both hands together.  Age norms are provided to determine how the child’s fine
motor skills are developing.  The Judgment of Line Orientation Task requires
the child to look at an array of lines and match two lines that are presented to
the array.  This task does not have a motor component.  By utilizing these two
types of tasks, it is possible to determine whether a motor difficulty underlies the
child’s difficulty in copying or writing.  If so, a referral to an occupational
therapist is appropriate.

Adaptive Behavior

Adaptive behavior skills are those that allow one to function in everyday life.  To
that end, most measures are completed by the parent with some also completed
by the teacher and are normed for the child’s age.  The areas assessed include:

• communication (answering the phone, using computers, getting one’s needs

met, ordering in a restaurant),
• activities of daily living (hygiene, household tasks, understanding how to
manage money and time),
• socialization (the ability to make and keep friends, approach others, act in
socially appropriate ways, and to attend social events),
• gross and fine motor abilities (for children under the age of 6), and
• work ability (for adolescents).

Adaptive behavior involves executive functions as well as ability.  Children and

adolescents who have an intellectual disability will score poorly on these
measures.  A child cannot be diagnosed with an intellectual disability solely with
an IQ below 70.  Adaptive behavior must also be assessed at that level.  The
Vineland Adaptive Behavior Scales-2 and the Adaptive Behavior Assessment
System are examples of adaptive behavior measures. Both assessments can be
completed by teacher and parents.

Behavioral and Emotional Functioning

A clinical interview of the parents and child is the most appropriate method for
evaluating a child’s behavioral and emotional functioning.  Questions may
include:

How is the child’s mood most of the time?

What is frustrating for the child?


How does he/she handle frustration?
What types of intervention have been attempted?

What has been successful in working with the child?

Individual interviews with the child and adolescent can also center on these
areas. In some cases a child may be forthcoming, while others may be reluctant
to share feelings and thoughts.  Observation of the child is an important part in
evaluating the child’s emotional functioning.  For example, how he/she reacts to
the examiner is as important as the tasks that he/she is asked to perform.

Social Skills

Social skills are evaluated through parent and teacher questionnaires and
observations.  In addition, there are some rating scales that can provide insight
into how the child relates to others.  The BASC-2 (discussed above) evaluates
social skills as well as behavioral and emotional functioning.  In addition
measures such as the Social Communication Questionnaire and the Social
Responsiveness Scale can provide information as to the child’s day to day social
functioning.

Academic Ability

Academic skills are screened during a neuropsychological evaluation.  This area

of assessment is often accomplished by the school psychologist.  Insurance
companies are reluctant to reimburse for academic assessment so make sure
that it is inquired about at the assessment or when discussing payment.

There are many academic measures that are used.  Two examples include The
Woodcock-Johnson Achievement Battery-IV and The Wechsler Individual
Achievement Test-II.  These measures evaluate overall reading skills,
mathematics, and written language.  Scores on these measures can be compared
to that of the IQ tests.  A significant discrepancy between ability and
achievement is considered a possible sign of a learning problem such as dyslexia
in reading and should be further evaluated through the school.

THERAPEUTIC INTERVENTION
Interpretation of the Results of the Evaluation

The neuropsychologist will compare a child’s test scores to those of other

children the same age.  This procedure is accomplished with all measures and a
profile is developed for the child.  This profile has strengths and weaknesses for
the particular profile.  It is helpful because it can point to areas where a child is
succeeding and those for which he/she may need assistance.

Since school is a large part of a child’s life, the profile can assist in explaining
why a child may be experiencing difficulty.  A reading problem may be due to an
underlying attentional difficulty, a perceptual problem, or a learning disability
in dyslexia.  It may also be related to problems with understanding language,
processing information, or an emotional reason such as anxiety or depression
which may make it difficult to absorb new learning.  A concussion or traumatic
brain injury (TBI) can also cause difficulty with learning and with retention of
new information.  Medications and medical treatments for seizure disorders (i.e.
epilepsy), genetic disorders, and cancers can also cause difficulty with learning. 
Many teachers and parents do not have the information necessary to understand
these disorders and to develop appropriate interventions.  Knowledge of a
child’s strengths can assist in developing appropriate strategies for remediation
and teaching (Hale et al., 2016).

