Child Neuropsychology. Clinical Practice

322 Pages·1986·4.802 MB·English

by  John E. Obrzut and George W. Hynd (Eds.)

This is a volume in
PERSPECTIVES IN
NEUROLINGUISTICS, NEUROPSYCHOLOGY, AND
PSYCHOLINGUISTICS: A Series of Monographs and Treatises
A complete list of titles in this series is available from the publisher on request.
CHILD NEUROPSYCHOLOGY
Volume 2
Clinical Practice
Edited by
JOHN E. OBRZUT
Department ot Educational Psychology
College of Education
University ot Arizona
Tucson, Arizona
GEORGE W. HYND
Departments of Educational Psychology and Psychology
University of Georgia
Athens, Georgia
and Department of Neurology
Medical College of Georgia
Augusta, Georgia
1986
ACADEMIC PRESS, INC.
Harcourt Brace Jovanovich, Publishers
Orlando San Diego New York Austin
Boston London Sydney Tokyo Toronto
COPYRIGHT © 1986 BY ACADEMIC PRESS, INC.
ALL RIGHTS RESERVED.
NO PART OF THIS PUBLICATION MAY BE REPRODUCED OR
TRANSMITTED IN ANY FORM OR BY ANY MEANS, ELECTRONIC
OR MECHANICAL, INCLUDING PHOTOCOPY, RECORDING, OR
ANY INFORMATION STORAGE AND RETRIEVAL SYSTEM, WITHOUT
PERMISSION IN WRITING FROM THE PUBLISHER.
ACADEMIC PRESS, INC.
Orlando, Florida 32887
United Kingdom Edition published by
ACADEMIC PRESS INC. (LONDON) LTD.
24-28 Oval Road, London NW1 7DX
Library of Congress Cataloging in Publication Data
Child neuropsychology.
(Perspectives in neurolinguistics, neuropsychology,
and psycholinguistics series)
Includes indexes.
Contents: v. 1. Theory and research — v. 2.
Clinical practice.
1. Pédiatrie neurology. 2. Neuropsychology.
1. Obrzut, John E. II. Hynd, George W. III. Series:
Perspectives in neurolinguistics, neuropsychology, and
psycholinguistics. [DNLM: Ί. Child Development Disorders.
2. Nervous System Diseases—in infancy & childhood.
3. Neuropsychology-in infancy & childhood. WS 340 C5357]
RJ486.C458 1986 618.92'89 86-3433
ISBN 0-Ί2-524042-2 (hardcover) (v. 2: alk. paper)
ISBN 0-12-524044-9 (paperback) (v. 2: alk. paper)
PRINTED IN THE UNITED STATES OF AMERICA
86 87 88 89 9 8 7 6 5 4 3 2 1
To all the special colleagues and students who have both
stimulated and encouraged this particular project from
its inception. Also, special thanks to Krystopher, who
provides the motivation to continue these professional
endeavors.
J.E.O.
To W. Louis Bashaw, who provided the time, support, and
friendship; and to Alphonse Buccino, who continues to fa-
cilitate our efforts to prepare psychologists to work with
neurologically impaired children.
G.W.H.
Contributors
Numbers in parentheses indicate the pages on which the authors" contributions begin.
Richard A. Berg* (113), Psychiatry/Psychology Division, St. Jude Chil-
dren's Research Hospital, Memphis, Tennessee 38101
John F. Bolter (59), Clinical Psychology Service, Silas B. Hays Army
Community Hospital, Fort Ord, California 93941
Thomas A. Boyd (15), Department of Psychology, Bradley Hospital, East
Providence, Rhode Island 02915, and Department of Psychiatry and
Human Behavior, Brown University, Providence, Rhode Island
02912
Raymond S. Dean (83), Neuropsychology Laboratory, Ball State Univer-
sity, Muncie, Indiana 47306, and Indiana University School of Medi-
cine, Muncie, Indiana 47306
Stephen R. Hooper (15), Department of Psychology, Bradley Hospital,
East Providence, Rhode Island 02915, and Department of Psychiatry
and Human Behavior, Brown University, Providence, Rhode Island
02912
Arthur MacNeill Hort on, Jr. (299), Veterans Administration Medical
Center, Baltimore, Maryland 21212, and The Johns Hopkins Univer-
sity, Baltimore, Maryland 21218
Cynthia R. Hynd (265), Division of Developmental Studies, Georgia State
University, Atlanta, Georgia 30303
George W. Hynd (3), Departments of Educational Psychology and Psy-
chology, University of Georgia, Athens, Georgia 30602, and Depart-
ment of Neurology, Medical College of Georgia, Augusta, Georgia
30912
* Present address: Department of Behavioral Medicine, West Virginia University Medi-
cal Center, Charleston, West Virginia 25330.