For children who have undergone treatment for cancer, brain tumors or who
have been diagnosed with genetic syndromes, it is important to track progress. 
In some cases a child will show a regression either due to treatment or because
they have lost skills because of extensive hospitalizations.  In either case, it is
important to monitor progress over time.

Children with ADHD often experience anxiety and depression.  Research has
found an approximate overlap of 25 to 30% of children with ADHD who have a
mood disorder.  Furthermore, children with a primary disorder of anxiety or 
depression can have problems with the ability to pay attention even if they do
not have a primary diagnosis of ADHD.  It is part of the neuropsychological
assessment to determine whether these disorders are present or whether one of
these diagnoses is more appropriate.

Problems with language processing can also affect learning as well as social
interaction.  Determining whether a language delay is at the root of the problem
rather than solely shyness — or in the most extreme case, autism — is
important.  Autistic-like behaviors or social deficits may appear to be present in
children with significant language problems.  Moreover, children with autism
may show language problems.  A comprehensive neuropsychological
examination is key in separating out these difficulties.

The neuropsychologist is frequently a member of the medical team and

information from all aspects can be combined to determine the most appropriate
approach for a child.  Tests such as brain imaging, electrophysiology, and blood
tests may be used in conjunction with the neuropsychological profile to
determine the most appropriate course of treatment.

Most importantly neuropsychological assessment can provide a better

understanding of the child and his/her functioning at home, school, and in the
community.  Understanding why a child is having difficulty is the first step in
providing appropriate support.  It is also important to provide as much support
as possible for a child to reach his/her potential.

What is the Cost of a Neuropsychological Assessment?

The cost of a neuropsychological evaluation varies depending on the reason for

the evaluation as well as the area of the country where it is performed.  Costs
can range from $1,200 to $5,000 depending on the scope of the assessment. 
Insurance pays for much of the assessment except in the case of determining
ADHD or dyslexia.  In those cases, a school psychologist working in the school
may be an appropriate professional to evaluate the child.  Some insurance
companies will pay for a neuropsychological assessment regardless of the reason
for the assessment.  Others will pay for a neuropsychological assessment only if
there is a medical diagnosis.  Medical diagnoses can include prematurity, failure
to thrive, severe neglect and abuse at early ages, as well as the usual genetic and
disease processes.  In some cases, insurance companies will require a pre-
authorization completed by the neuropsychologist.  A pre-authorization form
asks for possible diagnoses, the history of the problem, and what has been tried. 
Sometimes a pre-authorization request will be denied.  The neuropsychologist
may then complete a letter documenting the medical necessity of the assessment.

CARETAKER AUGMENTATION
Are there organizations or support groups that can be helpful?

There are many organizations on line to assist parents and teachers with these
children.  The following paragraphs provide information about key
organizations.

Learning Disabilities

For dyslexia a key website is that of the International Dyslexia Association

(http://eida.org/).  This site provides information about the disorder which
includes reading and written language as well as support for teachers.  IDA also
has an annual  conference that is geared toward parents and teachers and is a
wealth of information.  The Learning Disabilities Association (LDA)
(http://ldaamerica.org/) is a parent organization that not only provides
information about different types of learning disabilities but also has links to
advocates and other supportive staff.

ADHD

CHADD is an organization for children, adults, and parents of children with

ADHD.  The website is helpful in finding resources and includes conversations
about key difficulties seen in this disorder (http://www.chadd.org/).  CHADD has
an annual conference in which training is provided for advocacy, parent
behavioral management, and teacher resources.  Its website has columns that

include ‘Ask the expert’, parent to parent resources, a reference bibliography
and teacher to teacher forums.

There are several books that may also be helpful resources for parents:

1. “Smart but Scattered” series of books by Peg Dawson and Richard Guare
(Dawson & Guare, 2011)
2. “Straight Talk about Psychiatric Medications for Kids, Third Edition” by
Timothy E. Wilens MD (Wilens & Hammerness, 2016) “Taking Charge of
ADHD” series by Dr. Russell Barkley (Barkley, 2013)
3. “Executive Function in Education” By Lynn Meltzer (Meltzer, 2010)

Autism

Autism has many websites that can be searched.  The websites that have the
strongest ties to state of the art research include Autism Speaks
(autismspeaks.org) and the Autism Society (http://www.autism-society.org/). 
Another helpful website is by Dr. Ami Klin
(https://www.ted.com/talks/ami_klin_a_new_way_to_diagnose_autism?) and one
by Fred Volkmar (https://www.youtube.com/watch?v=vkftukvl79o) among many
others.

Helpful books may include the following:

1. “The Autistic Brain” by Temple Grandin and Richard Panek. (Grandin &
Panek, 2013)
2. “Look me in the eye: My life with Aspergers”  by John Elder Robinson
(Robison, 2007)
3. “A parent’s guide to Autism” by Sally Ozonoff, Geraldine Dawson, James
McPartland (Ozonoff, Dawson, & McPartland, 2014).

Tourette Syndrome

Tourette’s syndrome is an disorder that can affect social, behavioral, and

learning.  A major website for this disorder is from the Tourette Association of
America (http://tourette.org/Medical/whatists_cov.html).  This website provides
information about the disorder as well as state of the art psychotherapy and
medication treatment.  In addition an interesting video on Youtube
demonstrates this disorder and the challenges it presents
(https://www.youtube.com/watch?v=e8HtTb0Vk_o).

Seizure Disorders

Epilepsy affects approximately 150,000 people worldwide each year in the U.S. 
Approximately 1 in 26 people will develop a seizure disorder in their lifetime. It
is most common in young and older people.  Medication is generally used to
control seizures but approximately 25% of the population do not respond well to
the medications.  A helpful website is http://www.epilepsy.com/.

Traumatic Brain Injury/Concussion

There are approximately 200,000 traumatic brain injuries (TBI) that occur every
year.  While both genders have TBI, it is more frequent in males. A website that
is helpful with information about TBI as well as publications and organizations
can be found at http://www.ninds.nih.gov/disorders/tbi/tbi.htm.  It also has a list
of organizations that can be very helpful.

Concussions are a type of head injury that can have temporary symptoms or
ones that may last longer if there is more than one concussion experienced. 
Concussions often occur from sporting events but can occur in everyday life. 
Both genders are susceptible to concussions with girls possibly showing more
neurocognitive difficulty because of structural differences in the neck.  An
excellent website that provides additional information can be found at
http://www.cdc.gov/headsup/.

Rare Genetic Disorders

Genetic disorders that are not frequently found can be isolating for parents as
they try to understand the medical language, the challenges and treatments for 
these disorders, and parents who share their experiences.  The list below is by no
means exhaustive but may provide support for parents with newly diagnosed
children.

1. Mucopolysaccharidoses (MPS) and related diseases are diseases where the

body is unable to produce a specific enzyme that allows for the breaking
down of specific substrates. A website for parents and professionals for this
disorder is found at http://mpssociety.org/mps-diseases/.
2. Adrenoleukodystrophies are generally found in boys between the age of 4
and 10 where the brain begins to demyelinate (loss of white matter tracts in
the brain). Without treatment this disease is terminal.  A website that is
helpful can be found at http://www.aldfoundation.org/.
3. Rasopathies are genetic syndromes where the proteins that assist with signal
conduction in the nerves are affected. Further information can be found at
https://rasopathiesnet.org/rasopathies/.
4. Turner Syndrome affects girls and is where one of the x chromosomes is
deleted. The website (http://www.turnersyndrome.org/) provides additional
information.
5. Deletion syndromes. There are many deletion syndromes.  The following are
just a few:
• Velocardiofacial syndrome is a deletion of chromosome 22 long arm.
Difficulties are frequently seen with nonverbal and visual-spatial
difficulties.  http://www.vcfsfa.org.au/pages/what-is-vcfs.php
• 18q- syndrome is a deletion on the long arm of chromosome 18. It often
results in mental retardation as well as facial and limb abnormalities. 
Support can be found at http://www.chromosome18.org/18q/distal-18q/.
• Additional chromosome deletion support can be found at
http://www.rarechromo.org/html/chromosomesanddisorders.asp.

GLOSSARY
Neuropsychology:  The study of brain and behavior.  In children it is also the
study of how development affects brain structures as well as environmental
influences.

Neuropsychological Assessment:  A comprehensive evaluation of several areas of

a child’s life and functioning ability.  Combines psychological assessment with an
understanding of brain anatomy and development.