xi
xii Contributors
Robert M. Knights (229), Department of Psychology, Carleton Univer-
sity, Ottawa, Ontario, Canada K1S 5B6
John E. Obrzut (3), Department of Educational Psychology, College of
Education, University of Arizona, Tucson, Arizona 85721
Antonio E. Puente (299), Department of Psychology, University of North
Carolina at Wilmington, Wilmington, North Carolina 28403
Clare Stoddart (229), Department of Psychology, Carleton University,
Ottawa, Ontario, Canada K1S 5B6
Phyllis Anne Teeter (187), Department of Educational Psychology, Uni-
versity of Wisconsin at Milwaukee, Milwaukee, Wisconsin 53201
David E. Tupper (139), Cognitive Rehabilitation Department, LIFEstyle
Institute, Edison, New Jersey 08820
W. Grant Willis (245), School of Education, University of Colorado at
Denver, Denver, Colorado 80202
Preface
D. O. Hebb (1949) once suggested that the psychologist and neurophys-
iologist chart the same bay. While both psychologist and neurophysiolo-
gist may use the same fixed reference points, they may pursue different
but potentially complementary endeavors. The research in the area of
child neuropsychology, as discussed in Volume 1, reflects well the poten-
tial interface between the efforts of psychologists and those interested in
the neurophysiological basis of behavior. Clearly, significant progress has
been made in correlating neurodevelopmental behavior to its neurophysi-
ological basis. In this regard, the future for those who attempt to chart the
waters between neurobiology and cognitive developmental neuropsychol-
ogy has never looked more promising.
For the applied psychologist, the challenge of providing clinical neuro-
psychological services to children is likely to increase in proportion to the
advances made in understanding the neurophysiological basis of disor-
ders. However, it is becoming increasingly more difficult to keep abreast
of both the research in the area of developmental neuropsychology and
the efforts of psychologists in the applied or clinical domain.
The clinical child or pédiatrie neuropsychologist must have available a
source of clear and current information on issues germane to the provi-
sion of neurological services to children. In this volume, the editors place
strong emphasis on understanding the research in developmental neuro-
psychology such that the provision of clinical services may rest on a firm
conceptual foundation. Thus, for the clinician, the broader and deeper the
understanding of the neurophysiological and neuropsychological bases of
behavior, the greater the probability that the services provided will reflect
current and appropriate conceptualizations of brain-behavior relations in
children. In this light, the volume attempts to bridge the gap between
neurodevelopmental theory and clinical practice with a pédiatrie popula-
tion.
Compiled with this broad objective in mind, this volume is relevant to
clinical child or pédiatrie neuropsychologists, child or school psycholo-
gists, physicians interested in pédiatrie neuropsychological disorders, and
xiii
xiv Preface
other professionals who provide services to children with neurologically
based disorders. The book may also serve as a reference for audiologists,
speech and language therapists, or educators.
The chapters have been organized into three major parts. In the first,
the focus is on some of the more common neuropsychological disorders
encountered in children. After a brief introductory chapter by Hynd and
Obrzut, Hooper and Boyd present an overview of the neurodevelopmen-
tal disorders. Bolter, in the next chapter, discusses epilepsy in children.
Dean then provides a critical overview of the neuropsychological basis of
psychiatric disorders in children, and Berg addresses closed-head injury
in children. The second part offers an overview of different approaches
and issues relevant to neuropsychological evaluation of children. Tupper
addresses the importance of soft signs and neuropsychological screening,
while Teeter discusses the more traditional approaches to neuropsycho-
logical assessment with children. Stoddart and Knights offer a more con-
temporary perspective to assessment, while Willis discusses a topic often
ignored in the pédiatrie literature, actuarial and clinical assessment prac-
tices. The final part addresses what eventually must concern all who work
with patients suffering from neuropsychological disturbance, i.e., inter-
vention and treatment. Only two chapters are included in this part, since
so little research has documented or evaluated the effectiveness of differ-
ent intervention strategies with children who experience neurologically
based behavioral disorders. C. R. Hynd presents an overview of how one
might conceptualize and integrate differential diagnosis of neurodevelop-
mental learning disabilities with appropriate curriculum-based interven-
tion strategies. In the final chapter, Horton and Puente discuss the
broader applications of behavioral neuropsychology.
In no fashion can the chapters in this volume be considered as com-
pletely representative of the current status of clinical child neuropsychol-
ogy. This has not been our intent. As suggested previously, we have
attempted to provide a bridge between theory and research on the one
hand and applied practice on the other. The chapters included are those
representative of the multifaceted nature of potential applied concerns.
We hope that our efforts and those of our exceptionally well qualified
contributors offer a current and balanced perspective on clinical neuro-
psychology with children.
George W. Hynd
John E. Obrzut
REFERENCE
Hebb, D. O. (1949). The organization of behavior. New York: Wiley.
Chapter 1
Clinical Child
Neuropsychology: Issues
and Perspectives
GEORGE W. HYND
Departments of Educational Psychology and Psychology
University of Georgia
Athens, Georgia 30602
and
Department of Neurology
Medical College of Georgia
Augusta, Georgia 30912
JOHN E. OBRZUT
Department of Educational Psychology
College of Education
University of Arizona
Tucson, Arizona 85721
INTRODUCTION
Since the mid-1970s, significant efforts have been directed at under-
standing brain-behavior relations in children. A number of factors have
been responsible for the increase in these efforts to articulate the exact
nature and relations between developing neuropsychological organization
in children and deficits in performance reflective of either deviant devel-
opment or some trauma. Certainly, the efforts of researchers in the
neurosciences have resulted in a better understanding of the neurophysi-
ology associated with deficits in neurocognitive development (e.g., Duffy,
Denckla, Bartels, & Sandini, 1980; Duffy, Denckla, Bartels, Sandini, &
3
CHILD NEUROPSYCHOLOGY, VOL. 2
Copyright © 1986 by Academic Press, Inc.
All rights of reproduction in any form reserved.
4 George W. Hynd and John E. Obrzut
Kiessling, 1980; Galaburda & Eideiberg, 1982; Galaburda & Kemper,
1979). Also, the effect of federal legislation (e.g., Public Law 94-142; The
Education for All Handicapped Children Act) helped focus national ef-
forts in education on understanding and educating children with handicap-
ping conditions.
Another significant factor in the growth of interest in clinical child
neuropsychology is the recognition that the survival rates for children
suffering neurological trauma has increased to the point that the incidence
rates for children so afflicted will increase considerably through the 1980s
and 1990s. Two examples may serve to illustrate this point and thus draw
attention to the possible implications.
Children of very low birthweight (<1500 grams) now have a reasonable
chance for survival, due to the proliferation of neonatal intensive care
facilities. For those children whose birthweight is between 500 to 999
grams, approximately 25% will survive. For those infants whose weight at
birth is between 1000 to 1500 grams, nearly 80% will leave the hospital
alive (Horwood, Boyle, Torrance, & Sinclair, 1982). While mortality rates
are decreasing significantly in this population, morbidity continues to be a
significant concern. Nickel, Bennett, and Lamson (1982) found that at age
10 years, 64% of the children who received neonatal intensive care were
in a special education program at school.
With regard to children who survive acute lymphocytic leukemia, con-
cern exists that the effects of treatment may induce long-lasting neuropsy-
chological deficits. There is some evidence that for those children who
receive intrathecal methotrexate and/or intracranial radiation during
treatment, deficits seem to exist posttreatment in intellectual abilities
(Massari, 1982), memory, visual-motor integration, and in verbal fluency
(Goff, 1982). In some children, these deficits prove to be serious enough
that they are diagnosed as learning disabled (Elbert, Culbertson, Gerrity,
Guthrie, & Bayles, 1985). While these findings may be challenged (e.g.,
Berg, Tuseth, & Daniel, 1985), it does seem an important consideration if
one considers the prediction that by the year 2000, 4 out of every 100
children will be a long-term survivor of childhood cancer.
Most authorities would currently agree that the prevalence of various
handicapping conditions is between 10 and 16% of the population
(Gaddes, 1980; Hynd & Cohen, 1983; Myklebust & Boshes, 1969). With
the two preceding examples, it seems reasonable to project that the inci-
dence rate for various neurodevelopmental behavioral and learning disor-
ders will probably increase significantly in the next several decades. In
this context there may indeed be more children diagnosed as learning
disabled, behaviorally disordered, or as suffering attentional deficiencies
than at present.