Hard-Wired:  Brain areas that are fully functional at birth and that do not change
with experience.  Includes vision, auditory, tactile, and basic motor skills such as
sucking and movement from pain (reflexes)

Frontal lobes:  The frontal part of the brain.  This area develops last and can
continue developing into the late twenties.  Important for controlling impulses,
insight into behavior, and is thought to be where the seat of personality lies..

Concussion:  A severe hit to the head that results sometimes in unconsciousness

but most often the presenting symptoms are headaches, dizziness, light aversion,
and lethargy.

Autism Spectrum Disorders:  A diagnosis usually applied in childhood where the

child has difficulty interaction with others, understanding other people’s
perspectives, and can develop intense interests in circumscribed areas.

Attention Deficit Hyperactivity Disorder:  Is a neurodevelopmental disorder

characterized by problem with attention, impulse control, and/or hyperactivity.

Dyslexia:  A neurodevelopmental disorder that results in having significant

difficulties with reading, usually with phonetic analysis but sometimes with the
structure of the words.

Executive Functioning:  A neuropsychological construct that encompasses skills

including planning, organization, working memory (the ability to keep
information in mind while solving a problem), and cognitive flexibility.

Adaptive Behavior:  This is a measure of how a child performs in everyday life. 

Includes measures of communication, socialization, daily living skills (washing, 
dressing, etc.) and for younger children motor ability.
Scaled Scores:  Standardized test scores that have a mean of 10 with average
scores ranging from 7 to 13. Higher scores are better.

Standard Scores:  Standardized test scores that have a mean of 100 with average
scores ranging from 85 to 115.  Commonly used in intelligence tests. Higher
scores are better.

T-Scores:  Standardized test scores that have a mean of 50 with average scores
ranging from 40 to 60.  Higher scores are better

Z-scores:  Standardized test scores that are derived from the mean of the
expected score minus the obtained score divided by the standard deviation for
the test.

Cognitive Ability: Also referred frequently as IQ.  Measures the child’s ability to
solve problems, communicate verbally and nonverbally, understand visual
problems, solve problems while keeping the steps in mind, and evaluates how
quickly a child can solve a visual problem.

Wechsler IQ tests:  The gold standard of measures of cognition.  There are three
tests based on age.

Attention:  An important area for assessment.  Looks at how the child processes
information quickly, how he/she can sustain attention, and how he/she manages
impulses.

Behavior Rating Scales:  Generally completed by a caregiver (usually a teacher

and/or a parent) and provides information as to how the child functions
behaviorally and emotionally in the various settings.  These ratings are
compared to the child’s age.

Continuous Performance Measures:  Generally computer administered and

measure the child’s attentional skills on a long, boring test.

Learning and Memory:  Skills that are complementary.  Both of these areas are
significantly impacted by attention.

Receptive Language:  This is the ability to understand what is being said to one.

Expressive Language:  This is the ability to express one’s ideas and thoughts and
to engage in meaningful conversation.

Visual-Spatial Skills:  The ability to construct block designs from a model and to
copy figures appropriately.

Social Skills:  The ability to relate to others in an age appropriate manner.

Therapeutic Intervention/Feedback:  The providing of results from a

neuropsychological assessment in such a way that the caregiver can understand
what is being said and use the recommendations to assist the child.

REFERENCES
Barkley R. Taking Charge of ADHD (3 ed.). New York: Guilford, 2013.

Dawson P, Guare R. Smart buT Scattered. New York: Guilford Press, 2011.

Grandin T, Panek R. The autistic brain: Thinking across the spectrum. Boston:
Houghton Mifflin Harcourt, 2013.

Hale JB, Semrud-Clikeman M, Fiorello CA. School Neuropsychology. New York:

Guilford Press, 2016.

Meltzer L. Promotion executive function in the classroom. New York: Guilford,

2010.

Ozonoff S, Dawson G, McPartland JC. A parent’s guide to high-functioning autism

spectrum disorder: How to meet the challenges and help your child thrive. New
York: Guilford, 2014.

Robison JE. Look me in the eye: My life with Asperger’s. Portland, OR: Broadway
Books, 2007.

 Semrud-Clikeman M, Ellison PAT. Child Neuropsychology: Assessment and
Intervention. New York: Springer, 2009.

Wilens T, Hammerness PG. Straight talk about psychiatric medications for kids (4
ed.). New York: Guilford, 2016.

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